Transcript
00:00:00 The following is a conversation with Michael Mina.
00:00:02 He’s a professor at Harvard doing research
00:00:05 on infectious disease and immunology.
00:00:08 The most defining characteristic of his approach
00:00:10 to science and biology is that of a first principles thinker
00:00:14 and engineer focused not just on defining the problem,
00:00:17 but finding the solution.
00:00:20 In that spirit, we talk about cheap rapid at home testing,
00:00:24 which is a solution to COVID 19 that to me has become
00:00:27 one of the most obvious, powerful, and doable solutions
00:00:31 that frankly should have been done months ago
00:00:33 and still should be done now.
00:00:35 As we talk about its accuracy,
00:00:37 it’s high for detecting actual contagiousness
00:00:40 and hundreds of millions can be manufactured quickly
00:00:43 and relatively cheaply.
00:00:44 In general, I love engineering solutions like these
00:00:47 even if government bureaucracies often don’t.
00:00:51 It respects science and data, it respects our freedom,
00:00:54 it respects our intelligence and basic common sense.
00:00:59 Quick mention of each sponsor
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00:01:29 As a side note, let me say that
00:01:31 I’ve always been solution oriented, not problem oriented.
00:01:35 It saddens me to see that public discourse
00:01:38 disproportionately focuses on the mistakes
00:01:41 of those who dare to build solutions
00:01:43 rather than applaud their attempt to do so.
00:01:46 Teddy Roosevelt said it well
00:01:48 in his The Man in the Arena speech over 100 years ago.
00:01:52 I should say that both the critic
00:01:54 and the creator are important,
00:01:56 but in my humble estimation,
00:01:59 there are too many now of the former
00:02:01 and not enough of the latter.
00:02:03 So while we spread the derisive words
00:02:06 of the critic on social media, making it viral,
00:02:10 let’s not forget that this world is built
00:02:13 on the blood, sweat, and tears of those who dare to create.
00:02:18 If you enjoy this thing, subscribe on YouTube,
00:02:20 review it with five stars on Apple Podcast,
00:02:22 follow on Spotify, support on Patreon,
00:02:24 or connect with me on Twitter at Lex Friedman.
00:02:28 And now, here’s my conversation with Michael Minna.
00:02:32 What is the most beautiful, mysterious,
00:02:35 or surprising idea in the biology of humans or viruses
00:02:39 that you’ve ever come across in your work?
00:02:41 Sorry for the overly philosophical question.
00:02:45 Wow, well that’s a great question.
00:02:47 You know, I love the pathogenesis of viruses,
00:02:50 and one of the things that I’ve worked on a lot
00:02:56 is trying to understand how viruses interact with each other.
00:03:00 And so pre all this COVID stuff,
00:03:05 I was really, really dedicated to understanding
00:03:10 how viruses impact other pathogens,
00:03:14 so how if somebody gets an infection with one thing
00:03:18 or a vaccine, does it either benefit or harm you
00:03:21 from other things that appear to be unrelated to most people.
00:03:26 And so one system which is highly detrimental to humans,
00:03:32 but what I think is just immensely fascinating, is measles.
00:03:37 And measles gets into a kid’s body.
00:03:40 The immune system picks it up,
00:03:43 and essentially grabs the virus,
00:03:47 and does exactly what it’s supposed to do,
00:03:50 which is to take this virus
00:03:52 and bring it into the immune system
00:03:54 so that the immune system can learn from it,
00:03:56 can develop an immune response to it.
00:03:58 But instead, measles plays a trick.
00:04:00 It gets into the immune system,
00:04:03 serves almost as a Trojan horse,
00:04:05 and instead of getting eaten by these cells,
00:04:08 it just takes them over,
00:04:10 and it ends up proliferating in the very cells
00:04:12 that were supposed to kill it.
00:04:15 And it just distributes throughout the entire body,
00:04:17 gets into the bone marrow,
00:04:19 kills off children’s immune memories.
00:04:22 And so it essentially, what I’ve found
00:04:25 and what my research has found is that this one virus
00:04:28 was responsible for as much as half
00:04:31 of all of the infectious disease deaths in kids
00:04:34 before we started vaccinating against it,
00:04:36 because it was just wiping out children’s immune memories
00:04:40 to all different pathogens,
00:04:41 which is, I think, just astounding.
00:04:45 It’s just amazing to watch it spread throughout bodies.
00:04:49 We’ve done the studies in monkeys,
00:04:50 and you can watch it just destroy
00:04:52 and obliterate people’s immune memories
00:04:54 in the same way that some parasite
00:04:57 might destroy somebody’s brain.
00:04:59 Is that evolutionary just coincidence,
00:05:03 or is there some kind of advantage
00:05:04 to this kind of interactivity between pathogens?
00:05:08 Oh, I think in that sense, it’s just coincidence.
00:05:11 It probably is a, it’s a good way for measles to,
00:05:17 it’s a good way for measles to essentially
00:05:19 be able to survive long enough to replicate in the body.
00:05:23 It just replicates in the cells
00:05:25 that are meant to destroy it.
00:05:26 So it’s utilizing our immune cells for its own replication,
00:05:32 but in so doing, it’s destroying the memories
00:05:34 of all the other immunological memories.
00:05:37 But there are other viruses,
00:05:38 so a different system is influenza,
00:05:42 and flu predisposes to severe bacterial infections.
00:05:47 And that, I think, is another coincidence,
00:05:50 but I also think that there are some evolutionary benefits
00:05:55 that bacteria may hijack
00:05:57 and sort of piggyback on viral infections.
00:05:59 Viruses can, they just grow so much quicker than bacteria.
00:06:04 They replicate faster,
00:06:05 and so there’s this system with viruses,
00:06:07 with flu and bacteria,
00:06:09 where the influenza has these proteins
00:06:12 that cleave certain receptors,
00:06:15 and the bacteria want to cleave those same receptors.
00:06:18 They want to cleave the same molecules
00:06:19 that gave entrance to those receptors.
00:06:22 So instead, the bacteria found out, like,
00:06:25 hey, we could just piggyback on these viruses.
00:06:28 They’ll do it 100 or 1,000 times faster than we can.
00:06:31 And so then they just piggyback on,
00:06:33 and they let flu cleave all these sialic acids,
00:06:37 and then the bacteria just glom on in the wake of it.
00:06:39 So there’s all different interactions between pathogens
00:06:43 that are just remarkable.
00:06:45 So does this whole system of viruses
00:06:48 that interact with each other
00:06:49 and so damn good at getting inside our bodies,
00:06:52 does that fascinate you or terrify you?
00:06:54 I’m very much a scientist,
00:06:56 and so it fascinates me much more than it terrifies me.
00:07:00 But knowing enough, I know just how well,
00:07:03 you know, we get the wrong virus in our population,
00:07:08 whether it’s through some random mutation
00:07:10 or whether it’s this same COVID 19 virus,
00:07:12 and it, you know, these things are tricky.
00:07:14 They’re able to mutate quickly.
00:07:17 They’re able to find new hosts
00:07:20 and rearrange in the case of influenza.
00:07:24 So what terrifies me is just how easily
00:07:27 this particular pandemic could have been so much worse.
00:07:29 This could have been a virus
00:07:30 that is much worse than it is.
00:07:33 You know, same thing with H1N1 back in 2009.
00:07:37 That terrifies me.
00:07:38 If a virus like that was much more detrimental,
00:07:43 you know, that would be,
00:07:44 it could be much more devastating.
00:07:46 Although it’s hard to say, you know,
00:07:48 the human species were, well,
00:07:52 I hesitate to say that we’re good at responding to things
00:07:56 because there are some aspects that were,
00:07:58 this particular virus, SARS COVID 2 and COVID 19
00:08:01 has found a sweet spot where it’s not quite serious enough
00:08:06 on an individual level that humans just don’t,
00:08:08 we haven’t seen much of a useful response by many humans.
00:08:14 A lot of people even think it’s a hoax.
00:08:15 And so it’s led us down this path of,
00:08:19 it’s not quite serious enough
00:08:20 to get everyone to respond immediately
00:08:23 and with the most urgency, but it’s enough,
00:08:26 it’s bad enough that, you know,
00:08:27 it’s caused our economies to shut down and collapse.
00:08:30 And so I think I know enough about virus biology
00:08:34 to be terrified for humans that, you know,
00:08:37 it can, it just takes one virus,
00:08:39 just takes the wrong one to just obliterate us
00:08:42 or not obliterate us,
00:08:43 but really do much more damage than we’ve seen.
00:08:45 It’s fascinating to think that COVID 19
00:08:47 is a result of a virus evolving together with like Twitter,
00:08:52 like figuring out how we can sneak past the defenses
00:08:55 of the humans.
00:08:56 So it’s not bad enough.
00:08:58 And then the misinformation,
00:09:00 all that kind of stuff together is operating
00:09:03 in such a way that the virus can spread effectively.
00:09:06 I wonder, I mean, obviously a virus is not intelligent,
00:09:10 but there’s a rhyme and a rhythm
00:09:16 to the way this whole evolutionary process works
00:09:18 and creates these fascinating things
00:09:20 that spread throughout the entire civilization.
00:09:23 Absolutely, it’s, yeah,
00:09:26 I’m completely fascinated by this idea
00:09:30 of social media in particular,
00:09:33 how it replicates, how it grows.
00:09:36 You know, I’ve been, how it actually starts interacting
00:09:40 with the biology of the virus, masks,
00:09:42 who’s gonna get vaccinated, politics,
00:09:45 like these seem so external to virus biology,
00:09:49 but it’s become so intertwined.
00:09:52 And it’s interesting.
00:09:55 And I actually think we could find out
00:09:56 that the virus actually becomes,
00:10:00 obviously not intentionally,
00:10:03 but we could find that people choosing not to wear masks,
00:10:08 choosing not to counter this virus
00:10:10 in a regimented and sort of organized way,
00:10:14 effectively gives the virus more opportunity to escape.
00:10:18 We can look at vaccines.
00:10:20 We’re about to have
00:10:23 one of the most aggressive vaccination programs
00:10:25 the world has ever seen.
00:10:27 But we are unfortunately doing it
00:10:29 right at the peak of viral transmission
00:10:32 when millions and millions of people
00:10:34 are still getting infected.
00:10:36 And when we do that,
00:10:37 that just gives this virus so many more opportunities.
00:10:40 I mean, orders of magnitude more opportunity
00:10:43 to mutate around our immune system.
00:10:46 Now, if we were to vaccinate everyone
00:10:48 when there’s not a lot of virus,
00:10:49 then there’s just not a lot of virus.
00:10:51 And so there’s not going to be as many,
00:10:54 I don’t even know how many zeros are at the end
00:10:56 of however many viral particles
00:10:57 there are in the world right now,
00:10:59 more than quadrillions.
00:11:02 And so if you assume that at any given time,
00:11:04 somebody might have trillions of virus in them
00:11:06 and any given individual,
00:11:07 so then multiply trillions by millions
00:11:10 and you get a lot of viruses out there.
00:11:12 And if you start applying pressure, ecological pressure,
00:11:16 to this virus, that when it’s not abundant,
00:11:21 God, the opportunity for a virus to sneak around immunity,
00:11:25 especially when all the vaccines are identical,
00:11:27 essentially, it’s…
00:11:30 All it takes is one to mutate and then jumps.
00:11:32 Takes one.
00:11:33 Takes one in the whole world.
00:11:35 And we have to not forget
00:11:37 that this particular virus was one.
00:11:39 It was one opportunity and it has spread across the globe
00:11:42 and there’s no reason that can’t happen tomorrow anew.
00:11:46 It’s scary.
00:11:49 I have a million other questions in this direction,
00:11:51 but I’d love to talk about one of the most exciting aspects
00:11:56 of your work, which is testing or rapid testing.
00:12:00 You wrote a great article in Time on November 17th.
00:12:04 This is like a month ago about rapid testing titled,
00:12:10 How We Can Stop the Spread of COVID 19 by Christmas.
00:12:13 Let’s jot down the fact that this is a month ago.
00:12:15 So maybe your timeline would be different,
00:12:17 but let’s say in a month.
00:12:19 So you’ve talked about this powerful idea
00:12:21 for quite a while throughout the COVID 19 pandemic.
00:12:25 How do we stop the spread of COVID 19 in a month?
00:12:29 Well, we use tests like these.
00:12:33 So the only reason the virus continues spreading
00:12:36 is because people spread it to each other.
00:12:39 This isn’t magic.
00:12:41 Yes.
00:12:42 And so there’s a few ways to stop the virus
00:12:45 from spreading to each other.
00:12:47 And that is you either can vaccinate everyone
00:12:51 and vaccinating everyone is a way to immunologically
00:12:55 prevent the virus from growing inside of somebody
00:12:57 and therefore spreading.
00:12:58 We don’t know yet actually if this vaccine,
00:13:01 if any of these vaccines are going to
00:13:03 prevent onward transmission.
00:13:05 So that may or may not serve to be one opportunity.
00:13:10 Certainly I think it will decrease transmission.
00:13:12 But the other idea that we have at our disposal now,
00:13:16 we had it in May, we had it in June,
00:13:18 July, August, September, October, November,
00:13:21 and now it’s December.
00:13:22 We still have it.
00:13:23 We still choose not to use it in this country
00:13:26 and in much of the world.
00:13:28 And that’s rapid testing.
00:13:29 That is giving, it’s empowering people to know
00:13:33 that they are infected and giving them the opportunity
00:13:35 to not spread it to their loved ones
00:13:38 and their friends and neighbors and whoever else.
00:13:41 We could have done this.
00:13:43 We still can.
00:13:44 Today we could start.
00:13:46 We have millions of these tests.
00:13:48 These tests are simple paper strip tests.
00:13:51 They are, inside of this thing
00:13:54 is just a little piece of paper.
00:13:58 Now I can actually open it up here.
00:14:00 There we go.
00:14:01 So this, this is how we do it right here.
00:14:05 We have this little paper strip test.
00:14:08 This is enough to let you know if you’re infectious.
00:14:11 With somewhere around the order of 99% sensitivity,
00:14:14 99% specificity, you can know
00:14:18 if you have infectious virus in you.
00:14:20 If we can get these out to everyone’s homes,
00:14:23 build these, make 10 million, 20 million,
00:14:25 30 million of them a day.
00:14:26 You know, we make more bottles of Dasani water every day.
00:14:30 We can make these little paper strip tests.
00:14:33 And if we do that and we get these into people’s homes
00:14:36 so that they can use them twice a week,
00:14:39 then we can know if we’re infectious.
00:14:41 You know, is it perfect?
00:14:43 Absolutely not.
00:14:44 But is it near perfect?
00:14:45 Absolutely.
00:14:46 You know, and so if we can say,
00:14:48 hey, the transmission of this is, you know,
00:14:51 for every hundred people that get infected right now,
00:14:54 they go on to infect maybe 130 additional people.
00:14:57 And that’s exponential growth.
00:14:59 So a hundred becomes 130.
00:15:01 A couple of days later that 130 becomes
00:15:04 another 165 people have now been infected.
00:15:08 And you know, go over three weeks
00:15:10 and a hundred people become 500 people infected.
00:15:13 Now it doesn’t take much to have those hundred people
00:15:17 not infect 130, but infect 90.
00:15:20 All we have to do is remove say 30, 40% of new infections
00:15:24 from continuing their spread.
00:15:26 And then instead of exponential growth,
00:15:28 you have exponential decay.
00:15:30 So this doesn’t need to be perfect.
00:15:32 We don’t have to go from a hundred to zero.
00:15:34 We just have to go and have those hundred people infect 90
00:15:37 and those 90 people infect, you know, 82,
00:15:40 whatever it might be.
00:15:41 And you do that for a few weeks and boom,
00:15:43 you have now gone instead of a hundred to 500,
00:15:45 you’ve gone from a hundred to 20.
00:15:48 It’s not very hard.
00:15:49 And so the way to do that is to let people know
00:15:54 that they’re infectious.
00:15:55 I mean, we’re a perfect example right now.
00:15:58 This morning I used these tests to make sure
00:16:02 that I wasn’t infectious.
00:16:03 Is it perfect?
00:16:04 No, but it reduced my odds 99%.
00:16:06 I already was at extremely low odds
00:16:08 because I spend my life quarantining these days.
00:16:11 Well, the interesting thing with this test,
00:16:13 with the testing in general,
00:16:15 which is why I love what you’ve been espousing,
00:16:17 is it’s really confusing to me that this has not been
00:16:20 taken on as it’s one actual solution
00:16:24 that was available for a long time.
00:16:28 There doesn’t seem to have been solutions proposed
00:16:33 at a large scale and a solution that it seems
00:16:36 like a lot of people would be able to get behind.
00:16:38 There’s some politicization or fear of other solutions
00:16:44 that people have proposed, which is like lockdown.
00:16:47 And there’s a worry, you know,
00:16:48 especially in the American spirit of freedom,
00:16:50 like you can’t tell me what to do.
00:16:52 The thing about tests is it like empowers you
00:16:56 with information essentially.
00:16:59 So like it gives you more information about your,
00:17:06 like your role in this pandemic,
00:17:07 and then you can do whatever the hell you want.
00:17:10 Like it’s all up to your ethics and so on.
00:17:13 So like, and it’s obvious that with that information,
00:17:16 people would be able to protect their loved ones
00:17:19 and also do their sort of quote unquote duty
00:17:23 for their country, right?
00:17:25 Is protect the rest of the country.
00:17:26 That’s exactly right.
00:17:27 I mean, it’s just, it’s empowerment,
00:17:30 but you know, this is a problem.
00:17:32 We have not put these into action in large part
00:17:35 because we have a medical industry
00:17:37 that doesn’t want to see them be used.
00:17:40 We have a political and a regulatory industry
00:17:44 that doesn’t want to see them be used.
00:17:45 That sounds crazy.
00:17:46 Why wouldn’t they want them to be used?
00:17:48 We have a very paternalistic approach
00:17:51 to everything in this country.
00:17:52 You know, despite this country kind of being founded
00:17:55 on this individualistic ideal,
00:17:58 pull yourself up from your bootstraps, all that stuff.
00:18:01 When it comes to public health,
00:18:03 we have a bunch of ivory tower academics who want data.
00:18:09 They, you know, they want to see perfection.
00:18:12 And we have this issue of letting perfection
00:18:15 get in the way of actually doing something at all,
00:18:19 you know, doing something effective.
00:18:21 And so we keep comparing these tests, for example,
00:18:25 to the laboratory based PCR test.
00:18:27 And sure, this isn’t a PCR test,
00:18:30 but this doesn’t cost a hundred dollars
00:18:32 and it doesn’t take five days to get back,
00:18:34 which means in every single scenario,
00:18:36 this is the more effective test.
00:18:38 And we have, unfortunately, a system
00:18:41 that’s not about public health.
00:18:42 We have entirely eroded any ideals of public health
00:18:48 in our country for the biomedical complex,
00:18:51 you know, this medical industrial complex,
00:18:53 which overrides everything.
00:18:55 And that’s why, you know, I’m just,
00:18:58 can I swear on this pot?
00:18:59 Yes.
00:19:00 I’m just so fucking pissed that these tests don’t exist.
00:19:06 Meanwhile, and everyone says, you know,
00:19:08 oh, we couldn’t make these, you know,
00:19:10 that we could never do it.
00:19:11 That would be such a hard, a difficult problem.
00:19:14 Meanwhile, the vaccine gets,
00:19:16 we have at the same time that we could have gotten
00:19:18 these stupid little paper strip tests out to every household,
00:19:22 we have developed a brand new vaccine.
00:19:25 We’ve gone through phase one, phase two, phase three trials.
00:19:27 We’ve scaled up its production.
00:19:29 And now we have UPS and FedEx
00:19:31 and all the logistics in the world,
00:19:33 getting freezers out to where they need to be.
00:19:35 We have this immense, we see when it comes to sort of
00:19:39 medicine, you know, something you’re injecting into somebody,
00:19:42 then all of a sudden people say, oh, yes we can.
00:19:45 But you say, oh no, that’s too simple a solution,
00:19:48 too cheap a solution.
00:19:49 No way could we possibly do that.
00:19:52 It’s this faulty thinking in our country,
00:19:54 which, you know, frankly is driven by big money, big,
00:19:58 you know, the only time when we actually think
00:20:00 that we can do something that’s maybe aggressive
00:20:03 and complicated is when there’s billions and billions
00:20:05 of billions of dollars in it, you know.
00:20:08 I mean, on a difficult note, because this is part
00:20:09 of your work from before the COVID,
00:20:12 it does seem that I saw a statistic currently
00:20:15 is that 40% would not be taken,
00:20:18 of Americans would not be taking the vaccine,
00:20:20 some number like this.
00:20:21 So you also have to acknowledge that all the money
00:20:24 that’s been invested, like there doesn’t appear
00:20:26 to be a solution to deal with like the fear,
00:20:30 distrust that people have.
00:20:32 I bet, I don’t know if you know this number,
00:20:34 but for taking a strip, like a rapid test like this,
00:20:38 I bet you people would say,
00:20:41 like the percentage of people that wouldn’t take it
00:20:43 is in the single digits, probably.
00:20:45 I completely think so.
00:20:46 And you know, there’s a lot of people
00:20:48 who don’t want to get a test today.
00:20:50 And that’s because it gets sent to a lab,
00:20:53 it gets reported, it has all this stuff.
00:20:55 And we’re a country which teaches people
00:20:58 from the time they’re babies, you know,
00:21:01 to keep their medical data close to them.
00:21:04 We have HIPAA, we have all these,
00:21:05 we have immense rules and regulations
00:21:07 to ensure the privacy of people’s medical data.
00:21:11 And then a pandemic comes around
00:21:12 and we just assume that the average person
00:21:15 is gonna wipe all that away and say,
00:21:17 oh no, I’m happy giving out not just my own medical data,
00:21:20 but also to tell the authorities,
00:21:22 everyone who I’ve spent my time with,
00:21:24 so that they all get a call and are pissed at me
00:21:26 for giving up their names.
00:21:28 You know, so people aren’t getting tested
00:21:29 and they’re definitely not giving up their contacts
00:21:32 when it comes to contact tracing.
00:21:34 And so for so many reasons, that approach is failing.
00:21:38 Not to even mention the delays in testing
00:21:41 and things like that.
00:21:41 And so this is a whole different approach,
00:21:44 but it’s an approach that empowers people
00:21:46 and takes the power a bit away from the people in charge.
00:21:51 You know, and that’s what’s really grating on,
00:21:54 I think, public health officials who say,
00:21:56 no, we need the data.
00:21:57 So they’re effectively saying, if I can’t have the data,
00:22:00 I don’t want the individuals,
00:22:02 I don’t want the public to have their own data either.
00:22:04 Which is a terrible approach to a pandemic
00:22:06 where we can’t solve a public health crisis
00:22:09 without actively engaging the public.
00:22:13 It just doesn’t work.
00:22:14 And you know, and that’s what we’re trying to do right now,
00:22:17 which is a terrible approach.
00:22:19 So first of all, there’s a,
00:22:20 you have a really nice informative website,
00:22:22 rapidtest.org, with information on this.
00:22:24 I still can’t believe this is not more popular.
00:22:26 It’s ridiculous.
00:22:27 Okay, but our, one of the FAQs you have
00:22:32 is a rapid test too expensive.
00:22:35 So can cost be brought down?
00:22:38 Like I pay, I take a weekly PCR test
00:22:41 and I think I pay 160, 170 bucks a week.
00:22:46 No, I mean, it’s criminal.
00:22:47 Absolutely we can get costs.
00:22:49 This thing right here costs less than a dollar to make.
00:22:53 With everything combined, plus the swabs,
00:22:55 you know, maybe it costs a dollar 50.
00:22:58 Could be sold for, frankly, it could be sold for $3
00:23:02 and still make a profit if they wanna sell it for five.
00:23:04 This one here, this is a slightly more complicated one,
00:23:08 but you can see it’s just got
00:23:10 the exact same paper strip inside.
00:23:13 And this is really, it doesn’t look like much,
00:23:15 but it’s kind of the cream of the crop
00:23:17 in terms of these rapid tests.
00:23:19 This is the one that the US government bought
00:23:20 and it is doing an amazing job.
00:23:23 It has a 99.9% sensitivity and specificity.
00:23:27 So it’s really, it’s really good.
00:23:29 And so essentially the way it works is you just,
00:23:31 you use a swab, you put the,
00:23:34 once you kind of use a swab on yourself,
00:23:36 you put the swab into these little holes here.
00:23:39 You put some buffer on it and you close it
00:23:41 and a line will show up if it’s positive
00:23:43 and a line won’t show up if it’s negative.
00:23:45 It takes five, 10 minutes.
00:23:48 This whole thing, this can be made so cheap
00:23:51 that the US government was able to buy them,
00:23:54 buy 150 million of them from Abbott for $5 a piece.
00:24:00 So anyone who says that these are expensive,
00:24:03 we have the proof is right here.
00:24:05 This one at its, Abbott did not lose money on this deal.
00:24:10 They got $750 million for selling 150 million of these
00:24:14 at five bucks a piece.
00:24:17 All of these tests can do the same.
00:24:20 So anyone who says that these should be,
00:24:22 unfortunately what’s happening though
00:24:23 is the FDA is only authorizing
00:24:25 all of these tests as medical devices.
00:24:28 So what happens when you, if I’m a medical company,
00:24:32 if I’m a test production company
00:24:34 and I wanna make this test and I go through
00:24:37 and the FDA at the end of my authorization,
00:24:40 the FDA says, okay, you now have a medical device,
00:24:45 not a public health tool, but a medical device.
00:24:47 And that affords you the ability to charge
00:24:50 insurance companies for it.
00:24:53 Why would I ever as a, you know,
00:24:55 in our capitalistic economy and sort of infrastructure,
00:25:01 why would I ever not sell this for $30
00:25:03 when insurance will pay for it or $100?
00:25:06 You know, it might only cost me 50 cents to make,
00:25:09 but by pushing all of these tests through a medical pathway
00:25:13 at the FDA, what extrudes out the other side
00:25:17 is an expensive medical device that’s erroneously expensive.
00:25:20 It doesn’t need to be inflated in cost,
00:25:22 but the companies say, well, I’d rather make fewer of them
00:25:27 and just sell them all for $30 a piece
00:25:30 than make tens of millions of them, which I could do,
00:25:34 and sell them at a dollar marginal profit.
00:25:39 And so it’s a problem with our whole medical industry
00:25:43 that we see tests only as medical devices
00:25:46 and what I would like to see is for the government
00:25:49 in the same way that they bought 150 million of these
00:25:51 from Abbott, they should be buying, you know,
00:25:55 all of these tests, they should be buying 20 million a day
00:25:59 and getting them out to people’s homes.
00:26:00 This virus has cost trillions of dollars
00:26:03 to the American people.
00:26:05 It’s closed down restaurants and stores
00:26:07 and obviously the main streets across America
00:26:09 have shuttered.
00:26:11 It’s killing people, it’s killing our economy,
00:26:14 it’s killing lifestyles and lives.
00:26:17 This is an obvious solution.
00:26:19 To me, this is exciting.
00:26:20 This is like, this is a solution.
00:26:21 I wish like in April or something like that
00:26:25 to launch like the larger scale manufacturing deployment
00:26:30 of tests.
00:26:33 Doesn’t matter what test they are.
00:26:35 It’s obviously the capitalist system
00:26:37 would create cheaper and cheaper tests
00:26:38 that would be hopefully driving down to $1.
00:26:42 So what are we talking about?
00:26:43 In America, there’s, I don’t know,
00:26:46 300 plus million people.
00:26:49 So that means you wanna be testing regularly, right?
00:26:54 So how many do you think is possible to manufacture?
00:26:57 What would be the ultimate goal to manufacture per month?
00:27:00 Yep, so if we wanna slow this virus
00:27:03 and actually stop it from transmitting,
00:27:05 achieve what I call herd effects.
00:27:07 Like vaccine herd immunity,
00:27:09 herd effects are when you get that R value below one
00:27:13 through preventing onward transmission.
00:27:14 If we wanna do that with these tests,
00:27:15 we need about 20 million to 40 million of them every day,
00:27:20 which is not a lot.
00:27:21 In the United States.
00:27:22 In the United States.
00:27:23 So we could do it.
00:27:24 There’s other ways.
00:27:25 You can have two people in a household swab each other,
00:27:29 swab themselves rather,
00:27:31 and then mix, put the swabs into the same tube
00:27:33 and onto one test so you can pool.
00:27:35 So you can get a two or three X gain in efficiency
00:27:40 through pooling in the household.
00:27:42 You could do that in schools or offices too,
00:27:44 wherever and just use a swab.
00:27:45 You have a, there’s two people.
00:27:47 I mean, even if it’s just standing in line
00:27:50 at a public testing site or something,
00:27:52 you could just say, okay,
00:27:53 these two are the last people to test or swab themselves.
00:27:57 They go into one thing.
00:27:58 And if it comes back positive,
00:27:59 then you just do each person and it’s rapid.
00:28:02 So you can just say to the people, one of you is positive.
00:28:05 Let’s test you again.
00:28:07 So there’s ways to get the efficiency gains much better.
00:28:10 But let’s say, I think that the optimal number right now
00:28:13 that matches sort of what we can produce more or less today,
00:28:16 if we want it, is 20 million a day.
00:28:19 Right now, one company that,
00:28:20 I don’t have their test here,
00:28:21 but one company is already producing 5 million tests
00:28:24 themselves and shipping them overseas.
00:28:27 It’s an American company based in California called Inova,
00:28:30 and they are giving 5 million tests to the UK every day.
00:28:36 Not to the, you know, and this is just because there’s no,
00:28:39 the federal government hasn’t authorized these tests.
00:28:42 So without the support of the government.
00:28:44 So yeah, so essentially,
00:28:46 if the government just puts some support behind it,
00:28:49 then yeah, you can get 20 million, probably easy.
00:28:53 Oh yeah, this, I mean, just here,
00:28:55 I have three different companies.
00:28:57 These, they all look similar.
00:28:58 Well, this one’s closed,
00:28:59 but these are three different companies right here.
00:29:02 This is a fourth, Abbott.
00:29:04 Now, this is a fifth.
00:29:05 This is a sixth.
00:29:07 These two are a little bit different.
00:29:08 Do you mind if in a little bit,
00:29:10 would you take some of these or?
00:29:11 Yeah, let’s do it.
00:29:12 We can absolutely do them.
00:29:15 So you have a lot of tests in front of you.
00:29:17 Could you maybe explain some of them?
00:29:20 Absolutely.
00:29:21 So there’s a few different classes of tests
00:29:24 that I just have here, and there’s more tests.
00:29:26 There’s many more different tests out in the world too.
00:29:28 These are one class of tests.
00:29:31 These are rapid antigen tests
00:29:33 that are just the most bare bones paper strip tests.
00:29:36 These are, this is the type that I wanna see produced
00:29:42 in the tens of millions every day.
00:29:43 It’s so simple.
00:29:45 You don’t even need the plastic cartridge.
00:29:47 You can just make the paper strip,
00:29:52 and you could have a little tube like this
00:29:55 that you just dunk the paper strip into.
00:29:57 You don’t actually need the plastic,
00:30:00 which I’d actually prefer,
00:30:01 because if we start making tens of millions of these,
00:30:03 this becomes a lot of waste.
00:30:05 So I’d rather not see this kind of waste be out there.
00:30:07 And there’s a few companies,
00:30:08 Quidel is making a test called the Quick View,
00:30:11 which is just this.
00:30:12 It’s a, they’ve gotten rid of all the plastic.
00:30:16 And for people who are just listening to this,
00:30:18 we’re looking at some very small tests
00:30:20 that fit in the palm of your hand,
00:30:22 and they’re basically paper strips
00:30:24 fit into different containers.
00:30:26 And that’s hence the comment about the plastic containers.
00:30:29 These are just injection molded, I think.
00:30:32 And they’re, you know,
00:30:34 they can build them at high numbers,
00:30:36 but then they have to like place them in there appropriately
00:30:38 and all this stuff.
00:30:39 So it is a bottleneck,
00:30:41 or somewhat of a bottleneck in manufacturing.
00:30:44 The actual bottleneck, which the government, I think,
00:30:47 should use the Defense Productions Act to build up,
00:30:49 is there’s a nitrocellulose membrane,
00:30:52 a laminated membrane on this,
00:30:54 that allows the material,
00:30:57 the buffer with the swab mixture to flow across it.
00:31:02 So the way these work,
00:31:03 they’re called lateral flow tests.
00:31:05 And you take a swab,
00:31:07 you swab the front of your nose,
00:31:10 you dunk that swab into some buffer,
00:31:12 and then you put a couple of drops of that buffer
00:31:15 onto the lateral flow.
00:31:17 And just like paper,
00:31:19 if you dip a piece of paper into a cup of water,
00:31:21 the paper will pull the water up through capillary action.
00:31:25 This actually works very similarly.
00:31:26 It flows through somewhat a capillary action
00:31:29 through this nitrocellulose membrane.
00:31:32 And there’s little antibodies on there,
00:31:33 these little proteins that are very specific,
00:31:36 in this case, for antigens or proteins of the virus.
00:31:39 So these are antibodies similar to the antibodies
00:31:42 that our body makes from our immune system,
00:31:45 but they’re just printed on these lateral flow tests,
00:31:48 and they’re printed just like a little, a line.
00:31:50 So then you slice these all up into individual ones.
00:31:54 And if there’s any virus on that buffer,
00:31:56 as it flows across, the antibodies grab that virus,
00:31:59 and it creates a little reaction with some colloids in here
00:32:03 that cause it to turn dark.
00:32:04 Just like a pregnancy test,
00:32:07 one line means negative, it means a control strip worked,
00:32:11 and two lines mean positive.
00:32:13 It means, you know, if you get two lines,
00:32:16 it just means you have virus there.
00:32:17 You’re very, very likely to have virus there.
00:32:18 And so they’re super simple.
00:32:21 It is the exact same technology as pregnancy tests.
00:32:23 It’s the technology, this particular one from Abbott,
00:32:27 this has been used for other infectious diseases
00:32:31 like malaria, and actually a number of these companies
00:32:34 have made malaria tests that do the exact same thing.
00:32:37 So they just coopted the same form factor
00:32:41 and just changed the antibodies
00:32:43 so it picks up SARS CoV2 instead of other infections.
00:32:46 Is it also, the Abbott one, is it also a strip?
00:32:48 Yep, yeah, this Abbott one here is,
00:32:51 there’s the, in this case,
00:32:52 instead of being put in a plastic sheath,
00:32:53 it’s just put in a cardboard thing and literally glued on.
00:32:56 I mean, it looks like nothing, you know, it’s just,
00:32:59 it looks like a, like,
00:33:02 I mean, it’s just the simplest thing you could imagine.
00:33:04 The exterior packaging looks very Apple like, it’s nice.
00:33:07 It does, yeah, yeah.
00:33:09 Yeah, so it’s nice when it comes in a,
00:33:11 this is how they’re packaged, you know,
00:33:14 so, and they don’t have to, you know,
00:33:17 these are coming in individual packages against,
00:33:20 again, because they’re really considered
00:33:21 individual medical devices,
00:33:24 but you could package them in bigger packets and stuff.
00:33:27 You wanna be careful with humidity
00:33:28 so they all have a little,
00:33:30 one of those humidity removing things
00:33:33 and oxygen removing things.
00:33:36 So that’s, this is one class, these antigen tests.
00:33:39 If we could just pause for a second, if it’s okay,
00:33:42 and could you just briefly say what is an antigen test
00:33:47 and what other tests there are out there,
00:33:49 like categories of tests?
00:33:50 Sure.
00:33:51 Just really quick.
00:33:52 So the testing landscape is a little bit complicated,
00:33:55 but it’s, but I’ll break it down.
00:33:56 There’s really just three major classes of tests.
00:34:00 We’ll start with the first two.
00:34:02 The first two tests are just looking for the virus
00:34:06 or looking for antibodies against the virus.
00:34:10 So we’ve heard about serology tests,
00:34:12 or maybe some people have heard about it.
00:34:14 Those are a different kind of test.
00:34:15 They’re looking to see has somebody in the past,
00:34:19 does somebody have an immune response against the virus,
00:34:21 which would indicate that they were infected
00:34:23 or exposed to it.
00:34:24 So we’re not talking about the antibody tests.
00:34:26 I’ll just leave it at that.
00:34:27 Those, they actually can look very similar to this,
00:34:31 or they can be done in a laboratory.
00:34:35 Those are usually done from blood
00:34:37 and they’re looking for an immune response to the virus.
00:34:40 So that’s one.
00:34:41 Everything I’m talking about here
00:34:43 is looking for the virus itself,
00:34:44 not the immune response to the virus.
00:34:46 And so there’s two ways to look for the virus.
00:34:49 You can either look for the genetic code of the virus,
00:34:51 like the RNA, just like the DNA of somebody’s human cells,
00:34:55 or you can look for the proteins themselves,
00:34:57 the antigens of the virus.
00:34:59 So I like to differentiate them.
00:35:02 If you were a PCR test that looks for RNA in,
00:35:08 let’s say if we made it against humans,
00:35:10 it would be looking for the DNA inside of our cells.
00:35:13 That would be actually looking for our genetic code.
00:35:16 The equivalent to an antigen test
00:35:19 is sort of a test that like actually is looking
00:35:21 for our eyes or our nose or physical features of our body
00:35:25 that would delineate, okay, this is Michael, for example.
00:35:30 And so you’re either looking for a sequence
00:35:33 or you’re looking for a structure.
00:35:35 The PCR tests that a lot of people have gotten now
00:35:38 and they’re done in labs usually
00:35:40 are looking for the sequence of the virus, which is RNA.
00:35:43 This test here by a company called Detect,
00:35:46 this is one of Jonathan Rothberg’s companies.
00:35:50 He’s the guy who helped create modern day sequencing
00:35:54 and all kinds of other things.
00:35:56 So this Detect device, that’s the name of the company,
00:35:58 this is actually a rapid RNA detection device.
00:36:01 So it’s almost, it’s like a PCR like test
00:36:04 and we could even do it here.
00:36:06 It’s really, it’s a beautiful test in my opinion,
00:36:09 works exceedingly well.
00:36:10 It’s gonna be a little bit more expensive.
00:36:12 So I think it could confirm,
00:36:14 could be used as a confirmatory test for these.
00:36:16 Is there a greater accuracy to it?
00:36:19 Yes, I would say that there is a greater accuracy.
00:36:21 There’s also a downfall though of PCR
00:36:23 and tests that look for RNA.
00:36:26 They can sometimes detect somebody
00:36:29 who is no longer infectious.
00:36:32 So you have the RNA test
00:36:33 and then you have these antigen tests.
00:36:35 The antigen tests look for structures,
00:36:37 but they’re generally only going to turn positive
00:36:40 if people have actively replicating virus in them.
00:36:43 And so what happens after an infection dissipates,
00:36:48 you’ve just gone from having sort of a spike.
00:36:51 So if you get infected, maybe three days later,
00:36:53 the virus gets into exponential growth
00:36:56 and it can replicate to trillions of viruses
00:36:59 inside the body.
00:37:00 Your immune system then kind of tackles it
00:37:02 and beats it down to nothing.
00:37:04 But what ends up in the wake of that,
00:37:07 you just had a battle.
00:37:08 You had this massive battle that just took place
00:37:10 inside your upper respiratory tract.
00:37:12 And because of that, you’ve had trillions and trillions
00:37:16 of viruses go to zero, essentially.
00:37:19 But the RNA is still there.
00:37:21 It’s just these remnants.
00:37:23 In the same way that if you go to a crime scene
00:37:24 and blood was sort of spread all over the crime scene,
00:37:28 you’re going to find a lot of DNA.
00:37:30 There’s tons of DNA.
00:37:31 There’s no people anymore, but there’s a lot of DNA there.
00:37:35 Same thing happens here.
00:37:36 And so what’s happening with PCR testing
00:37:38 is when people go and use these exceedingly high sensitivity
00:37:42 PCR tests, people will stay positive for weeks or months
00:37:46 after their infection has subsided,
00:37:49 which has caused a lot of problems, in my opinion.
00:37:51 It’s problems that the CDC and the FDA and doctors
00:37:54 don’t want to deal with.
00:37:56 But I’ve tried to publish on it.
00:37:58 I’ve tried to suggest that this is an issue,
00:38:01 both to New York Times and others.
00:38:02 And now it’s unfortunately kind of taken
00:38:04 on a life of its own of conspiracy theorists
00:38:06 thinking that they call it a case demic.
00:38:10 They say, oh, you know, PCR is detecting people
00:38:13 who are no longer, who are false positive.
00:38:16 They’re not false positives.
00:38:17 They’re late positives, no longer transmissible.
00:38:20 I think the way you, like what I saw in rapidtest.org,
00:38:25 I really liked the distinction between diagnostic
00:38:27 sensitivity and contagiousness sensitivity.
00:38:30 That’s, it’s so, that website is so obvious
00:38:36 that it’s painful because it’s like, yeah,
00:38:38 that’s what we should be talking about is
00:38:41 how accurately is a test able to detect your contagiousness?
00:38:46 And you have different plots that show that actually
00:38:48 there’s, you know, that antigen tests,
00:38:52 the tests we’re looking at today, like rapid tests,
00:38:55 are actually really good at detecting contagiousness.
00:38:58 Absolutely.
00:38:59 It all mixes back with this whole idea that,
00:39:02 of the medical industrial complex.
00:39:04 You know, in this country, and in most countries,
00:39:07 we have almost entirely defunded
00:39:10 and devalued public health, period.
00:39:13 You know, we just have.
00:39:15 And what that means is that we don’t even,
00:39:20 we don’t have a language for it.
00:39:22 We don’t have a lexicon for it.
00:39:23 We don’t have a regulatory landscape for it.
00:39:25 And so the only window we have to look at a test today
00:39:30 is as a medical diagnostic test.
00:39:32 And that becomes very problematic when we’re trying
00:39:37 to tackle a public health threat
00:39:40 and a public health emergency.
00:39:42 By definition, this is a public health emergency
00:39:44 that we’re in.
00:39:45 And yet we keep evaluating tests
00:39:48 as though the diagnostic benchmark is the gold standard.
00:39:52 Where if I’m a physician, I am a physician,
00:39:55 so I’ll put on that physician hat for a moment.
00:39:59 And if I have a patient who comes to me
00:40:01 and wants to know if their symptoms are a result of them
00:40:06 having COVID, then I want every shred of evidence
00:40:10 that I can get to see, does this person currently
00:40:12 or did they recently have this infection inside of them?
00:40:17 And so in that sense, the PCR test is the perfect test.
00:40:21 It’s really sensitive.
00:40:22 It will find the RNA if it’s there at all
00:40:25 so that I could say, you know, yeah,
00:40:26 you have a low amount of RNA left.
00:40:28 You might’ve been, you said your symptoms
00:40:30 started two weeks ago.
00:40:32 You probably were infectious two weeks ago
00:40:36 and you have lingering symptoms from it.
00:40:38 But that’s a medical diagnosis.
00:40:41 It’s kind of like a detective recreating a crime scene.
00:40:44 They wanna go back there and recreate the pieces
00:40:48 so that they can assign blame or whatever it might be.
00:40:52 But that’s not public health.
00:40:53 In public health, we need to only look forward.
00:40:56 We don’t wanna go back and say,
00:40:57 well, was this person, are there symptoms
00:40:59 because they had an infection two weeks ago?
00:41:01 In public health, we just wanna stop the virus
00:41:04 from spreading to the next person.
00:41:06 And so that’s where we don’t care
00:41:08 if somebody was infected two weeks ago.
00:41:11 We only care about finding the people
00:41:13 who are infectious today.
00:41:15 And unfortunately, our regulatory landscape
00:41:19 fails to apply that knowledge
00:41:23 to evaluate these tests as public health tools.
00:41:26 They’re only evaluating the tests as medical tools.
00:41:29 And therefore, we get all kinds of complaints
00:41:32 that say this test, which detects 99 plus,
00:41:37 99.8% of current infectious people,
00:41:43 by the FDA’s rubric, they’ll say,
00:41:45 no, no, it’s only 50% sensitive.
00:41:48 And that’s because when you go out into the world
00:41:50 and you just compare this against PCR positivity,
00:41:53 most people who are PCR positive in the world right now
00:41:56 at any given time are post infectious.
00:42:00 They’re no longer infectious
00:42:01 because you might only be infectious for five days,
00:42:04 but then you’ll remain PCR positive
00:42:06 for three or four or five weeks.
00:42:09 And so when you go and just evaluate these tests
00:42:11 and you say, okay, this person’s PCR positive,
00:42:13 does the rapid antigen test detect that?
00:42:17 More often than not, it’s no.
00:42:19 But that’s because those people don’t need isolation.
00:42:23 They’re post infectious.
00:42:24 And it’s become much more of a problem
00:42:27 than I think even the FDA themself is recognizing
00:42:31 because they are unwilling at this point
00:42:33 to look at this as a public health problem
00:42:37 requiring public health tools.
00:42:38 We’ll definitely talk about this a little bit more
00:42:41 because the concern I have is that
00:42:43 a bigger pandemic comes along.
00:42:45 What are the lessons we draw from this
00:42:47 and how we move forward?
00:42:48 Let’s talk about that in a bit.
00:42:50 But sort of, can we discuss further the lay of the land here
00:42:55 of the different tests before us?
00:42:56 Absolutely.
00:42:57 So I talked about PCR tests and those are done in the lab
00:43:00 or they’re done essentially with a rapid test like this,
00:43:05 the detect, and we can even try this in a moment.
00:43:07 It goes into a little heater.
00:43:09 So you might have one of these in a household
00:43:11 or one of these in a nursing home or something like that
00:43:14 or in an airport.
00:43:16 Or you could have one that has 100 different outlets.
00:43:19 This is just to heat the tube up.
00:43:21 These are the rapid tests.
00:43:22 They’re super simple, no frills.
00:43:25 You just swab your nose and you put the swab into a buffer
00:43:30 and you put the buffer on the test.
00:43:32 So we can use these right now if you want.
00:43:34 We can try it out.
00:43:35 And all the tests we’re talking about,
00:43:36 they’re usually swabbing the nose.
00:43:39 Like that’s the…
00:43:41 That’s still the main, yeah.
00:43:43 There are some saliva tests coming about
00:43:45 and these can all work potentially with saliva.
00:43:48 They just have to be recalibrated.
00:43:50 But these swabs are really not bad.
00:43:52 This isn’t the deep swab that goes like way back
00:43:57 into your nose or anything.
00:43:58 This is just a swab that you do yourself
00:44:01 like right in the front of your nose.
00:44:03 So if you wanna do it.
00:44:04 Yeah, do you mind if I?
00:44:05 Sure, yeah.
00:44:06 Yeah, why don’t we start with this one?
00:44:08 Because this is Abbott’s Buy Next Now test
00:44:10 and it’s really, it’s pretty simple.
00:44:12 This is the swab from the Abbott test.
00:44:15 That’s correct.
00:44:16 That’s the swab from the Abbott test.
00:44:18 So what I’m gonna do to start
00:44:21 is I’m going to take this buffer here,
00:44:23 which is, this is just the buffer
00:44:26 that goes onto this test.
00:44:27 So this is a brand new one.
00:44:28 I just opened this test out.
00:44:32 I’m gonna just take six drops of this buffer
00:44:34 and put it right onto this test here.
00:44:40 Two, three, four, five, six.
00:44:43 Okay.
00:44:44 And now you’re gonna take that swab, open it up.
00:44:48 Yep, and now just wipe it around inside the,
00:44:50 into the front of your nose.
00:44:52 Do a few circles on each nostril.
00:44:58 That looks good.
00:45:03 This always makes me wanna sneeze.
00:45:05 Yeah.
00:45:07 Okay, now I’m gonna have you do it yourself.
00:45:11 I’m getting emotional.
00:45:13 Hold it parallel to the test.
00:45:14 So put the test down on the table.
00:45:16 Yep, and then go into that bottom hole.
00:45:19 Yep, and push forward
00:45:20 so that you can start to see it in the other hole.
00:45:22 There you go.
00:45:23 Now turn, if it’s, once it hits up against the top,
00:45:26 just turn it three times.
00:45:28 One, two, three, and sort of, yep.
00:45:30 And now you just close,
00:45:32 so pull off that adhesive sticker there.
00:45:37 And now you just close the whole thing.
00:45:41 And.
00:45:42 And that’s it.
00:45:43 That’s it.
00:45:44 Now what we will see
00:45:46 is we will see a line form.
00:45:49 What’s happening now is the buffer that you put in there
00:45:53 is now moving up onto the paper strip test,
00:45:58 and it has the material from the swab in there.
00:46:02 And so what we’ll see is a line will form,
00:46:05 and that’s gonna be the control line.
00:46:08 And then we’ll also see the,
00:46:11 ideally we’ll see no line for the actual line.
00:46:14 We’ll see no line for the actual test line.
00:46:17 And that’s because you should be negative.
00:46:20 So one line will be positive and two lines will be negative.
00:46:24 That’s very cool.
00:46:25 There’s this purple thing creeping up
00:46:28 onto the control line.
00:46:31 That’s perfect.
00:46:32 That’s what you wanna be seeing.
00:46:35 So you want to see that,
00:46:37 so right now you essentially want to see
00:46:41 that that blue line turns pink or purply color.
00:46:45 There’s a blue line that’s already there printed.
00:46:49 It should turn sort of a purple pink color.
00:46:52 And ideally there will be no additional line for the sample.
00:47:00 And if there is,
00:47:02 that’s the 99 point whatever percent accuracy on,
00:47:06 that means I have, I’m contagious.
00:47:09 That would mean that you’re likely contagious
00:47:11 or you likely have infectious virus in you.
00:47:14 What we can do,
00:47:15 because one of the things that my plan calls for
00:47:19 is because sometimes these tests
00:47:21 can get false positive results, it’s rare.
00:47:24 Maybe 1% or in the case of this Binex now,
00:47:27 this Abbott test 0.1%.
00:47:30 So one in a thousand, one in 500,
00:47:31 something like that can be falsely positive.
00:47:34 What I recommend is that when somebody is positive
00:47:38 on one of these,
00:47:39 you turn around and you immediately test
00:47:41 on a different test.
00:47:42 You could either do it on the same,
00:47:43 but for good measure,
00:47:45 you want to use a separate test
00:47:48 that is somewhat orthogonal,
00:47:51 meaning that it shouldn’t turn falsely positive
00:47:54 for the same reason.
00:47:56 This particular test here,
00:47:58 this detect test because it is looking for the RNA
00:48:02 and not the antigen,
00:48:03 this is an amazingly accurate test
00:48:05 and it’s sort of a perfect gold standard
00:48:09 or confirmatory test for any of these antigen tests.
00:48:12 So one of the recommendations that I’ve had,
00:48:14 especially if people start using antigen tests
00:48:17 before you get onto a plane
00:48:20 or as what I call entrance screening,
00:48:22 if somebody is positive,
00:48:24 you don’t immediately tell them,
00:48:26 you’re positive, go isolate for 10 days.
00:48:28 You tell them, let’s confirm on one of these,
00:48:31 on a detect test.
00:48:33 That is because it’s completely orthogonal,
00:48:36 it’s looking for the RNA instead of the antigen.
00:48:40 There’s no reason, no biological reason
00:48:43 that both of these should be falsely positive.
00:48:47 So if one’s falsely positive and the other one is negative,
00:48:50 especially because this one’s more sensitive,
00:48:53 then I would trust this as a confirmatory test.
00:48:56 If this one’s negative, then the antigen test
00:49:00 would be considered falsely positive.
00:49:02 It does look like there’s only a single line,
00:49:04 so this is very exciting news.
00:49:05 That’s right, yep.
00:49:06 It says wait 15 minutes to see both lines,
00:49:10 but in general, if somebody’s really gonna be positive,
00:49:14 that line starts showing up within a minute or two.
00:49:17 So you wanna keep the whole,
00:49:18 we’ll keep watching it for the whole 15 minutes
00:49:20 as it’s sitting there, but I would say
00:49:22 you’re knowing that you’ve had PCR tests recently
00:49:25 and all that.
00:49:26 The odds are pretty good.
00:49:27 The odds are very good.
00:49:28 The packaging, very iPhone like.
00:49:30 I’m digging the sexy packaging.
00:49:33 I’m a sucker for good packaging, okay.
00:49:36 So then there’s this test here,
00:49:37 which is, this is another, it’s funny.
00:49:41 Let me open this up and show you.
00:49:42 This is a really nice test.
00:49:44 It’s another antigen test.
00:49:45 Works the exact same way as this, essentially,
00:49:48 but what you can see is it’s got lights in it
00:49:51 and a power button and stuff.
00:49:52 This is called an allume test, which is fine,
00:49:57 and it’s a really nice test, to be honest,
00:49:59 but it has to pair with an iPhone.
00:50:04 And so it’s good as a,
00:50:05 I think that this is gonna become,
00:50:08 there’s a lot of use for this from a medical perspective,
00:50:11 where you want good reporting.
00:50:13 This can, because it pairs with an iPhone,
00:50:15 it can immediately send the report
00:50:19 to a department of health,
00:50:20 whereas these paper strip tests, they’re just paper.
00:50:23 They don’t report anything unless you wanna report it.
00:50:26 Okay, so I’m gonna just pick it apart.
00:50:28 And so you can see is there’s fluorescent readers
00:50:32 and little lasers and LEDs and stuff in there.
00:50:34 You can actually see the lights going off.
00:50:37 And there’s a paper strip test right inside there,
00:50:39 but you can see that there’s a whole circuit board
00:50:41 and all this stuff, right?
00:50:44 And so this is the kind of thing
00:50:48 that the FDA is looking for,
00:50:52 for home use and things like that,
00:50:54 because it’s kind of foolproof.
00:50:56 You can’t go wrong with it.
00:50:58 It pairs with an iPhone, so you need Bluetooth.
00:51:00 So it’s gonna be more limited.
00:51:01 It’s a great test, don’t get me wrong.
00:51:03 It’s as good as any of these.
00:51:05 But when you compare this thing with a battery
00:51:08 and a circuit board and all this stuff,
00:51:10 it’s got its purpose, but it’s not a public health tool.
00:51:14 I don’t wanna see this made in the tens of millions a day
00:51:17 and thrown away.
00:51:18 This is just.
00:51:19 But FDA likes that kind of stuff.
00:51:20 FDA loves this stuff,
00:51:22 because they can’t get it out of their mind
00:51:23 that this is a public health crisis.
00:51:26 We need, I mean, just look at the difference here.
00:51:29 Something with flashing lights is essential.
00:51:32 It’s got batteries, it’s got a Bluetooth thing.
00:51:34 It’s a great test, but to be honest,
00:51:36 it’s not any better than this one.
00:51:39 And so I want this one.
00:51:43 It’s nice and all.
00:51:44 The form factor is nice,
00:51:46 and it’s really nice that it goes to Bluetooth.
00:51:49 But it goes against the principle of just 20 million a day.
00:51:52 The easy solution, everybody has it.
00:51:54 You can manufacture and probably,
00:51:57 you could’ve probably scaled this up in a couple of weeks.
00:52:00 Oh, absolutely.
00:52:00 These companies, I mean, the rest of the world has these.
00:52:04 They can be scaled up.
00:52:05 They already exist.
00:52:06 You know, SD biosensors,
00:52:08 one company’s making tens of millions a day,
00:52:10 not coming to the United States,
00:52:11 but going all over Europe,
00:52:13 going all over Southeast Asia and East Asia.
00:52:16 So they exist.
00:52:17 The US is just, you know, we can’t get out of our own way.
00:52:21 I wonder why somebody,
00:52:22 I don’t know if you were paying attention,
00:52:23 but somebody like an Elon Musk type character.
00:52:26 So he was really into doing
00:52:28 some like obvious engineering solution,
00:52:30 like this at home rapid test
00:52:33 seems like a very Elon Musk thing to do.
00:52:37 I don’t know if you saw,
00:52:38 but I had a little Twitter conversation with Elon Musk.
00:52:41 Does he not like, what is he,
00:52:43 do you know what his thoughts are on rapid testing?
00:52:45 Well, he was using a slightly different one,
00:52:47 one of these, but that requires an instrument
00:52:49 called the BD Veritor.
00:52:50 And he got a false positive,
00:52:52 or no, I shouldn’t say,
00:52:53 he didn’t necessarily get a false positive.
00:52:54 He got discrepant results.
00:52:55 He did this test four times.
00:52:57 He got two positives, two negatives,
00:53:00 but then he got a PCR test
00:53:02 and it was a very low positive result.
00:53:05 So I think what happened is he just tested himself
00:53:07 at the tail end of an,
00:53:09 this was actually right before he was about to send those.
00:53:11 It was the day of essentially that he was sending
00:53:12 the astronauts up to the space station the other day.
00:53:15 So he was using these rapid tests
00:53:17 cause he wanted to make sure that he was good to go in
00:53:20 and he got discrepant results.
00:53:23 Ultimately they were correct,
00:53:25 but two were negative, two were positive.
00:53:26 But what really happened once he shared his PCR results
00:53:30 and they were very low positive.
00:53:32 So really what was happening is,
00:53:34 my guess is he found himself right at the edge
00:53:37 of his positivity, of his infectiousness.
00:53:39 And so the test worked how it was supposed to work.
00:53:42 It probably had he used it two days earlier,
00:53:45 it would have been screaming positive.
00:53:47 He wouldn’t have gotten discrepant results,
00:53:49 but he found himself right at the edge
00:53:51 by the time he used the test.
00:53:52 So the PCR would always pick it up
00:53:55 cause it’s still, cause that will still stay positive
00:53:57 then for weeks potentially.
00:53:59 But the rapid antigen test was starting to falter,
00:54:02 not in a bad way,
00:54:03 but just he probably was really no longer
00:54:06 particularly infectious.
00:54:07 And so it was kind of when it gets to be a very low viral
00:54:10 load, it becomes stochastic.
00:54:12 It’s fascinating this duality.
00:54:14 So one you can think from an individual perspective,
00:54:18 it’s unclear when you take four and half are positive,
00:54:23 half are negative, like what are you supposed to do?
00:54:25 But from a societal perspective,
00:54:28 it seems like if just one of them is positive,
00:54:30 just stay home for a couple of days, for a while.
00:54:34 So when you’re a CEO of a company,
00:54:36 you’re launching astronauts to space,
00:54:38 you may not want to rely absolutely on the antigen test
00:54:43 as a thing by which you steer your decisions
00:54:47 of like 10,000 plus people companies.
00:54:50 But us individuals just living in the world,
00:54:53 if you can, if it comes up positive,
00:54:57 then you make decisions based on that.
00:54:59 And then that scales really nicely to an entire society
00:55:01 of hundreds of millions of people.
00:55:03 And that’s how you get that virus to stop spreading.
00:55:07 That’s exactly right.
00:55:08 You don’t have to catch every single one.
00:55:10 And the nice thing is that these will,
00:55:12 these will catch the people who are most infectious.
00:55:15 So with Elon Musk, it generally that test,
00:55:19 we don’t have the counterfactual.
00:55:20 We don’t have his results from three days earlier
00:55:23 when he was probably most infectious.
00:55:26 But my guess is the fact that it was catching two
00:55:30 out of the four, even when he was down at a CT value
00:55:33 of really, really very, very low viral load on the PCR test
00:55:36 suggests that it was doing its job.
00:55:39 And you just wanna, and the nice thing is
00:55:42 because these can be produced at such scale,
00:55:45 getting one positive doesn’t immediately have to mean
00:55:49 10 days of isolation.
00:55:51 That’s the CDC is more conservative stance to say,
00:55:55 if you’re positive on any tests,
00:55:57 stay home for 10 days and isolate.
00:55:59 But here, people would just have more tests.
00:56:01 So the recommendation should be test daily.
00:56:04 If you turn positive, test daily
00:56:06 until you’ve been negative for 24, 48 hours
00:56:09 and then go back to work.
00:56:10 And the nice thing there is right now,
00:56:12 people just aren’t testing
00:56:13 because they don’t wanna take 10 days off.
00:56:15 They’re not getting paid for it.
00:56:16 So they can’t take 10 days off.
00:56:18 Do you know what Elon thinks about this idea
00:56:21 of rapid testing for everybody?
00:56:23 So I understood I need to look at that whole Twitter thread.
00:56:26 So I understand his perhaps criticism of,
00:56:30 he had like a conspiratorial tone from my vague look at it
00:56:34 of like, what’s going on here with these tests?
00:56:37 But what does he actually think about
00:56:40 this very practical to me engineering solution
00:56:42 of just deploying rapid tests to everybody?
00:56:45 It seems like that’s a way to open up the economy in April.
00:56:48 Well, to be honest,
00:56:49 I’ve been trying to get in touch with him again.
00:56:51 I think, take somebody like Elon Musk
00:56:54 with the engineering prowess within his ranks,
00:56:57 to easily, easily build these at the tens of millions a day.
00:57:04 He could build the machines from scratch.
00:57:07 A lot of the companies,
00:57:08 they buy the machines from South Korea or Taiwan, I believe.
00:57:12 We don’t have to, we can build these machines.
00:57:15 They’re simple to build.
00:57:16 Put somebody like Elon Musk on it,
00:57:20 take some of his best engineers and say,
00:57:21 look, the US needs a solution in two weeks.
00:57:26 Build these machines, figure it out.
00:57:29 He’ll do it, he could do it.
00:57:30 This is a guy who is literally,
00:57:33 he has started multiple entirely new industries.
00:57:37 He has the capital to do it without the US government
00:57:40 if he wanted to.
00:57:41 And you know what, it would,
00:57:43 the return on investment for him would be huge.
00:57:47 But frankly, the return on investment in the country
00:57:50 would be hundreds of billions of dollars,
00:57:53 because it means we could get society open.
00:57:55 So I know that his first experience
00:57:58 with these rapid tests was confusing,
00:58:01 which is how I ended up having this Twitter
00:58:04 kind of conversation with him very briefly.
00:58:06 But I think that if he understood
00:58:09 sort of a little bit more, and I think he does,
00:58:11 I really love to talk to him about it,
00:58:13 because I think he could totally change
00:58:14 the course of this pandemic in the United States,
00:58:17 single handedly.
00:58:18 He loves grand things.
00:58:19 Yeah, I think out of all the solutions I’ve seen,
00:58:24 this is the obvious engineering solution
00:58:29 to at least a pandemic of this scale.
00:58:32 I love that you say the engineering solution.
00:58:35 So this is something I’ve been really trying to,
00:58:38 I’m an engineer, my previous history was all engineering,
00:58:42 and that’s really how I think.
00:58:44 I then went into medicine and PhD world,
00:58:46 but I think that the world,
00:58:52 like one of the major catastrophes,
00:58:53 or one of the major problems,
00:58:55 is that we have physicians making the decisions
00:58:57 about public health and a pandemic,
00:59:01 when really we need engineers.
00:59:03 This is an engineering problem.
00:59:05 And so what I’ve been trying to do,
00:59:06 I actually really want to start a whole new field
00:59:10 called public health engineering.
00:59:12 And so I’ve been, eventually I want to try
00:59:15 to bring it to MIT and get MIT
00:59:16 to want to start a new department or something.
00:59:19 That’s a doubly awesome idea.
00:59:21 Yeah.
00:59:22 That, this is really, okay.
00:59:24 I love this, I love every aspect.
00:59:26 I love everything you’re talking about.
00:59:29 A lot of people believe,
00:59:30 because vaccines started being deployed currently,
00:59:34 that we are no longer in need of a solution.
00:59:39 We’re no longer in need of slowing the spread of the virus.
00:59:45 To me, as I understand,
00:59:46 it seems like this is the most important time
00:59:49 to have something like a rapid testing solution.
00:59:52 Can you kind of break that apart?
00:59:54 What’s the role of rapid testing currently
00:59:57 in the next, what is it, three, four months maybe?
01:00:01 Even more.
01:00:02 The vaccine rollout isn’t gonna be as peachy
01:00:05 as everyone is hoping.
01:00:07 And I hate to be the Debbie Downer here,
01:00:09 but there’s a lot of unknowns with this vaccine.
01:00:13 You’ve already mentioned one,
01:00:14 which is there’s a lot of people
01:00:16 who just don’t want to get the vaccine.
01:00:19 I hope that that might change as things move forward
01:00:21 and people see their neighbors getting it
01:00:23 and their family getting it and it’s safe and all.
01:00:25 We don’t know how effective the vaccine is gonna be
01:00:27 after two or three months.
01:00:28 We’ve only measured it in the first two or three months,
01:00:30 which is a massive problem,
01:00:33 which we can go into biologically,
01:00:35 because there’s very good reasons to believe
01:00:38 that the efficacy could fall way down
01:00:40 after two or three months.
01:00:42 We don’t know if it’s gonna stop transmission.
01:00:44 And if it doesn’t stop transmission,
01:00:46 then there’s, you know,
01:00:48 herd immunity is much, much more difficult to get
01:00:50 because that’s all based on transmission blockade.
01:00:54 And frankly, we don’t know how easily
01:00:57 we’re going to be able to roll it out.
01:00:58 Some of the vaccines need really significant cold chains,
01:01:01 have very short half lives outside of that cold chain.
01:01:05 We need to organize massive numbers of people
01:01:10 to be able to distribute these.
01:01:11 Most hospitals today are saying that they’re not equipped
01:01:14 to hire the right people
01:01:16 to be even administering enough of these vaccines.
01:01:19 And then a lot of the hospitals
01:01:20 are frustrated because they’re getting much lower,
01:01:22 smaller allocations than they were expecting.
01:01:24 So I think right now, like you say,
01:01:28 right now is the best time,
01:01:31 you know, besides three or four or five or six months ago,
01:01:34 right now is the best time to get these rapid tests out.
01:01:38 And we need to, I mean,
01:01:39 the country has the capacity to build them.
01:01:42 We have, we’re shipping them overseas right now.
01:01:45 We just need to flip a switch,
01:01:47 get the FDA to recognize
01:01:48 that there’s more important things than diagnostic medicine,
01:01:51 which is the effectiveness of the public health program
01:01:54 when we’re dealing with a pandemic.
01:01:57 They need to authorize these as public health tools,
01:02:00 or, you know, frankly, the president could,
01:02:05 you know, there’s a lot of other ways to get these tests
01:02:08 to not have to go through
01:02:09 the normal FDA authorization program,
01:02:11 but maybe have the NIH and the CDC give a stamp of approval.
01:02:15 And if we could, we could get these out tomorrow.
01:02:19 And that’s where that article came from,
01:02:20 you know, how we can stop the spread of this virus
01:02:23 by Christmas, we could, you know, now it’s getting late.
01:02:26 And so we have to keep updating that timeframe,
01:02:30 maybe putting Christmas in the title wasn’t,
01:02:32 I should have said how we can stop
01:02:33 the spread of this virus in a month.
01:02:35 It would be a little bit more timeless,
01:02:37 but we could do it, you know, we really could do it.
01:02:40 And that’s the most frustrating part here is that
01:02:43 we’re just choosing not to as a country.
01:02:46 We’re choosing to bankrupt our society
01:02:48 because some people at the FDA and other places
01:02:52 just can’t seem to get their head around the fact
01:02:54 that this is a public health problem,
01:02:56 not a bunch of medical problems.
01:02:58 Is there a way to change that policy wise?
01:03:00 So this is a much bigger thing that you’re speaking to,
01:03:03 which I love in terms of the MIT engineering approach
01:03:09 to public health.
01:03:11 Is there a way to push this?
01:03:13 Is this a political thing?
01:03:14 Like where some Andrew Yang type characters
01:03:17 need to like start screaming about it?
01:03:20 Is it more of an Elon Musk thing
01:03:24 where people just need to build it
01:03:26 and then on Twitter start talking crap
01:03:28 to politicians for not doing it?
01:03:31 What are the ideas here?
01:03:34 I think it’s a little of both.
01:03:37 I think it’s political on the one hand,
01:03:38 and I’ve certainly been talking to Congress a lot,
01:03:41 talking to senators.
01:03:42 Are they receptive?
01:03:43 Oh, yeah.
01:03:44 I mean, that’s the crazy thing.
01:03:45 Everyone but the FDA is receptive.
01:03:47 I mean, it’s astounding.
01:03:49 I mean, I advise, informally I advise the president
01:03:53 and the president elects teams.
01:03:55 I talk to Congress, I talk to senators, governors,
01:04:01 and then all the way down to mayors of towns and things.
01:04:05 And I mean, months ago I held a round table discussion
01:04:08 with Mayor Garcetti, who’s the mayor of LA,
01:04:12 and I brought all the companies who make these things.
01:04:15 This was in like July or August or something.
01:04:17 I brought all the companies to the table
01:04:18 and said, okay, how can we get these out?
01:04:21 And unfortunately, it went nowhere
01:04:23 because the FDA won’t authorize them
01:04:25 as public health tools.
01:04:28 The nice thing is that this is one of the nice
01:04:31 and frustrating things.
01:04:32 This is one of the few bipartisan things that I know of.
01:04:35 And like you said, it’s a real solution.
01:04:38 Lockdowns aren’t a solution.
01:04:40 They’re an emergency bandaid to a catastrophe
01:04:45 that’s currently happening.
01:04:46 They’re not a solution.
01:04:48 And they’re definitely not a public health solution
01:04:51 if we’re taking a more holistic view of public health,
01:04:53 which includes people’s wellbeing,
01:04:55 includes their psychological wellbeing,
01:04:57 their financial wellbeing.
01:04:59 Just stopping a virus if it means
01:05:01 that all those other things get thrown under the bus
01:05:03 is not a public health solution.
01:05:05 It’s a myopic or very tunnel visioned approach
01:05:11 to a virus that’s spreading.
01:05:14 This is a simple solution with essentially no downfall.
01:05:20 There is nothing bad about this.
01:05:22 It’s just giving people a result.
01:05:25 And it’s bipartisan.
01:05:27 The most conservative and the most liberal people,
01:05:30 everyone just wants to know their status.
01:05:32 Nobody wants to have to wait in line for four hours
01:05:35 to find out their status on Monday,
01:05:39 a week later, on Saturday.
01:05:40 It just doesn’t make any sense.
01:05:41 It’s a useless test at that point.
01:05:43 And everyone recognizes that.
01:05:45 So why do you think, like the mayor of LA,
01:05:49 why do you think politicians are going for these,
01:05:54 from my perspective, like kind of half ass lockdowns,
01:05:58 which is not, so I have seen good evidence
01:06:01 that like a complete lockdown can work,
01:06:04 but that’s in theory, it’s just like communism in theory
01:06:07 can work.
01:06:09 Like theoretically speaking, but it just doesn’t,
01:06:12 at least in this country, we don’t,
01:06:14 I think it’s just impossible to have complete lockdown.
01:06:17 And still politicians are going for these kind of lockdowns
01:06:21 that everybody hates,
01:06:24 that’s really hurting small businesses.
01:06:28 Like why are they going for that?
01:06:29 And big businesses, and yeah, all businesses,
01:06:32 but like basically not just hurting,
01:06:35 they’re destroying small businesses, right?
01:06:38 Which is going to have potentially, I mean,
01:06:43 yeah, I’ve been reading as I don’t shut up
01:06:47 about the rise and fall of the Third Reich,
01:06:49 and there’s economic effects that take a decade to,
01:06:57 there’s going to be long lasting effects
01:06:58 that may be destructive to the very fabric of this nation.
01:07:02 So why are they doing it,
01:07:04 and why are they not using the solution?
01:07:06 Is there any intuition?
01:07:07 I mean, you’ve said that FDA has a stranglehold, I guess,
01:07:11 on this whole public health problem.
01:07:14 Is that all it is?
01:07:16 That’s honestly, it’s pretty much all it is.
01:07:20 The companies, so somebody like Mayor Garcetti
01:07:23 or Governor Baker, Cuomo, Newsom,
01:07:27 any of these, DeWine, I’ve talked to a lot of governors
01:07:31 in this country at this point,
01:07:34 and of course the federal government,
01:07:36 including the president’s own teams,
01:07:40 and the heads of the NIH, the heads of the CDC about this.
01:07:45 The problem is the tests don’t exist in this country
01:07:50 at the level that we need them to right now
01:07:53 to make that kind of policy, to make that kind of program.
01:07:57 They could, but they don’t.
01:07:59 And so what that means is that when Mayor Garcetti says,
01:08:03 okay, what are my actual options today,
01:08:06 despite these sounding like a great idea,
01:08:08 he looks around and he says, well, they’re not authorized.
01:08:11 They don’t exist right now for at home use.
01:08:15 And from his perspective,
01:08:16 he’s not about to pick that fight with the FDA,
01:08:19 and it turns out nobody is.
01:08:20 Why are people afraid of,
01:08:22 it seems like an easy struggle to fight.
01:08:25 It’s like a…
01:08:25 So they don’t see it as a fight.
01:08:28 They think that the FDA is the end all be all.
01:08:31 Everyone thinks the FDA is the end all be all.
01:08:34 And so they just defer, everyone is deferential,
01:08:37 including the heads of all the other government agencies
01:08:40 because that is their role.
01:08:42 But what everyone is failing to see
01:08:44 is that the FDA doesn’t even have a mandate or a remit
01:08:48 to evaluate these tests as public health tools.
01:08:50 So they’re just falling in this weird gray zone
01:08:53 where the FDA is saying, look,
01:08:56 we evaluate medical products.
01:08:57 That’s the only thing that I meant,
01:08:59 like Tim Stenzel, head of in vitro diagnostics at the FDA,
01:09:02 he’s doing what his job is,
01:09:04 which is to evaluate medical tools.
01:09:09 Unfortunately, this is where I think the CDC
01:09:12 has really blundered.
01:09:13 They haven’t made the right distinction to say, look,
01:09:17 okay, the FDA is evaluating these for doctors to use
01:09:20 and all that, but we’re the CDC
01:09:23 and we’re the public health agency of this country
01:09:25 and we recognize that these tools
01:09:27 require a different authorization pathway
01:09:30 and a different use, not prescription.
01:09:30 There’s a difference between medical devices
01:09:33 and public health.
01:09:35 And I guess FDA is not designed for this public health,
01:09:38 especially in emergency situations.
01:09:40 And they actually explicitly say that.
01:09:43 I mean, when I go and talk to Tim,
01:09:46 and he’s a very reasonable guy,
01:09:48 but when I talk to him, he says,
01:09:50 look, we don’t, we just do not evaluate
01:09:55 a public health tool.
01:09:56 If you’re telling me this is a public health tool,
01:09:57 great, go and use it.
01:09:59 And so I say, okay, great, we’ll go and use it.
01:10:03 And then the comment is,
01:10:05 but does it give a result back to somebody?
01:10:08 I say, well, yes, of course it gives a result
01:10:11 back to somebody, it’s being done in their home.
01:10:13 So then it’s defined as a medical tool, can’t use it.
01:10:16 So it’s stuck in this gray zone where unfortunately,
01:10:19 there’s this weird definition that any tool,
01:10:21 any test that gives a result back to an individual
01:10:25 is defined by CMS, Centers for Medicaid Services,
01:10:29 as a medical device requiring medical authorization.
01:10:34 But then you go and ask, it gets crazier,
01:10:36 because then you go and ask Seema Verma,
01:10:38 the head of CMS, you know, okay,
01:10:43 can these be authorized as public health tools
01:10:47 and not fall under your definition of a medical device?
01:10:50 So then the FDA doesn’t have to be the ones
01:10:52 authorizing it as a public health tool.
01:10:54 And Seema Verma says, oh, we don’t have any jurisdiction
01:10:59 over point of care and sort of rapid devices like this.
01:11:04 We only have jurisdiction over lab devices.
01:11:07 So it’s like nobody has ownership over it,
01:11:10 which means that they just keep,
01:11:11 they stay in this purgatory of not being approved.
01:11:15 And so this is where I think, frankly, it needs a president.
01:11:18 It needs a presidential order to just unlock them,
01:11:21 to say this is more important than having a prescription.
01:11:25 And in fact, I mean, really what’s happening now,
01:11:28 because there is this sense that tests
01:11:31 are public health tools,
01:11:32 even if they’re not being defined as such,
01:11:35 the FDA now is pretty much,
01:11:37 not only are they not authorizing these
01:11:39 as public health tools,
01:11:41 what they’re doing by authorizing
01:11:43 what are effectively public health tools as medical devices,
01:11:47 they’re just diluting down the practice of medicine.
01:11:50 I mean, his answer right now, unfortunately is,
01:11:54 well, I don’t know why you want these to be
01:11:56 sort of available to everyone without a prescription.
01:11:58 We’ve already said that a doctor can write
01:12:01 a whole prescription for a whole college campus.
01:12:04 It’s like, well, if you’re going in that direction then,
01:12:06 and that’s no longer medicine,
01:12:08 having a doctor write a prescription for a college campus,
01:12:11 for everyone on the campus to have repeat testing,
01:12:14 now we’re just in the territory of eroding medicine
01:12:18 and eroding all of the legal rules
01:12:20 and reasons that we have prescriptions in the first place.
01:12:23 So it’s just everything about it is just destructive
01:12:27 instead of just making a simple solution,
01:12:29 which is these are okay as public health tools
01:12:32 as long as they meet X and Y metrics,
01:12:35 go and CDC can put their stamp of approval on them.
01:12:38 What do you think, sorry if I’m stuck on this,
01:12:41 your mention of MIT and public health engineering, right?
01:12:47 I mean, it has a sense of,
01:12:49 I talked to computational biology folks.
01:12:51 It’s always exciting to see computer scientists
01:12:54 start entering the space of biology.
01:12:56 And there’s actually a lot of exciting things
01:12:58 that happen because of that,
01:12:59 trying to understand the fundamentals of biology.
01:13:03 So from the engineering approach to public health,
01:13:07 what kind of problems do you think can be tackled?
01:13:09 What kind of disciplines are involved?
01:13:11 Like, do you have ideas in this space?
01:13:14 Oh yeah.
01:13:15 I mean, I can speak to one of the major activities
01:13:19 that I wanna do.
01:13:20 So what I normally do in my research lab
01:13:22 is develop technologies that can take a drop
01:13:26 of somebody’s blood or some saliva
01:13:27 and profile for hundreds of thousands
01:13:30 of different antibodies against every single pathogen
01:13:33 that somebody could be possibly exposed to.
01:13:35 That’s awesome.
01:13:36 So this is all new technology
01:13:38 that we’ve been developing more
01:13:39 from a bioengineering perspective.
01:13:43 But then I use a lot of the mathematics tools
01:13:47 to A, interpret that.
01:13:49 But what I really wanna do, for example,
01:13:51 to kind of kick off this new field
01:13:52 of what I consider public health engineering
01:13:55 is to create, maybe it’s a little ambitious,
01:13:57 but create a weather system for viruses.
01:14:02 I want us to be able to open up our iPhones,
01:14:06 plug in our zip code and get a better sense,
01:14:08 get a probability of why my kid has a runny nose today.
01:14:11 Is it COVID?
01:14:13 Is it a rhinovirus, an adenovirus, or is it flu?
01:14:16 And we can do that.
01:14:17 We can start building the rules of virus spread
01:14:21 across the globe, both for pandemic preparedness,
01:14:24 but also for just everyday use in the same way
01:14:28 that people used to think that predicting the weather
01:14:31 was gonna be impossible.
01:14:33 Of course, we know that’s not impossible now.
01:14:34 Is it always perfect?
01:14:35 No, but does it offer, does it completely change the way
01:14:39 that we go about our days?
01:14:42 Absolutely.
01:14:44 I envision, for example, right now,
01:14:46 we open up our iPhone, we plug in a zip code,
01:14:50 and if it tells us it’s gonna rain today,
01:14:51 we bring an umbrella.
01:14:53 So in the future, it tells us,
01:14:56 hey, there’s a lot of SARS CoV2 in your community.
01:14:59 Instead of grabbing your umbrella, you grab your mask.
01:15:02 We don’t have to have masks all the time.
01:15:05 But if we know the rules of the game
01:15:07 that these viruses play by,
01:15:09 we can start preparing for those.
01:15:10 And every year, we go into every flu season blindfolded
01:15:15 with our hands tied behind our back, just saying,
01:15:18 I hope this isn’t a bad flu season this year.
01:15:21 I don’t, I mean, this is, we’re in the 21st century.
01:15:28 We have the tools at our disposal now
01:15:31 to not have that attitude.
01:15:32 This isn’t like 1920s.
01:15:35 You know, we can just say,
01:15:37 hey, this is gonna be a bad flu season this year.
01:15:40 Let’s act accordingly and with a targeted approach.
01:15:44 You know, we don’t, for example,
01:15:47 we don’t just use our umbrellas all day long,
01:15:50 every single day, in case it might rain.
01:15:53 We don’t board up our homes every single day
01:15:55 in case there’s a hurricane.
01:15:56 We wait, and if we know that there’s one coming,
01:15:58 then we act for a small period of time accordingly.
01:16:03 And then we go back, and we’ve prepared ourselves
01:16:05 in like these little bursts to not have it ruin our days.
01:16:09 I can’t tell you how exciting
01:16:10 that vision of the future is.
01:16:13 I think that’s incredible.
01:16:14 And it seems like it should be within our reach,
01:16:17 the, just these like weather maps of viruses
01:16:22 floating about the Earth, and it seems obvious.
01:16:26 It’s one of those things where right now,
01:16:28 it seems like maybe impossible.
01:16:31 And then looking back like 20 years from now,
01:16:34 we’ll wonder like why the hell
01:16:37 this hasn’t been done way earlier.
01:16:39 Though one difference between weather,
01:16:42 I don’t know if you have interesting ideas in this space.
01:16:45 The difference between weather and viruses
01:16:47 is it includes, the collection of the data
01:16:51 includes the human body, potentially.
01:16:54 And that means that there is some, as with the contact
01:16:59 tracing question, there’s some concern about privacy.
01:17:03 There seems to be this dance that’s really complicated.
01:17:07 With Facebook getting a lot of flack
01:17:11 for basically misusing people’s data,
01:17:13 or just whether it’s perception or reality,
01:17:17 there’s certainly a lot of reality to it too,
01:17:19 where they’re not good stewards of our private data.
01:17:25 So there’s this weird place where it’s like obvious
01:17:28 that if we do, if we collect a lot of data
01:17:33 about human beings and maintain privacy
01:17:37 and maintain all like basic respect for that data,
01:17:40 just like honestly common sense respect for the data,
01:17:43 that we can do a lot of amazing things for the world,
01:17:46 like a weather map for viruses.
01:17:48 Is there a way forward to gain trust of people
01:17:53 or to do this well, do you have ideas here?
01:17:56 How big is this problem?
01:17:58 I think it’s a central problem.
01:18:00 There’s a couple central problems that need to be solved.
01:18:02 One, how do you get all the samples?
01:18:05 That’s not actually too difficult.
01:18:07 I’m actually, I have a pilot project going right now
01:18:10 with getting samples from across all the United States.
01:18:14 Tens of thousands of samples every week
01:18:16 are flowing into my lab and we process them.
01:18:19 So it’s taking the, it’s taking like one of the,
01:18:22 basically there’s biology here and chemistry
01:18:26 and converting that into numbers.
01:18:27 That’s exactly right.
01:18:28 So what we’re doing, for example,
01:18:30 there’s a lot of people who go to the hospital every day,
01:18:32 a lot of people who donate blood, people who donate plasma.
01:18:36 So one of the projects that I have,
01:18:38 I’ll get to the privacy question in a moment,
01:18:40 but this, so what I wanna do is the name that I’ve given
01:18:43 this as a global immunological observatory.
01:18:46 There’s no reason not to have that.
01:18:48 Good name.
01:18:49 I’ve said, instead of saying, well,
01:18:51 how do we possibly get enough people on board
01:18:53 to send in samples all the time?
01:18:56 Well, just go to the source.
01:18:57 So there’s a company in Massachusetts
01:18:59 that makes 80% of all the instruments
01:19:02 that are used globally to collect plasma from plasma donors.
01:19:07 So I went to this company, Hemenetics, and said,
01:19:11 is there a way you have 80% of the global market
01:19:15 on plasma donations?
01:19:18 Can we start getting plasma samples
01:19:21 from healthy people that use your machines?
01:19:24 So that hooked me up with this company called Octopharma.
01:19:26 And Octopharma has a huge reach
01:19:28 and offices all over the country
01:19:30 where they’re just collecting people’s plasma.
01:19:32 They actually pay people for their plasma
01:19:35 and then that gets distributed to hospitals
01:19:37 and all this stuff is anonymous plasma.
01:19:39 So I’ve just been collecting anonymous samples.
01:19:43 And we’re processing them, in this case,
01:19:45 for COVID antibodies to watch from January
01:19:48 up through December, we’re able to watch
01:19:51 how the virus entered into the United States
01:19:54 and how it’s transmitting every day across the US.
01:19:58 So we’re getting those results organized now
01:20:02 and we’re gonna start putting them publicly online soon
01:20:06 to start making at least a very rough map of COVID.
01:20:10 But that’s the type of thinking that I have
01:20:12 in terms of like, how do you actually capture
01:20:14 huge numbers of specimens?
01:20:17 You can’t ask everyone to participate on sort of a,
01:20:20 I mean, you maybe could if you have the right tools
01:20:23 and you can offer individuals something in return
01:20:25 like 23andMe does.
01:20:27 That’s a great way to get people to give specimens
01:20:29 and they get results back.
01:20:31 So with these technologies that I’ve been building
01:20:34 along with some collaborators at Harvard,
01:20:36 we can come up with tools that people might actually want.
01:20:39 So I can offer you your immunological history.
01:20:43 I can say, give me a drop of your blood on a filter paper,
01:20:47 mail it in and I will be able to tell you
01:20:49 every infectious disease you’ve ever encountered
01:20:52 and maybe even when you encountered it roughly.
01:20:55 I could tell you, do you have COVID antibodies right now?
01:20:58 Do you have Lyme disease antibodies right now?
01:21:00 Flu, triple E and all these different viruses.
01:21:03 Also peanut allergies, milk allergies, anything.
01:21:07 If your immune system makes a response to it,
01:21:11 we can detect that response.
01:21:14 So all of a sudden we have this very valuable technology
01:21:17 that on the one hand gives people maybe information
01:21:19 they might want to know about themselves,
01:21:22 but on the other hand becomes this amazingly rich
01:21:25 source of big data to enter into
01:21:28 this global immunological observatory
01:21:29 sort of mathematical framework to start building
01:21:32 these maps, these epidemiological tools.
01:21:34 But you asked about privacy
01:21:36 and absolutely that’s essential to keep in mind
01:21:40 first and foremost.
01:21:41 So privacy can be,
01:21:43 you can keep these samples 100% anonymous.
01:21:47 They are just, when I get them, they show up with nothing.
01:21:49 They’re literally just tubes.
01:21:51 I know a date that they were collected
01:21:52 and a zip code that they’re collected from
01:21:54 or even just sort of a county level ID.
01:21:59 So with an IRB and with ethical approval
01:22:02 and with the people’s consent,
01:22:03 we can maybe collect more data,
01:22:05 but that would require consent.
01:22:07 But then there’s this other approach
01:22:09 which I’m really excited about,
01:22:10 which is certainly going to gain some scrutiny I think,
01:22:14 but we’ll have to figure out where it comes into play.
01:22:17 But I’ve been recognizing that we can take somebody’s
01:22:20 immunological profile and we can make a biological
01:22:24 fingerprint out of it.
01:22:25 And it’s actually stable enough
01:22:27 so that I could take your blood.
01:22:28 Let’s say I don’t know who you are,
01:22:30 but you sent me a drop of blood a year ago
01:22:34 and then you sent me a drop of blood today.
01:22:36 I don’t know that those two blood spots
01:22:38 are coming from the same person.
01:22:39 They’re just showing up in my lab.
01:22:42 But I can run our technology over
01:22:46 and it just gives me your immunological history.
01:22:49 But your immunological history is so unique to you
01:22:52 and the way that your body responds to these pathogens
01:22:55 is so unique to you
01:22:57 that I can use that to tether your two samples.
01:22:59 I don’t know who you are, I know nothing about you.
01:23:02 I only know when those samples came out of a person.
01:23:06 But I can say, oh, these two samples a year apart
01:23:09 actually belong to the same person.
01:23:10 Yeah, so there’s sufficient information
01:23:12 in that immunological history to match the samples.
01:23:16 Or from a privacy perspective, that’s really exciting.
01:23:18 Does that generally hold for humans?
01:23:20 So you’re saying there’s enough uniqueness to match?
01:23:23 Yeah, because it’s very stochastic, even twins.
01:23:25 So this, I believe, we haven’t published this yet.
01:23:28 We will soon.
01:23:29 You have a twin too, right?
01:23:30 I do have a twin, I have an identical twin brother,
01:23:32 which makes me interested in this.
01:23:34 He looks very much like me.
01:23:36 Oh, is that how that works?
01:23:37 Yeah.
01:23:38 And DNA can’t really tell us apart.
01:23:42 But this tool is one of the only tools in the world
01:23:45 that could tell twins apart from each other.
01:23:48 Could still be accurate enough to say this blood,
01:23:51 it’s like 99.999% accurate to say
01:23:56 that these two blood samples came from the same individual.
01:24:00 And it’s because it’s a combination,
01:24:01 both of your immunological history,
01:24:04 but also how your unique body responds to a pathogen,
01:24:09 which is random.
01:24:10 The way that we make antibodies is, by and large,
01:24:14 it’s got an element of randomness to it.
01:24:17 How the cells, when they make an antibody,
01:24:19 they chop up the genetic code to say,
01:24:22 okay, this is the antibody that I’m gonna form
01:24:24 for this pathogen.
01:24:26 And you might form, if you get a coronavirus, for example,
01:24:29 you might form hundreds of different antibodies,
01:24:31 not just one antibody against the spike protein,
01:24:33 but hundreds of different antibodies
01:24:35 against all different parts of the virus.
01:24:38 So that gives this really rich resolution of information
01:24:42 that when I then do the same thing
01:24:43 across hundreds of different pathogens,
01:24:45 some of which you’ve seen, some of which you haven’t,
01:24:48 it gives you an exceedingly unique fingerprint
01:24:50 that is sufficiently stable over years and years and years
01:24:54 to essentially give you a barcode.
01:24:57 And I don’t have to know who you are,
01:24:59 but I can know that these two specimens
01:25:01 came from the same person somewhere out in the world.
01:25:04 So fascinating that there’s this trace,
01:25:07 your life story in the space of viruses,
01:25:11 in the space of pathogen, like these,
01:25:16 you know, because there’s this entire universe
01:25:18 of these organisms that are trying to destroy each other.
01:25:23 And then your little trajectory through that space
01:25:25 leaves a trace, and then you can look at that trace.
01:25:29 That’s fascinating.
01:25:30 And that, I mean, there’s, okay,
01:25:33 that data period is just fascinating.
01:25:35 And the vision of making that data universally connected
01:25:40 to where you can make, like infer things,
01:25:43 and just like with the weather, is really fascinating.
01:25:47 And there’s probably artificial intelligence
01:25:49 applications there, start making predictions,
01:25:51 start finding patterns.
01:25:53 Exactly, we’re doing a lot of that already.
01:25:54 And that’s how, how do we have this going?
01:25:57 You know, I’ve been trying to get this funded for years now.
01:26:00 And I’ve spoken to governments, you know,
01:26:02 everyone says, cool idea, not gonna do it.
01:26:05 You know, why do we need it?
01:26:07 Oh, really?
01:26:08 The why do you need it?
01:26:08 Yeah, the why do you need it.
01:26:10 And of course now, you know, I mean,
01:26:12 I wrote in 2015 about this,
01:26:15 why we would, why this would be useful.
01:26:18 And of course, now we’re seeing why it would be useful.
01:26:21 Had we had this up and running in 2019,
01:26:25 had we had it going, we were drawing blood from,
01:26:28 you know, we’re getting blood samples from hospitals
01:26:30 and clinics and blood donors from New York City,
01:26:32 let’s just say, you know, that could have,
01:26:36 we didn’t run the first PCR test for coronavirus
01:26:40 until probably a month and a half or two months
01:26:43 after the virus started transmitting in New York City.
01:26:46 So it’s like with the rain,
01:26:48 we didn’t start wearing umbrella or taking out umbrellas.
01:26:52 Exactly, for two months, but different than the rain,
01:26:55 we couldn’t actually see that it was spreading right now.
01:26:58 And so Andrew Cuomo had no choice
01:27:00 but to leave the city open.
01:27:02 You know, there were hints that maybe the virus
01:27:03 was spreading in New York City,
01:27:05 but you know, he didn’t have any data to back it up.
01:27:07 No data.
01:27:08 And so it was just week on week and week.
01:27:12 And he didn’t have any information to really go by
01:27:17 to allow him to have the firepower
01:27:18 to say we’re closing down the city.
01:27:20 This is an emergency.
01:27:21 We have to stop spread before it starts.
01:27:25 And so they waited until the first PCR tests
01:27:28 were coming about.
01:27:29 And then the moment they started running PCR tests,
01:27:30 they find out it’s everywhere.
01:27:32 You know, and so that was a disaster
01:27:33 because of course New York City, you know,
01:27:36 was just hit so bad because nobody was,
01:27:39 you know, we were blind to it.
01:27:41 We didn’t have to be blind to it.
01:27:43 And the nice thing about this technology is
01:27:45 we wouldn’t have, with the exact same technology
01:27:47 we had in 2017, we could have detected
01:27:51 this novel coronavirus spreading in New York City in 2020.
01:27:56 Not because we changed, not because we are actually
01:27:58 actively looking for this novel coronavirus,
01:28:01 but because we would see, we would have seen patterns
01:28:04 in people’s immune responses using AI,
01:28:06 or just frankly using our, just the raw data itself.
01:28:10 We could have said, hey, it looks like there’s
01:28:13 something that looks like known coronavirus
01:28:15 is spreading in New York, but there’s gaps.
01:28:18 You know, there’s, for some reason,
01:28:19 people aren’t developing an immune response
01:28:21 to this coronavirus that seems to be spreading
01:28:23 to these normal things that, you know,
01:28:25 and it just looks, the profile looks different.
01:28:29 And we could have seen that and immediately,
01:28:31 especially since we had an idea that
01:28:33 there was a novel coronavirus circulating in the world,
01:28:37 we could have very quickly and easily seen,
01:28:39 hey, clearly we’re seeing a spike of something
01:28:42 that looks like a known coronavirus,
01:28:44 but people are responding weirdly to it.
01:28:46 Our AI algorithms would have picked it up,
01:28:49 and just our basic, heck, you could have put it
01:28:52 in an Excel spreadsheet, we would have seen it.
01:28:55 So.
01:28:56 Some basic visualization would have shown it.
01:28:58 Exactly, we would have seen spikes,
01:28:59 and they would have been kind of like off, you know,
01:29:02 immune responses that the shape of them
01:29:04 just looked a little bit different,
01:29:06 but they would have been growing,
01:29:07 and we would have seen it, and it could have
01:29:09 saved tens of thousands of lives in New York City.
01:29:12 So to me, the fascinating question,
01:29:14 everything we’ve talked about,
01:29:15 so both the huge collection of data at scale,
01:29:18 just super exciting, and then the kind of obvious
01:29:23 at scale solution to the current virus
01:29:26 and future ones is the rapid testing.
01:29:30 Can we talk about the future of viruses
01:29:34 that might be threatening our very existence?
01:29:39 So do you think like a future natural virus
01:29:44 can have an order of magnitude greater effect
01:29:49 on human civilization than anything we’ve ever seen?
01:29:52 So something that either kills all humans,
01:29:56 or kills, I don’t know, 60, 70% of humans.
01:30:01 So something like something we can’t even imagine.
01:30:06 Is that something that you think is possible?
01:30:09 Because it seems to not have happened yet.
01:30:11 So maybe like the entirety, whoever the programmer is
01:30:17 of the simulation that sort of launched the evolution
01:30:20 from the Big Bang seems to not want to destroy us humans.
01:30:24 Or maybe that’s the natural side effect
01:30:26 of the evolutionary process that humans are useful.
01:30:30 But do you think it’s possible
01:30:31 that the evolutionary process will produce a virus
01:30:34 that will kill all humans?
01:30:35 I think it could.
01:30:36 I don’t think it’s likely.
01:30:38 And the reason I don’t think it’s likely
01:30:39 is on the one hand, it hasn’t happened yet,
01:30:45 in part because mobility is a recent phenomena.
01:30:50 People weren’t particularly mobile
01:30:52 until fairly recently.
01:30:55 Now, of course, now that we have people flying back
01:30:58 and forth across the globe all the time,
01:31:02 the chances of global pandemics
01:31:05 has escalated exponentially, of course.
01:31:08 And so on the one hand,
01:31:10 that’s part of why it hasn’t happened yet.
01:31:11 We can look at things like Ebola.
01:31:14 Now, Ebola, we haven’t generally had major Ebola epidemics
01:31:19 in the past, not because Ebola wasn’t transmitting
01:31:21 and infecting humans, but because it was largely affecting
01:31:25 and infecting humans in disconnected communities.
01:31:29 So you see out in rural parts of Africa, for example,
01:31:34 in Western Africa, you might end up having
01:31:36 isolated Ebola outbreaks,
01:31:39 but there weren’t connections that were fast enough
01:31:42 that would allow people to then spread it into the cities.
01:31:45 Of course, we saw back in 2014, 15 massive Ebola outbreak
01:31:53 that wasn’t because it was a new strain of Ebola,
01:31:58 but it was because there’s new inroads and connections
01:32:01 between the communities and people got it to the city.
01:32:04 And so we saw it start to spread.
01:32:07 So that should be a little bit foreshadowing
01:32:11 of what’s to come.
01:32:12 And now we have this pandemic.
01:32:15 We had 2009, we have this.
01:32:18 There is a benefit or there is sort of a natural check.
01:32:23 And this is like kind of like a Voltaire
01:32:26 predator prey dynamic kind of systems,
01:32:28 ecological systems and mathematics that
01:32:32 if you have something that’s so deadly,
01:32:34 people will respond more maybe with a greater panic,
01:32:39 a greater sense of panic, which alone could, you know,
01:32:42 destroy humanity.
01:32:43 But at the same time, we now know that we can lock down.
01:32:47 We know that that’s possible.
01:32:49 And so if this was a worse virus
01:32:50 that was actually killing 60% of people as infecting,
01:32:53 we would lock down very quickly.
01:32:55 My biggest fear though, is let’s say that was happening.
01:32:59 You need serious lockdowns if you’re gonna keep things going.
01:33:03 So the only reason we were able to keep things going
01:33:05 during our lockdowns is because it wasn’t so bad
01:33:08 that we were still able to have people work
01:33:10 in the grocery stores.
01:33:13 Still have people work in the shipping
01:33:14 to get the food onto the shelves.
01:33:16 So on the one hand, we could probably figure out
01:33:18 how to stop the virus,
01:33:21 but can we stop the virus without starving?
01:33:24 You know, and I’m not sure that that,
01:33:26 if this was another acute respiratory virus
01:33:30 that say had a slightly, say it transmitted the same way,
01:33:34 but say it actually did worse damage to your heart,
01:33:36 but it was like a month later
01:33:38 that people started having heart attacks in mass.
01:33:41 You know, it’s like not just one offs, but really severe.
01:33:45 Well, that could be a serious problem for humanity.
01:33:50 So in some ways I think that there are lots of ways
01:33:53 that we could end up dying at the hand of a virus.
01:33:56 I mean, we’re already seeing it.
01:33:57 Just, I mean, my fear is still,
01:34:00 I think coronaviruses have demonstrated
01:34:02 a keen ability to destroy or to create outbreaks
01:34:06 that can potentially be deadly to large numbers of people.
01:34:10 Flu strains, though, are still by and large my concern.
01:34:14 So you think the bad one might come from the flu,
01:34:17 the influenza?
01:34:18 Yeah, their replication cycle,
01:34:20 they’re able to genetically recombine
01:34:22 in a way that coronaviruses aren’t.
01:34:24 They have segmented genomes,
01:34:25 which means that they can just swap out
01:34:27 whole parts of their genomes, no problem,
01:34:29 repackage them, and then boom,
01:34:32 you have a whole antigenic shift, not a drift.
01:34:35 What that means is that on any occasion,
01:34:38 any day of the year, you can have, boom,
01:34:40 a whole new virus that didn’t exist yesterday.
01:34:44 And now with farming and industrial livestock,
01:34:49 we’re seeing animals and humans come into contact much more.
01:34:53 Just the opportunities for an influenza strain
01:34:58 that is unique and deadly to humans increases.
01:35:01 All the while, transmission and mobility has increased.
01:35:06 It’s just a matter of time, in my opinion.
01:35:09 What about from immunology perspective
01:35:12 of the idea of engineering a virus?
01:35:16 So not just the virus leaking from a lab or something,
01:35:18 but actually being able to understand the protein,
01:35:23 like everything about what makes a virus enough
01:35:26 to be able to figure out ways to maybe target it
01:35:33 or untarget it, attack biologics.
01:35:36 Subverse immunity.
01:35:38 Yeah.
01:35:38 Yeah.
01:35:39 Is that something, obviously that’s somewhere
01:35:43 on the list of concerns, but is that anywhere close
01:35:48 of the top 10 highlights along with nuclear weapons
01:35:51 and so on that we should be worried about?
01:35:53 Or is the natural pandemic really the one
01:35:55 that’s much greater concern?
01:35:58 I would say that the former, that manmade viruses
01:36:02 and genetically engineered viruses should be right up there
01:36:08 with the greatest concerns for humanity right now.
01:36:11 We know that the tools, for better or worse,
01:36:15 the tools for creating a virus are there.
01:36:19 We can do it.
01:36:20 And I mean, heck, the human species
01:36:25 is no longer vaccinated against smallpox.
01:36:28 I didn’t get a smallpox vaccine.
01:36:29 You didn’t get a smallpox vaccine, at least I don’t think.
01:36:32 And so if somebody wanted to make smallpox
01:36:37 and distribute it to the world in some way,
01:36:41 it could be exceedingly deadly and detrimental to humans.
01:36:46 And that’s not even sort of using your imagination
01:36:51 to create a new virus.
01:36:52 That’s one that we already have.
01:36:54 Unlike the past when smallpox would circulate,
01:36:57 you had large fractions of the community
01:37:00 that was already immune to it.
01:37:02 And so it wouldn’t spread
01:37:03 or it would spread a little bit slower.
01:37:05 But now we have essentially in a few years,
01:37:07 we’ll have a whole global population that is susceptible.
01:37:11 Let’s look at measles.
01:37:12 We have an entire, I mean, measles, I have,
01:37:18 there are some researchers in the world right now,
01:37:20 which for various reasons are working on creating
01:37:23 a measles strain that evades immunity.
01:37:26 It’s not for bioterrorism,
01:37:28 at least that’s not the expectation.
01:37:29 It’s for using measles as an oncolytic virus to kill cancer.
01:37:34 And the only way you can really do that
01:37:36 is if your immune system doesn’t,
01:37:38 if you take a measles virus and there’s,
01:37:41 we don’t have to go into the details of why it would work,
01:37:43 but it could work.
01:37:44 Measles likes to target potentially cancer cells.
01:37:49 But to get your immune system not to kill off the virus
01:37:51 if you’re trying to use the virus to target it,
01:37:53 you maybe want to make it blind to the immune system.
01:37:57 But now imagine we took some virus like measles,
01:38:00 which has an R naught of 18, transmits extremely quickly.
01:38:04 And now we have essentially,
01:38:05 let’s say we had a whole human race
01:38:07 that is susceptible to measles.
01:38:10 And this is a virus that spreads
01:38:13 orders of magnitude easier than this current virus.
01:38:17 Imagine if you were to plug something toxic
01:38:20 or detrimental into that virus and release it to the world.
01:38:24 So it’s possible to be both accidental and intentional.
01:38:29 Absolutely.
01:38:30 Yeah, so Mark Lipsitch is a good colleague of mine
01:38:32 at Harvard, we’re both in the,
01:38:35 he’s the director of the Center
01:38:37 for Communicable Disease Dynamics from a faculty member.
01:38:40 He’s spoken very, very forcefully
01:38:42 and he’s very outspoken about the dangers
01:38:47 of gain of function testing,
01:38:49 where in the lab we are intentionally creating viruses
01:38:53 that are exceedingly deadly
01:38:56 under the auspices of trying to learn about them.
01:38:59 So that if the idea is that if we kind of accelerate
01:39:02 evolution and make these really deadly viruses in the lab,
01:39:07 we can be prepared for if that virus ever comes about
01:39:11 naturally or through unnatural means.
01:39:14 The concern though is, okay, that’s one thing,
01:39:17 but what if that virus got out on somebody’s shoe?
01:39:20 Just what if?
01:39:24 If the effects of an accident are potentially catastrophic,
01:39:29 is it worth taking the chances just to be prepared
01:39:33 a little bit for something that may
01:39:34 or may not ever actually develop?
01:39:36 And so it’s a serious ethical quandary we’re in,
01:39:40 how to both be prepared,
01:39:43 but also not cause a catastrophic mistake.
01:39:49 As a small tangent,
01:39:51 there’s a recent really exciting breakthrough of alpha two,
01:39:56 of alpha fold two solving protein folding
01:39:59 or achieving state of the art performance
01:40:00 on protein folding.
01:40:02 And then I thought proteins have a lot to do with viruses.
01:40:09 It seems like being able to use machine learning
01:40:14 to design proteins that achieve certain kinds of functions
01:40:19 will naturally allow you to use maybe down the line,
01:40:22 not yet, but allow you to use machine learning
01:40:26 to design basically viruses,
01:40:28 maybe like measles, like for good,
01:40:31 which is like to attack cancer cells, but also for bad.
01:40:37 Is that a crazy thought
01:40:43 or is this a natural place where this technology may go?
01:40:46 I suppose as all technologies can,
01:40:48 which is for good and for bad.
01:40:52 Do you think about the role of machine learning in this?
01:40:54 Oh yeah, absolutely, I mean, alpha fold is amazing.
01:40:59 It’s an amazing algorithm, a series of algorithms.
01:41:03 And it does demonstrate, to me,
01:41:07 it demonstrates just how powerful,
01:41:10 everything in the world has rules.
01:41:12 We just don’t know the rules.
01:41:13 We often don’t know them,
01:41:14 but our brain has rules, how it works.
01:41:17 Everything is plus and minus.
01:41:19 There’s nothing in the world that’s really not
01:41:21 at its most basic level, positive, negative.
01:41:25 It’s all, obviously, it’s all just charge.
01:41:28 And that means everything.
01:41:30 You can figure it out with enough computational power
01:41:32 and enough, in this case, I mean,
01:41:34 machine learning and AI is just one way to learn rules.
01:41:40 It’s an empirical way to learn rules,
01:41:42 but it’s a profoundly powerful way.
01:41:44 And certainly, now that we are getting to a point
01:41:49 where we can take a protein and know how it folds,
01:41:54 given its sequence, we can reverse engineer that
01:41:57 and we can say, okay, we want a protein to fold this way.
01:42:01 What does the sequence need to be?
01:42:03 We haven’t done that yet so much,
01:42:06 but it’s just the next iteration of all of this.
01:42:09 And so let’s say somebody wants to develop a virus
01:42:12 it’s gonna start with somebody wanting to develop a virus
01:42:15 to defeat cancer, something good.
01:42:18 And so it would start with a lot of money
01:42:20 from the federal government for all the positives
01:42:25 that will come out of it.
01:42:27 But we have to be really careful
01:42:29 because that will come about.
01:42:32 There’s no doubt in my mind that we will develop,
01:42:35 we’re already doing it.
01:42:36 We engineer molecules all the time for specific uses.
01:42:39 Oftentimes, we take them from a lab
01:42:41 and then we take them from a lab and then we make them.
01:42:44 Oftentimes, we take them from nature and then tweak them.
01:42:48 But now we can supercharge it.
01:42:49 We can accelerate the pace of discovery.
01:42:53 To not have it just be discovery,
01:42:54 we have it be true ground up engineering.
01:42:58 Let’s say you’re trying to make a new molecule
01:43:02 to stabilize somebody with some retinal disease.
01:43:06 So we come up with some molecule
01:43:08 to stability of somebody with retinal degeneration.
01:43:14 Just a small tweak to that,
01:43:16 to say make a virus that causes the human race
01:43:18 to become blind.
01:43:20 I mean, it sounds really conspiracy theoryish,
01:43:22 but it’s not.
01:43:25 We’re learning so much about biology
01:43:27 and there’s always nefarious reasons.
01:43:28 I mean, heck, look at how AI and just Google searches,
01:43:33 those can be, they are every single day
01:43:37 being leveraged by nefarious actors
01:43:39 to take advantage of people, to steal money,
01:43:43 to do whatever it might be.
01:43:45 Eventually, probably to create wars
01:43:48 or already to create wars.
01:43:50 And I mean, I don’t think there’s any question at this point
01:43:53 behind disinformation campaigns.
01:43:55 And so it’s being leveraged.
01:43:56 This thing that could be wholly good
01:44:00 is always going to be leveraged for bad.
01:44:02 And so how do you balance that as a species?
01:44:04 I’m not quite sure.
01:44:06 The hope is, as you mentioned previously,
01:44:08 that there’s some, that we were able
01:44:10 to also develop defense mechanisms.
01:44:12 And there’s something about the human species
01:44:14 that seems to keep coming up with ways to,
01:44:18 just like on the deadline,
01:44:21 just at the last moment,
01:44:22 figuring out how to avoid destruction.
01:44:26 I think I’m eternally optimistic about the human race
01:44:30 not destroying ourselves,
01:44:32 but you could do a lot of things
01:44:34 that would be very painful.
01:44:36 Yes.
01:44:36 Well, we’re doing it already, just,
01:44:38 I mean, we are seeing how our regulation today,
01:44:42 we did this thing, it started as a good thing,
01:44:45 regulation of medical products,
01:44:48 but now it is unwillingly and unintentionally harming us.
01:44:55 Our regulatory landscape,
01:44:57 which was developed totally for good in our country
01:45:00 is getting in the way of us deploying a tool
01:45:04 that could stop our economies
01:45:06 from having to be sort of sputteringly closed,
01:45:11 that could stop deaths from happening
01:45:12 at the rate that they are.
01:45:14 And it’s, I think we will come to a solution.
01:45:19 Of course, now we’re gonna get the vaccine
01:45:21 and it’s gonna make people lose track
01:45:23 of like why we even bother testing, which is a bad idea.
01:45:25 But we’re already seeing that.
01:45:28 We have this amazing capacity to both do damage
01:45:32 when we don’t intend to do damage
01:45:36 and then also to pull up when we need to pull up
01:45:39 and stop complete catastrophe.
01:45:41 And so we are an interesting species in that way,
01:45:46 that’s for sure.
01:45:47 So there’s a lot of young folks, undergrads,
01:45:50 grads, they’re also young, listen to this.
01:45:54 So is there, you’ve talked about a lot of fascinating stuff
01:45:57 that’s like, there’s ways that things are done
01:46:01 and there’s actual solutions
01:46:03 and they’re not always like intersecting.
01:46:05 Do you have advice for undergraduate students
01:46:09 or graduate students or even people in high school now
01:46:12 about a life, about a career of how they might be able
01:46:17 to solve real big problems in the world,
01:46:20 how they should live their life
01:46:22 in order to have a chance to solve big problems
01:46:24 in the world?
01:46:25 It’s hard.
01:46:26 I struggle a little bit sometimes to give advice
01:46:28 because the advice that I give
01:46:30 from my own personal experience is necessarily distinct
01:46:32 from the advice that would make other people successful.
01:46:36 I have unending ambitions to make things better, I suppose.
01:46:42 And I don’t see barricades
01:46:44 where other people sometimes see barricades.
01:46:48 Now, even just little things like when this virus started,
01:46:51 I’m a medical director at Brigham and Women’s Hospital
01:46:54 and so I oversee or helped oversee
01:46:56 molecular virology diagnostics.
01:46:58 So when this virus started, wearing my epidemiology hat
01:47:01 and wearing my sort of viral outbreak hat,
01:47:03 I recognized that this is gonna be a big virus
01:47:05 that was important on a global level.
01:47:07 Even if the CDC and WHO weren’t ready to admit
01:47:10 that it was a pandemic,
01:47:10 it was obvious in January that it was a pandemic.
01:47:14 So I started trying to get a test built at the Brigham,
01:47:18 which is one of Harvard’s teaching hospitals.
01:47:20 The first encounters I had with the upper administration
01:47:25 of the hospital were pretty much, no, why would we do that?
01:47:28 That’s silly, who are you?
01:47:30 And I said, well, okay, don’t believe me, sure.
01:47:33 But I kept pushing on it.
01:47:35 And then eventually I got them to agree.
01:47:38 It was really only a couple of weeks
01:47:40 before the Biogen conference happened.
01:47:43 We started building the test.
01:47:44 I think they started looking abroad and saying,
01:47:46 okay, this is happening, sure, like, maybe he was right.
01:47:50 But then I went a step further and I said,
01:47:52 we’re not gonna have enough tests at the hospital.
01:47:55 And so my ambition was to get a better testing program
01:47:59 started and so I figured what better place
01:48:03 to scale up testing than the Broad Institute.
01:48:06 Broad Institute is amazing, very high throughput,
01:48:08 high efficiency research institute
01:48:10 that does a lot of genomic sequencing, things like that.
01:48:13 So I went to the Broad and I said,
01:48:15 hey, there’s this coronavirus
01:48:17 that’s obviously gonna impact our society greatly.
01:48:20 Can we start modifying your high efficiency instruments
01:48:25 and robots for coronavirus testing?
01:48:27 Everyone in my orbit, in the hospital world,
01:48:33 just said, that’s ridiculous.
01:48:35 How could you possibly plan to do that?
01:48:37 It’s impossible.
01:48:38 And to me, it was like the most dead simple thing to do.
01:48:43 It didn’t, but the higher ups and the people
01:48:46 who think about, I think one of the things
01:48:48 is to recognize that most people in the world
01:48:51 don’t see solutions, they just see problems.
01:48:53 And it’s because it’s an easy thing to do.
01:48:55 Thinking of problems and how things will go wrong
01:49:00 is really easy because you’re not coming up
01:49:03 with a brand new solution.
01:49:04 And this to me was just a super simple solution.
01:49:07 Hey, let’s get the Broad to help build tests.
01:49:09 Every single hospital director told me no,
01:49:12 like it’s impossible.
01:49:13 My own superiors, the ones I report to in the hospital,
01:49:16 said, you know, Mike, you’re a new faculty member.
01:49:20 Your ideas probably would be right,
01:49:23 but you’re too naive and young to know that it’s impossible.
01:49:27 Obviously now the Broad is the highest
01:49:30 throughput laboratory in the country.
01:49:32 And so I think my recommendation to people
01:49:37 is as much as possible, get out of the mode
01:49:40 of thinking about things as problems.
01:49:42 Sometimes you piss people off,
01:49:44 I could probably use a better filter sometimes
01:49:47 to try to like be not so upfront with certain things.
01:49:51 But it’s just so crucial to always just see,
01:49:54 to just bring it, like think about things in new ways
01:49:57 that other people haven’t.
01:49:59 Cause usually there’s something else out there.
01:50:01 And one of the things that has been most beneficial to me,
01:50:04 which is that my education was really broad.
01:50:07 It was engineering and physics.
01:50:10 And well, and then I became a Buddhist monk.
01:50:13 Well, and then I became a Buddhist monk for a while.
01:50:15 And so that gave me a different perspective,
01:50:18 but then it was medicine and immunology.
01:50:20 And now I’ve brought all of it together
01:50:23 from a mathematics and biology and medicine perspective
01:50:27 and policy and public health.
01:50:29 And I think that, you know,
01:50:30 I’m not the best in any one of these things.
01:50:32 I recognize that there are gonna be geniuses out there
01:50:36 who are just worlds better than me
01:50:37 at any one of these things that I try to work on.
01:50:41 But my superpower is bringing them all together,
01:50:43 you know, and just thinking,
01:50:45 and that’s, I think how you can really change the world.
01:50:49 You know, I don’t know that I’ll ever change the world
01:50:51 in the way that I hope.
01:50:53 But that’s how you can have a chance.
01:50:55 Yeah, that’s how you can have a chance, exactly.
01:50:57 And I think it’s also what, you know, this to me,
01:51:01 this rapid testing program,
01:51:02 like this is the most dead simple solution in the world.
01:51:06 And this literally could change the world.
01:51:07 It could change the world.
01:51:08 It could change, and it is, you know,
01:51:09 there’s countries that are doing it now.
01:51:11 The US isn’t, but I’ve been advising many countries on it.
01:51:13 And I would say that, you know,
01:51:16 some of the early papers that we put out earlier on,
01:51:19 a lot of the things actually are changing.
01:51:22 You don’t always, unless you really look hard,
01:51:24 you don’t know where you’re actually having an effect.
01:51:26 Sometimes it’s more overt than other times.
01:51:30 In April, I published a paper that was saying,
01:51:33 hey, with the PCR values from these tests,
01:51:36 we need to really focus on the CT values,
01:51:38 the actual quantitative values
01:51:39 of these lab based PCR tests.
01:51:42 At the time, all the physicians and laboratory directors
01:51:46 told me that was stupid.
01:51:46 You know, why would you do that?
01:51:48 They’re not accurate enough.
01:51:49 And of course, now it’s headline news that, you know,
01:51:52 Florida, they just mandated reporting out the CT values
01:51:56 of these tests, cause there’s a real utility of them.
01:51:58 You can understand public health from it.
01:52:00 You can understand better clinical management.
01:52:03 You know, that was a simple solution
01:52:05 to a pretty difficult problem.
01:52:07 And it is changing.
01:52:09 The way that we approach all of the lab testing
01:52:11 in this country is starting to, it’s taken a few months,
01:52:13 but it’s starting to change because of that.
01:52:15 And, you know, that was just me saying,
01:52:18 hey, this is something we should be focusing on.
01:52:20 Got some other people involved and other people.
01:52:22 And now people recognize, hey, there’s actual value
01:52:26 in this number that comes out of these lab based PCR tests.
01:52:29 So sometimes it does grow fairly quickly.
01:52:33 But I think the real answer,
01:52:35 if my only answer, I don’t know what, you know,
01:52:38 I recognize that everyone, some people are gonna be
01:52:40 really focused on and have one small, but deep skillset.
01:52:45 I go the opposite direction.
01:52:46 I try to bring things together.
01:52:48 And, but the biggest thing I think is just,
01:52:52 don’t see barriers, like just see,
01:52:55 like there’s always a solution to a barrier.
01:52:58 If there’s a barrier,
01:52:59 that literally means there’s a solution to it.
01:53:01 That’s why it’s called a barrier.
01:53:02 And just like you said, most people will just present to you,
01:53:06 only be thinking about it and present to you with barriers.
01:53:09 And so it’s easy to start thinking
01:53:10 that’s all there is in this world.
01:53:12 And just think big.
01:53:13 I mean, God, you know, there’s nothing wrong
01:53:15 with thinking big.
01:53:17 Elon Musk thought big and, you know,
01:53:19 and then thinking big builds on itself.
01:53:21 You know, you get a billion dollars from one big idea
01:53:25 and then that allows you to make three new big ideas.
01:53:27 And there’s a hunger for it if you think big
01:53:29 and you communicate that vision with the world.
01:53:32 All the most brilliant and like passionate people
01:53:35 will just like, you’ll attract them
01:53:37 and they’ll come to you.
01:53:38 And then it makes your life actually really exciting.
01:53:41 The people I’ve met at like Tesla and Neuralink,
01:53:45 I mean, there’s just like this fire in their eyes.
01:53:47 They just love life.
01:53:48 And it’s amazing, I think, to be around those people.
01:53:53 I have to ask you about what was the philosophy,
01:53:57 the journey that took you to becoming a Buddhist monk
01:54:01 and what did you learn about life?
01:54:07 What did you take away from that experience?
01:54:09 How did you return back to Harvard
01:54:12 and the world that’s unlike that experience, I imagine?
01:54:17 Yeah, well, I was at Dartmouth at the time.
01:54:22 Well, I went to Sri Lanka.
01:54:23 I was already pretty interested in developing countries
01:54:25 and sort of under resourced areas.
01:54:27 And I was doing a lot of engineering work
01:54:30 and I went there, but I was also starting to think
01:54:33 maybe health was something of interest.
01:54:37 And so I went to Sri Lanka
01:54:40 because I had a long interest in Buddhism as well,
01:54:43 just kind of interested in it as a thing.
01:54:46 Which aspect of the philosophy attracted you?
01:54:49 I would say that the thing that interested me most
01:54:52 was really this idea of kind of a butterfly effect
01:54:57 of like what you do now has ripple effects
01:55:02 that extend out beyond what you can possibly imagine,
01:55:07 both in your own life and in other people’s lives.
01:55:10 And in some ways, Buddhism has, not in some ways,
01:55:13 in a pretty deep way, Buddhism has that
01:55:14 as part of its underlying philosophy
01:55:18 in terms of rebirth and sort of your actions today
01:55:23 propagate to others, but also propagate
01:55:26 to sort of what might happen in your circle
01:55:30 of what’s called samsara and rebirth.
01:55:32 And I don’t know that I subscribe fully
01:55:36 to this idea that we are reborn,
01:55:39 which always was a little bit of a debate internally,
01:55:44 I suppose, when I was a monk.
01:55:47 But it has always been, it was that
01:55:50 and then it was also meditation.
01:55:52 At the time I was a fairly elite rower.
01:55:55 I was rowing at the national level
01:55:57 and rowing to me was very meditative.
01:56:01 It was just, even if you’re in a boat with other people,
01:56:07 I mean, on the one hand, it’s like the extreme
01:56:09 of like a team sport, but it’s also the extreme
01:56:13 sort of focus and concentration that’s required of it.
01:56:16 And so I was always really into just meditative
01:56:18 type of things.
01:56:19 I was doing a lot of pottery too,
01:56:20 which was also very meditative.
01:56:22 And so Buddhism just kind of really,
01:56:25 there are a lot of things about meditating
01:56:28 that just appealed.
01:56:30 And so I moved to Sri Lanka,
01:56:32 planning to only be there for a couple of months.
01:56:35 And then I was shadowing in this medical clinic
01:56:37 and there was this physician who was just really,
01:56:40 I mean, it’s just kind of a horrible situation.
01:56:43 Frankly, this guy was trained decades earlier.
01:56:46 He was an older physician and he was still just practicing
01:56:49 like these fairly barbaric approaches to medicine
01:56:52 because he was a rural town
01:56:55 and he just didn’t have a lot of,
01:56:58 he didn’t have any updated training, frankly.
01:57:00 And so, I just remember this like girl came in
01:57:03 with like shrapnel in her hand
01:57:05 and his solution was to like air it out.
01:57:08 And so he was like, without even numbing her hand,
01:57:12 he was like cutting it open more with this idea
01:57:16 that like the more oxygen and stuff.
01:57:20 And it just, I think there was something about all of this.
01:57:23 And I was already talking to these monks at the time.
01:57:25 I would be in this clinic in the morning and I’d go
01:57:28 and my idea was to teach English
01:57:31 to these monks in the evening.
01:57:34 Turned out I’m a really bad English teacher.
01:57:37 So they just taught, they allowed me just to sit with them
01:57:40 and meditate and they were teaching me more about Buddhism
01:57:42 than I could have possibly taught them about English
01:57:44 or being an American or something.
01:57:50 And so I just slowly, I just couldn’t take,
01:57:52 I like couldn’t handle being in that clinic.
01:57:55 So more and more, I just started moving to,
01:57:57 spending more and more time at this monastery.
01:57:59 And then after about two months,
01:58:00 I was supposed to come back to the States
01:58:02 and I decided I didn’t want to.
01:58:04 So I moved to this monastery in the mountains
01:58:07 primarily because I didn’t have the money
01:58:09 to like just keep living.
01:58:11 So living in a monastery is free.
01:58:13 And so I moved there and just started meditating
01:58:16 more and more and then months went by
01:58:17 and it just really gravitated.
01:58:22 I gravitated to the whole notion of it.
01:58:24 I mean, it became, it sounds strange,
01:58:28 but meditating almost just like anything
01:58:30 that you’ve put your mind to became exciting.
01:58:34 It became like there weren’t enough hours
01:58:36 in the day to meditate.
01:58:38 And I would do it for 18 hours a day, 15 hours a day,
01:58:41 just sit there and you, and like,
01:58:46 I mean, I hate sleeping anyway,
01:58:48 but I wouldn’t want to go to sleep
01:58:49 because I felt like I didn’t accomplish
01:58:51 what I needed to accomplish in meditation that day,
01:58:54 which is so strange because there is no end,
01:58:57 but it was always, but there are these,
01:59:00 there are these steps that happen during meditation
01:59:02 that are very prescribed in a way.
01:59:05 Buddha talked about them and these are ancient writings,
01:59:08 which exist.
01:59:08 I mean, the writings are real.
01:59:09 They’re thousands of years old now.
01:59:11 And so whether it was Buddha writing them or whoever,
01:59:16 there are lots of different people
01:59:17 who have contributed to these writings over the years.
01:59:22 But they’re very prescribed
01:59:23 and they tell you what you’re gonna go through.
01:59:26 And I didn’t really focus too much on them.
01:59:30 I read a little bit about them,
01:59:31 but your mind really does.
01:59:32 When you actually start meditating at that level,
01:59:35 like not an hour here and there,
01:59:36 but like truly just spending your day as meditating,
01:59:39 it becomes kind of like this other world
01:59:42 where it becomes exciting and you’re actively working,
01:59:47 you’re actively meditating,
01:59:49 not just kind of trying to quiet things.
01:59:51 That’s sort of just the first stage
01:59:53 of trying to get your mind to focus.
01:59:54 Most people never get past that first stage,
01:59:56 especially in our culture.
01:59:58 Could you briefly summarize
02:00:00 what’s waiting beyond the stage of just quieting the mind?
02:00:05 It’s hard for me to imagine that there’s something
02:00:08 that could be described as exciting on there.
02:00:12 Yeah, it’s an interesting question.
02:00:14 So I would say, so the first thing,
02:00:18 the first step is truly just to like be able
02:00:20 to close your eyes, focus on your breath
02:00:23 and not have other thoughts enter into your mind.
02:00:26 That alone is just so hard to do.
02:00:28 Like I couldn’t do it now if I wanted, but I could then.
02:00:33 But once you get past that stage,
02:00:38 you start entering into like all these other,
02:00:41 you go through the kind of,
02:00:42 I went through this like pretty trippy stage,
02:00:44 which is a little bit euphoric
02:00:47 where you just kind of start not hallucinating.
02:00:49 I mean, it wasn’t like some crazy thing
02:00:51 that would happen in a movie,
02:00:53 but definitely just weird.
02:00:55 You start getting into the stage
02:00:56 where you’re able to quiet your mind for so long,
02:01:01 for hours at a time that like for me,
02:01:04 I started getting really excited
02:01:07 about this idea of mindfulness,
02:01:09 which is part of Buddhism in general,
02:01:11 but it’s part of Theravada Buddhism in particular
02:01:13 for this in this way, which was you take,
02:01:19 you start focusing on your daily activities,
02:01:21 whether that’s sipping a cup of tea or walking
02:01:25 or sweeping around.
02:01:29 I lived on this mountainside in this cottage thing,
02:01:32 it was built into the rock.
02:01:33 And so every morning I would wake up early
02:01:36 and sweep around it and stuff,
02:01:37 cause that’s just what we did.
02:01:40 And you start to, you meditate on all those activities.
02:01:44 And one of the things that was so exciting,
02:01:46 which sounds completely ridiculous now
02:01:48 was just almost learning about your daily activities
02:01:54 in ways that you never would have thought about before.
02:01:56 So what’s involved with like picking up this glass of water?
02:02:03 If I said, okay, I’m just gonna pick,
02:02:05 I’m gonna take a drink of water,
02:02:06 to me right now, it’s a single activity.
02:02:10 But during meditation, it’s not a single activity.
02:02:16 It’s a whole series of activities
02:02:18 of like little engineering feats and feelings.
02:02:21 And it’s gripping the water
02:02:24 and it’s feeling that the glass is cold
02:02:25 and it’s lifting and it’s moving and dragging and dragging.
02:02:29 And you start to learn a whole new language of life.
02:02:34 And that to me was like this really exhilarating thing
02:02:37 that it was an exhilarating component of meditation
02:02:41 that there was never enough time.
02:02:44 It’s kind of like learning a new computer language.
02:02:46 Like it gets really exciting when you start coding
02:02:48 and all these new things you can do.
02:02:50 You learn how to experience life in a much richer way.
02:02:55 And so you never run out of ways
02:02:57 to go deeper and deeper and deeper
02:02:58 in the way you experienced even just
02:03:00 the drinking of the glass of water.
02:03:02 That’s exactly right.
02:03:03 And what becomes kind of exhilarating
02:03:05 is you start to be able to predict things
02:03:07 that you never are,
02:03:09 I don’t even have predictions, right word.
02:03:11 But I always think of the matrix,
02:03:13 where I forget who it was,
02:03:15 somebody was shooting at Neo
02:03:17 and he like leans backwards and he dodges the bullets.
02:03:22 In some ways, when you start breaking
02:03:24 every little action that your hands do
02:03:26 or that your feet do or that your body does
02:03:27 down into all these little actions
02:03:29 that make up one what we normally think of as an action,
02:03:33 all of a sudden you can start to see things
02:03:35 almost in slow motion.
02:03:37 I like to think of it very much like language.
02:03:40 The first time somebody hears a foreign language,
02:03:44 it sounds really fast usually.
02:03:45 You don’t hear the spaces between words.
02:03:48 And it just sounds like a stream of consciousness.
02:03:53 And it just sounds like a stream of noises
02:03:55 if you’ve never heard the language before.
02:03:57 And as you learn the language,
02:03:58 you hear clear breaks between words
02:04:01 and it starts to gain context.
02:04:02 And all of a sudden like that,
02:04:04 what once sounded very fast slows down and it has meaning.
02:04:10 That’s our whole life.
02:04:11 Well, there’s this whole language happening
02:04:13 that we don’t speak generally.
02:04:15 But if you start to speak it
02:04:17 and if you start to learn it and you start to say,
02:04:19 hey, I’m picking up this glass
02:04:21 is actually 18 little movements.
02:04:24 Then all of a sudden it becomes extremely exciting
02:04:27 and exhilarating to just breathe.
02:04:29 Breathing alone and the rise and fall of your abdomen
02:04:31 or the way the air pushes in and out of your nose
02:04:34 becomes almost interesting.
02:04:37 And what’s really neat is the world just starts slowing down
02:04:41 and I’ll never forget that feeling.
02:04:44 And if there was one euphoric feeling from meditation
02:04:47 I want to gain back,
02:04:48 but I don’t think I could without really meditating
02:04:51 like that again and I don’t think I will,
02:04:54 was this like slow motion of the world.
02:04:57 It was finding the spaces between all the movements
02:05:01 in the same way that the spaces between all the words happen.
02:05:04 And then it almost gives you this new appreciation
02:05:06 for everything, it was really amazing.
02:05:10 And so I think it came to an abrupt end though
02:05:14 when the tsunami hit.
02:05:15 I was there in the Indian Ocean tsunami hit in 2004.
02:05:19 And it was like this dichotomy of being a monk
02:05:22 and just meditating in this extraordinary place.
02:05:28 And then the tsunami hits and kills 40,000 people
02:05:30 in a few minutes on the coast
02:05:32 of this really small little country in Sri Lanka.
02:05:34 And then my whole world of being a monk
02:05:40 came crashing down.
02:05:41 And when I go to the coast,
02:05:46 and I mean, that was just a devastating visual sight
02:05:53 and emotional sight.
02:05:54 But the strangest thing happened,
02:05:56 which was that everyone just wanted me to stay as a monk.
02:05:59 You know, people in that culture, they wanted to,
02:06:03 the monks largely fled from the coastlines those,
02:06:07 you know, and so then there I was
02:06:09 and people wanted me to be a monk.
02:06:11 They wanted me to stay on the coast,
02:06:12 but be a monk and not help,
02:06:14 like not help in the way that I considered helping.
02:06:18 They wanted me just to keep meditating
02:06:20 so that they could bring me offerings
02:06:23 and have their sort of karmic responsibilities
02:06:28 attended to as well.
02:06:29 And so that was really bizarre to me.
02:06:32 It was like, how could I possibly just sit around
02:06:36 while all these people, half of everyone’s family just died?
02:06:40 And so in any case, I stopped being a monk
02:06:44 and I moved to this refugee camp
02:06:45 and lived there for another six months or so
02:06:47 and just stayed there, not as a monk,
02:06:54 but tried to raise some money from the US
02:06:56 and tried to like, I didn’t know what I was doing.
02:06:58 Frankly, I was 22.
02:07:03 And I don’t think I appreciated at the time
02:07:06 how much of a role I was having in that community’s life.
02:07:10 But it’s taken me many years to process all of this
02:07:14 since then, but I would say it’s what put me
02:07:17 into the public health world, living in that refugee camp.
02:07:21 And that difference that happened,
02:07:22 from being a monk to being in this devastating environment
02:07:28 just really changed my whole view
02:07:30 of sort of why I was existing, I suppose.
02:07:34 Well, so there’s this richness of life
02:07:40 in a single drink of water that you experience,
02:07:42 and then there’s this power of nature
02:07:46 that’s capable to take the lives of thousands of people.
02:07:50 So given all that, the absurdity of that,
02:07:54 let me ask you, and the fact that you study things
02:07:58 that could kill the entirety of human civilization,
02:08:01 what do you think is the meaning of this all?
02:08:03 What do you think is the meaning of life,
02:08:05 this whole orchestra we’ve got going on?
02:08:08 Does it have a meaning?
02:08:09 And maybe from another perspective,
02:08:15 how does one live a meaningful life, if such is possible?
02:08:22 Well, from what I’ve seen,
02:08:26 I don’t think there’s a single answer to that by any stretch.
02:08:29 One of the most interesting things about Buddhism to me
02:08:32 is that the human existence is part of suffering,
02:08:36 which is very different from Judeo Christian existence,
02:08:40 which is that human existence is something to be,
02:08:47 is a very different, it’s something to,
02:08:50 there’s a richness to it.
02:08:51 In Buddhism, it’s just another one of your lives,
02:08:55 but it’s your opportunity to attain nirvana
02:08:59 and become a monk, for example, and meditate
02:09:02 to attain nirvana,
02:09:04 else you kind of just go back into the samsara,
02:09:06 the cycle of suffering.
02:09:09 And so, when I look at, I mean, in some ways,
02:09:14 the notion of life and what the purpose of life is,
02:09:18 they’re kind of completely distinct,
02:09:20 this sort of Western view of life,
02:09:22 which is that this life is the most precious thing
02:09:27 in the world versus this is just another opportunity
02:09:30 to try to get out of life.
02:09:33 I mean, the whole notion of nirvana, and in Buddhism,
02:09:35 it getting out of this sort of cycle of suffering
02:09:40 is to vanish.
02:09:41 If you could attain nirvana throughout this life,
02:09:45 the idea is that you don’t get reborn.
02:09:48 And so, when I look at these two,
02:09:51 on the one hand, you have Christian faith
02:09:55 and other things that want to go to heaven
02:09:57 and live forever in heaven.
02:09:58 Then you have this other whole half of humans
02:10:01 who want nothing more than to get out of the cycle
02:10:05 of rebirth and just, poof, not exist anymore.
02:10:09 The cycle of suffering, yeah.
02:10:10 Yeah, and so how do you reconcile those two?
02:10:12 And I guess.
02:10:13 Do you have both of them in you?
02:10:15 Do you basically oscillate back and forth?
02:10:18 I don’t think I, I think I just,
02:10:19 I look at us and I think we’re just a bunch of proteins.
02:10:23 That we form and we, they work in this really amazing way
02:10:29 and they might work in a bigger scale.
02:10:31 There might be some connections
02:10:33 that we’re not really clear about,
02:10:35 but they’re still biological.
02:10:36 I believe that they’re biological.
02:10:38 How did these proteins become conscious
02:10:40 and why do they want to help civilization
02:10:43 by having at home rapid tests at scale?
02:10:47 Well, I think, I don’t have an answer to that one,
02:10:50 but I really do believe. I was hoping you would.
02:10:53 It’s just, you know, this is just an evolution
02:10:56 of consciousness I don’t, I don’t personally think is,
02:11:02 my feeling is that we’re a bunch of pluses and minuses
02:11:05 that have just gotten so complex
02:11:07 that they’re able to make rich feelings, rich emotions.
02:11:10 And I do believe though, you know, on the one hand,
02:11:13 I sometimes wake up some days,
02:11:16 my fiance doesn’t always love it,
02:11:18 but you know, I kind of think we’re all just a bunch
02:11:20 of robots with like pretty complicated algorithms
02:11:23 that we deal with.
02:11:26 And, you know, in that sense, like, okay,
02:11:28 if the world just blew up tomorrow
02:11:30 and nothing existed the day after that,
02:11:35 it’s just another blip in the universe, you know?
02:11:37 But at the same time, I don’t know.
02:11:40 So that’s kind of probably my most core basic feeling
02:11:42 about life is like, we’re just a blip
02:11:45 and we may as well make the most of it
02:11:47 while we’re here blipping.
02:11:48 It’s one hell of a fun blip though.
02:11:52 It is, it’s an amazing blink of an eye in time.
02:11:59 Michael, this is, you’re one of the most interesting people
02:12:01 I’ve met, one of the most interesting conversations,
02:12:03 important ones now, I’m going to publish it very soon.
02:12:07 I really appreciate taking the time,
02:12:09 I know how busy you are, it was really fun.
02:12:12 Thanks for talking today.
02:12:14 Well, thanks so much, this was a lot of fun.
02:12:16 Thanks for listening to this conversation
02:12:19 with Michael Mina and thank you to our sponsors.
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02:12:59 And now, let me leave you with some words
02:13:01 from Teddy Roosevelt.
02:13:03 It is not the critic who counts.
02:13:06 Not the man who points out how the strong man stumbles
02:13:10 or where the doer of deeds could have done them better.
02:13:13 The credit belongs to the man who actually is in the arena,
02:13:17 whose face is marred by dust and sweat and blood,
02:13:21 who strives valiantly, who errs,
02:13:24 who comes short again and again,
02:13:27 because there is no effort without error and shortcoming,
02:13:30 but who does actually strive to do the deeds,
02:13:33 who knows great enthusiasms, the great devotions,
02:13:37 who spends himself in a worthy cause,
02:13:40 who at the best knows in the end that triumph
02:13:43 of high achievement, and who at the worst, if he fails,
02:13:47 at least fails while daring greatly,
02:13:50 so that his place shall never be
02:13:53 with those cold and timid souls
02:13:55 who neither know victory nor defeat.
02:13:58 Thank you for listening and hope to see you next time.