Transcript
00:00:00 The following is a conversation with Michael Mina, his second time on the podcast.
00:00:04 He’s a professor at Harvard doing research on infectious disease and immunology. In my view,
00:00:11 the most powerful, doable, and obvious solution to COVID 19 from the very beginning is rapid
00:00:18 at home testing. This is what Michael has been talking about and writing about since the beginning
00:00:24 of the pandemic. The accuracy of these tests is high for the task of detecting contagiousness,
00:00:30 which is what matters. Hundreds of millions can be manufactured quickly and relatively cheaply.
00:00:36 Privacy and individual freedoms are preserved. I believe that if you give people the power of
00:00:41 information, information about whether they are contagious or not, they will do the right thing
00:00:47 at scale, all while respecting their freedom and minimizing the destructive effects of the pandemic
00:00:54 on our health and our economy. The solution was obvious in May of 2020. It was obvious when Michael
00:01:01 and I spoke the first time a year ago, and it is obvious today. We talk about why it has not yet
00:01:08 been done and how we can still do it. This is the Lex Friedman podcast. To support it, please check
00:01:15 out our sponsors in the description. And now here’s my conversation with Michael Mina.
00:01:22 We spoke a year ago about rapid at home testing, and I think you think it should have been,
00:01:30 still should be a big part of the solution to COVID. So let’s recap. Where do things stand
00:01:36 today in terms of rapid at home testing? Well, it’s certainly something that you’re right,
00:01:44 I do think we should have them today. We’ve now had almost 20 months of living in anxiety,
00:01:53 uncertainty, being afraid for our health, for our family’s health, for our friends, you know,
00:01:59 shutdowns, economic instability, everything has been uncertain because of this virus.
00:02:05 And then there’s this little test, and it’s the first time for many people that they’re using it
00:02:10 and they’re feeling empowered. They’re feeling like they can control their little slice
00:02:16 of this pandemic. So as these tests have come out and more and more and more Americans have
00:02:22 had an opportunity to go and buy them from, you know, CVS or Walgreens or wherever they’re at,
00:02:28 I think that it’s really shifting the tenor of the discussion. For a long time, all of 2020,
00:02:35 it was like, I often felt like it was me and a few other people against the world, you know,
00:02:41 these tests should be public health tools, these tests are infectiousness indicators,
00:02:47 they shouldn’t be compared to PCR, you know, all of these different things. And we could,
00:02:51 of course, go through and recap what the benefits and the metrics are that we should be looking at.
00:02:58 But the point is, last year and most of this year was about educating scientists, educating
00:03:05 public health leaders, educating physicians to get them to understand that there is a different
00:03:12 reason to test in a pandemic than purely diagnostics and transmission blockade and
00:03:17 severing transmission chains is a big one. So now, I think we’re at a point where people
00:03:21 are now understanding and they’re understanding because they are feeling it, they’re holding it
00:03:26 and they’re doing it and they’re seeing, they’re feeling the delight of seeing a negative
00:03:29 and saying, I feel more comfortable. It’s not perfect, but it’s pretty darn close to perfect
00:03:35 to allowing me to go and see my mom without mistakenly infecting her, you know, or whatever
00:03:42 the story might be. And now that that’s happening, I think all of a sudden we’re seeing a massive
00:03:48 change politically for these tests. Biden just came out the COVID 19 action plan the other day
00:03:54 and one of the main pillars of it was testing and in particular, bringing rapid tests,
00:03:59 scaling them up. So on that front, I think finally there is success. People are actually understanding
00:04:08 and, you know, I haven’t stopped beating this drum for far too long and I like hate rapid tests now.
00:04:15 So maybe it’s good to step back. Would you say most Americans have not taken a rapid at home test?
00:04:21 Absolutely. Most have definitely not taken a rapid test. So like many of them probably don’t know.
00:04:26 They kind of probably say testing, they have like memories of testing, like PCR testing,
00:04:33 they have to go into somewhere and they have to like a swab deep in their nose and that’s
00:04:39 the experience. So maybe when, if you have to travel like Canada or something like that,
00:04:43 you have to get tested, that kind of stuff. So what are rapid at home tests?
00:04:48 Yeah. So the rapid at home tests are, I like to call them paper strip tests. They’re simple tests
00:04:56 that, I wish I brought some today, but I didn’t. They’re simple tests that you swab. At the moment,
00:05:05 most of them use a swab that you just swab the front of your nose. So it’s not one of the deep
00:05:10 swabs that goes into your brain. And so it’s not very uncomfortable. It’s just like picking your
00:05:16 nose, if you will, and you put that swab into a little tube and the tube has some liquid in it.
00:05:27 And then you put a few drops of that liquid onto a paper strip or you drop the paper strip
00:05:32 into the tube, just like one of those indicators for the pool. And if you, just like a pregnancy
00:05:39 test, then if you get two lines, you’re positive, one line, you’re negative. It’s super simple. It
00:05:45 takes 30 seconds, once you know how to do it, of hands on time. And you wait around 10 minutes,
00:05:50 and then you read the result. They are extraordinarily effective to answer one
00:05:57 question, am I infectious? And that is the public health question that we need to answer and
00:06:05 consistently ask during this pandemic. Are you infectious? Am I infectious? Because it’s only
00:06:11 when we know that we’re infectious that we can be empowered to not mistakenly infect others.
00:06:19 The PCR test is a little different. And we can go into the pros and cons, but one of the major
00:06:28 differences is that a PCR test gets a lot of… A lot of people talking about the PCR test say it’s
00:06:36 much more sensitive. And at an analytical level, it is. It can detect one molecule instead of
00:06:44 100,000. But for public health, we don’t want a test that can detect one molecule. In fact,
00:06:52 that has created a net negative for public health. We just want to know, am I infectious?
00:06:58 And to know that question, to know if I’m infectious, I only need a test that is going
00:07:04 to be positive if I have a high viral load, like a million. And the virus grows so fast,
00:07:10 it will grow from zero to a billion in a day. So you don’t really need, even on the front end of an
00:07:16 infection, you don’t need better sensitivity. If the trade off is that you don’t get the result
00:07:21 for one, two or three days, you absolutely want a rapid result that can tell you, yes,
00:07:27 you’re infectious, you’re transmitting to others right now. And I’m going to give you the result
00:07:33 right now. So it is a much more effective tool because it’s fast, because it’s accessible. We
00:07:38 can use them in the home. And there’s some issues with using them at home. We can talk a little bit
00:07:43 about what those issues are, like reporting and how do you use everything on the honor system if
00:07:49 you have a test that you’re taking at home and you use it to go to work. But they can be accessible.
00:07:55 PCR has to go into a lab. It takes a lot of time for somebody to get a PCR test. They either have
00:08:00 to go online and order it. It takes the next day for it to come back. They swab themselves,
00:08:04 they ship it out the next day, and then they get a result two days later. That’s four days minimum
00:08:10 for the most part. And at that point, you’re not even infectious, even if you did happen to be
00:08:15 infectious when you first ordered the test. So it’s really the speed of these tests and the
00:08:20 accessibility and distribution of them that makes them so immensely powerful.
00:08:23 So you have this like amazing graphic you tweeted. It’s exactly what you’re saying,
00:08:28 which is rapid antigen test answers the question, am I currently infectious? And you have, I think,
00:08:36 a comparison of seven different tests based on the viral load. And based on the viral load across
00:08:43 these different tests, you look at the likelihood of infectiousness. So what does this graphic show?
00:08:50 We can overlay that for people. I think it’s just really nice and really clear.
00:08:54 Yeah. So what that’s showing is that we can never ask what’s the sensitivity of a test and just let
00:09:01 that be the answer. That’s what the FDA does currently. And that question doesn’t mean
00:09:06 anything. We have to say, what is the sensitivity of the test to detect what? And so we can have
00:09:12 different viral loads. For example, you can have a viral load of one or you can have a viral load
00:09:18 of a trillion. And a PCR test will tell you that you are positive regardless of whether it’s one
00:09:25 or a trillion. Now, so we can’t ask the question, how sensitive is a rapid test compared to PCR?
00:09:33 Because that covers the whole gamut. What we really want to say is, how sensitive is the rapid test
00:09:38 to detect me if I am infectious? And that gets to about 97% or so sensitive. If the question is,
00:09:46 how likely is it to detect me if I’m a super spreader? That’s a really important one to be
00:09:51 able to detect. They’re all about 100% sensitive. So if you have extraordinarily high viral loads
00:09:56 to the point where you might be a super spreader, these simple rapid tests will essentially always
00:10:01 catch you and tell you you’re positive. And then as you go down the line, if you’re no longer
00:10:06 infectious at all, then these rapid tests might have a 0% sensitivity compared to PCR.
00:10:14 But that’s actually a good thing. The FDA and others look at it as though it’s a bad thing
00:10:19 because they average it all together and say, oh, this is only a 40% sensitive test compared to PCR.
00:10:26 But that’s not the right way to look at it. You want to say, well, out of all of the samples,
00:10:30 how many of them were not transmissible? How many were mid, moderate, high, extremely high,
00:10:34 super spreader? And you should at the very least create a weighted average based on
00:10:38 transmissibility potential. We don’t do that. And that’s why nobody in America has these tests,
00:10:44 because that’s why they’re very rare. Because we have slowed down their authorization because of
00:10:50 that misunderstanding that they don’t have to be 80% or 90% sensitive compared to any time PCR
00:10:56 positivity. They need to be 80% or 90% or more if you’re infectious. And for that question,
00:11:03 they’re like 95% up to 100% sensitive when you’re most infectious.
00:11:08 So when you have a lot of virion particles in you, that’s what it means when you say viral load,
00:11:14 that means you’re going to be very infectious. The more you have, the more infectious you are.
00:11:18 And this test is basically very good at detecting when you’re very infectious.
00:11:25 Why don’t we have rapid at home tests? You said there’s a bit of confusion. FDA is involved.
00:11:33 You’ve talked about, you continue to talk about that these at home tests are classified as,
00:11:40 I guess, medical devices. And so because of that, FDA is looking at them differently
00:11:47 than they probably should be looked at. So what’s the problem here? Can you sort of explain
00:11:54 what does it mean to be a medical device? Why is that an issue? Where is the FDA messing up?
00:11:59 So when we declare something as a medical device and we evaluate as a medical device,
00:12:05 then it makes sense that the comparison, if you’re trying to get a new one onto the market,
00:12:11 that the comparison would be against a gold standard medical device for that purpose.
00:12:17 So PCR is currently the gold standard, or at least in the eyes of the FDA,
00:12:24 the PCR test is the gold standard medical device. And that’s because it’s so sensitive.
00:12:33 As a physician, I have one patient in front of me at a time. And that patient comes to me and I
00:12:39 don’t have to care about the 99.9999% of people in the world who are not in front of me. I only
00:12:47 care about that one patient. And so when I get a sample from that patient and that patient’s saying,
00:12:51 Doc, I don’t feel well. I haven’t been feeling well for the last few weeks. Do you think this
00:12:56 is COVID? Well, for that question, I want to have the absolute best sensitivity test,
00:13:04 regardless of what it means for transmissibility, because my patient isn’t sitting in my office
00:13:08 saying, Doc, do you think I’m infectious? They’re saying, Doc, do you think I have recently been or
00:13:14 am infected? And these are totally different things. One is medicine. And if the patient’s
00:13:20 infected, the time isn’t of the essence because they’re sitting there in my office. I can say,
00:13:24 look, I’m sorry you’re not feeling well. Let’s get a PCR test on you. We’ll be able to tell
00:13:29 you if you have any evidence that there has been recently an infection inside of you.
00:13:35 And you’ll get the results in a couple of days. And it might be expensive. And so insurance is
00:13:41 going to pay for it. And you’re just one person. And so I don’t really care how many resources it
00:13:46 takes to get you this answer. On the other hand, there’s public health testing. And public health
00:13:53 testing has to account for all of the people you’re not seeing as well as the person you’re
00:13:59 testing at the moment. So accessibility becomes a central theme. Frequency of tests, it has to
00:14:05 account for all the days that you’re not sitting there in front of your doctor’s office getting a
00:14:10 test as well as the one you are. So it has to say how frequently. What if you’re infected tomorrow,
00:14:15 but you’re at the doctor’s office today getting a negative COVID test? That PCR test at the doctor’s
00:14:20 office today is going to do nothing to let you know that you get exposed and infected tomorrow.
00:14:26 The only way to know that is to be testing yourself frequently.
00:14:31 And the reason it matters is that these tests can be accessible if we are okay with saying
00:14:37 the real purpose of a public health test is to answer the question, am I infectious?
00:14:42 The reason we want to answer that is if you’re infectious, that’s when you isolate. We actually
00:14:47 don’t want to isolate PCR positive individuals who are no longer infectious. That’s bad public
00:14:56 health practice. If I haven’t been infectious for three weeks, I don’t want to have somebody tell
00:15:01 me that I need to go and isolate for 10 days just because I happen to use a PCR test today,
00:15:08 three weeks after I was infectious. And furthermore, I definitely don’t want the public
00:15:13 health agency to come and round up all the people I was with last night and say, you guys have to
00:15:18 quarantine for 14 days because you were with Michael who wasn’t infectious yesterday.
00:15:23 It’s nonsensical to do that. And it’s a huge disincentive to actually get tested. That’s
00:15:29 exactly right. Huge disincentive to get tested. People, if it’s too sensitive, especially with
00:15:33 flights, things like that, we shouldn’t be stopping people from taking a flight if they haven’t been
00:15:39 infectious for 60 days. And to be clear, people are only infectious for somewhere between three
00:15:46 and seven days, but can be positive on a PCR test for 30 to 70 days. So, I mean, it’s potentially
00:15:54 a tenfold difference in terms of how long you’re PCR positive versus how long you’re infectious.
00:16:00 So, we don’t want to be taking people during those 30 to 70 days and saying you need to isolate just
00:16:05 because you go and get a swab, or you can’t go on your trip just because you had COVID last month.
00:16:11 That’s not good use of a test. So, the reason we don’t have these tools right now is because
00:16:20 when we evaluate a rapid test as a medical device, the FDA says, well, this has to achieve
00:16:28 the properties that we expect from a medical device, which again, doesn’t have to take time
00:16:34 into account, doesn’t really have to take cost or resources or scalability or access into account.
00:16:39 It only takes sensitivity and specificity to catch molecules. And so, just by definition, I mean, it
00:16:48 is a mathematical fact, you know, that if you have a perfect public health test for COVID, which means
00:16:55 that it would be 100% sensitive and 100% specific for contagious people or for the infectious stage
00:17:03 of an infection, then it literally can’t, it is an impossibility for that test to achieve an 80%
00:17:13 sensitivity at a population level against a medical device, which is what the FDA asks for.
00:17:19 And that’s because you’re only infectious for maybe 20%. So, theoretically, it should only have
00:17:26 a 20% sensitivity against the PCR while still being a perfect medical, a perfect public health
00:17:33 test. And the test is answering the question, am I infectious? That’s what you’re testing for,
00:17:37 not for the exact counting of the virion particles in your system. That’s exactly right. Okay. So,
00:17:43 why are we still here? So, have you had conversations with folks? You said that there’s a
00:17:50 bunch of leaders that are kind of starting to wake up to this idea, but why is this taking this so
00:17:58 long? Why don’t we still have hundreds of millions of at home tests? The reason it’s taking long,
00:18:06 the reason it’s taking long, I think, is because every agency and government is generally deferential
00:18:15 to the FDA. And in this context, I would argue that government hasn’t been particularly creative.
00:18:24 So, for example, last year, when Trump was still president, I would, or in the transition,
00:18:29 and I recall talking to the White House a number of times and saying,
00:18:32 here’s a plan to give us our lives back. I think that was actually the title of the Atlantic
00:18:37 article. And this plan can stop shutdowns, it can stop outbreaks, it can allow society to keep
00:18:45 running and could have prevented the outbreaks of last winter and fall and saved hundreds of
00:18:51 thousands of lives. So, when I bring that to the White House or to the government, the federal
00:18:57 government, whoever it might be, and I say, here’s a plan, this would work. They say, what I get back
00:19:03 is, this sounds really interesting, Michael. It looks like it checks out. But there’s one problem,
00:19:09 we don’t have the test, there’s no scale. And that’s kind of where it all dropped. It’s like
00:19:13 this defeatist attitude of like, don’t have the test, so we can’t act on it. But now it’s really
00:19:20 changing. Well, and so that’s really where things have been. And so nobody’s paid attention. It’s
00:19:25 always been this like esoteric thing that, yeah, maybe one day we’ll get around to it, but really
00:19:30 it’s not that important. And the pandemic’s going away. But this was like 100% predictable, everything
00:19:36 that’s happening today. We predicted it last year. It’s not, this isn’t like rocket science or
00:19:41 anything. The variants and all those kinds of things. So the FDA, we can start to understand
00:19:46 why, but also like one question I want to ask, is it possible to go around the FDA?
00:19:52 Yeah. So why has the FDA not changed? And why has nobody tried to push the FDA to change?
00:20:01 I think what the real reason is the FDA has one job around these tests and it is to authorize
00:20:08 them as medical devices. They haven’t been charged with doing anything else. So in their eyes,
00:20:14 they’re doing exactly what they’re supposed to do. They’re evaluating these tests as medical
00:20:20 devices and they’re telling company after company after company, sorry, you don’t make the cut.
00:20:26 And the only way to make the cut is really to kind of skew your clinical trials to favor
00:20:31 the rapid test being positive, which isn’t really good practice. We shouldn’t be trying to
00:20:36 skew clinical trials. But that’s kind of what’s happened. It’s been forced upon the companies to
00:20:43 do that. And so I think the FDA truly believes from the bottom of their heart that they are
00:20:48 doing the right thing here. And I would argue that to an extent they are. I’ve been pretty
00:20:53 hard on the FDA, but maybe the issue is a higher level issue. Like the in vitro diagnostics
00:21:00 division is they get applications and they evaluate them and the applications are for
00:21:04 medical claims. That’s however, because there’s been a misunderstanding of these tests and
00:21:10 the companies only know to apply for these as medical claims because there’s nothing else in
00:21:18 this country to apply for except the medical claim. So we don’t have a public health pathway
00:21:24 to evaluate a test and authorize a test. It doesn’t exist. We have defunded and devalued
00:21:30 public health for so long that we literally don’t have a language for it. We don’t have laws,
00:21:36 a language, words. Is it called a public health test? Is it called something else?
00:21:40 I call it a public health test because I’m trying to create a new definition here,
00:21:45 but that’s why nobody’s acted because everyone says, well, there’s no other pathway. So the FDA
00:21:53 in vitro medical diagnostics division is the only pathway. So what I am trying to do is to say, look,
00:22:01 the FDA very clearly states that they do not authorize or review public health tools
00:22:09 and they don’t authorize or review public health tests for COVID. So what I want the president of
00:22:17 the United States to do is to utilize executive powers and take an executive action that can
00:22:24 simply state like one line. One line could potentially change all of this. And it’s a pretty
00:22:31 obvious and simple line. And it is that any tools used for public health testing during this public
00:22:39 health emergency will be designated as public health tools. Like it’s obvious, like it’s public
00:22:47 health emergency. It’s a tool used for public health that should be designated as a public health
00:22:51 tool. If we can do that, if we can get that language out there so that that’s the president’s
00:22:57 decision, then all of a sudden the FDA is off the hook. They’re not trying to cram a square peg
00:23:05 through a round hole. They can say, look, the antigen tests are not on us anymore. At least if
00:23:11 they’re going to be used for public health, like when you test a thousand people at a time or test
00:23:16 a school classroom if they’ve been exposed, this is public health. And so then the CDC could take
00:23:23 it over. The CDC could say, okay, what are the metrics we are interested in? And they could say,
00:23:30 we’re interested in a test that can catch you if you’re infectious. So you want high viral load
00:23:34 detection. That’s fast, that’s scalable. And hey, if your test has been used in Europe for months
00:23:40 and has performed extremely well, then we’ll give you a certificate by right immediately. And that
00:23:47 could actually get hundreds of millions of additional tests into the United States tomorrow.
00:23:54 So you need some kind of classification from an FDA or from somebody to call it a public health
00:23:59 tool in order for it to be manufactured. Is it possible to just go around all of this and just
00:24:04 for somebody to manufacture at scale tests? Well, if you did that and you just called them,
00:24:11 you put a claim on them that called them public health tools, the FDA has a very
00:24:19 weird view of this and they will tell you that it’s illegal, that it’s a crime.
00:24:24 Is there a way to say like Elon Musk did with the flamethrower, it’s not a flamethrower?
00:24:29 Yeah. Believe me, I’ve tried to think of all the different approaches. There’s major
00:24:38 inconsistencies here. So it’s not like we don’t have a precedent for a public health test even
00:24:42 during this pandemic. There is a very strong precedent. Pooled testing, we have companies
00:24:50 like Ginkgo based out here in Cambridge that are working with 100 different labs around the country.
00:24:57 So that might mean like not a ton of quality control over those labs. I don’t want to say
00:25:04 that they don’t, I’m just saying the reality is if you’re working with that many labs,
00:25:07 it’s hard to say, they’re running pooled testing of millions and millions and millions of kids.
00:25:15 So here you have a company that’s testing in each pool five to 25 kids at a time,
00:25:22 millions of kids in a pretty distributed way across the country in all these different labs
00:25:28 and the FDA doesn’t care at all. You don’t need an EUA. It doesn’t need a regulatory authority.
00:25:33 It’s collection on site. It’s getting shipped to a lab. There’s no oversight of it. So why does
00:25:40 that have no oversight but a rapid test for the exact same purpose? You’re just giving people
00:25:47 immediate results instead of two day delayed pooled PCR results. So it’s a much more effective tool.
00:25:53 Why is the rapid test used for the same purpose, not designated as a public health tool, but
00:25:58 requiring FDA authorization? It’s a ridiculous reason and it’s because the FDA says that if
00:26:07 a test, and this is actually CMS that says this and the FDA adopts it, if a test alters your
00:26:17 behavior, if you get a single result and it’s going to alter your behavior, then that is a
00:26:22 medical device. But the thing that I find ridiculous is like, okay, but you can give a
00:26:29 pooled test that alters 25 people’s behavior at once and that’s not falling, like that’s more
00:26:35 risky. One person turns positive in the pool and 25 people have to be quarantined.
00:26:42 And how do they evaluate the accuracy? So for people who don’t know, pooled test
00:26:47 is you’re testing a small fraction of the people. And if one of them is positive,
00:26:54 then you basically say, we have to retest everybody in the pool.
00:26:57 Yeah. So you take, let’s say you have a school and each classroom you might have 20 kids each swab
00:27:03 their nose in a classroom and all those swabs go into a single tube. And then you rinse that tube
00:27:09 out with some saline and you run a PCR test on that tube of 25 samples, 20 samples. And so if
00:27:16 that tube turns positive in the PCR test, then all 20 or 25 of those students are now having
00:27:23 to quarantine. And if there’s no positive, then all 20 or 25 students are interpreting that their
00:27:31 result is negative. So it really is ridiculous decision by the FDA to say that if the test itself
00:27:40 only tests one sample at a time, it’s medicine because it will tell you one person at a time,
00:27:44 if you’re positive or if you’re negative. But if you do it as a pool and you tell 25 people that
00:27:51 your pool was negative, then that’s somehow different. That’s public health, not medicine.
00:27:58 There’s no logic there. Was it just personalities and
00:28:00 accidents of history or something like that? For example, you talk about the public health
00:28:06 tools and CDC, you look at masks. So masks were decided to somehow be an effective tool
00:28:12 to help with the pandemic. So I’m sure the evidence that was used there was probably not
00:28:20 as strong as the evidence supporting antigen rapid tests. I was very much reading a lot of research
00:28:26 on masks. It’s tricky. It’s really tricky to show how well they stop the transmission of a virus,
00:28:31 especially when you don’t fully understand how the virus is transmitted or the viral load required,
00:28:36 all that kind of stuff. But then the CDC pretty quickly decided masks or whatever,
00:28:41 there’s some oscillations back and forth, but then they quickly decided, everybody decided
00:28:47 masks is a good tool. So masks being decided a good tool and then rapid antigen tests,
00:28:53 not a good tool. Is that just like certain personalities who didn’t speak up in a meeting
00:28:58 or who did speak up in a meeting? Is this just like a weird roll of the dice or is there a
00:29:03 better explanation? I think it’s somewhat of a roll of the dice, but I also think it’s that testing.
00:29:09 So doctors don’t pretend to really understand much about fluid dynamics and how well masks are
00:29:20 working. That’s way out of their realm. Doctors do believe that they understand all aspects of
00:29:28 the tests. And so the greatest barriers to rapid tests being brought to market or being rolled out
00:29:39 heavily and supported as public health tools, the greatest barriers came from physicians saying,
00:29:47 hell no, we can’t use a test that’s not as sensitive as a PCR.
00:29:51 And look at what happens if you use this antigen test and not a PCR test. You get people who are
00:29:58 showing a positive on a PCR and negative on an antigen. And they just assume that that was a
00:30:05 false negative on the antigen. For public health, I would call it a false positive on the PCR test.
00:30:12 But this type of thinking literally does not exist in medicine. And I think the biggest problem here
00:30:18 is that we placed physicians in decision making power. When this pandemic hit, everyone called up
00:30:28 clinical laboratory folks and microbiologists and physicians to ask, well, what kind of test should
00:30:34 we use, that kind of thing. And there is no training in medical school for this kind of
00:30:40 public health work. You have to optimize on the right qualities of a test that have nothing to
00:30:47 do with medicine. And then sometimes, if not frequently, they’re actually at odds. And I’ll
00:30:54 give an example why the physicians, you could see why the physicians would have been against it from
00:30:59 their perspective. And they say, if a physician is a TSA agent at the airport, you know, a TSA agent,
00:31:08 their role at any given time, and the role they think that the instruments need to play is I want
00:31:14 you to scan the bag as well as possible. This is the only bag that I’m interested in at the moment.
00:31:20 And this is my lane, this is my bag. I want to make sure that my instrument’s doing, I don’t want
00:31:26 the crappy instrument in my lane, I want to make sure that I’m doing everything I can. But what
00:31:32 those TSA agents don’t have to worry about is, well, how many other instruments are there in this
00:31:36 airport? Is anyone getting through the lines here without going through security? The average TSA
00:31:42 agent doesn’t have to worry about that. They literally have one job to do, and it’s pay
00:31:45 attention to this lane. If there’s a big gap in the security line and people are flowing through
00:31:52 without going through security, that’s not on the TSA agent. That’s not a big systematic problem of
00:31:56 that of the system. And we can’t expect that TSA agent to have ever even thought about that. Like,
00:32:04 that’s not on them. They were trained to look at the bag. And that’s kind of like physicians.
00:32:09 That’s kind of like physicians. And probably some physicians will hear this and feel like I’m
00:32:15 insulting it. I don’t mean to be likening the two professions or anything like that. But the point
00:32:20 is that a physician has one duty. Do no harm to this patient. Time is an of the essence. Scale,
00:32:28 how many tests can my hospital perform in a day? How many tests can my county or country perform
00:32:35 in a day? That’s not a physician’s training to think like that at all. And so what has happened
00:32:42 is doctors got on board early and said, oh, hell no. We’ve seen these antigen tests before. They’re
00:32:47 not particularly sensitive compared to PCR. And early in the pandemic, there was like pissing
00:32:52 matches between labs who had the most sensitive PCR. And it just distracted everything. I was
00:33:00 trying to say pretty early, like, we don’t need sensitivity. We just need frequency. We just need
00:33:06 scale. We need to think differently because our only goal if we’re doing frequent routine testing
00:33:12 of asymptomatic people is not medicine. It’s to say, do you need to isolate now? And if you have
00:33:17 a PCR test that’s taking three days to return and you’re like, if I was currently spreading virus
00:33:23 before I walked in here and you handed me, this actually happened to me today when I walked into
00:33:27 Harvard. Today was my first day back into Harvard since February of 2020. I go in, I scan my badge
00:33:35 and they hand me a PCR tube and they say like, return this by noon or something before your work
00:33:42 day is done. And I’m looking at it. I’m like, what is this going to do? Like, what if I’m super
00:33:48 spreader right now? You’re giving me free reign to walk around and infect everyone in the school
00:33:52 and you’re going to give me my result to tell me I did that in two days from now? It doesn’t really
00:33:58 make sense. So who is supposed to be, so it’s understandable that doctors kind of feel that way,
00:34:04 just like you said, do no harm. Who’s supposed to care about public health? Is it the FDA? Is there
00:34:12 some other organization yet to be created? Is it like, just like with the military, the reason we
00:34:19 have civilian leadership when you talk about war, is it the president that’s supposed to do like
00:34:25 override FDA, override doctors, override and basically politicians in representing the people
00:34:32 in the state of emergency make big public health decisions? Like who is supposed to do it? Besides
00:34:37 you on Twitter. It’s like most people really thinking about solutions to COVID will mention
00:34:45 you or will mention this idea of rapid at home testing. And it’s, you watch that happening,
00:34:53 this discussion that this is an obvious part of the solution and the solution is not happening.
00:34:57 So who is supposed to implement this idea? I think the CDC that it should start there.
00:35:04 Override the FDA? Well, I don’t even think it needs to override it. And that’s why I think
00:35:08 these should just be designated as a different tool so that the company is, it’s not overriding.
00:35:14 It’s just saying, look, this isn’t even, this isn’t in your jurisdiction to the FDA. This is
00:35:19 just a public health tool. But the problem is the centers for Medicaid, Medicare services
00:35:25 designates any tool, just like FDA, they designate these as medical devices purely because they could
00:35:31 change somebody’s behavior based on the result of one test. So to change that at this point,
00:35:37 unless you can get CMS buy in, you know, we don’t have, there is no designation as a public health
00:35:42 tool, but the president can just say, these are public health tools. These are not to be
00:35:50 regulated as medical devices if their goal is not medicine, but public health.
00:35:55 And if he does it, he does have the authority to do that as president and to say, I’m tasking the CDC
00:36:03 to certify these tests or, or authorize them for use in the United States. And, you know,
00:36:08 he has to say something like that. He can’t come out and say, these are public health tools, have
00:36:14 free reign, just, you know, any company start, start shipping them in the US because that would
00:36:19 create pandemonium and we’d have a lot of bad tests. But there’s a lot of really good tests
00:36:25 out there. We just are taking like six to 12 months to run trials. They’re failing because
00:36:30 they can’t keep up with PCR. And if the president were to do this, then the CDC could take it over
00:36:37 and they could say, okay, it’s on us. We’re going to decide. The UK actually did this. They,
00:36:44 early on, they said, okay, they laid out a very clear regimen. They said, this is how we are going
00:36:49 to evaluate rapid antigen tests because they’re public health tools. They did it in a, in a domain
00:36:56 that was outside of their normal medical diagnostic regulatory agencies. And they, they literally just
00:37:02 had a very fast screening to say, what are the best tests? They went through a huge number of
00:37:08 different tests and they said, okay, these are the, this is the rank order of which tests are good,
00:37:12 which are bad, which are scalable, which are not. And they were able to start deploying them in
00:37:18 weeks, not years. So I think the CDC really needs to take charge. The problem is when it comes to
00:37:24 like law, if everyone currently perceives this as like fully within the domain of the FDA and they’ve
00:37:31 never heard of such enough public health test idea enabling, but the, but the FDA itself has created
00:37:39 the idea by saying we don’t regulate public health tools. So the word is out there. The FDA has said,
00:37:45 we don’t regulate them. So that gives the president an opportunity to say, okay, these are
00:37:51 those, you know, these are public health tools by definition. And, and I do think that this is a kind
00:37:57 of a crisis and it’s a crisis of testing, but it’s also a crisis of like, really, we’re going to go
00:38:02 through this whole pandemic and never figure this thing out. That’s just really sad. You know, if we
00:38:08 get through this and don’t figure out how to evaluate a rapid test. So how do vaccines
00:38:15 play with this? So one of the things that when people discuss solutions to COVID, there’s a
00:38:22 sense that once you have a vaccine COVID is solved. So how does that interplay? Like, why do we still
00:38:29 need tests if we have vaccines? Yeah, I actually wrote an op ed in New York times or Wall Street
00:38:36 Journal or something that was titled why we still need rapid tests with vaccines. And the real reason
00:38:44 is because we have evaluated our vaccines based on their ability to stop disease. In fact, most of
00:38:51 the trials didn’t evaluate them based on their ability to stop transmission. They didn’t even
00:38:57 evaluate that at all, no less put it as one of the metrics for authorization. And with a virus like
00:39:04 this, it would be a bit naive to think that it’s really going to stop transmission well.
00:39:12 I think a lot of excitement happened right after the first clinical trials. And I’m sure we were
00:39:17 talking about it when I was last here, I would imagine given the timing. But those first clinical
00:39:22 trials came out and everyone jumped for joy that these things were going to be the end to this
00:39:27 pandemic. But we had really short sighted vision there by not recognizing two main features. One is
00:39:35 that they might not stop transmission. Another, I guess three, another is that new variants might
00:39:41 come around that will break through the vaccine protective immunity. And the third is that we were
00:39:48 measuring the efficacy of these vaccines during the peak of their performance in the first few
00:39:54 months after people got vaccinated. And that gives a skewed view of just how effective these are going
00:39:59 to be long term. So what happened with the vaccines is that everyone got very comfortable,
00:40:05 including the CDC saying, if you’ve been vaccinated, this is the end of the pandemic for
00:40:10 you. And let’s keep it up. But then Delta comes along and waning immunity comes along. And both
00:40:17 of these things compound exactly as anticipated to get breakthrough cases. And unfortunately,
00:40:24 what we’re seeing now is the CDC and the administration went so all in on saying that
00:40:30 breakthrough cases are rare, that transmission doesn’t really happen if you’re vaccinated
00:40:35 without great data, especially with Delta, that once people started seeing breakthrough cases,
00:40:41 they started interpreting that as a failure of the vaccine. The vaccines are still working to
00:40:46 keep people out of the hospital for the most part, but they’re not working to stop transmission.
00:40:53 And if our goal is to stop transmission, which until we decide as a society that we have different
00:41:00 goals, like we’re okay with people getting ill and letting transmission go because we don’t want
00:41:06 to worry about it anymore. We’re not there yet. So until we decide that we’re not going to stop
00:41:10 transmission, we need other avenues besides the vaccine because it’s not doing it. It also means
00:41:16 that herd immunity isn’t going to happen. And unfortunately, as long as we keep letting spread
00:41:21 happen in the context of vaccinated people, we’re kind of giving this virus a bootcamp
00:41:27 of exactly what it needs to do and mutate to get around our vaccine derived antibodies.
00:41:33 And that makes me very nervous. So the more we can do to stop spread
00:41:38 in the unvaccinated, in the elderly vaccinated, and in other people,
00:41:43 the better. We just should be focusing on that. So in your eyes, the solution would look like this.
00:41:49 You would make enough tests where every single person will get tested every single day?
00:41:53 I think that that would be… I don’t want to do that actually. I want to do a variation on that.
00:42:00 I think what we should do is have a dynamical testing program. It doesn’t have to be
00:42:06 complicated. Every household has a box of tests in their cupboard. And if you haven’t seen any
00:42:14 cases in your community for a long time, stop testing. Do wastewater testing to see if there’s
00:42:19 any RNA coming back. If you start to see RNA in the wastewater that represents the virus,
00:42:25 and you’re still wanting to stop outbreaks, you say, hey, you know those tests that are in your
00:42:30 cupboards, households in this county, why doesn’t each household or each person in each household
00:42:35 use one test per week? Can you start to just pause on that idea? That’s really cool, the wastewater
00:42:44 testing. That’s the thing? So you can get a sense of how prevalent the virus is in a particular
00:42:49 community by testing the wastewater? That’s exactly right. And so the viral load associated,
00:42:56 the viral load that you can find in the community represents the prevalence of the virus in the
00:43:02 community, which is really quite nice. That’s a nice way to paint like a map of the intensity
00:43:08 of the virus. Okay, so when it goes above a certain level, you can start doing much higher
00:43:17 frequency testing in each household. That’s right. So I don’t want people to be in testing purgatory,
00:43:23 like that’s not what I want. I just want us to get through this damn pandemic. And so we can
00:43:29 monitor the wastewater or any other methods. We can monitor the hospitals and the clinics. And
00:43:34 if somebody does come in with COVID like symptoms, and then a few other people come in,
00:43:38 you realize, okay, we got spread happening in our community. Send out a text message,
00:43:43 put it on the news, put in the newspaper, whatever you need to do, tell people, tell families,
00:43:48 use your test. And if the cases get worse, because you’re just doing it once a week,
00:43:53 that’s not going to stop transmission, but it’s going to enable you to identify where outbreaks
00:43:58 are happening. If you start to find outbreaks in pockets, then the rule is simply, okay,
00:44:03 let’s squash the outbreak real fast. So everyone in that area in certain zip code or whatever it
00:44:08 might be, test every two days for seven days or every day for seven days, and you’ll get rid of
00:44:15 the outbreak. We can do that. And if you’ve now gone, again, a week or two with no cases
00:44:23 identified, stop the testing again. That’s the nice thing that everything changes when people
00:44:28 have the tests in their home. It becomes dynamic. It can become easy. You send a text message,
00:44:35 take your test today. If some people don’t do it, that’s fine. The only goal is to get R below one,
00:44:41 and you stop the outbreak. People think it has to be near perfect. I always hear people say,
00:44:48 oh, what if somebody doesn’t use it? Or what if somebody lies? Well, you have 98% of people
00:44:54 testing or even 50%. That’s a whole lot better. And another big difference that people, I think,
00:45:00 oftentimes have a problem wrapping their head around, especially to an extent physicians who
00:45:07 are used to different kinds of metrics, is that all we have to do to completely stop an outbreak
00:45:14 from spreading in a community is to get, for every 100 infected people, to get them to go on
00:45:21 and infect 95. Most people would say, oh my God, that’s a horrible program. You’re still letting
00:45:29 100 people go and infect 95 people. But for a virus like this, that’s a massive public health
00:45:36 win. If you can get 100 people to infect 90, most people, doctors, I would say, like a lot of people
00:45:42 would say, that sounds like a failure, to be honest. But if you do that for multiple days in
00:45:47 a row, then in a couple of weeks, you’ve gone from a big outbreak to a very, very small outbreak.
00:45:53 And on the other hand, if you don’t do that, if you allow 100 people to just infect 140 people,
00:45:59 because you’re not doing the testing, then instead of having 20 people at the end of
00:46:03 those four weeks with the testing, you literally would have 600. Massive differences here.
00:46:10 The only goal then is to get R below one, have 100 people infect less than 100, and you stop the
00:46:16 outbreaks and everyone stays safe. From everything you’ve seen, how cheap can these things get?
00:46:21 From like in the past year, in terms of the developments you’ve seen with the various test
00:46:26 manufacturers, how cheap can it be to make a test, to manufacture a test? So there’s the
00:46:32 manufacturing process that could be 50 cents, maybe less. It’s hard to really have eyeballs
00:46:38 inside these companies in terms of where they’re producing them in China and Taiwan, a number of
00:46:43 other places. Some of them are produced here in the United States too, but 50 cents, say,
00:46:49 was a very, very reasonable, generous number for how much it costs per test.
00:46:54 You look at a place with high market competition that has actually authorized a lot of these tests
00:46:59 like Germany. Germany has 60, 70 some odd different companies of high quality rapid tests
00:47:04 authorized. You can go there and buy it for 80 cents, and they’re still making a profit.
00:47:10 And so it’s extremely cheap. Market competition can drive these tests way down in terms of cost.
00:47:19 I think one of the most important features of a rapid test program is what do you do with the
00:47:25 result? Is it going to be used for you to gain entry to school or work? Is it going to be reported
00:47:33 to the public health agencies? All of these, the primary mode should be just get people tests,
00:47:38 but really if you’re going to be using it for a workplace thing, like what Biden is now saying,
00:47:42 vaccinate or test, which is going to lead to a crisis if we don’t fix this soon because we’re
00:47:46 going to have massive demand for testing in the next couple of weeks. But when he says that,
00:47:52 that’s essentially saying, okay, companies need to make sure that their people are testing.
00:47:56 So are you going to base it on the honor system? I would say you probably would not base
00:48:02 testing on the honor system if it’s like to take somebody who would otherwise be quarantined from
00:48:08 work in school. And so you can go to school as long as your test is negative. So test to stay
00:48:13 program is a big thing that I’ve been pushing for and others have. Businesses bringing people into
00:48:19 work who need to test, they need to have verification, but they don’t want to set up
00:48:24 nursing stations in their lobbies or in the school parking lot or whatever. Everyone’s tired of that.
00:48:30 We need to bring the tests into the home, but that means we need the technology to enable it.
00:48:34 And so I was at a conference recently. Do you know Mike Milken? Milken Institute. He’s a very
00:48:42 wealthy billionaire, but he’s done a lot of philanthropy and he has a conference to raise
00:48:46 money for prostate cancer research. I was at this conference recently, Francis Collins,
00:48:52 a number of other people were there. And every morning we all had to test in the morning,
00:48:58 which I thought was a great idea obviously before we walked into that conference. But you didn’t
00:49:05 have to test there and they didn’t base it on the honor system. Every morning I scanned a QR code on
00:49:11 the box and eMed, which is a service that provides test verification, popped up with a proctor right
00:49:19 on my phone or on my computer and said, okay, let’s go through your tests. And they watch you,
00:49:25 they videotape you using the test. So it’s all recorded. It’s all a reportable type of test.
00:49:30 And at the end of it, just from your home, you don’t actually see the proctor,
00:49:35 you know, but they’re just verifying that you actually do it. They verify the test,
00:49:39 they verify the test results with you. And at the end of it, you’ve then gotten
00:49:45 from your couch or from your car, wherever you are, an actual verified laboratory report that
00:49:51 can be considered proof that you yourself use the test and you yourself got a negative.
00:49:56 So the tools are out here if we want to use them at scale. And in fact, the CDC uses eMed now to
00:50:03 enable people to come back into the United States through an antigen test. So before you get on your
00:50:08 flight, you’re sitting in the airport in Heathrow or wherever you are, you can get on your computer,
00:50:13 use your eMed test, and you get the negative and CDC will accept that, TSA will accept you to come
00:50:19 back into the US with a rapid antigen test that you did without anyone else watching,
00:50:24 except for this proctor on your phone. Super simple.
00:50:27 How much private information is being collected? So like this, you know, people have in the United
00:50:33 States, the American way, they have a hesitancy on the overreach of government in things like
00:50:41 vaccine passports, like using any mechanism of verification that’s controlled by government
00:50:50 can lead to overreach by said government. So there’s a concern of that. Do you see there a way
00:50:58 of achieving testing that’s verified but does not violate people’s privacy or sense of freedom?
00:51:06 Absolutely. I think so. The way that right now in the United States, they’re requesting that
00:51:13 these tests get, that the results get delivered to public health agencies. But I’ve long held that
00:51:20 while that’s ideal, it should never be the thing that holds up somebody being allowed to know their
00:51:25 own status. But if you are going to work and you have to let your boss or your manager, whomever,
00:51:32 know that you were negative that day, or if you’re going to school, I think it’s going to be hard to
00:51:38 maintain complete privacy in that situation because they need to know your name. But sure, I mean,
00:51:46 could you cut off the public health reporting? Yes, you could. But I worry, I mean, can you opt
00:51:51 out? Maybe you could opt out. That should be a feature. I want to opt out of the public health
00:51:56 reporting because for whatever reason, otherwise I’m not going to do the test. But that means that,
00:52:03 okay, then you’re not going to go to work. So right now there’s this serious tension and
00:52:08 I am very uncomfortable with the idea that we force anyone to do anything. But there is a tension
00:52:14 between these two things for sure. And how do you balance that during a public health emergency?
00:52:21 I think first and foremost, let people, everyone has a right to know their status.
00:52:25 Right. The fact that we have made it hard for people
00:52:28 to know their status on their terms, I think is a travesty. I mean, it’s just so
00:52:34 terrible that we have prioritized us knowing at the expense of you. Essentially what public health
00:52:42 has long said during this pandemic is, if I’m public health, if I can’t know, then you can’t
00:52:48 know your status. That’s not the right way to look at public health. We need to engage the public.
00:52:54 And if some of them don’t want to participate in the public health part, but want to know
00:52:58 their status, by default, they are participating in public health, whether they know it or not,
00:53:03 because they’re not going to go get their mom sick by mistake. At least most people wouldn’t.
00:53:07 And then also you can create systems where you can, individuals can form
00:53:14 relationships based on their status without ever reporting it to a centralized place.
00:53:21 So you can go to, I don’t know, a local business owner might require that you show
00:53:28 that you’re negative, but that doesn’t require reporting it. You can, like there might be
00:53:35 basically like an ID that’s only in possession, you are the only person in possession of that.
00:53:42 So you literally show it, here’s a test I took, it’s negative and nobody else knows about that test.
00:53:48 So that could very well be done, even through a company like eMed. I think, and I might be wrong
00:53:53 here, I believe that they take the test result, and because they are considered a CLIA waived
00:54:00 laboratory, like a digital laboratory, they report their results by law out to the public health
00:54:07 agencies. But let’s say there was something a little different. Let’s say you were verifying
00:54:11 an over the counter test, and it doesn’t have to be a CLIA waive because it’s over the counter,
00:54:15 then you’re not bound by CLIA rules. And you could create the same service, but that just doesn’t
00:54:21 report out to the public health agencies. It gives people the option to opt in or out of public
00:54:27 health reporting. And I know that public health people get a little queasy when I talk about this,
00:54:34 but as a public health person myself, I guess of course I would prefer that the data be available
00:54:41 to evaluate to know where the cases are. But first and foremost, I want to make sure that the people
00:54:45 using the test are going to use the test. And if that means that they’re not reporting, and if
00:54:52 that’s the only way that they will use it is if it’s not reported, then that’s better than no test.
00:54:58 Especially given that the central to the vaccine hesitancy is a distrust of authority and the
00:55:05 distrust of government. So you’re asking people to get tested and report their status
00:55:17 to a centralized authority when they clearly do not trust that authority. It doesn’t make any
00:55:22 sense. It seems like a perfect solution to let people who are hesitant on the vaccine
00:55:28 to get their own status and have full control of that information and opt in,
00:55:33 provide that information if they wish to, but they have the full control of it and have the
00:55:37 freedom to do that information what they want. I fully agree with that. I really do. I think
00:55:43 we can have the verified services and we could have the privacy if you want it. If you need to
00:55:48 go into a restaurant and there’s a rule that you have to be a negative test, have it on your phone
00:55:53 and only your phone. And it’s okay. Like emails you the lab report, you have it. You can say,
00:55:59 look, that’s my name. I used it this morning. Negative. And in that case, you’d want something
00:56:04 that just is there and is not going anywhere else. And I think that those services, I think they can
00:56:10 exist. And it’s a struggle because for those companies, they don’t want to fall out of favor
00:56:17 with the CDC or with the FDA. And so this is a big problem in our marketplace in general by having
00:56:24 private companies who want to be the public health agents of this pandemic. We lose a lot of control
00:56:33 because the companies ultimately have to do what’s going to make them money so they survive and keep
00:56:38 performing the service. It’s really just such a hard problem. And this is why last time I was here,
00:56:45 I’m guessing I was probably really pushing for the government to be producing these tests. I think I
00:56:52 would have still been pushing for that. At this point, I’ve decided, okay, the government’s clearly
00:56:56 not going to do that. I’ve been thinking, I really want Elon Musk to produce the tests. I really am
00:57:03 sort of serious that these tests are simple to make, but we’ve been using machines to make them
00:57:09 that have been around for a long time. Scale is an issue right now, kind of. Really, it’s the EUA
00:57:15 process and getting the companies to be allowed to market in the US that’s the issue. But let’s
00:57:19 just say scale is the issue. And one company wants to make 20 million tests a day. These aren’t that
00:57:26 hard. We should be able to do that. We just need a faster machine, a better machine, and a quicker
00:57:31 one. And there’s a few folks, like you mentioned, know how to solve that problem. I’ve had a lot of
00:57:36 discussion with Tesla folks and know with people that used to work at Tesla, like Jim Keller,
00:57:41 about how to make stuff much cheaper, much better. That’s basically what Tesla is world class at.
00:57:46 It’s like, okay, does this thing have to cost $1,000? No, it can cost $10. And let’s figure out
00:57:53 how to manufacture it. Those folks are like the best in the world at doing that. Okay, but what
00:58:00 about this Biden action plan? So it sounds like the guy agrees with you, vaccinate or test. So
00:58:10 I think given that choice, a lot of people go test in America because there’s like a division,
00:58:15 it seems like. So is this just politics? Is this just words? Or do you think this is actually
00:58:22 going to lead to something? And maybe can you explain what the action plan is?
00:58:27 Sure. So there’s a number of pillars to the action plan. The two that I’ve been most focused on,
00:58:34 I mean, some of them are we want to get everyone vaccinated. We want to get everyone vaccinated.
00:58:37 All these things. And one pillar is saying any company in the United States that has
00:58:45 more than 100 employees is now required to ensure that any unvaccinated individuals in their workforce
00:58:55 test weekly. Another pillar is that the president’s going to reduce the cost of PCR tests.
00:59:04 By 35%, which is pretty moderate reduction. And is going to reduce the cost of antigen tests
00:59:14 and scale them up and make 280 million tests and put $2 billion into it.
00:59:22 So those are the two that I found most intriguing for the kind of mission that I’ve been on, which
00:59:26 is to just educate people around, hey, we have really, really powerful products that we can
00:59:31 educate people around. Hey, we have really, really powerful public health tools we have yet to deploy.
00:59:39 The issue at hand though, is that now that the president has said vaccinate or test,
00:59:47 there’s a problem inherent in that. It’s essentially to coerce people around vaccinated
00:59:52 to get vaccinated. Because vaccinate or test doesn’t make sense when the vaccinated people
00:59:56 can transmit the virus just fine. It should be vaccinate and test.
01:00:00 Exactly. The problem that I have with that vaccinate or test idea is it’s great if you
01:00:05 want to use it as a coercive effort to get people vaccinated. I’m not going to wade into that
01:00:12 argument. Do I agree with it or not? I’m just not going to even put my words under.
01:00:17 I disagree with it. Let me say, I disagree. As opposed to doing great science communication,
01:00:25 this weird, people talking down to the populace as if they’re children trying to trick them.
01:00:31 Here, have some candy. Everyone with common sense. Somebody told me I was having a conversation.
01:00:40 If the government is going to give you money to take the vaccine,
01:00:43 people that were already hesitant about the vaccine are not going to trust whatever the
01:00:49 heck you’re doing. Don’t trick people into taking the vaccine. Be honest and communicate
01:00:54 transparently everything that’s known about the vaccine. Communicate the data. Inspire people with
01:01:04 transparency and real communication of all the uncertainty around it and all the difficult
01:01:10 decisions of risk and all those kinds of things. As opposed to trying to trick them like children
01:01:16 into taking the vaccine anyway. Yes. Okay. Well, I didn’t have to say that.
01:01:22 So there we go. But you’re saying it should not be like vaccinate or test. That tradeoff
01:01:28 does not make sense. Exactly. By saying vaccinate or test is absolutely confusing
01:01:35 because it implies for anyone who’s thinking about it, it is implying. And I’ve seen this
01:01:40 because I have business leaders call me, Fortune 500 business leaders who call me and say,
01:01:44 what do I do? I have 8,000 employees. Where am I going to get my tests? And a lot of people are
01:01:50 saying, they’re calling this a pandemic of the unvaccinated. These types of divisive language
01:01:58 doesn’t help. This isn’t a pandemic of the unvaccinated. This is a pandemic of a fucking
01:02:02 virus. Don’t ever put it on the unvaccinated who frankly are just scared. They don’t know who to
01:02:09 trust. And we haven’t given them a lot of reason to trust public health, to be frank. So I agree.
01:02:17 I mean, now that you’ve opened the door, I’ll just say my piece. Absolutely, we need to be the most
01:02:22 honest we can with all of this. This is confusing language to say vaccinate or test. We need to be
01:02:30 very upfront and say, look, vaccines aren’t stopping transmission very well. Unfortunately,
01:02:37 this is the world we have. We have Delta. We’re going to have new mutants. We have a vaccine that
01:02:43 wanes somewhat over time. This is biology. I’m sorry. This is just what it is. And then we say,
01:02:50 but the vaccines are really protective for your personal health. They’re going to keep you out of
01:02:55 the hospital. This is what you should care about as an individual. And as a population,
01:03:01 we need to figure out, okay, we have to stop transmission if that’s our goal.
01:03:05 So we should use the tools that are going to stop transmission if that’s our goal. And saying
01:03:09 vaccinate or test, if our goal is to actually stop transmission, that’s confusing because vaccines are
01:03:15 not stopping it. There may be mildly lowering the risk of transmission. So I’m just not a fan of that
01:03:22 language. I think we should be being very, very clear, like you said, and upfront about what are
01:03:26 the limitations of the vaccine and of the test. And we should be very clear that it can only help.
01:03:34 The American public in aggregate is extremely intelligent. They will figure out when you say
01:03:41 that vaccine breakthrough cases are rare, and then they start seeing story after story of whole
01:03:47 parties of people who are vaccinated have outbreaks. And everyone knows more people now
01:03:52 who are having breakthrough cases than they knew who had regular cases before the vaccine.
01:03:57 People start to wonder, hmm, well, this is weird. They say that the vaccines are working,
01:04:02 breakthrough cases are rare. Maybe the whole vaccine program is failing entirely.
01:04:06 And so it ends up shooting ourselves in the foot if we try to create false expectations,
01:04:11 because we think it’s going to be beneficial for one thing when it’s not for the other.
01:04:16 And so to get back to the action plan, vaccinate or test, I think, and the increase in rapid tests,
01:04:25 I do think it was a bold move. I would say that it was the most prominent sort of display,
01:04:33 encouraging display of the fact that rapid tests are indeed effective public health tools.
01:04:40 My real concern now is that 280 million tests, that’s like less than one per person per year
01:04:46 in the United States. So that’s not the way that he said and delivered it. And what most people
01:04:52 think of when they hear the word 280 million, you don’t usually put a lot of thought into,
01:04:56 what does that number mean? It sounds a big number. Most people are now going to be expecting
01:05:01 that these tests are actually going to be staying in stock on the shelves at CVS and Walgreens and
01:05:06 Amazon or whatever. So that’s crisis number one is like, now the expectation is set for having rapid
01:05:13 tests, but they’re not going to scale that well. We won’t have them. And then there’s vaccinate or
01:05:18 test. And that’s going to bring millions and millions of people who are not currently testing
01:05:23 to have to start testing. So that’s going to overwhelm our PCR labs. And it’s going to create
01:05:28 five day delays again with PCR, if not longer, because we’ll have backlogs. And so the only real
01:05:34 solution to this is to just scale up the tests that are actually scalable. And that’s the simple
01:05:39 rapid tests. And it’s not even to scale them up through production and manufacturing here.
01:05:44 It’s to open the doors so that the companies that already exist here and can scale are allowed to do
01:05:50 it and to bring in the international market. Some of the biggest diagnostic companies in the world
01:05:56 are not selling their millions and millions and millions of tests in the billions of tests in the
01:06:00 United States because they don’t want to play the game that the FDA is currently requiring of them.
01:06:07 So we have an opportunity and I am very encouraged that the president actually did put these into the
01:06:12 action plan. And I do want to say for the record that I’m supportive of it in principle. But I
01:06:18 think now we actually are in the time where it has been set and we have to deal with the crisis before
01:06:25 it happens. Otherwise, there could be some real political points taken off. I do worry that the
01:06:32 president, if he doesn’t pull through with this and really make the tests available and we end
01:06:36 up getting into this other test crisis this fall, there could be political consequences to that.
01:06:41 And the reason is these rapid tests are so personal, they become emotional almost.
01:06:46 They give people that empowerment that I was talking about earlier. And when people can’t get
01:06:51 that because the shelves are out of stock, they actually feel frustrated and then that converts
01:06:57 into anger and blame. And so I do think that we have to be really smart about making a policy
01:07:04 like this and then ensuring that we can carry through with what the average American is actually
01:07:09 expecting. And speaking of politics, one of the great things about testing, maybe you can correct
01:07:16 me, but from my sense, it’s one of the only solutions to COVID that has not yet been politicized.
01:07:23 So masks and vaccines, whether you like it or not, have been heavily politicized where there’s
01:07:30 literally a red blue split on the use of those or like proud use, effective use of those tools.
01:07:42 And it seems like everybody I talked to about testing, everybody’s on board, red or blue.
01:07:47 They are, which is why I am particularly concerned about the vaccinate or test policy.
01:07:53 Because all of a sudden we just politicized it. We just
01:07:56 brought it with this thing that was fully bipartisan, really bipartisan. I mean, I’ve
01:08:01 talked to the fully, the really right side of Congress and the super liberal side of Congress,
01:08:08 the Senate, the same politicians, governors everywhere in this country have asked me for
01:08:14 support around these rapid tests because it’s just, you can have it reported or not. You can
01:08:20 have it in the home, in the privacy of your own home or not, or you do it at school.
01:08:24 And these tools are just so powerful to identify infectious people. They didn’t have to be
01:08:29 politicized. They still don’t. I don’t think that the action plan went so far that it’s going to
01:08:34 politicize them. But I do think already it’s starting to conjure up emotion saying, well,
01:08:39 now I have to get tested. The have to part, right. And that is where we go wrong. I have to get
01:08:46 we go wrong. I have to get tested or vaccinated. Screw that. I am independent, whatever. And
01:08:57 I do worry that this thing that was purely bipartisan, that we could have just scaled
01:09:02 up months ago. People would have, we could have delivered it to every household. Didn’t even have
01:09:05 to ask people to request it. Just delivered packages to every home in America by now easily.
01:09:12 And if we were smart about it, you know, we could have done it. The most unpleasant thing about
01:09:17 COVID is the uncertainty. And that’s what leads to fear on both the vaccine hesitant,
01:09:24 is the uncertainty about the vaccine and people who have taken the vaccine, the uncertainty around
01:09:32 like, am I in danger walking around? Can I go, can I walk down the hall? Like this fear of the world
01:09:38 around you. And I think testing allows you to remove a lot of that uncertainty. Like you,
01:09:45 you gain back confidence that you can operate in this world and not get infected and you become
01:09:50 like a nicer person. I find myself every time I get tested, I become a nicer person to others
01:09:56 because I know I’m not putting them in danger. I’m not putting people in danger.
01:10:00 It’s a, it’s a heavy burden to carry to worry. Am I infectious? Like I was out last night,
01:10:07 but I do want to go see my mom today, you know, like, am I infectious? I don’t know. And this has
01:10:12 created massive anxiety and I can’t, I completely agree that it is, it’s a relieving feeling and,
01:10:22 and it’s an amazing feeling to be in a room when, and I did this in the middle of the pandemic when
01:10:27 everyone was supposed to be wearing a mask indoors and everyone rapid tests, you know, and I said,
01:10:34 everyone should rapid test before you walk into this room. And it was a wonderful experiment
01:10:40 because everyone was just so relaxed. You know, the other, the alternative is everyone, nobody
01:10:46 tests and everyone wears a mask. You have a mask that maybe gives you 20% maybe protection during,
01:10:54 if you’re all in the same room together, if that, or you have a rapid test program where everyone
01:10:59 rapid test before, and that gives you like 95% to a hundred percent protection, not a hundred
01:11:04 percent, but close. And all of a sudden that allows everyone to take a big sigh and be like,
01:11:10 wow, this is the first time I’ve seen people without masks indoors in a long time. And I feel
01:11:15 pretty good. And restaurants, like restaurants are scary right now because you just don’t know
01:11:20 who might be infectious and nobody’s masked. And like, wouldn’t it be great to just go into
01:11:27 a restaurant where you know that everyone just tested negative that day? It just really reduces
01:11:32 anxiety. It makes individuals feel empowered. And I mean, at the end of the day, COVID and
01:11:39 our response to COVID is a, it’s truly an information problem. You know, why do we
01:11:45 quarantine anyone? Why did we ever close anything down? We didn’t close things down because everyone
01:11:49 is positive. We closed things down because we didn’t know if anyone was positive. We quarantine
01:11:56 a whole classroom of kids, not because they’re all positive, but because we don’t know if one
01:12:01 of them are positive. And so we just quarantine everyone when there’s a positive in the case,
01:12:05 in the, in the classroom, like one day, we’ll then ask the whole classroom not to come to school for
01:12:09 10 days. That’s not a biological problem. That’s an information problem. And the crazy thing is we
01:12:17 have the tool to solve that information problem. It’s literally our eyes on the virus. It’s how
01:12:23 we see this virus. And if everyone glowed green, when they were infectious, we would have never
01:12:27 had to close down anyone, any society. And we would have never had the outbreaks because we
01:12:31 would have been able to stay away from the green people, you know? And yeah, I like what you said,
01:12:36 the quarantine is an information problem. That’s absolutely right. What, is there something you
01:12:40 can say to what people can do, like listening to this, individuals? Do you just complain like
01:12:48 loudly? Like, why can’t we do this? Can you speak with your money somehow? What, what can people do
01:12:55 to help? God, it’s, it’s amazing to think you’re asking me this question and this video will go
01:13:01 out to, you know, the web and all the people that watch you. And last year in July, maybe
01:13:08 something like that, June, I forget exactly when it was, I was on Twiv this week in virology.
01:13:14 Shout out to Twiv. Those guys are awesome. They are awesome. I love, I love Twiv.
01:13:19 And they asked me the exact same question towards the end. They said, this makes so much sense. You
01:13:23 know, why wouldn’t we do this? What can people do? And so I said, oh, you know, just send me an email,
01:13:29 like write to me. I’m sure you could find my email somewhere online and get in touch and I will,
01:13:35 you know, and we can try to figure out how to make something happen. Bad idea.
01:13:41 Very smart.
01:13:43 Way too many emails. I didn’t, I feel bad because I didn’t end up getting back to anyone because I
01:13:47 just got inundated. But it did lead to the development of rapidtest.org where we did
01:13:53 automate the process of writing letters to congressional members and elected representatives.
01:13:59 So that helps. Fast forward to today. What can, what can people do? I honestly don’t know. Like,
01:14:07 what can the average person at this point do? We have tried everything. The FDA is immutable on
01:14:13 this. They will not change and we shouldn’t ask them to change because they have decided that this
01:14:19 is how they regulate medical devices and they’re going to stick to it. So what we need to do,
01:14:23 what we need to do, and maybe this is something to do, is get, if you know people who have sway
01:14:31 over politicians, lobbyists, whatever it might be, let people know to request that the president,
01:14:37 literally the president of the United States, uses executive powers to just do a simple,
01:14:45 something as simple as designating these powerful public health tools as public health tools.
01:14:50 Allow the CDC and the NIH or whomever it must be or academic centers of excellence designated by
01:14:58 the CDC to evaluate the tests in a very fast fashion with the appropriate metrics that these
01:15:05 tests need to achieve for public health. And within two days we can have 10 new tests authorized.
01:15:12 You know, this doesn’t have to be a six to 12 month endeavor. This could be a two day
01:15:16 endeavor. We actually did it. I judged the rapid test XPRIZE and it went great. We actually got
01:15:22 incredible metrics about how well does each test work and no clinical trials, you know,
01:15:28 just a couple days worth of work in the lab and boom. And if we actually systematize it,
01:15:33 it would be an hour or so in the lab. You know, so simple. So I don’t know. I mean,
01:15:39 I don’t know how to really impact change. Thankfully, you know, I have a platform and
01:15:44 I’ve been able to start talking with people who are very close to the President and the White
01:15:49 House. And I do think that some change is finally happening because the silver bullet of the vaccine
01:15:57 has not panned out to be the silver bullet. So now we got to now I think we’re moving from a country
01:16:03 that was a vaccine only approach to finally recognizing at the highest levels that there’s
01:16:08 other tools. Do you think it’s possible to reopen fully without solving the testing problem
01:16:15 completely? Like, do you think this vaccine approach will get us to reopen fully? I do.
01:16:22 Yeah, I think over time, though. I mean, if we a lot of people ask me, like, what’s what’s like
01:16:29 happening? Like, what’s the end game here? Like, where does this end? And it’s actually not a
01:16:36 mystery. The end game is we will grow out of this virus. And by that, I mean, you and I
01:16:46 and most people who are watching this are adults, right? Adults don’t like to get infected with a
01:16:53 virus for the very first time as adults. Babies are OK with it. And so what we have to do to
01:16:59 understand how we’re getting out of this virus is to look at babies like at newborns and say, OK,
01:17:06 how does a baby get out of their high risk time period? They get exposed. They get exposed multiple
01:17:12 times or vaccinated, of course. And eventually they get exposed enough that they build up this
01:17:18 nice cushion of immunity that’s sufficiently diverse that they can battle whatever gets
01:17:22 thrown at them because they’ve seen it all already. But one exposure doesn’t do it. I mean,
01:17:28 over the course of the first few years of life, kids get exposed to coronaviruses tons of times,
01:17:33 lots of different viruses they get. So unfortunately, what’s happening with us,
01:17:37 why this is so bad for us, is that as we’re adults, we don’t regenerate tissue very well.
01:17:43 We have like overabundant inflammatory response. We have all these problems that when we get an
01:17:47 infection for the first time, it sucks. It harms us. It causes us problems. But over time, just
01:17:53 like a baby, we’re going to start building up our immunity through vaccines and exposures.
01:17:58 And I hate to say it, but tons of people are getting exposed to Delta right now who don’t
01:18:03 know it. Tons. And if you’re vaccinated, you don’t know it, is my point there. And at the end of the
01:18:12 day, this is actually, I do not want this to be misconstrued as like saying, go get infected.
01:18:18 But the fact that people are getting infected will add to our level of protection later on.
01:18:23 And so… Yeah, but the question is how long that whole process takes. I think, you know,
01:18:28 my guess is probably by the end of next year, early 2023, we will probably start looking at
01:18:34 this as though it is not a particularly dangerous virus for most people. The elderly though,
01:18:39 it will still be, but that’s because their immunity… Variants and stuff. And I’ve heard
01:18:43 other people say the statement you just said a year ago about the spring, right? Well, that
01:18:50 probably was not wise. Well, I mean, it’s because the intuition is like, okay, now that there’s a
01:18:56 vaccine, you’re either going to take the vaccine or get infected and then there’ll be herd immunity
01:19:01 over, like it’ll be very quick. So, you know, that’s the intuition, but it seems like that’s not
01:19:09 happening. It seems like we’re in this constant state of fear mongering for different reasons.
01:19:16 It’s almost like the virus got deeply integrated, not into just our biology, but
01:19:24 in the game of politics and in the fear mongering around the news because the virus now started
01:19:31 being together with the vaccine and the masks and it started getting integrated into the division
01:19:39 and that’s so effective at monetizing social media, for example. And so it’s like, all right,
01:19:47 so how do you get out of that? Because you can always kind of present certain kinds of numbers
01:19:52 about number of cases or how full hospitals are and start making claims about that we’re still,
01:20:01 this is as bad as it’s ever been, those kinds of statements. And so I’m not sure exactly what the
01:20:06 way out is except the same way out as it was originally, which is testing is information.
01:20:13 Yeah.
01:20:13 It’s information.
01:20:15 Yeah. And I think we can do that. We can keep outbreaks suppressed with testing because it’s
01:20:21 information. Like people keep thinking of tests as being medical things. They’re not,
01:20:24 they’re information. It can allow us to control things. Just like we drive down a road and we
01:20:31 look at the cars and we don’t hit other cars because we have the information that they’re
01:20:35 in the lane next to us and they’re moving over. That’s just information.
01:20:39 Like you said, glow green. The problem with the virus, you don’t see. You’re walking around
01:20:45 and everybody is a potential infectious creature. And so if you see the world as a potential for
01:20:54 infection, you’re going to be terrified of that.
01:20:56 That’s exactly right. And that is what has happened. And that’s why I’ve been pushing so
01:21:01 hard for these tests because they can allow people, if you use them at a community level,
01:21:06 you can have enough people know that they’re positive, enough people are good people that
01:21:10 they won’t go out and infect others. And the other great thing about them is again,
01:21:15 a 10 day isolation period, especially for a vaccinated person, but in either case,
01:21:21 is also an information problem. We don’t have to isolate for 10 days if we’re infected. What if
01:21:26 we’re only infectious for two, especially if we’re vaccinated? Why are we telling people the only
01:21:31 reason the CDC ever and the WHO ever suggested a 10 day isolation or a 14 day quarantine is because
01:21:38 we didn’t know when people stopped being infectious. There’s actually some people stay infectious for
01:21:43 14 days. It’s rare. But there’s a lot of people who stay infectious for like four. And that’s
01:21:48 a whole nother week that we’re asking people to isolate. People would probably be much more likely
01:21:53 to comply if they only had to isolate as long as they wake up each morning and see two lines,
01:21:58 because you’re actually seeing it for your own two eyes. You’re being empowered to make your
01:22:02 own decision. You’re not being told you need to isolate for 10 days and you’re sitting there
01:22:06 thinking, oh, I feel fine. I don’t know. There’s a lot of asymptomatic spread. But if you see the
01:22:11 two lines every day, then you actually get to, you’re doing a little experiment for yourself to
01:22:18 prove to yourself, today I’m still infectious. Let’s hope it’s tomorrow. Come on immune system.
01:22:23 You can do this. And then you get to day four and boom, you start being negative.
01:22:28 That’s a much more tolerable thing because you are being able to make that decision based on
01:22:34 true data that is empowering you. And it really does change, changes everything,
01:22:40 because it’s all fear and empowerment and these are empowering devices.
01:22:46 Well, I wanted to have this conversation with you because obviously it’s a great solution.
01:22:50 Let’s keep talking about it. People who will listen to this should,
01:22:55 I guess, pressure local politicians, federal, national politicians.
01:23:01 Write articles with the title like, Dear POTUS, please designate these as public health tools.
01:23:08 Or just start talking about it in the media. Talk about it on social media, anywhere.
01:23:12 Testing is a public health good. Testing is a public health good. It should not be considered
01:23:18 a medical device. I shouldn’t have to pay to keep you safe. Testing should generally be free
01:23:26 for that matter, subsidized by the government. These tools exist. We should all… And I think
01:23:32 the more people that generate noise to just say, a public health test is a public health tool.
01:23:40 Period. You can’t even argue with it. That’s just true.
01:23:43 Yeah. I think if you talk about it enough, then certain people that have even a bigger platform,
01:23:49 like Elon Musk, Sunder Prachai, those folks that have power to really do large scale manufacturing,
01:23:58 also influence governments, will pay attention. And that’s the hope. Enough people talk about it.
01:24:04 I think business leaders, like business leaders, obviously have so much power here.
01:24:09 Yeah. They pay the lobbyists who make things
01:24:13 happen. Let’s be honest. There’s people who pull levers that are not the politicians themselves.
01:24:17 And I do think business leaders have so much to gain from these tools to keep their businesses
01:24:23 safe, to not have to quarantine and lockdown. And I hope that all of them hear this message to say,
01:24:29 let’s ask the president or the people around the president to designate these as public
01:24:34 health tools. Change the system. And if you can’t change every aspect of the system,
01:24:39 then figure out how to change the system enough so that you’re doing everything
01:24:43 in a safe way that is not endangering anyone, but it is only protective.
01:24:48 Yeah. You mentioned last time that you spent time as a Buddhist monk.
01:24:54 We didn’t spend much time talking about it. I just would love to talk to you about it a
01:25:00 little bit more. Maybe by way of advice, how do you recommend people can integrate
01:25:08 meditation into their lives? Or how does one meditate?
01:25:14 I think for me, meditation was really an active effort, which sounds weird because most people
01:25:26 think of meditation as the absence of activity. But just like anything, meditation requires
01:25:35 exercise. In this case, it requires exercise and quieting your mind. And the whole… Well,
01:25:42 there’s a lot of different reasons people meditate. Most people watching this podcast or this show,
01:25:49 what is this called? I don’t know.
01:25:50 Is this an interview? I’m not even recording. This is
01:25:53 just you and I talking. It is. Most people are meditating to bring
01:26:01 some balance and bring some sanity to their life and just be able to control their feelings and
01:26:06 emotions a little bit more. And for that purpose, I think the best way to… What meditation is,
01:26:14 if you can call it what you will, it’s just getting some alone time, some time to think
01:26:18 or not think. Whatever looks different for each person. For me, it was a very active effort to
01:26:26 try to quiet my mind with the explicit intent to detach from things, from lots of things.
01:26:34 And it’s actually… It sounds weird in our culture here to talk about detachment as a goal.
01:26:41 Detachment from loved ones, detachment from objects is easy to reconcile. People understand
01:26:47 that, yeah, I don’t want to be too attached to my car or whatever. But detachment from
01:26:52 a loved one is a very hard thing because we want to do the opposite usually. We want to love a loved
01:26:56 one. But in a lot of Buddhist thought, it is those attachments that keep people in this cycle of
01:27:05 rebirth. Now, I don’t personally believe in rebirth in a Buddhist sense in that you actually get
01:27:18 born multiple times. I think my personal feeling is we die and we’re vanished. That’s just me.
01:27:25 But I still really found meditation to be extraordinarily powerful to feel control over
01:27:36 a whole different part of my body that I never thought that it could be controlled, your mind.
01:27:42 You close your eyes and most of us immediately start seeing blotches and we start thinking about
01:27:50 things. And it’s an amazing feeling to start getting to the point where you can actually
01:27:59 quiet your mind and close your mind down so that you can just have peace, silence of your mind
01:28:08 for a long period of time. And I loved it. But it’s kind of a dangerous slope because you can
01:28:14 kind of get caught up in it and really start going from, okay, I’m trying to quiet my mind
01:28:19 to almost being addicted to quieting your mind. And it was a very active exercise every day,
01:28:25 15 hours a day to just practice quieting my mind. And eventually I could. And in Buddhism,
01:28:33 there’s a whole lot of stages that you go through too. Once you hit that point where you can quiet
01:28:38 your mind, then there’s other psychological things that happen. And eventually the end goal for a
01:28:47 Buddhist monk who’s spending their life meditating in the forest is to achieve nirvana, is to have
01:28:54 an absence of any attachment to the point where you’re not even attached to your own foot or your
01:29:00 own leg. You can cut it off. So you don’t even have an attachment to self, to ego? Do you feel
01:29:09 like a conscious being or no? Well, I never attained it, but I didn’t really. So the goal
01:29:16 is you have to first look at it through the eyes of samsara, which is the cycle of rebirth,
01:29:22 which is suffering. It’s a cycle of suffering is how it’s viewed. And the idea is like,
01:29:27 if I really love this hat and then the hat gets lost, I’m sad. So that makes me suffer.
01:29:34 And if I hate this hat and I see it, then it makes me sad or mad. And that is an emotion.
01:29:40 But if I’m completely ambivalent about that hat, I don’t care if it’s there,
01:29:45 I don’t care if it gets lost, if it’s shredded, then that invokes no emotional rise out of me,
01:29:52 good or bad. And so the idea is to find the balance there where you are so detached from
01:29:57 everything that you’re not getting a rise, negative or positive. And this is really,
01:30:03 it’s really such a distinct thing in a relative to our normal lives here in America where we live
01:30:13 for rises. You want happiness and joy. And then you also, nobody wants sadness, but when you come
01:30:20 out of sadness, you feel happy. Either way it averages out. And if it doesn’t average out,
01:30:26 then you’re in a bad spot. That would be things like major depressive disorder where you’re
01:30:31 truly not averaging out. But if you’re living a pretty happy life, that’s why there’s no right
01:30:36 or wrong. You can go up and down and you average out or you can just go that straight line.
01:30:40 So this is not necessarily the Buddhist ideal is somehow obviously the ideal you should strive for,
01:30:49 but the actual exercise of meditation that the Buddhist monks use seems like a
01:30:58 great tool for becoming aware of your own mind. And that seems to be important for
01:31:06 appreciating life. There’s some kind of experiencing life on a deeper level.
01:31:15 I think so. I mean, that’s my personal opinion is yes. And that I think it,
01:31:22 I don’t meditate anymore.
01:31:25 Back in the capitalist Western world where there’s meetings.
01:31:30 That’s right. I mean, I stopped after I was a monk and then the tsunami hit
01:31:34 and I lived in a refugee camp and that was the Indian Ocean tsunami in 2004. And it just really,
01:31:44 it was really interesting in Sri Lanka. They wanted me, I asked, well, what can I do to help?
01:31:49 It was a horrible, horrible hell on earth experience in many ways. But when I said,
01:31:57 what can I do to help? The answer was, well, you could meditate. That’s how, keep doing what you’re
01:32:04 doing. That’s how we can get good karma. And to me, coming from Western roots, I just couldn’t
01:32:11 deal with that. I just said that it doesn’t make sense to me. Why would I just sit and meditate
01:32:16 when there’s so much devastation happening here? And so I kind of stopped meditating then and then
01:32:22 never really recovered from that time in the refugee camp. But I do feel like I understand
01:32:29 or like I am aware of a part of me that most people never get the privilege to be aware of.
01:32:35 And that is a pretty profound feeling, I think, or just awareness to say, if I ever need to go
01:32:45 back to that, I have the capacity to do that. And I do use it. I mean, I don’t use it a lot,
01:32:51 but I use it when I really need to, to try to settle myself, to actually calm myself, whether
01:33:01 it’s pain, physical or emotional pain. It is possible to make those things go away, but just
01:33:09 like anything, it takes training. If you take yourself back to that place you were, Sam Harris
01:33:18 talks about that through his meditation practice, he’s able to escape the sense of free will
01:33:25 and the sense of agency. You can get away from that. Do you ever think about consciousness and
01:33:33 free will when you were meditating? Like, did you get some deep insight about the nature
01:33:40 of consciousness that you were somehow able to escape it through meditation or no?
01:33:46 I looked at it in a much more utilitarian way, I think.
01:33:52 The sensation, like minimizing amount of thoughts in your mind and then beginning to really
01:33:56 appreciate the sensation. You weren’t writing a book on free will.
01:34:01 Right. I mean, maybe if I kept at it, there’s a good chance that if the tsunami didn’t happen,
01:34:08 I might still be sitting there on the top of that mountain.
01:34:10 If there’s tsunamis, you see pain, you see, especially if you see cruelty and you’re
01:34:17 supposed to meditate through that, there’s something in the human spirit that pushes us
01:34:24 to want to help. If you see somebody who’s suffering, to react to that seems like to help
01:34:30 them as opposed to care less through meditation. Don’t become attached to the suffering of others.
01:34:36 Exactly. I mean, that’s, I do think that that’s, you know, and they’re two totally valid ways to
01:34:43 live life. They are, generally, I think they’re ingrained in us pretty early in society.
01:34:50 Right. And it’s hard to escape.
01:34:52 Yeah.
01:34:52 What about just in general, becoming detached from possessions, like minimalism in not having
01:35:00 many things. So, the capitalist world kind of pushes you towards having possessions and
01:35:09 deriving joy from more and more and better possessions. Have you returned back to the
01:35:15 joys of that world or do you find yourself enjoying the minimalist life?
01:35:21 A little of both. I think I really don’t like, I find things to be a burden, to be a massive
01:35:30 burden. And to me, when you have a burden like that, you know, even if it’s just knowing that
01:35:37 there’s like boxes in your basement of stuff, you know, whatever it might be, it makes it hard to
01:35:43 focus. And so, I personally like, I mean, my ideal, like if I had a, my house, for example,
01:35:52 would be to have like nothing on anything. And that to me is like peaceful. Some people find
01:36:01 that to be not peaceful. For me, it’s like, I love to have the idea that if needed, I could like
01:36:10 pack up and move and not worry about anything. Do I actually have that in reality? No. We’re
01:36:19 about to have a baby, you know, but it’s like, I already see it, it’s like stressful. There’s
01:36:24 like boxes of stuff showing up at the house, like bottles and clothes and all these little
01:36:30 hats and whatnot. And I do have to like sometimes go into my meditation to just say like, this is
01:36:39 okay. You know, like it’s okay to have all of this stuff. It’s not permanent, you know. And, but I do
01:36:49 think that it’s easy to get lost in it all. And it’s important to remember given all that, like
01:36:54 people who buy houses, you know, buy a home and buy a house and make a home out of it. And you
01:37:00 start a family. It’s easy to forget that even though you have all these responsibilities,
01:37:05 you’re still free. And like freedom takes work and it takes remembering, it takes
01:37:12 meditation on it, but you’re free. You’re born free, you live free. I mean, depends of course
01:37:18 which country, but in the United States, even with all the possessions, even with all the burdens
01:37:25 of sort of credit and owing money and all those kinds of things, you can scale everything down
01:37:33 and you’re free. But ultimately the people you love, you love each other, it doesn’t take much
01:37:40 money to be happy together. And for me, I personally value that freedom of having the freedom to
01:37:47 always pursue your happiness as opposed to being burdened by material possessions that, you know,
01:37:55 yeah, that basically limit your ability to be happy because you’re always paying off stuff.
01:37:59 You always catch, you know, trying to match the neighbors that are always a little bit richer,
01:38:04 that kind of pursuit. I think that pursuit is wonderful for innovation and for building
01:38:09 cooler, better things. But on an individual level, I think you have to remember that,
01:38:15 first of all, life is finite. And second of all, like your goal is not to get a bigger house.
01:38:20 Your goal is to be just content and happy in the moment.
01:38:24 I completely, completely agree with that. So in looking at our failure at scale
01:38:32 to engineer, to manufacture, to deploy tests, how do you feel about our prospect as a human
01:38:42 civilization? Are you optimistic? So this pandemic, it is what it is. It hurt a lot of people,
01:38:51 both it took lives, but it also hurt a lot of businesses and a lot of people economically.
01:39:00 But there’s very likely to be a much worse pandemic down the line. There might be other
01:39:05 threats to human civilization. Are you nevertheless optimistic?
01:39:10 Oh, I don’t think I’m optimistic about it at all, I think.
01:39:14 What are you most worried about?
01:39:15 It’s one of those things, it’s so existential that I don’t worry about it. But I do think,
01:39:23 I mean, in the United States, for example, so you asked about the human civilization,
01:39:27 but let’s talk about like American society for a moment. I do think that we’re probably seeing
01:39:35 the end of a really interesting experiment, like the American experiment,
01:39:39 and we’re seeing its limitations. We’re probably going to become another blip,
01:39:44 like another power that’s in the history books that like rose and collapsed.
01:39:48 Probably that’s where we’ll go. In terms of civilization, I think we’re demonstrating a
01:39:55 pretty significant inability to recognize the danger, whether that’s the pandemic or whether
01:40:03 that’s climate change. I think it’s extraordinary that we are not taking these things seriously.
01:40:12 Yeah.
01:40:13 And we’re not acting with the urgency. And I mean, in some ways, climate change
01:40:20 truly makes like this pandemic look like child’s play in terms of like the destruction it has the
01:40:26 potential to wreak. I tend to think if you just look at the progress of human history,
01:40:32 that the people who do good in the world outpower the people that do bad in the world.
01:40:41 So there’s something about our minds that likes to focus on the negative, like on the destructive,
01:40:49 because we’re afraid of it. It’s also, for some reason, more fun to watch destruction.
01:40:56 But it seems like the people who build, who create solutions, who innovate, and who just put
01:41:06 like both on the emotional level, so love out there and like on the actual engineering level,
01:41:12 tools that make for higher quality of life. I think those win out if you look at human history.
01:41:19 But the question is whether the negative stuff can sometimes peak to the level where everybody’s
01:41:24 just destroyed. But as long as that doesn’t happen, I tend to believe that there’ll be like
01:41:30 a gradual, with some noise, a gradual improvement of quality of life in human civilization.
01:41:37 I do think so, to a certain extent. But it’s that what you said, like unless there’s like some
01:41:43 significant peak of bad, you know, the problem with bad is that it can happen like that, you know,
01:41:50 good. You can’t build a society overnight, but you sure can kill one. Like I just think about
01:41:58 food crises and instability and just, I don’t know. But I do hope that, I mean, I completely agree. I
01:42:03 think we can engineer our way to a healthier, better world. Like I truly do. My concern is that
01:42:14 the people who are doing that until very recently don’t generally rule the world. Now, of course,
01:42:21 we’re seeing non elected leaders and, you know, people who run massive corporations essentially
01:42:31 having as much or really more power than elected leaders, or than kings and queens and such. So how
01:42:37 they choose to wield that power, you know, is an interesting choice. And I do hope that you’re
01:42:42 right in that over time, fear will drive companies to produce a better product or whatever, you know,
01:42:52 something like over time, it’s just like predator prey models. You get so bad or so everything like
01:42:59 it’s so revved up that all of a sudden, something cracks and they say, okay, I do want an electric
01:43:04 car or whatever. And that takes some combination of innovation, letting people know that you’re
01:43:10 an innovation, letting people know that these electric cars exist. It’s kind of rapid test too.
01:43:15 Like you get to finally feel it and see it, have an electric car. And then all of a sudden things
01:43:20 change and everyone says, oh, this is so bad. And actually I’m doing good for the world, relatively
01:43:25 speaking. And, you know, I guess the paradigm shift, it becomes a, for lack of a better word,
01:43:32 viral positivity does. And I mean, I believe that ultimately that wins out
01:43:39 out because I think there’s much more power to be gained. So I think most people want to do good.
01:43:46 And if you want to wield power, you want to channel people’s desire to do good.
01:43:54 And I think over time that’s exactly what people will do. But yeah, this, I mean, both on the
01:44:01 natural side, the pandemic, you know, there’s still biology at play. There’s still viruses
01:44:05 out there trying to kill us. There’s accidents. There’s nuclear weapons. There’s unintended
01:44:10 consequences of tools, whether it’s on the nanotechnology side or the artificial intelligence
01:44:16 side. Then there’s the natural things like meteors and all that kind of stuff and the climate change,
01:44:23 all of that. But I tend to think we humans are a clever bunch. And when there’s a deadline,
01:44:30 a real deadline or a real threat before us, we kind of step up. I don’t know, but maybe you have
01:44:37 to believe that until the very end. Otherwise life’s not as fun.
01:44:43 Yeah, that’s right. I mean, we’ll have to see, I guess. Well, ideally we won’t be alive to see that.
01:44:50 Well, no, Michael, I’m glad we talk again because this has been such a difficult time
01:45:00 that feels like there’s no solutions. And it’s so refreshing to hear that there’s a solution
01:45:08 to COVID. And there’s an engineering solution on the individual level, something people can do.
01:45:14 On the government level, it’s something people can do. On the global level, something people can do.
01:45:19 We should be doing rapid testing at scale. It’s obvious. It’s amazing that you still
01:45:27 are telling that story, pushing that message bravely, boldly. I really,
01:45:34 really appreciate the work you’re doing. And I will do in my small way the same to try to help out
01:45:41 and everybody else should too until we get hundreds of millions of tests in people’s hands.
01:45:47 It’s an obvious solution. We should have had it a long time ago. And I like solutions, not problems.
01:45:56 And this is obviously a solution. So thank you for presenting it to the world and thank you for
01:46:00 talking about it. It’s something that I can’t not do. If it saves one person’s life, then it was
01:46:07 worth the two years of lobbying for this. And so let’s hope we see a change. Thanks for talking today.
01:46:15 Absolutely.
01:46:17 Thanks for listening to this conversation with Michael Mina. To support this podcast,
01:46:21 please check out our sponsors in the description. And now, let me leave you with some words from
01:46:27 Lord Byron. Always laugh when you can. It is cheap medicine. Thank you for listening and hope to see
01:46:35 you next time.