#254 – Jay Bhattacharya: The Case Against Lockdowns

Jay Bhattacharya is a professor of medicine at Stanford University and co-author of the Great Barrington Declaration. Please support this podcast by checking out our sponsors: – Athletic Greens: https://athleticgreens.com/lex and use code LEX to get 1 month of fish oil – InsideTracker: https://insidetracker.com/lex and use code Lex25 to get 25% off – Coinbase: https://coinbase.com/lex to get $5 in free Bitcoin – ROKA: https://roka.com/ and use code LEX to get 20% off your first order – Indeed: https://indeed.com/lex to get $75 credit EPISODE LINKS: Jay’s Twitter: https://twitter.com/DrJBhattacharya Great Barrington Declaration: https://gbdeclaration.org/ PODCAST INFO: Podcast website: https://lexfridman.com/podcast Apple Podcasts: https://apple.co/2lwqZIr Spotify: https://spoti.fi/2nEwCF8 RSS: https://lexfridman.com/feed/podcast/ YouTube Full Episodes: https://youtube.com/lexfridman YouTube Clips: https://youtube.com/lexclips SUPPORT & CONNECT: – Check out the sponsors above, it’s the best way to support this podcast – Support on Patreon: https://www.patreon.com/lexfridman – Twitter: https://twitter.com/lexfridman – Instagram: https://www.instagram.com/lexfridman – LinkedIn: https://www.linkedin.com/in/lexfridman – Facebook: https://www.facebook.com/lexfridman – Medium: https://medium.com/@lexfridman OUTLINE: Here’s the timestamps for the episode. On some podcast players you should be able to click the timestamp to jump to that time. (00:00) – Introduction (10:18) – How deadly is Covid? (39:48) – Covid vs Influenza (45:42) – Francis Collins email to Fauci (1:06:19) – Francis Collins (1:13:48) – Vaccine safety and efficacy (1:20:46) – Vaccine hesitancy (1:37:21) – Great Barrington Declaration and lockdowns (1:53:39) – Focused Protection (2:15:31) – Fear (2:19:57) – Advice for young people (2:24:56) – Fear of death (2:26:53) – Meaning of life

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Lex Fridman?

  The following is a conversation with Jay Bhattacharya, professor of medicine, health policy, and economics at Stanford University. Please allow me to say a few words about lockdowns and the blinding destructive effects of arrogance on leadership, especially in the space of policy and politics. Jay Bhattacharya is the co-author of the now-famous Grade Barrington Declaration, a one-page document that, in October 2020, made a case against the effectiveness of lockdowns. Most of this podcast conversation is about the ideas related to this document. And so, let me say a few things here about what troubles me.

• 0:41Lex Fridman?

  Those who advocate for lockdowns as a policy often ignore the quiet suffering of millions that it results in, which includes economic pain, loss of jobs that give meaning and pride in the face of uncertainty, the increase in suicide and suicidal ideation, and, in general, the fear and anger that arises from the powerlessness forced onto the populace by the self-proclaimed elites and experts. Many folks, whose job is unaffected by the lockdowns, talk down to the masses about which path forward is right and which is wrong. What troubles me most is this very lack of empathy among the policymakers for the common man, and, in general, for people unlike themselves.

• 1:26Lex Fridman?

  The landscape of suffering is vast and must be fully considered in calculating the response to the pandemic with humility and with rigorous, open-minded, scientific debate. Jay and I talk about the email from Frances Collins to Anthony Fauci that called Jay and his two co-authors fringe epidemiologists, and also called for a devastating published takedown of their ideas. These words from Frances broke my heart. I understand them. I can even steelman them. But nevertheless, on balance, they show to me a failure of leadership.

• 2:06Lex Fridman?

  Leadership in a pandemic is hard, which is why great leaders are remembered by history. They are rare. They stand out. And they give me hope. Also, this whole mess inspires me at my small individual level to do the right thing in the face of conformity, despite the long odds.

• 2:29Lex Fridman?

  I talked to Francis Collins. I talked to Albert Burla, Pfizer CEO. I also talked, and will continue to talk with people like Jay and other dissenting voices that challenge the mainstream narratives and those in the seats of power. I hope to highlight both the strengths and weaknesses in their ideas with respect and empathy, but also with guts and skill. The skill part, I hope to improve on over time. And I do believe that conversation and an open mind is the way out of this. And finally, as I've said in the past, I value love and integrity far, far above

• 3:10Lex Fridman?

  money, fame, and power. Those latter three are all ephemeral. They slip through the fingers of anyone who tries to hold on and leave behind an empty shell of a human being. I prefer to die a man who lived by principles that nobody could shake and a man who added a bit of love to the world.

• 3:33Lex Fridman?

  And now, a quick few second mention of each sponsor. Check them out in the description. It's the best way to support this podcast. First is Athletic Greens, the all-in-one nutrition drink I drink twice a day. Second is InsideTracker, a service I use to track my biological data. Third is Coinbase, a platform I use to buy cryptocurrency. Fourth is Roka, my favorite sunglasses and prescription glasses. And fifth is Indeed, a hiring website. So the choice is health, money, style, or teamwork. Choose wisely, my friends. And now, onto the full ad reads. As always, no ads in the middle. I try to make these interesting, but if you skip them, please still check out the sponsors. I enjoy their stuff. Maybe you will too.

• 4:18Lex Fridman?

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• 5:01Lex Fridman?

  drink it twice a day now, and I rely on it as the nutritional base for all the crazy stuff I do diet wise and exercise wise and all the mental crazy, long hours of deep work and so on. They'll give you one month supply of fish oil when you sign up to athleticgreens.com/lex. That's athleticgreens.com/lex.

• 5:23Lex Fridman?

  This show is also brought to you by InsideTracker, a service I use to track biological data. They have a bunch of plans, most of which include blood tests that give you a lot of information that you can then make decisions based on. They have algorithms that analyze your blood data, DNA data, and fitness tracker data to provide you with a clear picture of what's going on inside you to offer you science-backed recommendations for positive diet and lifestyle changes. The great Andrew Huberman talks a lot about it. David Sinclair talks about it. He's talked about with me on the podcast. In general, I love the idea of collecting biological data and using that data to make decisions. This personalized decisions. It feels like the future. It's like an

• 6:06Lex Fridman?

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• 6:30Lex Fridman?

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• 7:15Lex Fridman?

  That's Coinbase.com/lex. I'm pretty sure I'm going to talk to the CEO soon. I look forward to that conversation. It's an incredible service. I don't care that they're a sponsor. It's just I've been a fan for a long time. I think they've been a big part of bringing cryptocurrency into the mainstream. This show is also brought to you by Roka, the makers of glasses and sunglasses that I love wearing for their design, feel and innovation on materials, optics and grip. Roka was started by two All-American swimmers from Stanford, and it was born out of an obsession with performance. I like to wear these stylish glasses in all kinds of conditions.

• 7:59Lex Fridman?

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• 8:42Lex Fridman?

  I've used them as part of many hiring efforts I've done for the teams I've led in the past. They have tools like Indeed Instant Matching, giving you quality candidates whose resumes and Indeed fit your job description immediately. You may hear in my voice a bit of a melancholy tone. I've just been going through a bunch of difficult things in my life and it's just been rough. One of the things that gives me a lot of, I don't know, hope, just on a basic human level, maybe strength is the better word, is having a great team of people around me. And not necessarily in terms of productivity, but just as human beings. You spend a lot of time with the people on your team.

• 9:26Lex Fridman?

  And so you should do a great job, I guess, hiring them and use the best tools for the job. I happen to be part of a great team already, so I'm really proud of that. I'm really grateful for that. Anyway, right now, get a free $75 sponsored job credit to upgrade your job post at indeed.com/lex. Get it at indeed.com/lex. Terms and conditions apply. Go to indeed.com/lex. This is the Lex Fridman Podcast, and here is my conversation with Jay Bhattacharya.

• 10:18Lex Fridman?

  To our best understanding today, how deadly is COVID? Do we have a good measure for this very question?

• 10:27Speaker 01

  So the best evidence for COVID, the deadliness of COVID, comes from a whole series of seroprevalent studies. Seroprevalent studies are these studies of antibody prevalence in the population at large. I was part of the very first set of seroprevalent studies, one in Santa Clara County, one in LA County, and one with Major League Baseball around the US.

• 10:48Lex Fridman?

  If I may just pause you for a second. If people don't know what serology is and seroprevalence, it does sound like you say zero prevalence. It's not. It's sero and serology's antibodies. So it's a survey that counts the number of antibodies.

• 11:04Speaker 01

  Specific to COVID.

• 11:05Lex Fridman?

  People that have antibodies specific to COVID, which perhaps shows an indication that they likely have had COVID. And therefore, this is a way to study how many people in the population have been exposed to or have had.

• 11:19Speaker 01

  Exactly. Yeah, exactly. So the idea is that we don't know exactly the number of people with COVID just by counting the people that present themselves with symptoms of COVID. COVID has, it turns out, a very wide range of symptoms possible, ranging from no symptoms at all to this deadly viral pneumonia that's killed so many people. And the problem is like, if you just count the number of cases, the people who have very few symptoms often don't show up for testing. We just don't, they're outside of the can of public health. And so it's really hard to know the answer to your question without understanding how many people are infected. Because you can probably tell the number of deaths. That's even though that there's some controversy over that.

• 12:02Speaker 01

  But that, so the numerator is possible, but the denominator is much harder.

• 12:07Lex Fridman?

  How much controversy is there about the death? We're going to go on a million tangents. Is that, okay, we're gonna, I have a million questions. So one, I love data so much, but I'm like almost tuned out paying attention to COVID data because I feel like I'm walking on shaky ground. I don't know who to trust. Maybe you can comment on different sources of data, different kinds of data. The death one, that seems like a really important one. Can we trust the reported deaths associated with COVID? Or is it just a giant messy thing that mixed up? And then there's this kind of stories about hospitals being incentivized to report a death as COVID death.

• 12:48Speaker 01

  So there's some truth in some of that. Let me just, so let me just talk about the incentives. So in the United States, we passed this CARES Act that was aimed at making sure hospital systems didn't go bankrupt in the early days of the pandemic. A couple of things they did, one was they provided incentives to treat COVID patients, tens of thousands of dollars extra per COVID patient. And the other thing they did is they gave a 20% bump to Medicare payments for elderly patients who treat with COVID. The idea is that there's more expensive to treat them at, I guess, the early days. So that did provide an incentive to sort of have a lot of COVID patients in the hospital because your financial success of the hospital, or at least not, the lack of financial ruin,

• 13:32Speaker 01

  depended on having many COVID patients. The other thing on the death certificates is that reporting of deaths is a separate issue. I don't know that there's a financial incentive there, but there is this sort of like complicated, you know, when you fill out a death certificate for a patient with a lot of conditions, like let's say a patient has diabetes, a patient that while that diabetes could lead to heart failure, you know, you have a heart attack, heart failure, your lungs fill up, then you get COVID and you die. So what do you write on the death certificate? Was it COVID that killed you? Was it the lungs filling up? Was it the heart failure? Was it the diabetes? It's really difficult to like disentangle. And I think a lot of times what's happened is they, people have like erred on the side

• 14:16Speaker 01

  of signing it as COVID. Now, what's the evidence of this? There's been a couple of audits of death certificates in places like Santa Clara County, where I live, in Alameda County, California, where they carefully went through the death certificate and said, okay, is this reasonable to say this was actually COVID or is this was COVID incidental? And they found that about 25%, 20, 25% of the deaths were more likely incidental than directly due to COVID. I personally don't get too excited about this. I mean, it's a philosophical question, right? Like ultimately, what kills you? Which is an odd thing to say if you're not in medicine, but like really it's a, it's almost always multifactorial. It's not always just the bus hits you. The bus hits you, you get a brain bleed.

• 15:01Speaker 01

  Was it the brain bleed that killed you? Would it have burst anyway? I mean, you know, the bus hits you, killed you, right?

• 15:06Lex Fridman?

  The way you die is a philosophical question, but it's also a sociological and psychological question because it seems like every single person who has passed away over the past couple of years, kind of the first question that comes to mind was COVID. Not just because you're trying to be political, but just in your mind.

• 15:23Speaker 01

  No, I think there's a psychological reason for this, right? So. You know, we have, we spent the better part of at least a half century in the United States not worried too much about infectious diseases. And we, the notion was we'd essentially conquered them. It was something that happens in faraway places to other people. And that's true for much of the developed world. Life expectancy were going up for decades and decades. And for the first time in living memory, we have a disease that can kill us. I mean, I think we're effectively evolved to fear that, like the panic centers of our brain, a lizard part of our brain takes over. And our central focus has been avoiding this one risk. And so it's not surprising that, that people, when they're filling out death certificates

• 16:08Speaker 01

  or thinking about what, what led to the death, this most salient thing that's in the front of everyone's brain would, would jump to the top.

• 16:15Lex Fridman?

  And we can't ignore this very deep psychological thing when we consider what people say on the internet, what people say to each other, what people write in scientific papers, what everything. It feels like when COVID has been, has been brought onto this world, everything changed in the way people feel about each other, just the way they communicate with each other. I think the, the level of emotion evolved, I think it, in many people, it brought out the worst in them. For sometimes short periods of time, and sometimes it was always therapeutic, like

• 16:58Lex Fridman?

  you were waiting to get out like the darkest parts of you, just to say, if you're angry at something in this world, I'm going to say it now. And I think that's probably talking to some deep primal thing that fear we have for formalities of all different kinds. And then when that fear is aroused and all the deepest emotions, it's like a Freudian psychotherapy session, but across the world.

• 17:25Speaker 01

  Something that psychologists are going to have a field day with for a generation trying to understand. I mean, I think, I mean, I think what you say is right, but piled on top of that is also this sort of.

• 17:38Speaker 01

  This impetus to empathy, to empathize compassion toward others, essentially militarized, right? So I'm protecting you by some actions. And those actions, if I don't do them, if you don't do them, well, that must mean you hate me. It's created this like social tension that I've never seen before. And we have started, we started, we looked at each other as if we were just simply sources of germs, rather than people to get to know, people to enjoy, people to get to learn from. It colored basically almost every human interaction for every human on the planet.

• 18:21Lex Fridman?

  Yeah, the basic common humanity. It's like you can wear a mask, you can stand far away, but the love you have for each other, when you look into each other's eyes, that was dissipating and by region too. I've experienced, having traveled quite a bit throughout this time, it was really sad, even people that are really close together, just the way they stood, the way they looked at each other. And it made me feel for a moment that the fabric that connects all of us is more fragile than I thought.

• 18:54Speaker 01

  I mean, if you walk down the street, or if you ever, if you did this during COVID, I'm sure you had this experience where you walk down the street, if you're not wearing a mask, or even if you are, people will jump off the sidewalk that you walk past them, as if you're poison.

• 19:09Speaker 01

  Even though the data are that COVID spreads indifferently outdoors, if at all, really outdoors. But it's not simply a biological or infectious disease phenomenon, or immunological phenomenon. It is a change in the way humans treated each other, I hope temporary.

• 19:27Lex Fridman?

  I do want to say on the flip side of that, so I was mostly in Boston, Massachusetts, when the pandemic broke out. I think that's where I was, yeah. And then I got, came here to Austin, Texas, to visit my now good friend, Joe Rogan. And he was the first person, without pause, this wasn't a political statement, this wasn't anything, just walked toward me, gave me a big hug and said, "It's great to see you." And I can't tell you how great it felt, because I, in that moment, realized the absence of that connection back in Boston over just a couple of months. It's, we'll talk about it more, but it's tragic to think about that distancing,

• 20:08Lex Fridman?

  that dissolution of common humanity at scale, what kind of impact it has on society, just across the board, political division, and just in the quiet of your own mind, in the privacy of your own home, the depression, the sadness, the loneliness, at least the suicide, and forget suicide, just low-key suffering.

• 20:30Speaker 01

  Yeah, no, I think that's, that's the suffering, that isolation. We're not meant to live alone. We're not meant to live apart from one another. I mean, that's, of course, the ideology of lockdown is to make people live apart, alone, isolated, so that we don't spread diseases to each other, right? But we're not actually designed as a species to live that way. And that, what you're describing, I think, if everyone's honest with themselves, have felt, especially in places where lockdowns have been sort of very militantly enforced, has felt deep into their core.

• 21:00Lex Fridman?

  Well, if I could just return to the question of deaths. You said that the data isn't perfect because we need these kind of seroprevalence surveys to understand how many cases there were to determine the rate of deaths. And we need to have a strong footing in the number of deaths. But if we assume that the, the number of deaths is approximately correct, like, what's your sense, what kind of statements can we say about the deadliness of COVID against, across different demographics? Maybe not in a political way or in the current way, but when history looks back at this moment of time, 50 years from now, 100 years from now, the way we look

• 21:40Lex Fridman?

  at the pandemic 100 years ago, what will they say about the deadliness of COVID?

• 21:47Speaker 01

  I mean, I think the deadliness of COVID depends on not just the virus itself, but who it infects. So probably the most important thing about it, about the deadliness of COVID is, is this steep age gradient in the mortality rate. So according to these seroprevalent studies that have been done, now hundreds of them, mostly from before vaccination, because vaccination also reduces the mortality risk of COVID. The seroprevalent studies suggest that the risk of, of death, if you're, say, over the age of 70, is very high, you know, 5% if you get COVID.

• 22:25Speaker 01

  If you're if you're under the age of 70, it's lower 0.05. But there's not a single sharp cutoff. It's more like I have a rule of thumb that I use. So if you're 50, say, the infection fatality rate from COVID is 0.2%. According to the seroprevalence data, that means 99.8% survival. If you're 50 and for every seven years of age above that, double it. Every seven years of age below that, have it. So 57 year old have a 0.4% mortality. A 64 year old would have a 0.8% and so on. And if you have a severe chronic disease like diabetes or if you're morbidly obese, it's like adding seven, seven years to your life.

• 23:06Lex Fridman?

  And this is for unvaccinated folks?

• 23:09Speaker 01

  This is unvaccinated in the before Delta also.

• 23:13Lex Fridman?

  Are there a lot of people that will be listening to this with PhDs at the end of their name that would disagree with the 99.8, would you say?

• 23:21Speaker 01

  So I think there's some disagreement over this. And the disagreement is about the quality of the seroprevalence studies that were conducted. So as I said earlier, I was the senior investigator in three different seroprevalence studies and very early in the epidemic. I view them as very high quality studies. We, in Santa Clara County, what we did is we used a test kit to, that we obtained from someone who was, works in Major League Baseball, actually. He'd ordered these test kits very early in March 2020 that measures, very accurately measures antibody levels, antibodies in the, in the bloodstream.

• 24:03Speaker 01

  The test kits were eventually, were approved by the, had an EUA by the emergency use authorization by the FDA, sort of shortly after we did this. And it had a very low false positive rate. False positive means if you, if you, if you don't have these COVID antibodies in your bloodstream, the kit shows up positive anyways. That, that turns out to happen about 0.5% of the time. And based on studies, a very large number of studies looking at blood from 2018, you try it against this kit and, you know, 0.5% of the time, 2018, there shouldn't be antibodies there. So for COVID, if it turns positive, it's a false positive, 0.5% of the time.

• 24:44Speaker 01

  And then, you know, like a false negative rate, about 10%, 12%, something like that. I don't remember the exact number, but the false positive rate is the important thing there, right? So you have a population in March 2020 or April 2020 with very low fraction of patients having been exposed to COVID. You don't know how much, but low. Even a small false positive rate could end up biasing your study quite a bit. But there's a formula to adjust for that. You can adjust for the false positive rate, false negative rate. We did that adjustment and those studies found in a community population, so leaving aside people in nursing homes who have a higher death rate from COVID, that the death rate was 0.2% in Santa Clara County and in LA County.

• 25:27Lex Fridman?

  Across all age groups in the community, community meaning just like regular folks.

• 25:32Speaker 01

  Yeah, so like that's actually a real important question, too. So the Santa Clara study, we did this Facebook sampling scheme, which is, I mean, not the ideal thing, but it's like, it was very difficult to get a random sample during lockdown, where we put out an ad on Facebook soliciting people to volunteer for the study, randomly selected set of people. We were hoping to get a random selection of people from Santa Clara County, but it tended to, the people who tended to volunteer were from the richer parts of the county. Like, I had Stanford professors writing, begging to be in the study because they wanted to know their antibody levels. So we did some adjustment for that. In LA County, we hired a firm that had a pre-existing representative sample of LA County.

• 26:18Speaker 01

  So, but it didn't include nursing homes, it didn't include people in jail, things like that, didn't include the homeless populations. So it's representative of a community dwelling population, both of those. And there we found that, both in LA County and Santa Clara County, in April 2020, something like 40 to 50 times more infections than cases in both places. So for every case that had been reported to the public health authorities, we found that, you know, 40 or 50 other infections, people with antibodies in their blood, that suggested that they'd had COVID and recovered.

• 26:54Lex Fridman?

  So people were not reporting, or severe, at least in those days, under reporting?

• 26:59Speaker 01

  Yeah, I mean, there was, you know, there's testing problem. I mean, there weren't so many tests available. People didn't know. A lot of them, we asked a set of questions about the symptoms they'd faced. And most of them said they face no symptoms, or the most, 30, 40% of them said they face no symptoms.

• 27:15Lex Fridman?

  I mean, even these days, how many people report that they get COVID, when they get COVID? Okay, have those numbers, that 0.2%, has that approximately held up over time?

• 27:25Speaker 01

  That is, so Professor Johnny Inedes, who's a colleague of mine at Stanford, is a world expert in meta-analysis, probably the most cited scientist on earth, I think, at least living. He did a meta-analysis of now 100 or more of these seroprevalence studies.

• 27:42Speaker 01

  And what he found was that that 0.2% is roughly the worldwide number. In fact, I think he cites a lower number, 0.15%, as the median infection fatality rate worldwide. So we did these studies and it generated an enormous amount of blowback by people who thought that the infection fatality rate is much higher. And there's some controversy over the quality of some of the other studies that are done. And so there are some people who look at this same literature and say, well, the lower quality studies tend to have lower IFRs, the higher quality studies.

• 28:15Lex Fridman?

  IFR?

• 28:15Speaker 01

  Oh, infection fatality rate, I apologize. I do this in lectures too.

• 28:20Lex Fridman?

  And I'm going to rudely interrupt you and ask for the basics sometimes, if it's okay.

• 28:26Speaker 01

  No, of course. So these higher quality studies, they say, tend to produce higher. But the problem is that if you want a global infection fatality rate, you need to get seroprevalence studies from everywhere, even in places that don't necessarily have the infrastructure set up to produce very, very high quality studies. And in poor places in the world, the, like places like Africa, the infection fatality rate is incredibly low.

• 28:54Speaker 01

  And in some richer places, like New York City, the infection fatality rate is much higher. There's a range of IFRs, not a single number. This sometimes surprises people because they think, well, it's a virus. It should have the same properties no matter where it goes. But the virus. Kills or infects or hurts in interaction with the host. And the properties of both the host and the virus combine to produce the outcome.

• 29:24Lex Fridman?

  But you also mentioned the environment too.

• 29:27Speaker 01

  Well, I'm thinking mainly just about the person. Like, if I'm going to think about it, like, the most simplest way to think about it is age. Age is the single most important risk factor. So, older places are going to have a higher IFR than younger places. Africa, 3% of Africa is over 65. So, in some sense, it's not surprising that they have a low infection fatality rate.

• 29:49Lex Fridman?

  So, that's one way you would explain the difference between Africa and New York City?

• 29:53Speaker 01

  Yeah.

• 29:53Lex Fridman?

  In terms of the fatality rate, is the age the average age?

• 29:56Speaker 01

  Yeah, and especially in the early days of the epidemic in New York City, the older populations living in nursing homes were differentially infected based on, because of policies that were adopted, right? To send COVID-infected patients back to nursing homes to keep hospitals empty.

• 30:14Lex Fridman?

  What do you mean by differentially infected?

• 30:17Speaker 01

  The policy that you adopt determines who is most exposed.

• 30:21Lex Fridman?

  Right, that, okay.

• 30:23Speaker 01

  So, that's what I mean by differentially.

• 30:23Lex Fridman?

  The policy, it's the person that matters. I mean, it's not like the virus just kind of doesn't care. I mean, the policy determines the nature of the interaction. And there's also, I mean, there is some contribution from the environment. Different regions have different proximity, maybe, of people interacting or the dynamics of the way they interact.

• 30:44Speaker 01

  The heterogeneity, like, if you have, if you have situations where there's lots of intergenerational interactions.

• 30:51Lex Fridman?

  Yeah.

• 30:51Speaker 01

  Then you have a very different risk profile than if, than if you have societies that are, where generations are more separate from one another.

• 31:00Speaker 01

  Okay, so let me just finish real fast about this. So, you, you, you have, in New York, you have a population that was infected in the early days that was very likely going to die, had a much higher likely of dying if infected. And so, New York City had a higher IFR, especially in the early days, than, than, than, like, Africa has had. The other thing is treatment, right? So, the treatments that we adopted in the early days of the epidemic, I think, actually may have exacerbated the risk of death.

• 31:32Lex Fridman?

  Which treatments?

• 31:34Speaker 01

  Using ventilators, like the over reliance on ventilators is what I'm primarily thinking of, but I can think of other things. But that also, we've learned over time how better to manage patients with the disease. So you have those, you have all those things combined. So that's where the controversy over this, over this number is.

• 31:52Lex Fridman?

  I mean, New York City also is a, is a central hub for those who tweet and those who write powerful stories and narratives in article form. And I remember there was quite dramatic stories about sort of doctors in the hospitals and these kinds of things. I mean, there's very serious, very dramatic, very tragic deaths going on always in hospitals. Those stories, loved ones losing each other on a deathbed, that's always tragic. And you can always write a hell of a good story about that, and you should, about the loss of loved ones.

• 32:32Lex Fridman?

  But they were doing it pretty, pretty well, I would say, over this kind of dramatic deaths. And so in response to that, it's very unpleasant to hear, even to consider the possibility that the death rate is not as high as you might otherwise, as you might feel.

• 32:52Speaker 01

  Yeah, I was surprised by the reaction, both by regular people and also the scientific community in response to those studies, those early studies in April of 2020. To me, they, they were, they were studies. I mean, they're, they're the kinds of, not exactly the kinds of work I've worked on all my life, but it's kind of, kind of like the kind of, you know, you write a paper and you get responses from your fellow scientists and you, you know, change the paper to improve it, you have, you hopefully learn something from it.

• 33:21Lex Fridman?

  Well, but to push back, it's just a study. But there's some studies, and this is kind of interesting because I've received similar pushback on other topics.

• 33:33Lex Fridman?

  There is some studies that if wrong might have a wide ranging detrimental effects on society. So that's the way they would perceive the studies. If you say the death rate is lower and you end up, as you often do in science, realizing that, nope, that was a flaw in the way the study was conducted, or we're just not representative of a broader population. And then you realize the death rate is much higher, that might be very damaging in people's view. So that's probably where the scientific community sort of steel man the kind of response is that's where they felt like, you know, there's some findings

• 34:15Lex Fridman?

  where you better be damn sure before you kind of report them.

• 34:20Speaker 01

  Yeah, I mean, we were pretty sure we were right. And it turns out we were right. So like when we so we released the Santa Clara study via this open, open science process and this server called Med Archive. It's designed for releasing studies have not yet been peer reviewed in order to garner comment from the scientists before peer review. The LA County study, we went through this traditional peer review process and got it published in the Journal of American Medical Association sometime in like July, I think, I forget the date of 2020. The Santa Clara study released in April of 2020 in this sort of working paper archive. The reason was that we felt we had an obligation, we had a result

• 35:04Speaker 01

  that was, we thought was quite important. And we wanted to tell the scientific community about it and also tell the world about it. And it wasn't, we wanted to get feedback. I mean, that's part of the purpose of sending it to these kinds of places. I think a lot of the problem is that when people think about published science, they think of it as automatically true. And if it goes through peer review, it's automatically true. If it hasn't gone through peer review, it's not automatically true. And especially in medicine, when we're not used to having this access to pre peer reviewed.

• 35:37Speaker 01

  Work, I mean, in economics, actually, that's quite normal. You, it takes years to get something published. So there's a very active debate over or discussion about papers before they're peer reviewed in this, in this sort of working paper way. Much less normal or much, much newer in, in, in medicine. And so I think part of that, the perception about what those, that, that, what process happens in open science, when you release a study, that, that got people confused. And you're right, it was a very important result because we had just locked the world down in, in middle of March with, I think catastrophic results. And if, if that study was right, if our study was right, that meant we'd made a mistake. And not because of the death rate was low. That's actually not the key thing there.

• 36:22Speaker 01

  The key thing is that we had adopted these policies, these test and trace policies, these policies, these lockdown policies aimed at suppressing the virus level to close to zero. That was essentially the idea. If we can just get the virus to go away, we won't have to ever worry about it again. The main problem with our result as far as that strategy was concerned wasn't the death rate, it was the 40 to 50 times more infections than cases. It was the two and a half percent or three percent or four percent prevalence rate that we identified of the antibodies in the population. If that number is right, it's too late. The virus is not going to go to zero. And no matter how much we test and trace and isolate, we're not going to get the viral level down to zero.

• 37:08Lex Fridman?

  So we're gonna have to let the virus go through the entire population in some way?

• 37:13Speaker 01

  Well, that, we can talk about that in a bit. That's the Great Barrington Declaration. You don't have to let the virus go through the population. You can shield preferentially. The, the policy we chose was to shield preferentially the, the laptop class, the set of people who could work from home without losing their job.

• 37:30Lex Fridman?

  Yeah.

• 37:31Speaker 01

  And we did a very good job at protecting them.

• 37:33Lex Fridman?

  Well, let me.

• 37:36Lex Fridman?

  Take a small tangent. We're going to jump around in time, which I think will be the best way to tell the story. So that was the beginning.

• 37:45Speaker 01

  Yeah. Okay. Actually, can I go back one more thing for that? Because that's really important. And I should have. I should have started with this. What led me to do those studies was a paper that I had remembered seeing from the H1N1 flu epidemic in 2009. This is where I had been much less active in writing about that. I had written up like a paper or two about that when I in 2009. There, there was actually the same debate over the mortality rate, except it unfolded over the course of three years, two or three years. The early studies of the mortality rate in H1N1 counted the number of cases in the denominator, kind of the number of deaths in the numerator, cases meaning people

• 38:29Speaker 01

  identified as having H1N1, showing up the doctor, you know, tested to have it. And the early estimates of the H1N1 mortality were like 4%, 3%, really, really high. Over the course of a couple of more years, a whole bunch of seroprevalence studies, seroprevalence studies of H1N1 flu came out. And it turned out that there were 100 or more times of people infected per case. And so the mortality rate was actually something like 0.02% for H1N1, not the 3, 3, like a hundredfold difference.

• 39:06Lex Fridman?

  So this made you think, okay, it took us a couple of two or three years to discover the truth behind the actual infections for H1N1. And then what's the truth here? And can we get there faster?

• 39:19Speaker 01

  Yeah. And there was, it spreads in a similar way as the, as the H1N1 flu did. I mean, it's, it's spread via aerosolization, via, you know, so person to person breathing, kind of, kind of contact up. It may be, maybe some by, by film eyes, but it seems like that's less likely now. In any case, it seemed really important to me to, to speed up the process of having those seroprevalence studies. So we can better understand who was at risk and what the right strategy ought to be.

• 39:46Lex Fridman?

  This might be a good place to kind of. Compare influenza, the flu and COVID in the context of the discussion we just had, which is how deadly is COVID? So you mentioned COVID is a very particular kind of steepness, more the X axis is age. So in that context, could you maybe compare influenza and COVID? Because a lot of people outside of the folks who suggest that the lizards who run the world have completely fabricated invented COVID, outside of those folks, kind of the natural process by which you dismiss the threat of COVID is say, well, it's just like the flu.

• 40:30Lex Fridman?

  The flu is a very serious thing, actually. So in that comparison, where does COVID stand?

• 40:38Speaker 01

  Yeah, the flu is a very serious thing. It kills 50, 60,000 people a year, something I found out, or depending on the particular strain that goes around, that's in the United States. The primary difference to me, there's lots of differences, but one of the most salient differences is the age gradient and mortality risk for the flu. So the flu is more deadly for children than COVID is. There's no controversy about that. Children, thank God, have much less severe reactions to COVID infection than they do to flu infections.

• 41:14Lex Fridman?

  And rate of fatalities and stuff like that?

• 41:16Speaker 01

  Rate of fatality, all of that.

• 41:17Lex Fridman?

  I think you mentioned, I mean, it's interesting to maybe also comment on, I think in another conversation, you mentioned there's a U shape to the flu curve. So meaning like there's actually quite a large number of kids that die from flu.

• 41:33Speaker 01

  Yeah. I mean, the 1918 flu, the H1N1 flu, that the Spanish flu in the US killed millions of younger people.

• 41:44Speaker 01

  And that is not the case with COVID. More than, I'm gonna get the number wrong, but something like 70, 80% of the deaths are people over the age of 60.

• 41:55Lex Fridman?

  Well, we've talked about the fear the whole time, really. But my interaction with folks, now, I wanna have a family, I wanna have kids, but I don't have that real firsthand experience, but my interaction with folks is at the core of fear that folks had is for their children. Like, that somehow, you know, I don't wanna get infected because of the kids, like, because God forbid something happens to the kids. And I think that, obviously, that makes a lot of sense, this kind of, the kids come first, no matter what, that's the number one priority, but for this particular virus,

• 42:36Lex Fridman?

  that reasoning was not grounded in data, it seems like, or that emotion and feeling was not grounded.

• 42:43Speaker 01

  Yeah, it wasn't. But at the same time, this is way more deadly than the flu, just overall, and especially to older people.

• 42:49Lex Fridman?

  Yes.

• 42:50Speaker 01

  Right?

• 42:51Lex Fridman?

  So the numbers, when the story is all said and done, COVID would take many more lives.

• 42:58Speaker 01

  Yeah. So, I mean, point two is, it sounds like a small number, but it's not a small number, worldwide.

• 43:04Lex Fridman?

  What do you think that number will be by the, you know, that's not, that's not like make, but would we cross, I think it's in the United States, it's, the way the deaths are currently reported, it's like 800,000, something like that, do you think we'll cross a million?

• 43:18Speaker 01

  Seems likely. Yeah.

• 43:20Lex Fridman?

  Do you think it's something that might continue with different variants? What?

• 43:25Speaker 01

  Well, I think, so we can talk about the end state of COVID. The end state of COVID is it's here forever. I think that there is good evidence of immunity after infection.

• 43:38Speaker 01

  Such that you're protected both against reinfection and also against severe disease upon reinfection. So the second time you get it, it's not true for everyone, but for many people, the second time you get it will be milder, much milder than the first time you get it.

• 43:53Lex Fridman?

  With the long tail, like that lasts for a long time?

• 43:57Speaker 01

  Yeah. So just there are studies that follow course of people who are infected for a year and the reinfection rate is something like somewhere between 0.3 and 1%.

• 44:07Lex Fridman?

  Yeah.

• 44:08Speaker 01

  And like a pretty fantastic study out of Italy has found that there's been one in Sweden, I think. There's a few, few studies have found that similar, similar things. And the reinfections tend to produce much milder disease, much less likely end up in the hospital, much less likely to die. So what the end state of COVID is, it's circulating the population forever and you get it multiple times.

• 44:30Lex Fridman?

  Yeah. And, and then there's, I think, studies and discussions like the, the best protection would be to get it and then also to get vaccinated. And then a lot of people push back against that for the obvious reasons from both sides, because somehow this, the discourse has become less scientific and more political.

• 44:49Speaker 01

  Well, I think, I think you want to, like, the first time you meet it is going to be the most deadly for you. And so the first time you meet it, it's just wise to be vaccinated. The vaccine reduces severe disease.

• 44:59Lex Fridman?

  Yeah. Well, we'll talk about the vaccine because I want to make sure I address it carefully and properly in full context. But yes, sort of to add to the context, a lot of the fascinating discussions we're having is in the early days of COVID and now for people who are unvaccinated. That's where the interesting story is. The policy story, the sociology, sociological story and so on. But let me go to something really fascinating, just because of the people involved, the human beings involved and because of how deeply I care about science and also kindness, respect and love and human things.

• 45:42Lex Fridman?

  Francis Collins wrote a letter in October 2020 to Anthony Fauci, I think somebody else. I have.

• 45:53Lex Fridman?

  The letter, oh, it's not a letter, email, I apologize. Hi, Tony and Cliff. CGBdeclaration.org. This proposal, this is the Great Barrington Declaration that you're a co-author on. This proposal from the three fringe epidemiologists who met with the secretary seemed to be getting a lot of attention, and even a co-signature from Nobel Prize winner Mike Levitt at Stanford. There needs to be a quick and devastating published take down of its premises. I don't see anything like that online yet. Is it underway? Question mark. Francis.

• 46:34Lex Fridman?

  Francis Collins, director of the NIH, somebody I talked to on this podcast recently. Okay. A million questions I want to ask, but first, how did that make you feel when you first saw this email come to light? Which, when, when, when did it come to light?

• 46:55Speaker 01

  This week, actually, I think, or last week.

• 46:57Lex Fridman?

  Okay. So this is because of freedom of information?

• 47:00Speaker 01

  Yeah.

• 47:00Lex Fridman?

  Which, by the way, sort of, maybe, because I do want to add positive stuff on, on the side of Francis here. Boy, when I see stuff like that, I wonder if all my emails leaked. How much embarrassing stuff. Like, I think I'm a good person, but I don't, I haven't read my old emails. Maybe, I'm pretty sure sometimes I could be an asshole.

• 47:27Speaker 01

  Well, I mean, look, he's a Christian, and I'm a Christian. I'm supposed to forgive, right? I mean, I think he was looking at this G, Great Barrington Declaration as a political problem to be solved, as opposed to a serious alternative approach to the epidemic.

• 47:44Lex Fridman?

  So maybe we'll talk about it in more detail, but just for, in case people are not familiar, Great Barrington Declaration was, was, was a document that you co-authored that basically argues against this idea of lockdown as a solution to COVID, and you proposed another solution that we'll talk about. But the point is, it's not. That dramatic of a document, it is just a document that criticizes one policy solution that was proposed.

• 48:13Speaker 01

  But it was the policy solution that had been put forward by Dr. Collins and by Tony Fauci and a few other, few other scientists. I mean, I think a relatively small number of scientists and epidemiologists in charge of the advice given to governments worldwide. And it was a challenge to that policy that said that, look, there, there is an alternate path, that the path we've chosen, this path of lockdown with an aim to suppress the virus to zero effectively, I mean, that was unstated, cannot work and is causing catastrophic harm to large numbers of poor and vulnerable people worldwide.

• 48:53Speaker 01

  We put this out in October 4th, I think of 2020, and it went viral. I mean, I've never actually been involved with anything like, like this, where I just put the document on the web and tens of thousands of doctors signed on, hundreds of thousands of regular people signed on. It, it really struck a chord of people, because I think even by October of 2020, people had this sense that there was something really wrong with the COVID policy that we'd been following. And they were looking for reasonable people to give an alternative. I mean, we're not arguing that COVID doesn't, isn't, isn't a serious thing. I mean, it is a very serious thing. This is why we, we had a policy that

• 49:34Speaker 01

  aimed at addressing it. We were, but we were saying that the policy we're following is not the right one. So how does a democratic government deal with that challenge? So to me, that, you asked me how I felt. I was actually frankly, just, I was, I suspected there'd been some email exchanges like that, not necessarily from Francis Collins, around the government around this time. I mean, I felt the full brunt of a propaganda campaign. Almost immediately after we published it, where newspapers mischaracterize it in the same way over and over and over again. And sought to characterize me as sort of a marginal fringe figure or whatnot.

• 50:19Speaker 01

  And Sunetra Gupta, Martin Kulldorff, were the tens of thousands of other people that signed it. I felt the brunt of that all year long. So to see this in black and white, in the handwriting essentially, I mean, the metaphorical handwriting of Francis Collins was actually frankly disappointment because I've looked up to him for years.

• 50:39Lex Fridman?

  Yeah, I've looked up to him as well. I mean, I look for the best in people and I still look up to him. What troubles me is several things. The reason I said about the asshole emails I send late at night is I can understand this email. It's fear, it's panic, not being sure. The fringe, three fringe epidemiologists.

• 51:11Speaker 01

  Plus Mike Levitt, who won a Nobel Prize. I mean.

• 51:15Lex Fridman?

  But using fringe, maybe in my private thoughts, I have said things like that about others, like a little bit too unkind. Like you don't really mean it. Now, add to that, he recently, this week, whatever, doubled down on the fringe. This is really troubling to me that, like, I can excuse this email, but to see the arrogance there, Francis honestly, I mean, broke my heart a little bit there. This was an opportunity to like, especially at this stage, to say, just like I told him, to say I was wrong to use those words in that email.

• 51:58Lex Fridman?

  I was wrong to not be open to ideas. I still believe that this is not like, say, like actually argue with the policy, with the policy of the proposed solution also.

• 52:13Lex Fridman?

  The devastating published take devastating takedown, devastating takedown, as you say, somebody who's sitting on billions of dollars that they're giving to scientists, some of whom are often not their best human beings because they're fighting with each other over money, not being cognizant of the fact that you're challenging the integrity, you're corrupting the integrity of scientists by allocating the money, you're now playing with that by saying devastating takedown. Where do you think the published takedown will come from? It will come from those scientists to whom you're giving money.

• 52:57Lex Fridman?

  What kind of example would they give to the academic community that thrives on freedom? Like this, this is, I believe Francis Collins is a great man. One of the things I was troubled by is the negative response to him from people that don't understand the positive impact that NIH has had on society, how many people it's helped. But this is exactly the, so he's not just a scientist. He's not just a bureaucrat who distributes money. He's also scientific leader that in a time, in difficult times we live in, is supposed to inspire us with trust, with love, with the freedom of thought.

• 53:39Lex Fridman?

  He's supposed to, you know, those fringe epidemiologists? Those are the heroes of science. When you look at the long arc of history, we love those people. We love ideas even when they get proven wrong.

• 53:52Speaker 01

  That's what always attracted me to science, like some, somebody, the lone voice saying, oh, no, the, the, the moon of Jupiter does move. I mean, you know, but the funny thing is, you know, Galileo was saying something truly revolutionary. We were saying that what we proposed in the Great Britain Declaration was actually just the old pandemic plan. It wasn't anything really fundamentally novel. In fact, there were plans like this that

• 54:22Speaker 01

  Lockdown scientists had written in late February, early March of 2020. So we were not saying anything radical. We were just calling for a debate effectively over the existing lockdown policy. And this is a disappointment, a really, truly a big disappointment. Because by doing this, you were absolutely right, Lex. He sent a signal to so many other scientists to just stay silent, even if you had reservations.

• 54:49Lex Fridman?

  Yeah, devastating takedown. The people, you know how many people wrote to me privately, like Stanford, MIT? How amazing the conversation with Francis Collins was? There's a kind of admiration because, okay, how do I put it? A lot of people get into science because they want to help the world. They get excited by the ideas and they, and they, they really are working hard to help in whatever the discipline is. And then there is sources of funding which help you do help at a larger scale. So you admire those, the people that are distributing the money because they're often,

• 55:34Lex Fridman?

  at least on the surface, are really also good people. Oftentimes they're great scientists. So like, it's amazing. That's why I'm sort of, like, sometimes people from outside think academia has broken some kind of way. No, it's, it's a beautiful thing. It's, it really is a beautiful thing. And that's why it's so deeply heartbreaking where this person is, I don't think this is malevolence. I think he's just incompetence of communication.

• 56:04Speaker 01

  Well, I think, I think there's, there's also arrogance at the bottom of it too.

• 56:08Lex Fridman?

  So like, you know. But all of us have arrogance.

• 56:10Speaker 01

  Yes, but there's a particular kind of arrogance, right? So here, it's, it's of the same kind of arrogance that you see when Tony Fauci gets on TV and says that, that if you criticize me, you're not simply criticizing a man, you're criticizing science itself.

• 56:24Lex Fridman?

  Right.

• 56:25Speaker 01

  Right? That is at the heart also of this email. This so, the certainty that the policies that they were recommending, Collins and Fauci were recommending to the President of the United States were right. Not just right, but right so, so far right that any challenge whatsoever to it is dangerous. And I think that, that is really the heart of that email. It's, it's, it's this idea that. My position is unchallengeable. Now, to be completely, to be as charitable as I can be to this. You know, I believe they thought that. I believe they, some of them still think that, that there was only one true policy possible in response to COVID. Every other policy was immoral.

• 57:09Speaker 01

  And if you, if you come from that position, then you write an email like that. You go on TV, you say effectively, la science est moi, right? I mean, that, that is, that is what happens when you have this sort of unchallengeable arrogance that the policy you're following is correct. I mean, when we wrote the Great Barrington Declaration, what I was hoping for was a discussion about how to protect the vulnerable. I mean, that was the key idea to me in the whole thing was better protection of the older population who really at really serious risk if infected with COVID. And we had been doing a very poor job, I thought, to date in many places in protecting the vulnerable. And what I wanted was a discussion by local public health about better methods, better

• 57:52Speaker 01

  policies to protect the vulnerable. So when, when I was, what we were met with instead, a series of essentially propagandist lies about it. So that, so for instance, I kept hearing from reporters in those days, why do you want to let the virus rip? Let it rip, let it rip. The words let it rip does not appear in the Great Barrington Declaration. The goal isn't to let the virus rip. The, the goal is to protect the vulnerable, to let society go as, you know, open schools and do other things that it functions best it can in the midst of a terrible pandemic, yes, but not let the virus rip, where no, the, the most vulnerable aren't protected. The goal was to protect the vulnerable. So why let it rip?

• 58:37Speaker 01

  Because it was a propaganda term to hit the fear centers of people's brains. Oh, these people are immoral. They just want to let the virus go through society and hurt everybody. That was, that was, that was the idea. This, it, it was a way to preclude a discussion and preclude a debate about the existing policy.

• 58:54Lex Fridman?

  So I have, this, this is an app called Clubhouse. I've gone back on it recently to practice Russian, unrelated, for, for a few big Russian conversations coming up. Anyway, it's a great way to talk to regular people in Russian. But I also, there was a, I was, I was nervous, I was preparing for a Pfizer CEO conversation, and there was a vaccine room. And so I joined it. And there's a, there's a pro-science room. It's like, these are like scientists that were calling each other pro-science. The whole thing was like theater to me. I mean, I haven't thoroughly researched, but looking at the resume, there were like pretty solid researchers and doctors.

• 59:38Lex Fridman?

  And they were mocking everybody who was at all. I mean, it doesn't matter what they stood for, but they were just mocking people. And the arrogance was overwhelming. I had to shut off because I couldn't handle that human beings can be like this to each other. And then I, I, I went back just to double check. Is this really happening? How many people are here? Is this theater? And then I asked to come on stage on Clubhouse to, to make a couple of comments. And then as I opened my mouth, I said, thank you so much. You know, this, this is a great room, sort of the usual civil politeness, all that kind of stuff.

• 1:00:16Lex Fridman?

  And I said, I'm worried that the kind of arrogance with which things are being discussed here will further divide us, not unite us. And, and before I said even the unite us, further divide us, I was thrown off stage. Now, this isn't why I mentioned platform, but like, I am like Lex Fridman, MIT also, which is something those people seem to sometimes care about, followers and stuff like that. Like, did you just do that? And then they said, enough of that nonsense. Enough of that nonsense. They said to me, enough of that nonsense.

• 1:01:01Lex Fridman?

  Somebody who is obviously interviewed Francis Collins is the Pfizer CEO.

• 1:01:09Speaker 01

  You're bringing on friendship epidemiologists also, so just.

• 1:01:12Lex Fridman?

  Yeah, exactly. But this broke my heart, the arrogance. And this is echoes of that arrogance is something you see in this email. And I really would love to, we have a million things to talk about, to try to figure out, how can we find a path forward?

• 1:01:24Speaker 01

  I think a lot of, a lot of the problems we've seen in the, the discussion over COVID, especially in the scientific community, you know, there's, there's two ways to look at science, I think, that, that have been competing with each other for a while now. One way, and this is the way that I view science and why I've always found it so attractive, is an invitation to a structured discussion where the discussion is tempered by evidence, by data, by reasoning and logic, right? So it's a dialectical process where if I believe A and you believe B, well, we talk about it, we come up with an experiment that distinguishes between the two.

• 1:02:07Speaker 01

  And while, you know, B turns out to be right, I'm all frustrated, but I buy you dinner. And I say, no, no, no, C. And then we go on from there, right? That's what science is at its best. It's this process of using data in discussion. It's a human activity, right? To learn, to have the truth unfold itself before us. On the other hand, there are, there's another way that people have used science or thought about science as a, as truth in and of itself, right? This like, if it's, if it's science, therefore it's true automatically. And there are, you know, what does the science say to do? Well, the science never says to do anything. The science says, here's what's true.

• 1:02:48Speaker 01

  And then we have to apply our human values to say, okay, well, if we do this, well, then this is likely to happen. That's what the science says. If we do that, then that is likely to happen. Well, we'd rather have this than that, right? And, but it doesn't, the science doesn't tell us that we'd rather have this than that. It's our human values that tell us that we'd rather have this than that. Science plays a role, but it's not the only thing. It's not the only role. It's like, it helps us understand the constraints we face, but it doesn't tell us what to do in face of those constraints.

• 1:03:17Lex Fridman?

  But underneath it, at the individual level, at the institutional level, it seems like arrogance is really destructive. So the flip side of that, the productive thing is humility. So sort of.

• 1:03:33Lex Fridman?

  Always not being sure that you're right. This is actually kind of, Stuart Russell talks about this for AI research. How do you make sure that AI, super intelligent AI doesn't destroy us? You built in a sort of module within it that it always doubts its actions. Like, it's not sure. Like, I know it says I'm supposed to destroy all humans, but maybe I'm wrong. And that maybe I'm wrong is essential for progress, for actually doing in the long arc of history better. Not the perfect thing, but better and better and better and better. I mean, the question I have here for you is, this email so clearly captures some maybe echo, but maybe a core to the problem.

• 1:04:18Lex Fridman?

  Do you put responsibility of this email, of the shortcomings and failures on individuals or institutions? Is this Francis Collins?

• 1:04:28Speaker 01

  No, this is an institutional failure, right? So the NIH, so I've had two decades of NIH funding. I've sat on NIH review panels. The purpose of the NIH is what you said earlier, Lex. The purpose of the NIH is to support the work of scientists. To some extent, it's also to help scientists, to direct scientists to work on things that are very important for public health or for the health of the public. So, and the way you do that is you say, okay, we're going to put, you know, $50 million on the research in Alzheimer's disease this year, or $70 million on HIV, or whatever it is, right? And that pot of money, then scientists compete with each other for the best ideas to use it to address that problem.

• 1:05:10Speaker 01

  So it's essentially an endeavor to support the work of scientists. It is not in and of itself a policy organ. It doesn't say what public health policy should be. For that, you have the CDC. And what happened during the pandemic is that people in the NIH were called upon to contribute to public health policymaking. And that created the conflict of interest you see in that email. Right? So now you have the head of the NIH, in effect, saying to all scientists, you must agree with me in the policy that I've recommended.

• 1:05:55Speaker 01

  Or else you're fringe. That is a deep conflict of interest. It's deep because first he's conflicted. He has this dual role as the head of the NIH, supporter of scientific funding, and then also inappropriately called to set or help set pandemic policy. That should never have happened. There should be a bright line between those two roles.

• 1:06:20Lex Fridman?

  Let me ask you about just Francis Collins. I don't know if you, I had a chance to talk to him on a podcast. I don't know if you maybe by chance gotten a chance to hear a few words.

• 1:06:27Speaker 01

  I heard some of it, yeah.

• 1:06:28Lex Fridman?

  Well, I have a kind of a question to that because a lot of people wrote to me quite negative things about Francis Collins. And like I said, I still believe he's a great man, a great scientist. One of the things when I talked to him off mic about the vaccine, the excitement he had about when we were recollecting, when they first got in an inkling that it's actually going to be possible to get a vaccine. Just, he wasn't messaging, just in the private or of our own conversation, he was really excited. And why was he excited? Because he gets to help a lot of people.

• 1:07:11Lex Fridman?

  This is a man that really wants to help people. And there could be some institutional self-delusion, arrogance, all those kinds of things that lead to this kind of email. But ultimately, the goal is this, I don't think people quite realize this. The reason he would call you a fringe epidemiologist, the reason there needs to be a devastating published takedown, he, I believe, really believes that this could be very dangerous. And it's a lot of burden to carry on his shoulders. Because like you said, in his role where he defines some of the public policy, like, you know, depending on how he thinks about the world, millions of people could die because of one decision he make.

• 1:07:56Speaker 01

  Yeah.

• 1:07:57Lex Fridman?

  And that's a lot of burden to walk with.

• 1:07:59Speaker 01

  Yeah, no, I think that's right. I don't think that he has bad intentions. I think that he was basically put, was put, or maybe put himself in a position where This kind of conflict of interest was going to create this kind of this kind of reaction.

• 1:08:16Lex Fridman?

  Yeah.

• 1:08:16Speaker 01

  Right? The kind of humility that you're calling for is almost impossible when you have that dual dual role that shouldn't you shouldn't have have as funder of science and also setter of scientific policy.

• 1:08:27Lex Fridman?

  I agree with everything you just said, except the last part. The humility is almost impossible. That humility is always difficult. I think I think there's a huge incentive to for humility in that position. Now, look at history. Great leaders that have humility are popular as hell. So if you like being popular, if you like having impact, legacy, these descendants of ape seem to care about legacy, especially as they get older in these high positions. Like, I think the incentive for humility is pretty high.

• 1:09:02Speaker 01

  Well, I mean, the thing is, is like, there's a lot that he has to be proud of in his career. I mean, like, the Human Genome Project wouldn't have happened without him. And he is he is a great man and a great scientist. But so it is tragic to me that his career has ended in this particular way.

• 1:09:17Lex Fridman?

  Can I ask you a question about my podcast conversation with him? By way of advice, or maybe criticism, there's a lot of people that wrote to me kind words of support, and a lot of people that wrote to me respectful, constructive criticism. How would you suggest to have conversations with folks like that? And maybe, I mean, because I have other conversations like this, including I was debating whether to talk to Anthony Fauci. He wanted to talk. And so what kind of conversation do you have? And sorry to take us on a tangent, but almost from an interview perspective of how to inspire

• 1:10:02Lex Fridman?

  humility and inspire trust in science, or maybe give hope that we know what the heck we're doing and we're going to figure this out? I mean, I think.

• 1:10:11Speaker 01

  You're I've had been now interviewed by many people. I think the style you have really works well, Lex. You have to, because I don't think you're going to be ever an attack dog trying to go after somebody and force them to like, you know, admit that they were wrong or whatever about. I mean, that's that I also actually find that form of journalism and podcasting really off putting. It's hard to watch.

• 1:10:36Lex Fridman?

  Also, it's a whole other tangent. Is that actually effective?

• 1:10:39Speaker 01

  I don't think so.

• 1:10:40Lex Fridman?

  Do you want to ask Hitler? And I think about this a lot, actually interviewing Hitler. I've been studying a lot about the rise and fall of the Third Reich. I think about interviewing Stalin. Like, I put myself in that mindset, like, how do you have conversations with people to understand who they are so that not so you can sit there and yell at them?

• 1:11:02Speaker 01

  Yeah.

• 1:11:02Lex Fridman?

  But to understand who they are so that you can inspire a very large number of people to be the best version of themselves?

• 1:11:08Speaker 01

  Well, that's the thing.

• 1:11:08Lex Fridman?

  And to avoid the mistakes of the past.

• 1:11:10Speaker 01

  I believe that everyone that's involved in this debate has good intentions. They have they're coming at it from their points of view. They don't they have they have their weaknesses. And if you can paint a picture in your questioning by sympathetic questioning of those strengths and weaknesses and their point of view, you've done a service. That's really all you I personally like to see in those kinds of interviews. I don't think a gotcha moment is really the key thing there. The key thing is understanding where they're coming from, understanding their thinking, understanding the constraints they faced and how did they manage them? That's going to provide a much, I mean, to me, that's what I look for when I when I

• 1:11:52Speaker 01

  listen to podcasts like yours, is an understanding of that of that of that person and the moment and how they dealt with it.

• 1:12:00Lex Fridman?

  I mean, I guess the hope is to discover in a sympathetic way a flaw in a person's thinking together.

• 1:12:08Speaker 01

  Yeah.

• 1:12:09Lex Fridman?

  As opposed to discovering the positive thing together, you discover the thing, well, I didn't really think about that.

• 1:12:15Speaker 01

  Yeah, I mean, that's what's, that's how science is, right? That's why we find it, I think, find it so attractive is this, I, I, I like it when a student shows me I'm thinking incorrectly, right? I think, I'm really grateful to that student because now I have an opportunity to change my mind about it and then start thinking even more correctly. I mean, that's, and there are moments when, I mean, like, this is probably a good time to say, like, what I think I got wrong during the pandemic, right? So like, for instance, you said Francis Collins had a moment when he learned that there was quite possible to get a vaccine going.

• 1:12:50Lex Fridman?

  Yeah.

• 1:12:51Speaker 01

  He must have learned that quite early. And I didn't learn that early. I mean, I, I didn't know, in March of 2020, in my experience with vaccine development, it would have take, I thought it would take a decade or more to get a vaccine. That was wrong, right? I didn't, that, and I was so happy when I started to see the preliminary numbers in the, in the Pfizer trial, that strongly suggested it was going to work.

• 1:13:20Lex Fridman?

  Yeah.

• 1:13:21Speaker 01

  And, and I was, I can't, I mean, like, very few times in my life, I'm so happy to be wrong.

• 1:13:26Lex Fridman?

  And it changes, kind of, I think I've heard you mention that lockdown is still a bad idea, unless the vaccine comes out in, like, tomorrow. There's still, like, suffering and economic pain, all kinds of pain can still happen in even just a, a, a scale of weeks versus months.

• 1:13:47Speaker 01

  Yeah.

• 1:13:48Lex Fridman?

  Well, let's talk about the vaccine. What are your thoughts on the safety and efficacy of COVID vaccines at the individual and the societal level?

• 1:13:57Speaker 01

  So for the vaccine safety data, it's, it's actually challenging to convey to the public how this is normally done. Like, normally, you would do this in the context of the trial. You'd have a law, a long trial with large numbers, relatively large numbers of people. You'd follow them over a long time, and the trial will give you some indication of the safety of the vaccine. And it did. I mean, but you, the, the trial, the way it was constructed, when it was, came out, that it was protective against COVID, it was no longer ethical to have a placebo arm. And so that placebo arm was vaccinated, a large part of it. And so that meant that from the trial, you were not going to be able to get data on the

• 1:14:39Speaker 01

  long-term safety profiles of the vaccine. And also, the other thing about trials, although there's tens of thousands of people enrolled, that's still not enough to get when you deploy a vaccine to the population scale, you're going to see things that weren't in the trial, guaranteed. Populations of people that weren't represented well in the trial are going to be given the vaccine and then that they're going to have things that happen to them that you didn't anticipate. So I wasn't surprised when people were a little bit skeptical when the trial was done about the safety profile, just the way the nature of the thing was going to make it so that it was going to be hard to get a complete picture from the trials itself.

• 1:15:19Speaker 01

  And the trials showed they were pretty safe and quite effective at preventing both you from getting COVID. I think the main endpoint of the trial itself was symptomatic COVID. Right? So that was like, that was, I mean, it was really, to me, like, about as amazing achievement as anything, organizing a trial of that scale and running it so quickly.

• 1:15:44Lex Fridman?

  And the final results being so surprisingly high.

• 1:15:48Speaker 01

  So good, right? And so, but the problem then was normally it would take a long time. The FDA would tell Pfizer to go back and try it in this subgroup, they'd work more on dosing, they do all of all these kinds of things that kind of didn't, we really didn't have time for in the middle of a pandemic. Right? So you have a, you have a basis for approval that it's less full than normally you would have for a population scale vaccine. But the results were good. The results looked really good. And actually, I should say, for the most part, that's been borne out when we've given the vaccine at scale in terms of protection against severe disease.

• 1:16:29Lex Fridman?

  Yeah.

• 1:16:30Speaker 01

  Right? So people who have got the vaccine for a very long time after they had the full vaccination have had great protection against going, being hospitalized and dying if they get COVID.

• 1:16:42Lex Fridman?

  Let's separate, because this seems to be. There's critics of both categories, but different. Kids and kids and old, not older people, like, uh, let's say five years old and above, or something like, or 13 years old and above. So, uh, for those, it seems like the reduction of the rate of fatalities and, and serious illness seems to be something like 10x.

• 1:17:12Speaker 01

  I mean, for older people, it is a godsend, this vaccine. It, it transforms the, the problem of focus protection from something that's quite challenging, possible, I believe, but quite challenging into something that's much, much more manageable. Because the vaccine in and of itself, when deployed in older populations, is a form of focus protection.

• 1:17:34Lex Fridman?

  Yes. Well, by the way, we'll talk about the focus protection in one segment because it's such a brilliant idea for this pandemic of a future pandemics. I thought the sociological, psychological discussion about the letter from Francis Collins is, um, because it was so recent, it was been so troubling to me. So I'm glad we talked about that first. But so that there seems to be, the vaccines work to reduce deaths. And that has the, especially the most transformative effects for the older.

• 1:18:06Speaker 01

  So can I let you give you, I've told you one thing that I got wrong in the pandemic. Let me tell you the second thing I got wrong for sure in the pandemic. In January of la, of this year, 2021, I thought that the vaccines would stop infection.

• 1:18:22Lex Fridman?

  Yes.

• 1:18:23Speaker 01

  Right? It would, would make it so that you were much less likely to be infected at all, because the, the antibodies that were produced by the vaccines look like they are neutralizing antibodies that would, would essentially block you from being infected at all.

• 1:18:38Speaker 01

  That turned out to be wrong. Right. So I think it became clear as data came out from Israel, which vaccinated very early, that they were seeing surges of infection, even in a very highly vaccinated population, that the vaccine does not stop infection.

• 1:18:55Lex Fridman?

  So you're a used car salesman and you're selling the vaccine. And the features you thought a vaccine would have, I mean, I have a similar kind of sense when the vaccine came out. Vaccine would reduce, if you somehow were able to get it, it would reduce rate of death and all those kinds of things. But it would also reduce the chance of you getting it. And if you do get it, the chance of you transmitting it to somebody else. And it turns out that those latter two things are not as definitive, or in fact, are, I mean, I don't know to which degree they're not.

• 1:19:31Speaker 01

  I mean, I think it's a little complicated because I think the first two or three months after you're fully vaccinated, after the second dose, you have 60, 70% efficacy peak against infection.

• 1:19:44Lex Fridman?

  Yeah.

• 1:19:45Speaker 01

  So that, which is pretty good. I mean, right. But by six, seven, eight months, that drops to 20%. Some places, some studies, like there's a study out of Sweden suggested it might even drop to zero.

• 1:19:55Lex Fridman?

  But and then you're also infectious for some period of time if you do get it, even though you're vaccinated.

• 1:20:01Speaker 01

  Correct.

• 1:20:02Lex Fridman?

  Although there seems to be loosely data that the period of time you're infectious is short.

• 1:20:06Speaker 01

  Is shorter, but the infectivity per day is about as high. So you still, it's the point is that the vaccine might reduce some risk of infecting others, but it's not a categorical difference. So unvaccinated, it's not safe to be in the presence of just vaccinated people. You can still get infected.

• 1:20:28Lex Fridman?

  Right. So, I mean, there's a million things I want to ask here, but is there in some sense, because the vaccine really helps on the worst part of this pandemic, which is killing people?

• 1:20:42Speaker 01

  Yes.

• 1:20:44Lex Fridman?

  Doesn't that mean, where does the vaccine hesitancy come from? In terms of, it seems like, obviously, a vaccine is a powerful solution to let us open this thing up.

• 1:20:57Speaker 01

  Yeah, so I wrote a Wall Street Journal op-ed with Sunat Gupta in December of last year.

• 1:21:01Lex Fridman?

  Yes.

• 1:21:02Speaker 01

  A very naive, with a very naive title, which says, "We can end the lockdowns in a month." And the idea was very simple. Vaccinate all vulnerable people. And then, open up.

• 1:21:15Lex Fridman?

  Open up.

• 1:21:16Speaker 01

  Right? And the idea was that the lockdown harms, this is related, this is directly related to the Great Barrier Declaration. The Great Barrier Declaration said, "The lockdown harms are devastating to the population at large. There's this considerable segment of people that are vulnerable. Protect them." Well, with the vaccine, we have a perfect tool to protect the vulnerable, which is, I still believe, I mean, is true, right? You vaccinate the vulnerable, the older population, and, as you said, there's a tenfold decrease in the mortality risk from getting infected, which is, I mean, amazing. So that was the strategy we outlined. What happened is that the vaccine debate got transformed. So first, you're asking about vaccine hesitancy. I think there's, first, there's like, there's

• 1:21:59Speaker 01

  the inherent limitations of how to measure vaccine safety, right? So we talked about a little bit about the trial, but also after the trial, there's a mechanism, and this is the work I've been involved with before COVID, on tracking and identifying and checking whether vaccines actually are safe. And the central challenge is one of causality. So you no longer have the randomized trial. But you want to know, is the vaccine, when it's deployed at scale, causing adverse events? Well, you can't just look at people who are vaccinated and see what adverse events happen, because you don't know what would have happened if the person had not been vaccinated. So you have to have some control group.

• 1:22:43Speaker 01

  Now, what happened is, there's several systems to do, to check this, that the CDC uses. One very, very, very commonly known one now is called VAERS, the Vaccine Adverse Event Reporting System. There, anyone who has an adverse event, that either a regular person or a doctor can just go report, "Look, I had the vaccine, and two days later I had a headache," or whatever it is. The person died a day after they had the vaccine, right? Now, the vaccine was rolled out to older people first, and older people die, sometimes, with or without the vaccine. So, sometimes you'll see someone's vaccinated, and a few days later, they die. Did the vaccine cause it, or something else caused it? It's really difficult to tell. In order to tell, you need a control group.

• 1:23:28Speaker 01

  For that, there are other systems the FDA and CDC have. There's one called VSD, Vaccine Safety Data Link. There's another system called BEST, I forget what the acronym is, essentially to track cohorts of people vaccinated versus unvaccinated with as careful a matching as you can do. It's not randomized, and see if you have safety signals that pop up in the vaccinated relative to the control group unvaccinated. And so that's, for instance, how the myocarditis risk was picked up in young, especially young men.

• 1:24:08Speaker 01

  It's also how the higher risk of blood clots in middle-aged and older women with the J&J vaccine was picked up. There, what you have is our situations where the baseline risk of these outcomes are so low that if you see them in the vaccinated arm at all, that it's not hard to understand that the vaccine did this, right?

• 1:24:31Lex Fridman?

  Right.

• 1:24:31Speaker 01

  Young men should not be having myocarditis. Middle aged women should not be having huge blood clots in the brain, right? So when you see that, you can say it's linked. Now, the rates are low, so young men, maybe one in 5,000, one in 10,000 of the vaccine, vaccine related myocarditis, pericarditis. Young women, middle aged women, I don't know, I don't, I'm not sure what the right number might be, but like I'd say, it's like in the, you know, one in hundreds of thousands, something like that.

• 1:25:00Speaker 01

  So these are rare outcomes, but they're, they are vaccine linked outcomes. How do you deal with that as a messaging thing? I think you just tell people. You tell people, here are the risks. You transparently tell them and just, you're not, you're not, so they're not getting into something that they don't know.

• 1:25:15Lex Fridman?

  Yeah. And don't treat people like they're children and need to be told lies because they won't understand the full complexity of the truth. People, I think, are pretty good at, or actually, you know, people with time are good at understanding data, but better than anything, they're, they're better at, they're extremely good at detecting arrogance and bullshit.

• 1:25:42Speaker 01

  Yeah.

• 1:25:43Lex Fridman?

  And if you give them either one of those.

• 1:25:45Speaker 01

  I mean, I'll give you one that's where I think it's greatly undermined vaccine has, greatly undermined the demand for the vaccine, is this weird denial that if you recover from COVID, you have extremely good immunity, both against infection and access to diseases.

• 1:26:00Lex Fridman?

  That's really strange.

• 1:26:01Speaker 01

  And that denial leads to people distrusting the message given by like the CDC director, for instance, in favor of the vaccine. Right? Why would you deny a thing that's such an obvious fact? It's like you can look at the data and it's just, I mean, it just pops out at you that people that are COVID recovered are not getting infected again at very high rates. Much lower rates.

• 1:26:24Lex Fridman?

  After these kinds of conversations, I'm sure after this very conversation, I often get a number of messages from Joe, Joe Rogan, and from Sam Harris, who to me are people I admire, I think are really intelligent, thoughtful human beings. They also have a platform. And I believe, at least in my mind, about this COVID set of topics, they represent a group of people.

• 1:26:54Lex Fridman?

  Each group has smart, thoughtful, well-intentioned human beings. And I don't know who is right, but I do know that they're kind of tribal, a little bit, those groups. And so the question I want to ask is like, what do you think about these two groups? And this kind of tension over the vaccine that sometimes it just keeps finding different topics on which to focus on, like whether kids should get vaccinated or not, whether there should be vaccine mandates or not, which seem to be often

• 1:27:36Lex Fridman?

  very kind of specific policy kinds of questions that miss the bigger picture.

• 1:27:40Speaker 01

  I think it's a symptom of the distrust that people have in public health. I think this kind of schism over the vaccine does not happen in places where the public health authorities have been much more trustworthy. Right? So you don't see this vaccine hasn't seen Sweden, for instance.

• 1:27:58Speaker 01

  What's happened in the United States is the vaccine has become,

• 1:28:03Speaker 01

  first because of politics, but then also because of the scientific arrogance, this sort of touchstone issue. And people line up on both sides of it. And the different language you're hearing is structured around that. So before the election, for instance, I did a, I was a, I did a testimony in the House on, on measurement of vaccine safety. And I was, I was invited by the Republicans. There were, I think, of four other experts invited by the Democrats, or three other experts invited by Democrats, each of whom had a lot of experience in measuring vaccine safety. I was really surprised to hear them each doubt whether the FDA would do a reasonable job in assessing vaccine safety, including by people with, who have long records of working with the FDA. I mean, these are.

• 1:28:49Speaker 01

  Professionals, great scientists, whose main, you know, sort of goal in life is to make sure that unsafe vaccines don't get released into the world. And if they are, they get pulled. And they're casting doubt on the vaccine, the ability to track vaccine safety before the election. And then, after the election, the rhetoric switched on a dime, right? All of a sudden, it's Republicans that are cast as if they're vaccine hesitant. That kind of political shift, the public notices. If all it takes is an election to change how people talk about the safety of the vaccine, well, we're not talking science anymore, many people think, right? I think that created its hesitancy.

• 1:29:33Speaker 01

  The other thing, I think, the hesitancy, some politicians viewed it as a political, as sort of like a political opportunity to sort of demonize people who are hesitant. And that itself fueled hesitancy, right? Like, if you're telling me I'm a rube that just doesn't want the vaccine because I want everyone to die, well, I'm gonna react really negatively.

• 1:29:59Speaker 01

  And if you're talking down to me about my legitimate, you know, sort of concerns about whether this vaccine is safe to take, I've heard from women who are thinking about getting pregnant, should I take the vaccine? I don't know. I mean, there are all kinds of questions, legitimate questions, that I think should have good data to answer, that we don't necessarily have good data to answer. So what do you do in face of that? Well, one reaction is to pretend like we know for a fact that it's safe, when we don't have the data to know for a fact in that particular group with that particular set of clinical circumstances, you know? And that, I think, breeds hesitancy. People can detect that bullshit. Whereas if you just tell people, you know, I don't know.

• 1:30:43Lex Fridman?

  Yeah, lead with humility.

• 1:30:45Speaker 01

  Yeah, you will end up with a better result.

• 1:30:49Lex Fridman?

  Let me ask you about, I've recently had a conversation with the Pfizer CEO.

• 1:30:54Lex Fridman?

  This is...

• 1:30:56Lex Fridman?

  Part therapy session, part advice, because I, again, I really want

• 1:31:02Lex Fridman?

  us to get through this together. And it feels like the division is a thing that prevents us from getting through this together. And once again, just like with Francis Collins, a lot of people wrote to me words of support, and a lot of people wrote to me words of criticism.

• 1:31:23Lex Fridman?

  I'm trying to understand the nature of the criticism. So some of the criticism had to do with against the vaccine and those kinds of things, that I have a better understanding of. But some kind of deep distrust of Pfizer. So actually, looking at Big Pharma broadly,

• 1:31:48Lex Fridman?

  I'm trying to understand, am I so naive that I just don't see it? Because, yes, there's corrupt people, and they they're greedy, they're flawed in all walks of life. But companies do quite an incredible job of taking a good idea to scale and making some money with that idea. But they are the ones that achieve scale on a good idea. I don't know. It's not obvious to me. I don't see where the manipulation is. So the fear that people have, and I talked to Joe about this quite a bit, I think this is a legitimate fear, and

• 1:32:32Lex Fridman?

  a fear you should often have, that money has influence, disproportionate influence, especially in politics. So the fear is that the policy of the vaccine was connected to the fact that lots of money could be made by manufacturing the vaccine.

• 1:32:52Lex Fridman?

  And I understand that. And I'm, it's actually quite a heck of a difficult task to alleviate that concern. Like, you really have to be a great man or woman or a leader to convince people that you're not full of shit, that you're not just playing a game on them. I don't know, it's a, it's a difficult task, but at the same time, I, I really don't like the natural distrust every billionaire, distrust everybody who's trying to make money, because it feels like, under a capitalistic system at least, the, the way to do a lot of good, like, to do good at scale in the world is by being, at least in part, motivated by profit.

• 1:33:32Speaker 01

  I mean, I share your ambivalence, right? So on the one hand, you have a fantastic achievement, the, the, the manufacturer, the discovery of the vaccine, and then the manufacturing at scale, so that, you know, billions of people can take the vaccine in a relatively short time. That is a remarkable achievement that could not have happened without companies like Pfizer. On the other hand, there is this sort of corrupting influence of that money. Just to give you one example, there's a, there's an enormous controversy over whether relatively inexpensive repurposed drugs can be used to treat the, the, the disease. None of, no company like Pfizer has any interest whatsoever in evaluating it.

• 1:34:17Speaker 01

  Even Merck, I think, it was Merck, that had the patent on ivermectin, now expired, has no interest at all in checking to see if it works.

• 1:34:28Lex Fridman?

  Not only do they not have interest, they have a way of talking about people who might have a little bit of interest. That's, again,

• 1:34:40Speaker 01

  Fringe.

• 1:34:42Lex Fridman?

  Full of arrogance.

• 1:34:43Speaker 01

  Yeah.

• 1:34:44Lex Fridman?

  And that, that is what troubles me. Is there not a, it's back to the play of science, it's not, they're not a bit of curiosity. One, okay, one, the natural curiosity of a human being that should always be there, and an open mind is. And second, in the case of ivermectin and other things like that, you have to acknowledge that there's a very large number of people. Who care about this topic? And this is a way to inspire them to also play in the space of science, to inspire them with science. You can't just dismiss everybody that you can't just dismiss people, period.

• 1:35:20Speaker 01

  Yeah, well, I mean, I think here, take ivermectin, right? There's actually a study funded by the NIH by Tony Fauci's NIAID and the NIH called Active Six. That's a randomized trial of ivermectin.

• 1:35:37Speaker 01

  It's due to be completed in March 2023.

• 1:35:41Speaker 01

  So normally, when you have private actors like these big drug companies that have no interest in conducting some kind of scientific experiment that would have some public benefit. It's the job of the government, then in this case, the NIH, to fund that kind of work.

• 1:35:59Speaker 01

  The NIH has been incredibly slow in its evaluations of these repurposed drugs. And it's been left to lots of other private, private, private activities of uneven quality. And hence, that's why you have these, these big fights. Because the data are not solid, you're going to have these big fights.

• 1:36:20Lex Fridman?

  Yeah, but also, okay, forget the, the process of science here, the studies, not enough effort being put into the studies. Just the way it's being communicated about.

• 1:36:29Speaker 01

  Yeah, no, like horse paste, I mean, come on. The FDA put a tweet out telling people who are like, they're taking ivermectin because they've heard good things about it. And they're sick and they're desperate. And just call it horse paste was just, that was, that was terrible.

• 1:36:44Lex Fridman?

  That was deeply irresponsible. My, my hope is grounded in the fact that young people see the, the bullshit of this. Young PhD students, graduate students, young students in college, they see the, the.

• 1:36:58Lex Fridman?

  Less than stellar way that our scientific leaders and our political leaders are behaving, and then the new generation will not repeat the mistakes of the past. That is my hope, because that's the cool thing I see about young people is they're good at detecting bullshit and they don't want to be part of that. That's my hope in the space of science. Let me return to this idea of the Great Barrington Declaration. Return to the beginning. So what are the basics? Can you describe what the Great Barrington Declaration is? What are some of the ideas in it? You mentioned focused protection. What are your concerns about lockdowns? Just paint the picture of this early proposal.

• 1:37:41Speaker 01

  Sure. So the Great Barrington Declaration, first, why is it called Great Barrington Declaration?

• 1:37:45Lex Fridman?

  It's such a great name. I mean, it's such an epic name, but the reason why it's called that is way less than epic.

• 1:37:54Speaker 01

  It was because the conference, which is organized by Martin Kulldorff, who was a professor at Harvard University, by a statistician. He actually designed the safety system, the statistical system that the FDA uses for tracking vaccine safety. He and I had met previously just the summer before that summer. And he invited me to come to this small conference where he was inviting me and Sunetra Gupta, who is a professor of theoretical epidemiology at Harvard, drive-in at Oxford University. And I mean, I jumped at the chance because I knew that Martin and Sunetra were both smarter

• 1:38:36Speaker 01

  than me, and it would be fun to like, talk about what the right strategy would be. On the drive in, I didn't know what the name of the town was, and I asked. They said it was Great Barrington. I had it in the back of my head. Martin and I arrived a little early, and we were writing an op-ed about some of the ideas, hopefully we'll get to talk about very soon, about focused protection and the right strategy. And when Sunetra arrived, we realized we'd actually come basically to the same place about the right way to deal with the epidemic. And I I thought, well, why don't we issue, why don't we write something like the Port Huron Statement is what I had that in the back of my head.

• 1:39:15Lex Fridman?

  Yes.

• 1:39:16Speaker 01

  And I'm like, well, what's the name of this town again? It was Great Barrington.

• 1:39:19Lex Fridman?

  Yeah, so it's not Barrington, it's Great Barr.

• 1:39:22Speaker 01

  It's which is fantastic, right?

• 1:39:24Lex Fridman?

  It's so over the top that it's perfect. It's it's literally like the Big Bang. There's something about these over the top fun titles that just really deliver them.

• 1:39:35Speaker 01

  So that's why that's my my main contribution was the work.

• 1:39:37Lex Fridman?

  Is the title, the name Great Barrington.

• 1:39:40Speaker 01

  But yeah, so it was it was kind of a so the and the idea is actually, while the title is great, and I think that it was written in a very stylish way. It's, you know, like it's a go, it's less than a page. You can go look online, read it. It's written in written for not for scientists, but for the general public so that people can understand the ideas really simply.

• 1:40:01Speaker 01

  But it is not actually a radical set of ideas. It actually represents the old pandemic plans that we've used for a century, dealing with other similar pandemics.

• 1:40:13Speaker 01

  And and there's it's twofold. First, let me talk about the science it rests on, and then I'll talk about the plan. The science actually most of it, we already talked about. There's this massive age gradient in the risk of COVID infection. Older people face much higher risk than younger people.

• 1:40:30Speaker 01

  The second bit of science is all that's not controversial, right? Even if you think the IFR is point seven or or or point two, no matter what, if everyone thinks everyone agrees on this age gradient.

• 1:40:41Speaker 01

  The second bit of science is also not controversial. The lockdown focused policies that we followed have absolutely devastating consequences on the health of the population.

• 1:40:54Speaker 01

  Let me just give you some examples. And this is this was known in October of 2020, we wrote it right. So the the UN was sounding alarms that there would be tens of millions of people who would starve as a consequence of the economic dislocation caused by the lockdowns. And that's come to pass, hundreds of thousands of children in places like South Asia dead from starvation.

• 1:41:19Speaker 01

  As a consequence of lockdowns. The priorities like the treatment of patients with tuberculosis in poor countries stopped because of lockdowns. Childhood vaccination of measles, most rubella, DPT, diptheria, so on, pertussis, tetanus, all those standard vaccination campaigns stopped. Tens of millions of children skipping these doses for diseases that are actually deadly for them.

• 1:41:55Lex Fridman?

  Is there, just on a small tangent, is it well understood to you, what are the mechanisms that stop all those things because of lockdowns? Is it some aspect of supply chain? Is it just literally because hospital doors are closed? Is it because there's a disincentive to go outside by people even when they deeply need help?

• 1:42:15Speaker 01

  It's all of the above. But a lot of those efforts, especially those vaccination efforts, are funded and run by Western efforts. Like GAVI is a, I think it's a Gates-funded thing, actually, that provides vaccines for millions of kids worldwide. And those efforts were scaled back. Malaria prevention efforts. So in the developing world, it was a devastating effect, these lockdowns. There was also direct effects. Like in India, the lockdowns, when they first instituted, there was an order that 10 million migrant workers who live in big cities and they live hand to mouth, they buy coconuts, they sell the coconuts with the money, they buy food from themselves and coconuts for

• 1:43:00Speaker 01

  the next day to sell, walk back to their villages or go back to their villages overnight. So 10 million people walking back to their villages or taking a train back. A thousand died en route, overcrowded trains, dying essentially on the side of the road. I mean, it was absolutely inhumane policy. And the lockdowns there, what it was, it's actually, it's kind of like what's happened in the West as well, but it was so severe. There was a zero prevalence study done in Mumbai by a friend of mine at the University of Chicago. What he found was that in the slums of Mumbai, there were 70% zero prevalence in July or August of 2020, whereas in the rest of Mumbai was 20%.

• 1:43:45Lex Fridman?

  Yeah.

• 1:43:46Speaker 01

  Right? So it was incredibly unequal. The lockdowns protected the relatively well off and spread the disease among the poor. So that's in the developing world. In the developed world, the health effects of lockdowns were also quite bad. Right? So we've talked already about isolation and depression. There was a study done in July of 2020 that found that one in four young adults seriously considered suicide. Now, suicide rates haven't spiked up so much, but the depths of despair that would lead somebody to seriously consider suicide itself should be, should be a source of great concern in public health.

• 1:44:31Lex Fridman?

  Yeah, this is one of the troubling things about measuring well-being is we're okay at measuring death and suicide. We're not so good at measuring suffering. It's like people talk about, maybe even Hallam or in the under Stalin or the concentration camps with Hitler. We talk about deaths, but we don't talk about the suffering over periods of years by people living in fear, by people starving, psychological trauma that lasts a lifetime, all of those things.

• 1:45:07Speaker 01

  I mean, and just to get back to that, that point, we closed schools, especially in blue states, we closed schools. Now, richer parents could send their kids to private schools, many of which stayed open even in the blue states. They could get pods, they could get tutors, but that's not true for, for poorer and middle-class parents. And as a result, what we did is we took away life opportunities for kids. We tried to teach five-year-olds to read via Zoom in kindergarten.

• 1:45:35Speaker 01

  Right? And the consequence, actually, you think, okay, we can just make it up, but it's really difficult to make that up. There's a literature in health economics that shows that even relatively small disruptions in schooling can have lifelong consequences, negative consequences for kids. So they end up growing up poorer, they lead shorter lives and less healthy lives as a consequence. And that's what the literature now shows is likely to happen with the interruptions of schooling that we had in the United States. Many European countries actually managed to avoid this. There were, in the early days of the epidemic, great indications that children first were

• 1:46:17Speaker 01

  not very severely at risk from COVID itself, nor are they super spreaders. Schools were not the source of community spread. Communities spread the disease to schools, not the other way around. And we can talk about the scientific basis of that if you'd like, but that was pretty well-known, even in October. We closed hospitals in order to keep them available to COVID patients, but as a result, women skipped breast cancer screening. And as a result, they are showing up with late-stage breast cancer that should have been picked up last year. Men and women skipped colon cancer screening, again, with later-stage disease that should have been picked up last year with earlier stage.

• 1:47:00Speaker 01

  For patients with diabetes, it's very important to have regular screening for blood sugar levels and sort of counseling for lifestyle improvement, and we skipped that. People stayed home with heart attacks and died at home with heart attacks. So you had this sort of wide range of medical and psychological harms that were being utterly ignored as a result of the lockdowns.

• 1:47:27Lex Fridman?

  Plus, there's the economic pain.

• 1:47:31Lex Fridman?

  So like you said, the whatever is a good term for the non laptop class, people would lose their jobs. Yes, there might be in the in the Western world support for them financially, but the the big loss there that is perhaps correlated with the depression and suicide is loss of meaning, loss of hope for the future, a loss of kind of a sense of stability. All the pride you have in being able to make money that allows you to pave your own way in the world. And yes, just having less money than you're used to. So your family, your kids are suffering all those kinds of things.

• 1:48:12Speaker 01

  There's a there's a again, economics literature on this on deaths of despair. It was called 2009. There was the the Great Recession. It led to an enormous uptake in overdose from drugs, suicidality, depression as a result of the job losses that happened during the Great Recession. Well, that's happening again, like an enormous increase in drug overdoses. That's not that's not an accident. That's a lockdown harm, right? Same same thing with with the the job losses. The job losses, by the way, are like, it's so interesting because the the states that stayed open have had much, much lower unemployment than the states that stayed closed.

• 1:48:55Speaker 01

  The labor force participation rates declined by 3%. It's women that separated because they they stayed home with their kids. We've reversed a generation of women, improving women's participation in the labor force.

• 1:49:11Lex Fridman?

  Do you think it has to do with institutions that we mentioned that there was so much priority given or so much power given to maybe NIH versus other civilian leaders? Or do people just not care about the economic pain, the leaders? I mean, because to me, it was obvious. I mean, probably it's just studying history. Whenever I listen to people on Twitter, on mainstream news, or just anything.

• 1:49:45Lex Fridman?

  I realized that's the very kind of top. The people that have a voice represent a tiny selection of people. And so whenever there's hard times, I always kind of think about the quiet, the voiceless, the quiet suffering of the tens of millions, of the hundreds of millions. Do political leaders not just give a damn?

• 1:50:10Speaker 01

  I mean, I think it was actually a very odd ethical thing at the beginning of the pandemic, where if you brought up economic harms at all, you were seen as callous. Right? So I had a reporter call me up almost at the very beginning of the epidemic, asking me about a very particular phenomenon. So like, he was anticipating a rise in child abuse, because children were going to be staying at home. Child abuse is generally picked up at school. And that actually happened. So like, the reported child abuse dropped, but actual child abuse increased. Because normally, you pick up the child abuse at school, and you have the intervention, right? So yeah, so I was talking about like, well, there's going to be some economic harms, and

• 1:50:53Speaker 01

  they're going to have health consequences, but the economic harms matter. But he counseled me, and I think he had my best interests at heart. Like, if you were to put that in the story, I would be, I would essentially be canceled. Because what the narrative that arose in March of 2020 is if you care about money at all, you're evil and crass, you must only care about lives. The problem with that narrative is that that money, which we're talking about, is actually lives of poor people, right? When you throw 100 million people around the world into poverty, you're going to see enormous harm to their health, enormous increases in mortality.

• 1:51:35Speaker 01

  It is not immoral to think about that and worry about that in the context of this pandemic response. Our mind focused so much on COVID that it forgot that there are so many other public health priorities as well that need our attention desperately.

• 1:51:49Lex Fridman?

  And this is the thing I sensed about San Francisco when I visited. I was thinking of moving there for a startup. This is the thing I'm really afraid of, especially if I have any...

• 1:52:04Lex Fridman?

  Effect on the world through a startup is losing touch in this kind of way. That you mentioned the laptop class, living in this world where you're only concerned about this particular of class of people. And also, you know, perhaps in early on in the pandemic amongst the laptop class, there was a legitimate concern for health. Like, you're not sure how deadly this virus is. You're not sure who to listen to. So there's a real concern. And then, at a certain point, when the data starts coming in, you start becoming more and more detached from the data. You don't start caring less and less, and you start just swimming in the space of narratives, like existing in the space of narratives.

• 1:52:46Lex Fridman?

  And you have this narrative in San Francisco, in the laptop class, that you're just very proud that you know the truth. You're the sole possessors of the truth. You congratulate yourself on it. And you don't care what actually gigantic detrimental effect that has on society, because you're mostly fine. That, I'm so terrified of that.

• 1:53:11Speaker 01

  Well, actually, I think the answer to that is just to remember.

• 1:53:14Lex Fridman?

  You remember.

• 1:53:15Speaker 01

  Yeah.

• 1:53:15Lex Fridman?

  Yeah.

• 1:53:16Speaker 01

  I don't think, you know, remember where you came from and remember who you're doing this for. At the back of your head should always be, what's the purpose? Like, why am I here? What's the purpose of this? And if the purpose is simply self-aggrandizement, then you should rethink, because it'll just end up being a hollow life.

• 1:53:35Lex Fridman?

  All of us will be forgotten in the end.

• 1:53:39Lex Fridman?

  Focus protection. The idea, the policy, what is focus protection?

• 1:53:44Speaker 01

  Right. So I was saying that there's two scientific bases, right? So one is this steep age gradient, and the second is the existence of lockdown arms. Again, I think there's very little disagreement in the scientific community about both of those facts. If you put those facts together, the obvious policy is to protect the people who are at the most severe risk from the disease itself. And that's the idea of focus protection. That's the general principle of it. The actual implementation of it depends on the living circumstances of the people that are at risk, the resources that are available in the community, the technology that's available to do this. And so it's almost always going to be, in fact, it'll always be a local thing.

• 1:54:29Speaker 01

  Because it'll depend on the, all of those, those things which are all local in nature. Right. So one very, very obvious thing in a, in a, in a country like ours, where so many older people live in institutionalized settings, in nursing home settings. And that's where older, really vulnerable, chronically ill patients often live. It is, and you know, this disease affects that group most like, most, most commonly. It is absolutely vital to protect that group. We should have known that in February 2020, from just from the Chinese data. And we should have thought about that group as the, as the, as the key constraint in our policymaking.

• 1:55:13Speaker 01

  Instead, we thought about in February, in March 2020, as hospital beds as the key constraint. Hospital beds and ventilator shortages and that we, so we, we ran around trying to like, address that constraint, you know, like a linear programming problem. You figure out what the, which constraint's binding and you address that one thing and then you go on to the next one. Right? If that's, if that one constraint, we said, okay, the constraint is hospital beds. That led to the decision in many of the Northeast states to send COVID infected patients who were on, on the verge of, or like, looked like they were about to recover, back to nursing homes. Who then spread the disease all through there because they wanted to preserve the hospital beds.

• 1:55:56Lex Fridman?

  Well, for somebody who loves the miracle optimization, I love the way you frame this. But those are kind of connected, right? If you actually focus on protecting the vulnerable, you will also have the effect of not hitting the ceiling of the available.

• 1:56:15Speaker 01

  That is, that's the irony. If we protected the vulnerable, the vulnerable, the most likely to be hospitalized. And so by protecting the hospital, about protecting the vulnerable, we would also have addressed the shortage of hospital beds more effectively.

• 1:56:28Lex Fridman?

  So that little shift in priority would have had a big impact. Okay, but specifically, the idea is to, and we could talk about different ideas of how to actually do this, but you know, you basically do a lockdown or something like that on a very small set of people.

• 1:56:46Speaker 01

  You may have to do that if it's, community spread is very high, but generally, I think. It would depend on, again, the living circumstances and the so for instance, if you are in a if you have a here's a very simple idea that doesn't require a lockdown forced on them. I don't actually generally not in favor of that kind of forced lockdown because you just won't get cooperation. But what you could do is provide resources to that group of people. So like imagine you live next door to somebody, an older couple.

• 1:57:18Speaker 01

  And if there's high community spread, well, they have to go grocery shopping. We did like some of these some communities did these like senior only grocery hour, right? But but they have to still have to go out and they might get exposed in when they're shopping amongst other seniors.

• 1:57:33Lex Fridman?

  Yeah.

• 1:57:34Speaker 01

  Well, why not organize home delivery of groceries to them? We did that for the laptop class, right? Or we can even just as a volunteer effort, you know, the older people living next door, just call them up and say, can I help you get go out and go shopping for you?

• 1:57:47Lex Fridman?

  And so you would have potentially federal support of that kind of thing. So these kinds of efforts.

• 1:57:53Speaker 01

  And identify where the vulnerable people live. It's really challenging in multi generational homes. LA County, for instance, there's a lot of older people living together with younger people in relatively crowded there. There it's really quite a challenge. But there again, you can use resources. So if grandma is worried that grandson has come home, but is potentially been exposed, grandson calls grandma says, I mean, I might have been at a party where I might do that where COVID was. Grandma calls public health, public health and says, okay, you can have this hotel room for a couple of days until you check to turn negative.

• 1:58:28Lex Fridman?

  In case it wasn't clear, the idea of focused protection is the people that are vulnerable, protect them. And everybody else goes on with their lives, open up the economy, just do as it was before.

• 1:58:44Speaker 01

  And there was still fear abroad. So there still would be some restrictions people would pose on themselves. They probably would go to parties less. The grandsons probably wouldn't go so many parties, right? That there would be less, less participation in big gatherings. You may even say like big gatherings in order to restrict communities. Spread again. I'm not against any of that, but you shouldn't be closing businesses. You shouldn't be closing churches and synagogues. You shouldn't be closing. You shouldn't be forcing people to not go to to to school. You should you should not be shuttering businesses. You should just let just allow society to go on. Some disease will spread, but as we've seen, the lockdown didn't stop the disease from spreading anyways.

• 1:59:24Lex Fridman?

  Right. So what do you make of the criticism that this idea like all good ideas cannot actually be implemented in a heterogeneous society where there's a lot of people intermixing? And once you open it up, people like the the younger people will just forget that this is even existing. And they'll stop caring about the older people and mess up the whole thing. And the government will not want to fund any kind of the great efforts you're talking about about food delivery. And then the food delivery services will be like, why the heck am I helping out on this anyway? Because like, it's not making me much money. And so therefore, like, all good ideas, it will collapse.

• 2:00:05Speaker 01

  That might be true. I mean, I think it's always a risk with policy thing. But I think like, think back to the moment where we actually felt like we were in this together to some extent.

• 2:00:14Lex Fridman?

  Yes.

• 2:00:15Speaker 01

  Right. I think I think that that that empathy that we had that was used to like,

• 2:00:22Speaker 01

  tell people to stay in and like happily, not not going happily, but like stay in to to like, wear a mask or to to do all these things that we thought would help other people could have been redirected to actually helping the people who most needed to be helped.

• 2:00:37Lex Fridman?

  Especially, I do remember March. So this is even way before Barrington, all of that kind of stuff. March, April, May, there was a feeling like if if we all just work together, we'll solve this.

• 2:00:54Speaker 01

  Right.

• 2:00:55Lex Fridman?

  And that maybe started to, when did that start breaking down? I mean, the the unfortunately, the election is mixed into this.

• 2:01:02Speaker 01

  Yeah.

• 2:01:03Lex Fridman?

  That it became politicized, but I think it lasted quite a long time.

• 2:01:07Speaker 01

  I think into the summer, I think there was some some of that sense. I don't know, they obviously varied among different people, but but I think that it's true. It would have been challenging. It's also true that it's heterogeneous, exactly the way you said. But what that means is you need a local response, a response. So like, like, my vision of a public health officer is someone that understands their community. Not necessarily the nation at large, but their community and then works within their community to figure out how to deploy the resources that they have available to do the kind of protection policies we're talking about. That's, that's what should have happened. Instead, they spent a huge amount of efforts closing, making sure businesses stayed closed, businesses that, I mean, there are, you know,

• 2:01:52Speaker 01

  like hardware stores that closed. What good did closing a hardware store do for this better cover? If it had an effect on spread COVID spread, I mean, it's going to be more checking to make sure that Plexiglas was put up everywhere, which now in retrospect turns out to probably made the disease worse. You know, masking enforcement, so shaming around mask, I mean, a huge amount of effort on things that were only tangentially related to focus protection. What if we turned our energy, that enormous energy put into that, instead into focus protection of the vulnerable? That's essentially the conversation I was calling for. And it wasn't, I mean, I didn't think of it as we had every single idea.

• 2:02:35Speaker 01

  I mean, we gave some concrete proposals and we got, but the criticism we got was that those, those concrete proposals weren't enough. And the answer to that I have is that's true. They weren't enough. I wasn't thinking of them as enough. I was thinking that they would, I wanted to involve an enormous number of people in local public health to help think about how to do focus protection in their communities.

• 2:02:57Lex Fridman?

  The question that's interesting here is about the future too. So COVID has very specific characteristics, like you mentioned about the curve of the, the, the death rate based on the, like it's, it's, it seems like with COVID, it's a little bit easier to actually identify a group of people that you need to protect. So other viruses may not be this way. So might lockdown be a good idea? Like hardcore lockdown for a future virus that's 10 times deadlier, but spreads at the same rate as COVID? Or maybe another way to ask that is imagine a virus that's 10 times deadlier. What's the right response?

• 2:03:40Speaker 01

  I mean, I think it's always going to be focus protection, but the group that needs the focus protection may change depending on the biology of the virus. Right? So the polio epidemic in the 40s and 50s in the US, the, the great, the people at most risk were children.

• 2:03:57Speaker 01

  We didn't know really at the beginning there was this fecal oral spread. And so we did all kinds of crazy things, including like spreading, spraying DDT in communities, which somehow was supposed to get rid of polio. But the focus was on whenever there was an outbreak, they would close a school down. And that was the right thing to do because that group that needed protection was children and those, the disease was spread, we thought, in schools. I don't think there's a single formula that works, but there's a single principle that works, right? No matter, I can't, it's hard to imagine a disease that's uniformly deadly across every group and every single person.

• 2:04:41Speaker 01

  There's always going to be some group that's differentially harmed. There's always going to be some group that's differentially protected and that, that may change over time, right? So like the, in the, in this disease, in this epidemic, as people got infected and recovered, we now had a class of people that were pretty well protected against the disease. They should be, they were like, instead of ostracizing them because they don't want a vaccine, we should, we should be allowing them to work. I mean, we're having, staffing shortages in hospitals now because we forgot that principle.

• 2:05:17Lex Fridman?

  It's quite a bit of this technology problem. So being able to, some of, how much of it is a sociological problem? How much of it is a technology problem? Like where do you put the blame sort of on why this didn't go so great and how it can go great in the beginning?

• 2:05:38Speaker 01

  I mean, think about lockdowns, like if we didn't have Zoom, we wouldn't have lockdowns. There's, there's a reason in 2009 we didn't lock down. I mean, we didn't have the technology to replace work with this remote, with this remote technologies.

• 2:05:52Lex Fridman?

  So we had good lockdown technology.

• 2:05:54Speaker 01

  Yeah.

• 2:05:55Lex Fridman?

  And Zoom. We didn't have good focused protection technology.

• 2:05:59Speaker 01

  Yeah, I mean, folks protection is always going to be complicated, especially for something like this that spreads so easily. It's going to be complicated. And I'm, I'm very, I'm the last person to say it would have been perfect. There's, there would have been people that would have gotten sick, but they got sick anyways. The hope was that if we suppress community spread low enough, we can protect the vulnerable. That was the hope by lockdown. The reality was that only a certain class of people were able to benefit from lockdown. The rest of society, we call them essential workers, had to keep working and they got sick.

• 2:06:30Lex Fridman?

  Yeah.

• 2:06:31Speaker 01

  And the disease kept spreading. It didn't actually have a substantial effect on the community spread in the, in, in non laptop class populations.

• 2:06:40Lex Fridman?

  And also, we should probably expand the class of people we call vulnerable to those who would suffer, who, who have the capacity to suffer, given the policies there you're weighing. It's very disingenuous to call the vulnerable just the people. Obviously, we had the very specific meaning, but broadly speaking, vulnerable should include anybody who can suffer based on the policies you take in response to a virus.

• 2:07:10Speaker 01

  This is something, this is that principle we just said is I completely agree with is, is something I think has been lost.

• 2:07:17Speaker 01

  And unfortunately lost, right? So the policies themselves, if they have harm, those are real.

• 2:07:25Lex Fridman?

  Yeah.

• 2:07:25Speaker 01

  And we shouldn't pretend like they're not and, and essentially demonize the people that, that, that suffer them. Or pretend, I mean, like I said, a lot of times, like the depression that we've been talking about, that's thought of as like not, not so important, but it is important. And especially the harm to the people in poor countries, it's like been out of sight, out of mind in much of the rich parts of the world.

• 2:07:51Lex Fridman?

  Once again, I have hope that we, seeing this, learning the lessons of history with the communications tools we have now, will learn this. It's like going to another country and bombing targeted terrorist locations. And there's going to be some civilians who die pretending that that the child who watches their dad die is not going to grow up, first of all traumatized, but second of all, potentially bring more hate to the world than the hate that you were allegedly fighting in the first place. That's another sort of considering only one kind of harm and not the full range of harms that are being caused by your policies.

• 2:08:30Speaker 01

  You know, like to good return to focus protection, we still should be following the policy now for COVID and we're not, right? So the vaccines, there's a great shortage of vaccines. You wouldn't know it in the United States and the rich parts of the world, but in there's a great shortage of vaccines. We're not going to be able to vaccinate the most of the, like the entire set of elderly at least, and or larger groups until late 2022. Huge numbers of older people around the world in poor countries that have not had, not COVID recovered yet, so they're still quite vulnerable, have not had the vaccine. And yet we're talking about vaccinating five year olds.

• 2:09:07Lex Fridman?

  Yeah.

• 2:09:09Speaker 01

  Who benefit, if at all, from the vaccines of just a very little bit because they face such a low risk of harm from COVID.

• 2:09:17Lex Fridman?

  Well, something that's a little bit near and dear to our specific, the two of our hearts. So you're at Stanford. So Stanford recently announced that they're going back to virtual, at least for some period of time in response to the, maybe you can clarify, but I think it's in response to the escalated.

• 2:09:38Lex Fridman?

  How would they phrase it? It's related to Omicron. And a few other universities are kind of like considering back and forth. In my perspective, as somebody who loves in-person lectures, who sees the value of that to students, to young minds. Also, looking at the data, seems the risk aversion in university policies around this, given how healthy the student population is, seems not well calibrated, let's put it this way. Also.

• 2:10:19Speaker 01

  Pathological.

• 2:10:21Lex Fridman?

  Pathological is one way to put it, given that, I believe, depending on the university, but I think many universities require that the student body is vaccinated at this point. So I think it's a big mistake by Stanford to do this. And I'd like to say that because I just hope MIT doesn't. But what are your thoughts about Stanford?

• 2:10:43Speaker 01

  I agree with you. I completely agree with you. I think we have failed in our mission to educate our students by this decision. And I think, frankly, just more broadly, I think we failed generally over the course of the last year and a half in living up to our educational mission.

• 2:11:02Speaker 01

  In-person teaching is vital. Now, I can understand, you have older faculty. The principle of focus protection says, provide some alternative teaching arrangements for them. That makes sense to me.

• 2:11:17Speaker 01

  From the kids' point of view, they're more harmed by not getting the education we promised them than by COVID. So applying this principle of this focus protection, let young professors teach in person. This is before the vaccine. After the vaccine, let everyone teach in person.

• 2:11:35Lex Fridman?

  Yeah, this is the part, I don't understand the discussion we're even having because.

• 2:11:41Lex Fridman?

  Okay, let's leave focused protection aside here because that's a brilliant policy for perhaps for the future when there's no vaccine. Now with the vaccine, I'm misunderstanding something here because we're now in a space that's psychological, not, it's no longer about biology. Because with the booster shots, which I believe MIT is now requiring before January, with the booster shots, the data shows no matter how old you are, the risks are very low for ending up in a hospital relative to all the other risks you face when you're older.

• 2:12:24Lex Fridman?

  I don't, I don't understand, can you explain the policy around closing a university, but also just a, a policy about just being so scared still in the university setting?

• 2:12:40Speaker 01

  I think the universities, the great universities have done great harm by modeling this kind of behavior.

• 2:12:46Lex Fridman?

  Yes, that, to me, sorry to keep interrupting, but to me, the university should be the beacon of great behavior, not, not the beacon of like scared, conservative, let's not mess up.

• 2:13:01Speaker 01

  Pathological.

• 2:13:02Lex Fridman?

  Let's not make it pathological, let's not make anybody angry, let's, it should be a place to play in the space of ideas.

• 2:13:08Speaker 01

  Yes, so I think the central problem is actually related to the central problem of COVID policy more generally. The goal seems to be to stop the disease from spreading rather than to reduce the harm from the disease. If the, if the goal is to stop the disease from spreading, the sad fact is we have no technology to stop, to accomplish that.

• 2:13:33Lex Fridman?

  At this point?

• 2:13:34Speaker 01

  Yes.

• 2:13:35Lex Fridman?

  Because like, it's already deeply integrated into the human civilization.

• 2:13:39Speaker 01

  Well, I mean, it's, it's here forever, right? There's a CERO survey of whitetail deer in the US. It turns out 80% of whitetail deer in the US have COVID antibodies. Dogs get it, cats get it, there's almost certainly human, human animal transmission of it. I mean, presumably, I mean, I've heard bats get it, apparently. So, so you have, you have a situation where you have this disease, it's here to stay.

• 2:14:05Lex Fridman?

  Yeah.

• 2:14:05Speaker 01

  And it, and the vaccines don't stop the spread of it, the lockdowns don't stop the spread of it. We have no technologies to stop the spread of it. And so we're burning the earth, trying to stop, do something that's impossible, rather than working on what's possible. And so like, you know, like letting regular college happen, that's a great good. Universities are a wonderful invention and it's contributed so much to society. Just decide to shut it down, that the universities should be fighting tooth and nail to not be shut down, not the other way around.

• 2:14:40Lex Fridman?

  Yeah. Whatever the mechanisms that results in the universities doing that, that's probably, this is me talking. It probably has to do with certain incentives for the administration, probably has to do with lawyers and legal kinds of things to to avoid legal trouble. But once again, it's when the administration has too much power and too much definition of what the policy is for the university. That's when you get into trouble. The beauty, the power of the university should be about the faculty and the students. Administration

• 2:15:13Lex Fridman?

  just gets in the way. Get out of the way.

• 2:15:15Speaker 01

  I mean, they can help organize things. They, they play some important role, but they

• 2:15:19Lex Fridman?

  Certainly do.

• 2:15:20Speaker 01

  But they need to remember what the mission is. The mission is not safety, the mission, actually, universities should be dangerous places, you know, for ideas and whatnot.

• 2:15:31Lex Fridman?

  What is the role of fear in a pandemic? We've been dancing around it. Is it useful? Is it destructive? Or is there sort of a complicated story here? Because sort of taking us back into January 2020, there was so much uncertainty. This could have been a pandemic that

• 2:15:49Lex Fridman?

  is a black death, the bubonic plague. It could have killed hundreds of millions of people. We don't know that. We're, we're very new to this. It's been a while. We're rusty. So like, there is, there is some value to fear so that you don't do the stupid thing. You don't just go on living.

• 2:16:07Speaker 01

  I guess where I come from, I think it's almost entirely counterproductive. I think fear should never be used as a tactic to manipulate human behavior by public health.

• 2:16:18Lex Fridman?

  So the fear on the individual level. That feeling of fear, you should be very hesitant about that feeling because it could be easily manipulated by the powerful.

• 2:16:28Speaker 01

  Exactly. So I think that fear is natural. And it's not something that you have to stoke to get when the facts on the ground suggest it, right? In fact, the tendency for humans in the face of threats from infectious disease is to exaggerate the fear in their own minds of being contaminated by the environment and by others. That's just natural to humans. And the role of public health is not necessarily to eradicate the fear, but like, obviously, technological advances can help eradicate the fear, but it's really to help manage

• 2:17:06Speaker 01

  that fear and help people put the sort of incentives that come out of that to useful things as opposed to harmful things. What's happened in this pandemic is that there's been a deliberate policy to stoke the fear, to help make people think that the disease is worse than it actually is. In survey after survey, you see this. And that's been incredibly damaging. So young people have readily given away their willingness to participate in regular life because, A, they fear COVID more than they ought, and B, they fear that they're going to harm the vulnerable in their lives.

• 2:17:49Speaker 01

  You put those two together and you get this powerful demand for lockdowns. You see this all over the world.

• 2:17:55Lex Fridman?

  Broadly speaking, you have a powerful demand for irrational policies, irrational policies, because I would like to mention the flip side of that. I've been saddened to see how much money there is to be made by the martyrs, the people, the conspiracy theorists that tell you, you should be afraid of the government, you should be afraid of the man. It feels like fear is the problem. I think there's some guy that once said something about we should be, we should fear, fear itself.

• 2:18:33Lex Fridman?

  He was the president or something.

• 2:18:34Speaker 01

  I vaguely remember that.

• 2:18:36Lex Fridman?

  So I, I, so I'm worried about both sides here. It that.

• 2:18:40Speaker 01

  Well, I just, I think the general principle is that should not be a tool of public policy. Right? The true, the public policy should attempt and public health policy in particular should attempt to address that fear. It's not that you should tell people lies, of course not. Tell people accurately what the risk is. Give people tools that have evidence that they can address their risk with.

• 2:19:07Speaker 01

  And level with people when we don't know. I think that is the right adult way for, to deal with this pandemic from a public health point of view. And that's, that is not the policy we have followed. Instead, public health has intentionally stoked the fear in order to gain compliance with its edicts. And I think the consequence of that is people distrust public health. They, they, what you're talking about, this distrust of government, I think is a partly a consequence of that. That, that movement, which is much smaller once upon a time, is much larger now because of essentially, people look at what the, what public health has done and said, I mean, they've lied to me a whole bunch of times and a whole bunch of things is, is the general sense. And there are consequences to that.

• 2:19:51Speaker 01

  We're going to have to work in public health for a long time to try to regain the trust of the public.

• 2:19:57Lex Fridman?

  Throughout all of this, you've been inspiring to me, to a lot of people. You've been fearless, bold in these kinds of challenging the policies and not in, in a martyr kind of way, because you're walking the line gracefully and beautifully, I would say. And looking at that, I think you're an inspiration to a lot of young people. So I have to ask, what advice would you give them? If they're thinking of going into science, if they're thinking of having an impact in the world, what advice would you give them about their career?

• 2:20:38Lex Fridman?

  And maybe about their life, thinking about somebody in high school, maybe in undergraduate college.

• 2:20:44Speaker 01

  I'd say a few things. One is, this is a wonderful profession. You have an opportunity to improve the lives of so many and do it by having fun, the kind of play we're talking about. It's an absolute privilege to be able to work in this kind of area. And to young people looking to say, that have some gifts or desired for this area, I say, please, you know, go for it.

• 2:21:09Lex Fridman?

  So this area signs broadly?

• 2:21:12Speaker 01

  Yeah. I mean, it could be, it could be, I don't have any gifts in AI, but like, you know, it could be your, but you know, or in health, or in medicine, or whatever, whatever your gifts lie, develop them, work hard and develop them because it's worth it. It's worth it, not just, not just because you get some status, but because the journey is fun and the result is improvement to the lives of so many. So I think that that is the encouragement I give. I'd also say, if you're looking at this ugliness of this debate that's happened over the pandemic, I'd say to the young people, we need you to come in and help transform it. Many of the people who've seen this debate that behaved poorly,

• 2:21:51Speaker 01

  I ask you forgive them. I've done my best to try, because they're, many of them are acting out of their own sense that they need to do good, but they've, but the mistake they've made is, is in, is in this arrogance and this power. But when you come in, remember that example as a negative example. And so that you, when you join the debate, you'll join it in a spirit of humility, in a spirit of trying to learn, while keeping that, that love of, that led you to enter the field in the first place.

• 2:22:22Lex Fridman?

  And yeah, choose forgiveness versus like derision. Like the people that you know have messed up, like give them a pass, because that's how, it feels like that's how improvement starts.

• 2:22:37Speaker 01

  Funny, I've been thinking this, it's like, I told you I'm Christian, right? So like, I thought, like, God has given me many opportunities to forgive people, learn to practice how to do that.

• 2:22:47Lex Fridman?

  Gave you a gift.

• 2:22:48Speaker 01

  It's a very humble thing, I guess.

• 2:22:50Lex Fridman?

  Is there a memory from when you were young that was very formative to you? So you just gave advice to some young people. Is there something that stands out to you that? A decision you made, an event that happened that made you the man you are today?

• 2:23:10Speaker 01

  I actually grew up in a relatively poor environment. Like, I was born in India and moved when I was four. My dad had eight brothers and sisters and my mom had four brothers and sisters. She grew up in the slum in Calcutta. My dad, his dad died when he was young and he supported his family, his brothers and sisters with university scholarship money. Came to the US and my dad worked in a McDonald's, even though he was an electrical engineer, couldn't find a job in 1971. And so he worked at McDonald's. We lived in a, like, this, basically, the housing port, like, development in Cambridge, this, like, this middle building on the 17th floor, this,

• 2:23:53Speaker 01

  like, housing development. I mean, I think that was transformative for me. Like, I didn't realize so much at the time, well, how that experience of being essentially, like, poor, lower-middle-class, what effect it had on my outlook.

• 2:24:10Lex Fridman?

  You mentioned to me offline that you listened to a conversation that I had with my dad. What impact did your dad have on your life? What memories do you have about him?

• 2:24:19Speaker 01

  He was a rocket scientist, actually. He helped design rocket guidance systems. Died when I was 20 and I still miss him to this day. And I think that experience of seeing him sacrifice his, himself for his family, a brilliant man, but in many ways frustrated with, like, his opportunities in the world, partly what led him to come to the US in the first place. That's transformed, that's had a transformative effect on me. And I wish I could tell him that, looking back.

• 2:24:56Lex Fridman?

  Do you think about your own mortality? Do you think about your death? Your dad is no longer with us. You're the, the old wise sage that represents.

• 2:25:08Speaker 01

  It's funny, I've only worried about death once in this pandemic. Although I had two of my, I had my cousin who's 73 and my, my uncle who's 74 die in India during the pandemic and I grieve them, both from COVID. Like the fear of COVID really is only hit me only really once during this. It wasn't for me and I recognize this is irrational. So on the eve of the Santa Clara County seroprevalence study, it was, it was a really interesting thing because so many people volunteered to help. And my, my, my daughter who's 20, she was, I guess it was 19 at the time.

• 2:25:51Speaker 01

  And my wife also volunteered to help with like various aspects of the study. And so the eve of the study, they were going to go out in public. And I didn't know what the death rate was because we hadn't done the study. And I suspected it was lower than people were saying, but I didn't know. I knew about the age gradient because I'd seen the Chinese data and my, my daughter's young, but my wife is my age and I didn't know the death rate. And I couldn't sleep the night before. Like what if I'm putting my family, my kid, my, my daughter and my wife at risk because of some, some activity that I'm doing. It was kind of, I don't know.

• 2:26:27Lex Fridman?

  So it's worried about the wellbeing and of others.

• 2:26:33Speaker 01

  Yeah.

• 2:26:33Lex Fridman?

  When you look in the mirror.

• 2:26:34Speaker 01

  If I die, I die. I mean, like I just, it's not, I, again, I'm Christian, so I don't, death is not the end for me. I believe. And so I don't, I don't particularly worried about my own death, but I do. I mean, I just, I think we can't help it. We worry about the, the wellbeing of our loved ones.

• 2:26:52Lex Fridman?

  So from the perspective of God, then let me ask you, what do you think is the meaning of this whole journey we're on? What do you think is the meaning of life?

• 2:27:02Speaker 01

  Oh, it's very simple. Love one another. Treat, treat your neighbor as yourself.

• 2:27:07Lex Fridman?

  It's love.

• 2:27:07Speaker 01

  Yeah.

• 2:27:08Lex Fridman?

  As simple as that. Well, I'd love to see a little bit more of that in this pandemic. It's an opportunity for the best of our nature to shine. It's, I've seen some of the worst. But I think some of that is just good therapy. And I'm hoping in the end, what we have here is, is love. At the very least, make your dad proud with some incredible rockets that were launching. I think you'd get along well with my dad, Lex. I definitely would. Thank you so much. This is an incredible honor to talk to you, Jay. You've been an inspiration to so many people. And keep fighting the good fight. Thank you so much for spending your valuable time with me today. Thank you for having me here. Appreciate it.

• 2:27:52Lex Fridman?

  Thanks for listening to this conversation with Jay Bhattacharya. To support this podcast, please check out our sponsors in the description. And now let me leave you with some words from Alice Walker. "The most common way people give up their power is by thinking they don't have any." Thank you for listening and hope to see you next time.