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Language: en
the following is a conversation with
francis collins director of the nih the
national institutes of health appointed
and reappointed to the role by three
presidents obama trump and biden
he oversees 27 separate institutes and
centers including nyad which makes him
anthony fauci's boss
at the nih francis helped launch and led
a huge number of projects that pushed
the frontiers of science health and
medicine including one of my favorites
the brain initiative that seeks to map
the human brain and understand how the
function arises from neural circuitry
before the nih francis led the human
genome project one of the largest and
most ambitious efforts in the history of
science
given all that francis is a humble
thoughtful kind man
and because of this to me he's one of
the best representatives of science in
the world he is a man of god and yet
also a friend of the late christopher
hitchens who called him quote one of the
greatest living americans
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in the description and now here's my
conversation with francis collins
science at his best is a source of hope
so for me it's been difficult to watch
as it has during the pandemic become at
times a source of division
what i would love to do in this
conversation with you
is touch some difficult topics and do so
with empathy and humility so that we may
begin to regain a sense of trust in
science and then it may once again
become a source of hope
i hope that's okay with you i love the
goal
let's start with some hard questions
you called for quote thorough expert
driven and objective inquiry into the
origins of coven 19 so let me ask
is there a reasonable chance that covet
19 leaked from a lab
i can't exclude that i think it's fairly
unlikely i wish we had more ability to
be able to ask questions of the chinese
government and
learn more about what kind of records
might have been in the lab that we've
never been able to see
but most likely this was a natural
origin of a virus probably starting in a
bat perhaps traveling through some other
intermediate yet to be identified host
and finding its way into humans
is answering this question within the
realm of science do you think will we
ever know i think we might know if we
find that intermediate host
and there has not yet been a thorough
enough
investigation to say that that's not
going to happen
and remember it takes a while to do this
with sars it was 14 years before we
figured out it was the civet cat that
was the intermediate host with mers it
was a little quicker to discover it was
the camel
with sarsko v2 there's been some looking
but especially now with everything
really tense between the us and china if
there's looking going on we're not
getting told about it
do you think it's a scientific question
or a political question it's a
scientific question but it has political
implications
so the world is full of scientists that
are working together but in the
political space in the political
political science space
there's tensions
what is it like to do great science in a
time of a pandemic when there's
political tensions it's very unfortunate
pasteur said science knows no one
country
he was right about that my whole career
in genetics especially
is dependent upon international
collaboration between scientists as a
way
to make discoveries get things done
scientists by their nature
like to be involved in international
collaborations the human genome project
for heaven's sake 2 400 scientists in
six countries working together not
worrying who is going to get the credit
giving all the data away i was the
person who was supposed to keep all that
coordinated it was a wonderful
experience
and that included china that was sort of
their first real entry into a big
international
big science kind of project and they did
their part
it's very different now
continue on the line of difficult
questions
especially difficult ethical questions
in 2014
us put a hold on gain and function
research in response to a number of
laboratory biosecurity incidents
including anthrax smallpox and influenza
in december 2017
nih lifted this ban
because quote gain of functional
research is important in helping us
identify understand and develop
strategies and effective countermeasures
against rapidly evolving pathogens that
pose a threat to public health
all difficult questions have arguments
on both sides can you argue the pros and
cons of getting a function research with
viruses
i can
and first let me say this term gain of
function
is causing such confusion that i need to
take a minute and just sort of talk
about what the common scientific
use of that term is and where it is very
different when we're talking about the
current oversight of potentially
dangerous human pathogens
as you know in science we're doing gain
of function experiments all the time
we support a lot of cancer immunotherapy
at nih
right here in our clinical center there
are trials going on where people's
immune cells are taken out of their body
treated with a genetic therapy that revs
up their ability to discover the cancer
that that patient currently has maybe
even at stage four and then give them
back
as those little ninja warriors uh go
after the cancer and it sometimes works
dramatically that's a gain of function
you gave that patient a gain in their
immune function that may have saved
their life
so gotta be careful not to say oh gain
of function is bad
most of what we do
in science that's good involves quite a
bit of the hat
and we are all living with gains of
function every day i have a gain of
function because i'm wearing these
eyeglasses otherwise i would not be
seeing you as clearly i'm happy for that
gain of function
so
that's where a lot of confusion has
happened the kind of gain of function
which is now subject to very rigorous
and very carefully defined oversight
is when you are working with an
established human pathogen that is known
to be potentially causing a pandemic
and you are enhancing or potentially
enhancing its transmissibility or its
virulence
we call that epp
enhanced potential pandemic pathogen
that requires
this very stringent oversight worked out
over three years
by the national
science advisory board on biosecurity
that needs to be looked at by a panel
that goes well beyond nih to decide are
the benefits worth the risks in that
situation
most of the time
it's not worth the risk only three times
uh in the last three or four years uh
have experiments been given permission
to go forward they were all an influenza
so i will argue that if you're worried
about the next pandemic
the more you know about the coming enemy
the better chance you have to recognize
when trouble is starting
and so if you can do it safely
studying influenza
or coronaviruses like sars mers and
sarsko v2
would be a good thing to be able to know
about but you have to be able to do it
safely because we all know
lab accidents can happen and i mean look
at sars where there have been lab
accidents and people have gotten sick as
a result
we don't want to take that chance unless
there's a compelling scientific reason
that's why we have this very stringent
oversight
the experiments being done at the wuhan
institute of virology
as a sub-award to our grant to eco
health
in new york
did not meet that standard of requiring
that kind of stringent oversight i want
to be really clear about that because
there's been so much thrown around about
it
was it gain a function well in the
standard use of that term that you would
use in science in general you might say
it was but in the use of that term that
applies to this very
specific
example of a potential pandemic pathogen
absolutely not
so nothing went on there that should not
have happened based upon the oversight
there was an instance
where the grantee institution failed to
notify us about the result of an
experiment that they were supposed to
tell us where they
mixed and matched uh some viral genomes
and got a somewhat larger viral load as
a result but it was not epp it was not
getting into that zone that would have
required this higher level of scrutiny
it was all bat viruses these were not
human pathogens
so they didn't cross a threshold within
that gray area that makes for an eppp
they did not and anybody who's willing
to take the time
to look at what epp means and what those
experiments were would have to agree
with what i just said what is the
biggest reason it didn't cross that
threshold is it because it wasn't
jumping to humans
is it because it did not have a
sufficient increase in virulence and
transmissibility what's your sense
eppp only applies
to agents that are known human pathogens
of potent of pandemic potential
these were all bat viruses derived in
the wild
not shown to be infectious to humans
just looking at what happened if you
took four different bat viruses and you
tried moving the spike protein gene from
one into one of the others to see
whether it would bind better to the ace2
receptor that doesn't get across that
threshold and let me also say for those
who are
trying to connect the dots here which is
the most troubling part of this and say
well this is how sarsko v2 got started
that is absolutely demonstrably false uh
these bat viruses that were being
studied had only about 80 percent
similarity in their genomes to sars cov2
they were like decades away in
evolutionary terms
and it is really irresponsible for
people to claim otherwise
speaking of people who claim otherwise
rand paul
what do you make of the battle of wars
between senator rand paul and dr anthony
fauci over this particular point
i don't want to talk about specific
members of congress but i will say it's
really unfortunate that tony fauci who
is the epitome of a dedicated public
servant
has now somehow been targeted for
political reasons
as somebody that
certain figures are trying to discredit
perhaps to try to distract from their
own failings
this never should have happened here's a
person who's dedicated his whole life uh
to trying to prevent illnesses from
infectious diseases including hiv
in the 1980s and 90s and now
probably the most
knowledgeable infectious disease
physician in the world and also a really
good communicator
is out there telling the truth about
where we are with sarsko v2
to certain political figures who don't
want to hear it and who are therefore
determined to discredit him
and that is disgraceful so with
politicians there they often play games
with black and white
they try to sort of uh use
the gray areas of science and then paint
their own picture
but i have a question about the gray
areas of science so like you mentioned
gain of function is a term there's very
specific scientific meaning but it also
has a more general term and it's very
possible to argue that the
not to argue not the way politicians
argue but just as human beings and
scientists that there was a gain of
function achieved
at the wuhan institute of
biology but it didn't cross a threshold
i mean there's a it's it's uh it but it
could have too so here's the thing when
you do these kinds of experiments
unexpected results may be achieved and
that's the gray area of science you're
you're taking risks with such
experiments
and i am very uncomfortable that we
can't
discuss the uncertainty in the gray area
of this
oh i'm comfortable discussing the gray
area what i'm uncomfortable with is
people deciding to define for themselves
what that threshold is based on sort of
some political argument the threshold
was very explicitly laid out
everybody agreed to that
in the basis of this three years of
deliberation so that's what it is if
that threshold needs to be reconsidered
let's reconsider it but let's not try to
take an experiment that's already been
done and decide that the threshold isn't
what it was because that that really is
doing a disservice to the whole process
i wish there was a discussion even in
response to
uh rand paul and i know we're not
talking about specific senators but just
that particular case i'm saying stuff
here i wish there's an opportunity to
talk about
given the current threshold this is not
gain of function
but maybe we need to reconsider the
threshold and have an action that's an
opportunity for discussion about the
ethics of gain or function you said that
there was three studies that passed that
threshold with influenza that's a
fascinating human question scientific
question about ethics because
you're playing like you said there's uh
there's pros and cons
you're taking risks here to prevent
horribly destructive viruses in the
future
but you also
are risking creating such viruses in the
future with nuclear weapons and nuclear
energy
you are
nuclear energy
promises a lot of positive effects and
yet you're taking risks here
with uh mutually sure destruction uh
nations possessing nuclear weapons oh my
you're a lot i hope we're not going
there well we're not but
a lot of people argue that that's the
reason we've nuclear weapons is the
reason we've prevented world wars
and yet they also have the risk of
starting world wars and this is what we
have to be honest about
with the with the benefits of risks of
science that you have to
make that calculation of what are the
pros and what are the cons i'm totally
with you but i want to reassure you lex
that this is not an issue that's been
ignored yes that this issue about the
kind of gain of function that might
result in a serious human pathogen has
been front and center in many
deliberations for a decade or more
involved a lot of my time along the way
by the way and has been discussed
publicly on multiple occasions including
two major meetings of the national
academy of sciences
getting input from everybody and
ultimately arriving at our current
framework now
we actually back in january of 2020 just
before covet 19 changed everything
had planned and even charged that same
national uh
science advisory by board on biosecurity
to reconvene and look at the current
framework and say do we have it right
let's look at the experience over those
three years and say is the threshold too
easy too hard
do we need to reconsider it let's look
at the experience kovit came along the
members of the board said please we're
all infectious disease experts we don't
have time for this right now but i think
the time is right to do this i'm totally
supportive of that and that should be
just as public a discussion as you can
imagine about what are the benefits and
the risk and if somebody decided
ultimately this came together and said
we just shouldn't be doing these
experiments under any circumstances if
that was the conclusion well that would
be the conclusion but it hasn't been so
far
if we can briefly look out into the next
hundred years on this
i apologize for the existential
questions
but
it seems obvious to me
that as gain of function type of
research and development becomes easier
and cheaper
it will become greater and greater risk
so if it doesn't no longer need to be
contained
within the laboratories of high security
it feels like this is one of the
greatest threats facing human
civilization do you worry that at some
point in the future a leaked man-made
virus may destroy
most of human civilization
i do worry about the risks and
at the moment where we have the greatest
control the greatest oversight
is when this is federally funded
research
but as you're alluding there's no reason
to imagine that's the only place that
this kind of activity would go on
if there was an evil source that wished
to create a virus that was highly
pathogenic in their garage
the technology does get easier
and there is no international oversight
about this either that you could say has
the same stringency as what we have in
the united states so yes that is a
concern
it would take
a seriously deranged group or person
to undertake this on purpose uh given
the likelihood that they too uh would go
down we
don't imagine there are going to be
bioweapons that only kill your enemies
and don't kill you sorry we're too much
alike for that to work
so
i don't see it as an imminent risk
there's lots of uh scary novels and
movies written about it but i do think
it's something we have to consider what
are all the things that ought to be
watched you may not know that if
somebody is ordering
a particular oligonucleotide
from one of the main suppliers and it
happens to match smallpox
they're going to get caught
so there is
effort underway to try to track any
nefarious actions that might be going on
in the united states or international is
there an international collaboration of
trying to track this stuff there is some
i wish it were stronger
this is a general issue like in terms of
do we have a mechanism particularly when
it comes to ethical issues
to be able to decide what's allowable
and what's not and enforce it i mean
look where we are with germline genome
editing for humans for instance there's
no enforcement mechanism there's just
bully pulpits and governments that get
to decide for themselves so you talked
about evil what about incompetence does
that worry you i was born in the soviet
union
my dad a physicist worked at chernobyl
that comes to mind that wasn't evil i
was
i don't know what word you want to put
it maybe incompetence is too harsh maybe
it's the inherent incompetence of
bureaucracy i don't know but for
whatever reason there was an accident
does that worry you of course it does
we know that sars for instance did
manage to leak out of a lab in china two
or three times
and at least in some instances people
died fortunately quickly contained
all one can do in that circumstance
because you need to
study the virus and understand it in
order to keep it from causing a broader
pandemic but you need to insist
upon the kind of biosecurity the bsl 2 3
and 4 framework under which those
experiments have to be done
and certainly at nih we're extremely
rigorous about that but you can't count
on every human being
to always do exactly what they're
supposed to so there's a risk there
which is another reason why if we're
contemplating supporting research on
pathogens that might be the next
pandemic
you have to factor that in not just
whether people are going to do something
on that we couldn't have predicted where
all of a sudden they created a virus
that's much worse without knowing they
were going to do that but also just
having an accident that's that's in the
mix when those uh estimates are done
about whether the risk is worth it or
not
continuing online of difficult questions
we're gonna get to fun stuff after a
while we will soon i promise
you are the director of the nih
you are dr anthony fauci's technically
his boss yep you have stood behind him
you have supported him just like you did
already in this conversation
it is painful for me to see division and
distrust
but
many people in politics and elsewhere
have called for anthony fauci to be
fired
when there's such calls of distrust in
public about a leader like anthony fauci
who should garner trust do you think
he should be fired absolutely not
to do so would be basically to give
the
opportunity
for those who want to make up stories
about anybody
to destroy them there is nothing
in the ways in which tony fauci has been
targeted that it's based upon truth
how could we then
accept those cries
for his firing as having legitimacy
it's a circular argument they've decided
they don't like tony so they make up
stuff and they twist
comments that he's made about things
like gain a function where he's
referring to the very specific gain of
function that's covered by this policy
and they're trying to say he lied to the
congress that's simply not true they
don't like the fact that tony changes
the medical recommendations about what
to do with covet 19 over the space of
more than a year
and they call that flip-flopping and you
can't trust the guy because he says one
thing last year and one thing this year
well the science has changed
delta variant has changed everything you
don't want him to be saying the same
thing he did a year ago that would be
wrong now it was the best we could do
then people don't understand that or
else they don't want to understand that
so when you basically whip up a largely
political argument against a scientist
and hammer at it over and over again to
the point where he now has to have 24 7
security to protect him against people
who really want to do violence to him
for that to be a reason to say that then
he should be fired is to hand the evil
forces the victory i will not do that
yet there's something difficult i'm
going to try to express to you
so
it may be your guitar playing
uh it may be something else
but there's a humility to you it may be
because you're a man of god there's a
humility to you
that
garners trust
and
when you're in a leadership position
representing science especially in
catastrophic events like the pandemic
it feels like as a leader you have to go
far above and beyond your usual duties
and i think there's no question that
anthony falci has delivered on his
duties
but it feels like he needs to go above
as a science communicator and if there's
a large number of people
that are that are distrusting him
it's also his responsibility to garner
their trust to gain their trust
as a as a person who's the face of
science do you are you torn on this the
responsibility
of anthology of yourself to represent
science
not just the communication of advising
what should be done
but
giving people hope giving people trust
in science
and alleviating division
do you think that's also a
responsibility of a leader or is that
unfair to ask
i think the best way you give people
trust is to tell them the truth
and so they recognize that when you're
sharing information it's the best you've
got at that point and tony fauci does
that at every moment
i don't think him expressing more
humility
would change the fact that they're
looking for a target of somebody to
blame
to basically distract people from the
failings of their own political party
maybe i'm less targeted not because of a
difference in oh the way in which i
convey the information i'm less visible
if tony were out of the scene and i was
placed in that role i'd probably be
seeing a ratcheting up of that same
targeting
i would like to believe
that if
tony fauci said
that when i originally made
recommendations not to wear masks
that was given on the on our best
available data and now we know that is a
mistake
so admit with humility that there's an
error that's not
that's not actually correct
but that's a that's a statement of
humility and i would like to believe
despite the attacks
he would win a lot of people over with
that
so a lot of people as you're saying
would use that see that here we go
here's that dr anthony fauci making
mistakes how can we trust him at
anything i believe if he was
the sp that public display of humility
to say that i made an error
that would win a lot of people over
that's my that's kind of
my sense to face the fire of the attacks
from politics you have like politicians
will attack no matter what but the
question is the people
would you to win over the people that
the biggest concern i've had
is that there was this
distrust of science that's been brewing
and i'm
maybe you can correct me but i'm a
little bit unwilling to fully blame the
politicians because politicians play
their games no matter what
it just feels like this was an
opportunity
to inspire people with the power of
science the development of the vaccines
no matter what you think of those
vaccines is one of the greatest
accomplishments in the history of
science indeed
and
the fact that that's not inspiring
listen i host a podcast whenever i say
positive stuff about the vaccine i get
to hear
a lot of different opinions i bet you do
the fact that i do is a big problem to
me because it's an incredible
incredible accomplishment of science
and so i
yeah i i i'm sorry but i have to put
responsibility on the leaders
even if it's not their mistakes that's
what the leadership is that's what
leadership is you take responsibility
for the situation i wonder if there's
something that could have been done
better
to
give people hope
that science will save us as opposed to
science will divide us
i think you have more confidence
in the ability to get beyond our current
divisions uh than i do after seeing just
how deep and dark they have become
tony fauci has said multiple times the
recommendation about not wearing masks
was for two reasons
a shortage of masks which were needed in
hospitals and
a lack of realization early in the
course of the epidemic
that this was a virus that could heavily
infect asymptomatic people
as that changed he changed now did he
make an error no he was making a
judgment based on the data available at
the time but he certainly made that
clear over and over again
it has not stopped uh those who would
like to demonize him from saying well he
just flip-flopped
he you can't trust a guy he says one
thing today and one thing tomorrow
well masks is a tricky one so it is a
tricky one early on i'm a co-author and
a paper one of one of many but this was
a survey paper overlooking the
the evidence
uh it's a summary of the evidence we
have for the effectiveness of masks it
seems that
it's difficult to do rigorous scientific
study on masks it is difficult
there's a lot of philosophical and
ethical questions i want to ask you but
within this
it's back to your words and anthony
fauci's words
when you're dealing with so much
uncertainty
and so much potential uncertainty about
how catastrophic this virus is in the
early days
and
knowing that each word you say may
create panic
how do you communicate science with the
world
it's a philosophical it's an ethical
it's a practical question
there was a discussion about masks a
century ago
and that too led to panic
so
i mean i'm trying to put myself in the
mind in your mind in the mind of anthony
fauci in those early days knowing that
there's limited supply masks
like what do you say
do you fully convey the uncertainty of
the situation of the
of the challenges of the supply chain
or do you say that masks don't work
that's a complicated calculation
how do you make that calculation
it is a complicated calculation
as a scientist your
temptation would be
to give a full brain dump of all the
details
of the information about what's known
and what isn't known what experiments
need to be done
most of the time that's not going to
play well in a sound bite on the evening
news so you have to kind of distill it
down to a recommendation that is the
best you can do
at that time with the information you've
got
so you're a man of god
and we'll return to that to talk about
some
some also unanswerable philosophical
questions but first let's linger on the
vaccine
because in the in the religious in the
christian community there was some
hesitancy with the vaccine
still is still is
there's a lot of data showing high
efficacy and safety of vaccines of covid
vaccines
but still they are far from perfect as
all vaccines are can you empathize with
people who are hesitant to take the
covet vaccine or to have their children
take the covet vaccine i can totally
empathize
especially when people are barraged by
conflicting information coming at them
from all kinds of directions
i've spent a lot of my time in the last
year trying to figure out how to do a
better job of listening
because i think we have all
got the risk of assuming we know the
basis for somebody's hesitancy
and that often
doesn't turn out to be what you thought
and the variety of reasons is quite
broad
i think a big concern is just this sense
of uncertainty about whether this was
done too fast and that corners were cut
and
there are good answers to that
along with that a sense that maybe this
vaccine will have long-term effects that
we won't know about for years to come
and one can say that hasn't been seen
with other vaccines and there's no
particular reason to think this one's
going to be different than the dozens of
others that we have experience with but
you can't absolutely say no there's no
chance of that
so it does
come down to listening and then trying
in a
fashion that doesn't convey a message
that you're smarter than the person
you're talking to because that isn't
going to help
to really address what the substance is
of the concerns
but my heart goes out to so many people
who are fearful about this because of
all the information that has been dumped
on them
some of it by politicians a lot of it by
the internet
some of it by
parts of the media that seem to
take pleasure in stirring up uh this
kind of fear
for their own reasons
and that is shameful
i'm really sympathetic
with the people who are confused and
fearful
i am not sympathetic with people who are
distributing information that's
demonstrably false
and continue to do so
they're taking lives
i didn't realize how strong that
sector of disinformation
it would be
and it's been
in many ways more effective uh than the
means of spreading the truth
this is going to take us into another
place but alex if there's something i'm
really worried about in this country and
it's not just this country but it's the
one i live in
is that we have another epidemic besides
covet 19
and it's an epidemic of the loss
of the anchor of
truth that truth as a means of making
decisions
uh truth is a means of figuring out
how to wrestle with a question like
should i get this vaccine for myself or
my children
seems to have lost its primacy
and instead it's an opinion of somebody
who
expressed it very strongly
or
some facebook post that i read
two hours
ago and for those to become substitutes
for objective truth
not just
of course for vaccines but for many
other issues like
was the 2020 election actually fair
this worries me deeply
it's bad enough to have polarization
and divisions
but to have no way of resolving those by
actually saying okay what's true here
makes me very worried about the path
we're on and i'm usually an optimist
well to give you an optimistic angle on
this
i actually think
that
this sense that there's no one place for
truth
it's just a thing that will inspire
leaders and science communicators to
speak not from a place of authority but
from a place of humility i think it's
just challenging people to communicate
in a new way
to be listeners first
i think the problem isn't that there's a
lot of misinformation
i think that
um
people
the the internet and and the world
are distrustful of people who
who speak as if they possess the truth
with an authoritarian kind of
tone yeah which was i think defining for
what science was in the 20th century
i just think it has to sound different
in the 21st
with uh it's a in the battle of ideas i
think humility and love wins
and
that's how science wins not through
having quote unquote truth because now
everybody can just say i have the truth
um i think you have to speak like i said
from humility not authority and so it
just challenges our leaders to uh go
back
and
learn to be part of my french less
and uh
more kind and like you said to listen to
listen to the experiences of people
that are good people not not the ones
who are trying to manipulate the system
and play a game and so on but real you
know real people who are just afraid of
uncertainty of hurting those they loved
and so on so i think it's just an
opportunity for leaders to go back and
take a class on effective communication
i'm with you on the shifting uh more
from where we are to humility and love
that's got to be the right answer that's
very biblical by the way
we'll get there
i i have to bring up uh joe rogan i
don't know if you know who he is i do
he's a podcaster comedian fighting
commentator and
my now friend and iver mekton uh
believer too yes that is the question i
have to ask you about
uh he has gotten some flack in the
mainstream media for not getting
vaccinated and when he got coveted
recently taking ivermectin as part of a
cocktail of treatments
the nih actually has a nice page on
ivermectin saying quote there's
insufficient evidence to recommend
either for
or against the use of ivermectin for the
treatment of covin19
results from adequately powered
well-designed and well-conducted
clinical trials are needed to provide
more specific evidence-based guidance on
the role of ivermecton in the treatment
of covenant 19.
so let me ask why do you think there has
been so much attack on joe rogan and
anyone else that's talking about
ivermectin when there's insufficient
evidence for or against
well let's unpack that
first of all i think the concerns about
joe are not limited to his taking
ivermectin that much more seriously his
being fairly publicly negative about
vaccines
at a time where people are dying
700 000 people have died from covet 19
estimates
by kaiser or at least a hundred thousand
of those were unnecessary deaths of
unvaccinated people
and for joe to promote that further even
as this uh
pandemic rages through our population
is simply irresponsible
so yeah the ivermectin is just one other
twist obviously ivermectin has been
controversial for months and months
the reason that it got particular
attention is because of the way in which
it seemed to have captured the
imagination of a lot of people and to
the point where they were taking doses
that were intended for livestock
and some of them got pretty sick as a
result from overdosing on this stuff
that was not good judgment
the drug itself remains uncertain
uh there's a recent review that looks at
all of the studies of ivormectin and
basically concludes that it probably
doesn't work
we are running a study right now i
looked at that data this morning
in a trial called active six which is
one of the ones that my public-private
partnership
is running we're up to about 400
patients who've been randomized to
ivermectin or placebo
and should know
perhaps as soon as a month from now in a
very carefully controlled trial did it
help or did it not so there will be an
answer
coming back to joe
again i don't think the fact that he
took divermectin and hoping it might
work
uh is that big a knock against him it's
more the conveying of we don't trust
what science says which is vaccines are
going to save your life we're going to
trust what's on the internet that says
ivermectin and hydroxychloroquine really
do work even though the scientific
community says probably not so let me
push back in that a little bit
so he doesn't he doesn't say let's not
listen to science
he doesn't say the vaccine don't get
vaccinated
he says it's okay
to ask questions i'm okay with that how
risky is the vaccine for certain
populations
what are the
benefits and risks
there's other friends of joe
and
friends of mine like sam harris who says
if you look at the data
it's obvious that the benefits outweigh
the risks
and what joe says
is yes but let's
still openly talk about risks and he
often brings up anecdotal evidence of
people who've had
uh highly negative effects from
vaccines
science is not done with anecdotal
evidence
and so you could infer a lot of stuff
from the way he expresses it but he also
communicates a lot of interesting
questions
and that's something maybe you can
comment on this
you know there's certain groups that are
healthy
they have uh they're younger they have
they exercise a lot they get the all you
know nutrition and all those kinds of
things
he shows
skepticism on whether
it's
so obvious that they should get
vaccinated and the same is
he makes this he kind of presents the
same kind of skepticism for
kids
for young kids so
with
empathy
and
uh
you know listening my russian ineloquent
description of what joe believes what
what is your kind of response to that
why should
certain categories of healthy and young
people still get vaccinated do you think
well first just to say it's great for
joe to be a skeptic to ask questions we
should all be doing that but then the
next step is to go and see what the data
says and see if they're actually answers
to those questions
so coming to healthy people
i've done a bunch of podcasts besides
this one
the one i think i remember most
was a podcast with a worldwide wrestling
superstar very nice he's about six foot
six
and just absolutely solid muscle
and he got coveted
and he almost died
and recovering from that he said i've
gotta let my
supporters know because you can imagine
worldwide wrestling fans are probably
not big
embracers of the need for vaccines
and he want he just turned himself into
a spokesperson for the fact that this
virus doesn't care how healthy you are
how much you exercise what a great
specimen you are it wiped him out
and we see that
you know the average person in the icu
right now with covet 19 is under age 50.
i think there's a lot of people still
thinking oh it's just those old people
in the nursing homes it's not going to
be about me they're wrong
and they're plenty of instances of
people who were totally healthy with no
underlying diseases
taking good care of themselves not obese
exercising who have died from this
disease
700 children have died from this disease
yes some of them had underlying factors
like obesity but a lot of them did not
so it's fair to say
younger people are less susceptible to
serious illness kids even less so than
young adults but it ain't zero
and if the vaccine is really safe and
really effective
then you probably want everybody to take
advantage of that even though some are
dropping their risks more than others
everybody's dropping their risks some
are you worried about variants so
looking out into the future are you
what's your vision for
all the possible trajectories that this
virus takes in human society i'm totally
worried about the variance
delta was
such an impressive arrival on the scene
in all the wrong ways i mean it took
over
the world yeah in the space of just a
couple months because of its extremely
contagious ability viruses would be
beautiful if they weren't terrifying
yeah exactly i mean this whole story of
viral evolution scientifically is just
amazingly elegant anybody who really
wanted to understand how evolution works
in real time
study sars cov2
because it's not just delta it's alpha
and it's beta and it's gamma and it's
the fact that these sweep through
uh the world's population
by
fairly minor differences in fitness
so the real question many people are
wrestling is is delta it is it is it
such a fit virus that nothing else will
be able to displace it
i don't know i mean there's now delta
ay4
which is a variant of delta that at
least in the uk
seems to be taking over
the delta population as though it's
maybe even a little more contagious that
might be the first hint that we're
seeing something new here it's not a
completely different virus it's still
delta but it's delta plus
you know the big worry
lex is
what's out there that is so different
that the vaccine protection doesn't work
and we don't know how different it needs
to be for the vaccine to stop working
that's the that's the terrifying thing
about each of these variants
it's like uh it's always a pleasant
surprise the vaccine seems to have still
have efficacy
and hooray for our immune system may i
say
because the vaccine immunized you
against that original wuhan virus
now we can see
that especially after two doses and even
more so after a booster your immune
system is so clever that it's also
making a diversity of antibodies to
cover some other things that might
happen to that virus to make it a little
different
and you're still getting really good
coverage
even for beta which was
south africa b1351 which is the most
different
it looks pretty good
but that doesn't mean it will always be
as good as that if something gets really
far away from the original virus now the
good news is we would know what to do in
that situation the mrna vaccines allow
you
to redesign the vaccine like that
and to quickly get it through a few
thousand participants in a clinical
trial to be sure it's raising antibodies
and then bang you could go
but i don't want to have to do that
there will be people's lives at risk in
the meantime and what's the best way to
keep that from happening well don't
quite try to cut down the number of
infections
because you don't get variance unless
the virus is replicating in a person so
how do we
uh solve this thing how do we get out of
this pandemic what's like if you had a
like a wand or something or
uh you could really implement policies
what's the full cocktail of solutions
here oh it's a full cocktail it's not
just one thing
in our own country here in the u.s it
would be getting those 64 million
reluctant people to actually go ahead
and get vaccinated there's 64 million
people who didn't get vaccinated adults
yes not even counting the kids wow 64
million wow and that astounding
get the kids vaccinated hopefully their
parents will see that as a good thing
too
uh get those of us who are due for
boosters boosted because that's going to
reduce our likelihood of having
breakthrough infections and keep
spreading it
uh convince people that until we're
really done with this and we're not now
that social distancing and mask wearing
indoors are still critical uh to cut
down the number of new infections
but of course that's our country
this is a worldwide pandemic
i worry greatly about the fact that low
and middle income countries have for the
most part not even gotten started with
access to vaccines and we have to figure
out a way to speed that up
because otherwise that's where the next
variant will probably arrive
and who knows how bad it will be and it
will cross the world quickly as we've
seen happen repeatedly in the last 22
months
i think i'm really surprised annoyed
frustrated
that testing
rapid at home testing from the very
beginning wasn't a big big part of the
solution it seems first of all nobody's
against it that's one huge plus for
testing that it's everybody supports
second of all like that's what america
is good at is like mass manufacturer
stuff like
like stepping up engineers stepping up
and really deploying it plus without the
collection of data it's giving people
freedom
is giving them information and then
freedom to decide what to do with that
information it's such a powerful
solution i don't understand well now i
think the biden administration is
i think emphasized like the scaling of
testing manufacturers so but i just feel
like it's an obvious solution get a test
that
costs less than a dollar manufacturer
costs less than a dollar to buy
and just everybody gets tested every
single day
don't share that data with anyone you
just make the decisions and i believe in
the intelligence of people to make the
right decision to stay at home when the
test is positive i am so completely with
you on that and nih has been smack in
the middle of trying to make that dream
come true
we're running a trial right now
in georgia indiana hawaii
uh and where's the other one
oh kentucky
basically blanketing a community with
free
i'm testing that's beautiful and look to
see what happens as far as stemming the
the spread of the epidemic and measuring
it by waste water because you can really
tell whether you've cut back the amount
of infection in the community
yeah you i'm so with you we got off to
such a bad start with testing
and of course all the testing was being
done for the first several months in big
box laboratories
where you had to send the sample off and
put it through the mail somehow and get
the result back sometimes five days
later after you've already infected a
dozen people it was just a completely
wrong model but it's what we had and
everybody was like oh we got to stick
with pcr because if you start using
those home tests that are based on
antigens lateral flow
probably there's going to be false
positives and false negatives okay sure
no test is perfect but
having a test that's not acceptable or
accessible is the worst setting so we
nih with some
requests from congress got a billion
dollars uh to create this program called
rapid acceleration of diagnostics rad x
and we turned into a venture capital
organization and we invited every small
business or academic lab that had a cool
idea about how to do home testing to
bring it forward and we threw them into
what we called our shark tank
of business experts engineers technology
people people understood uh how to deal
with supply chains and manufacturing
and right now today uh there are about
two million tests being done based on
what came out of that program including
most of the home tests that you can now
buy on the pharmacy shelves we did that
and i wish we had done it faster but it
was an amazingly speedy effort
and you're right companies are really
good once they've gotten fda emergency
use authorization and we helped a lot of
them get that
they can scale up their manufacturing
i think in december we should have about
million tests for that month ready to go
and if we can get one or two more
platforms
approved and by the way we are now
helping fda by being their validation
lab
if we can get a couple more of these
approved we could be in the half a
billion tests
a month which is really getting where we
need to be wow yeah that's a dream
that's a dream for me it seems like an
obvious solution engineering solution
everybody's behind it it leads to hope
versus division i love it
okay
a happy story a happy story i was
waiting for one yeah all right well one
last dive into the not happy but you
won't even have to comment on it uh well
comment on the broader philosophical
question so
nih again i said uh joe rogan as the
first one who pointed me to this
nih was recently accused of funding
research of a paper that had images of
sedated puppies with their heads
inserted into small enclosures
containing disease carrying sand flies
so
i could just say that this this story is
not
true
or at least the
i think it is true that the paper that
showed those images cited
nih is a funding source but that
citation is not correct
yeah
uh but that brings up a
bigger philosophical question what that
it
could have been correct how difficult is
it as a director of nih or just an
ancient organization that's funding so
many
amazing deep research studies
to ensure the ethical fortitude of those
studies when the ethics of science is
there's such a gray area between what is
and what isn't ethical
well tough issues um certainly animal
research is a tough issue
i was going to bring up it's a good
example of that tough issue is in 2015
you announced that nih would no longer
support any biomedical research involved
involving chimpanzees
so that's like one example of
looking in the mirror
thinking deeply about what isn't isn't
ethical and there was a conclusion that
biomedical research on
chimps is not ethical
that was the conclusion that was based
on a lot of deep thinking and a lot of
input from
people who have considered this issue
and a panel of the national academy of
sciences that was asked to review
the issue i mean the question
that i wanted them to look at was are we
actually learning anything that's really
essential from chimpanzee invasive
research at this point
or is it time to say that these closest
relatives of ours
should not be subjected to that any
further and ought to be retired to a
sanctuary
and that was the conclusion that there
was really no
kind of medical experimentation that
needed to be done on chimps in order to
proceed so why are we still doing this
many of these were chimpanzees that were
purchased because we thought they would
be
good uh
hosts for hiv aids and they sort of
weren't
and they were kept around in these
primate laboratories with people coming
up with other things to do but they
weren't compelling scientifically so i
think that was the right decision i took
a lot of flack from some of the
scientific community said well you're
caving in to the animal rights people
and now that you've said no more
research on chimps what's next
certainly when it comes to companion
animals
um everybody's heart
starts
to be hurting when you see anything done
that seems harmful to a dog or a cat i
have a cat i don't have a dog and i i
understand that completely that's why we
have these oversight groups that decide
before you do any of that kind of
research is it justified
and what kind of
provision is going to be made to avoid
pain and suffering
and those are
those have input from the public as well
as the scientific community
is that completely saying that every
step that's happening there is
ethical by some
standard that would be hard for anybody
to agree to no but at least it's a
consensus of what people think is
acceptable
dogs are the only host
for some diseases like leishmaniasis
which was that paper that we were not
responsible for but i know why they were
doing the experiment or like lymphatic
filariasis
which is an experiment that we are
supporting in georgia
that involves dogs getting infected with
a parasite because that's the only model
we have to know whether a treatment is
going to work or not
so i will defend that
i am not in the place of those who think
all animal research is evil
because i think if there's something
that's going to be done
to save a child from a terrible disease
or an adult and it involves animal
research that's been carefully reviewed
then i think ethically why it doesn't
make me comfortable it still seems like
it's the right choice
i think to say all animal research
should be taken off the table
is also very unethical because that
means you have basically doomed a lot of
people
for whom that research might have saved
their lives to having no more hope
and uh to me personally there's far
greater concerns ethically in terms of
uh factory farming for example the
treatment of animals in other contexts
oh there's so much that goes on outside
of medical research that is much more
troubling
that said i think all cats have to go
that's just my off the record opinion
that's why i'm not involved with any
ethical decisions i'm just joki