In world where it’s almost impossible to tell if someone is lying or delusional, where is line between an unintentional error in perception and intentional misrepresentation? This question is proving to have profound consequences in medical practice.

In healthcare, where the difference between facts and opinion continue to blur, tribalism and factionalism are a growing concern.

In this episode of Fixing Healthcare, cohosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to probe the many problems with medical misinformation in America.

When both physicians and patients crave simple answers to complex problems, ultimately, is it our fears that drive our perception of what’s real? To find out, press play or peruse the transcript below.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.

UNFILTERED TRANSCRIPT

Jeremy Corr:

Welcome to Unfiltered, our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. I’ll then pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off?

Robert Pearl:

Hey, Zubin, welcome to this month’s show.

Zubin Damania:

Ah, it’s always a pleasure to be back, brother.

Robert Pearl:

With Halloween coming up, do you have a custome in mind?

Zubin Damania:

I’m going to go as a burned out physician who just doesn’t know what to do. In other words, I’m just going to go as myself circa 2009.

Robert Pearl:

Excellent. Yeah, I was planning to be a crazy knife bearing surgeon. I think reality and fiction often overlap and intersect, and I think we both have the same thoughts right now.

Zubin Damania:

Both characters are truly terrifying.

Robert Pearl:

I don’t know about you, but I feel like there’s a dark cloud over the world now with economic uncertainties that exist, the war in Ukraine, the evermore problematic American political system. Would you care to cheer me up?

Zubin Damania:

Yeah, I’ll cheer you up this way. I agree that it feels that way for sure. And actually the only way I cheer myself up is by realizing everything that we think is absolute reality like that is just all a thought matrix we live in. So we do the best we can in that relative world. But in reality, right here, right now is just absolute stillness and peace and perfection. And so those two things exist simultaneously. And if you can tap into both and feel into both, then it’s much less depressing because you realize in the end everything’s going to be okay because it already is.

Robert Pearl:

I love your Buddhist tranquility, but I’m still concerned that as our nation divides wider and deeper, something I’ve thought about a lot is trying to figure out where the line is or how do we establish the line between unintentional errors in perception and intentional misrepresentation. I often find it difficult to ascertain where the people are saying what they truly believe, but it’s just wrong, versus when they’re lying. Any thoughts of how you discern the difference?

Zubin Damania:

So this degree of discernment has become increasingly difficult because there is an aspect of self-deception that humans are really good at. We’re increasingly good at it when we’re divided into these tribal groups and social media creates a virtual belonging for us, this meaning crisis is solved by belonging to a group. So in a way when what we may think is misinformation from the standpoint of one virtual group may be absolutely believed as true from the standpoint of another. And therefore, if you were to say, create a law that says we’re going to fight misinformation this way by these criteria, there’s always going to be groups that say that’s total crap, because from our standpoint, we’re actually telling the truth. And actually humans have evolved to self-deceive potentially to some extent because in order to fool others in a tribe, in order to get away with something, we’re so good, we’re such good lie detectors as humans, that discernment that you’re talking about, that in order to fool people, we have to believe what we’re saying.

And so to some degree, that degree of self-deception then projects in a way that it’s very hard to discern, does that person actually believe what they’re saying? Even though objectively I can measure things and say this is not true. And I think that’s where we are. We’re in this sense making crisis. How do you even know what’s true anymore and who believes what? So I share your frustration with that. It is very hard, but I think you have to get at the meta crisis underlying it, which is this meaning crisis, the sense making crisis and the tribalization.

Robert Pearl:

A few years ago I did some research with a neurologist, George York, and we looked at the literature on perception. What we found was fascinating. In times of great fear or opportunities for pleasure or wealth, people’s brains shift what they see. You put individuals in headsets and you ask them to ascertain where the two images that have been rotated are identical, and 95% of the time they’ll get it right. But you put them in a group of three others who are in on the experiment and all three of the others consciously report a wrong answer to particular problems, and two thirds of the time the unknowing subject will give the incorrect answer.

Now people might say, Oh, this is just going along with the crowd, but interviews of the subjects later confirmed that what they actually saw were the wrong images. And this to me is the question, the tribalism that you’ve spoken about many times and you’ve discussed on your podcasts and other shows. How do we understand this and what can we do to minimize it? At least from my perspective, I don’t think it’s a good thing to have tribalism in healthcare.

Zubin Damania:

Yeah. So I think what you’re pointing at is the fact that we don’t so much perceive reality as constructed. And that construction is a complex interplay between whatever’s input to our senses and whatever we’re constructing. In fact, our occipital lobe, according to Professor Donald Hoffman, is so big and such a huge user of energy in the brain that it would be overkill to actually just re-represent what the senses are telling us. But it’s just about right to construct a world. So since we are humans, we’re contextual creatures, we’re social creatures where as we talked about the last time, we’re right brain and left brain creatures both. And that right brain wants to see things in their context and it sees these other creatures that are in our group or in our tribe constructing things a certain way and it influences our construction. This is absolutely true. It’s probably the explanation for a large component of the placebo effect in medicine too.

That therapeutic alliance, that sense of being heard is bigger than even if you can tell them, Hey, this is a placebo, but we find it works for a lot of people and we’re going to sit with you. And even that just saying that has a therapeutic effect. So I think that tribalism, first of all, it’s recognizing that this is actually how humans are. That objective reality is a very tricky thing. And so if we’re constructing reality from these inputs, then let’s try to understand the ought to, what ought a good healthcare system, good society, good set of ethics look like? And I think that’s where we might agree a lot more than we disagree. We’re always arguing over the is like, well what’s going on? What is this? What is that? No, but what would we like? And I think once we start to align around that tribalism, we might be able to build that corpus callosum between the tribes.

Robert Pearl:

So let’s dive a little deeper. Let’s look at doctors who recommend treatments that prove lucrative to themselves but have been shown to add little clinical value for patients. Do you think they promote them out of conscious greed or do you think they actually see them as valuable regardless of what the literature concludes?

Zubin Damania:

Ooh, another great example of us constructing our reality and our sense of morality and ethics from first principles. And the first principles in this case are, we want to do good, but we also need to survive. We have the Maslow’s hierarchy we have to provide and so on. We’ve done all this training and now they’re telling me that maybe the colonoscopy that I trained to do for all these years, that’s the bread and butter of the generation of cash for my specialty in gastroenterology. Now there’s a study saying, well maybe it’s not as good as we thought as a population wide screening tool. Probably works on some individual level, but as a population, okay, what are you going to do? You are going to immediately, unconsciously, and to some degree consciously react and say, yeah, wait a minute now, you did the study wrong, there’s things you didn’t look at, you haven’t seen the patients I’ve seen.

When a patient comes and says, You saved my life by detecting that precancerous polyp, you haven’t had that experience and you’re just a egghead and a data analyst and you’re missing the big picture. I think that’s all absolutely believed by the person. I think deep down there is a doubt that what if this is true and I must defend against that and so on because there is an existential risk to the income. And Upton Sinclair said it’s very difficult to have a man believe something when his livelihood depends on him not believing it. And that’s just how humans are. We’re constructing this reality. So how do we address that? Well that’s a difficult thing because a straight on attack throwing data at people is not going to change what’s happening. You need to shift in the overall sort of paradigm. And that’s very difficult to do.

Robert Pearl:

Does this phenomenon you’re talking about, explain the 180 degree contrasting views of people about vaccines.

Zubin Damania:

A thousand percent. So those vaccine views are based, I think increasingly on our morality and our moral taste buds. The six moral taste buds that Jonathan Haidt talks about, care versus harm, liberty versus oppression, sanctity versus degradation, fairness versus cheating, authority versus subversion, loyalty versus betrayal. Those are the six. How you feel those taste buds will determine how you look at vaccines. And one of those is loyalty versus betrayal. Let’s say you are conservative and you have loyalty to group and then the group is saying, we don’t trust these vaccines because it just so panned out that Trump wasn’t a big proponent of the vaccine. Well now that tribal loyalty has to conflict with the care versus harm, but they’ll feel care versus harm as, oh we’re actually harming young people by giving them myocarditis with these unnecessary vaccines. So, that’s how they’ll spin it.

Now on the left they’ll say, Hey, care versus harm, I don’t want to kill grandma, I don’t want people to die. So we want vaccines. And their loyalty versus betrayal is, well, I’m loyal to these ideas of “the science,” which is increasingly a politicized feeling. So they will fight tooth and nail for a vaccine, even if in say a 13 year old boy there’s a risk of myocarditis, they’ll very much downplay that as, Oh, the risk of COVID myocarditis is worse. But really there isn’t great data to say one way or the other. So they won’t accept the uncertainty there. And I think that’s entirely moral matrix driven. They’re all trying to be good. And once you see that the tendency to be judgemental towards in group and out groups tends to soften a bit. And then you can just determine, okay, so how can we do the most good here? How can we build some bridges? And I think it’s existential a risk to us that we have to do that now, we have to start looking from that morality standpoint.

Robert Pearl:

I don’t know, it sounds like it’s a pretty big gap to close between people who see a intervention as being so life saving and people who see it as so problematic. I just rarely have seen a gap as big as this one.

Zubin Damania:

It’s really heartbreaking because previously, and actually this is spilling over into childhood vaccines. So now we’re seeing this hesitancy towards childhood vaccines, which was there at a small level before and now it’s increasing because again, the tribalization, the politicization and you can blame all kinds of people and you could probably blame some people more than others for this, but it is an increasing factor. And I think things like social media, the Zuckerverse and all this other stuff have really fed into this because their monetization models benefit from division, they benefit from the outrage and the headline clickbait stuff, but unfortunately, so okay, Robbie, I’m feeling into how you’re even phrasing these questions.

You are very discouraged right now. That’s clear. You’ve said it explicitly, but you can also feel it in your tone of voice and I think many people are, I think many people who are smart people who’ve worked in healthcare feel as you do. I see them when I go talk and things like that. And all I can say is I happen to tend on the optimistic side because the only way out is through. And I think if we fail to destroy ourselves, I think we will increasingly wake up to what’s actually happening. It just is going to be ugly for a while. So we have to keep talking about it. We have to keep pushing through making the implicit that we think we understand more explicit so people can go, Oh this what’s really happening. But it is hard.

Robert Pearl:

Yeah, it’s particularly hard I’ll say as a scientist, you see data, you see logic. If people have problems with the specific information, you repeat experiments. There are ways you could explore questions, but when at the end of that process you still have two seemingly unconnected, completely contradictory conclusions, then that becomes hard to put in a scientific model for which the healthcare world has tried to achieve for 5,000 years.

Zubin Damania:

Yeah. And this is where the fundamental of schism between our science-based consensus reality that we’ve, like you said, 5,000 years of growth of the scientific method, and the way humans actually instantiate these hive mind group thinks that are powered by their moral taste buds and loyalty. And part of it, Robbie, I think is the meaning crisis in a bigger sense. We used to have a common mythology. You and I have talked about the hero’s journey. That’s a common mythology across cultures, but we’ve lost some of the sense. And so now we find our meaning in tribe, in group, in belonging. And when that becomes paramount, then the consensus reality starts to fracture because then we’re creating our own consensus reality within the group instead of within the collective as science has done since the enlightenment and prior. So it can feel very frustrating to a science minded person and it definitely has felt frustrating to me.

Robert Pearl:

Multiple times a month I get a call from a CEO of an artificial intelligence company and the calls are almost all exactly the same. They tell me that first of all, they’re the best engineers that exist in healthcare. Then they tell me that they have an application that will save three hours a day per physician, but they can’t understand why no one is buying it. Now I tell them that they’re delusional, although I say it in much nicer languages.

Zubin Damania:

Good for you.

Robert Pearl:

I say the problem they should be having is managing the line out the door. But we just talked about ourselves as scientists. In practice, we’re just as liable to be misled as anyone else. How do we as physicians minimize that risk?

Zubin Damania:

Yeah, this is great because again, we feel in the scientific community that we’re immune to this stuff, but we’re as susceptible like you said. And I think part of it is how we’re even training ourselves, educating ourselves. Do we talk about these issues of group think and cognitive bias and errors in thinking and even the kind of cardinal signs of conspiracy thinking, or cardinal signs of misinformation. We don’t even train people on that because sometimes we can turn that back on ourselves. Some of them are things like cherry picking data. Well, we in science do that well if we have an emotional investment in something. I gave the example of say colonoscopy. If you’re emotionally invested in something, you’ll cherry pick the data to support what you believe. So the fake experts, pulling up an expert that really doesn’t have a lot of business talking about this, but they have some credentials.

The moving goal posts. No matter what information you present someone, they’ll say, well, but then what about this? And they’ll move the goal post further. The conspiracy thinking, the logical fallacies. If we trained ourselves on that stuff or had it as part of our curriculum, even in elementary school, junior high, high school, boy, we’d have the tools and the agency we then restore our agency, because right now it’s almost like we’re zombies walking towards the abyss. We don’t even know it. In science, outside of science, once we actually can see clearly the trajectory, I think there’s much more chance that we’re going to be motivated to do different.

Robert Pearl:

So let’s dive even a level deeper. You live in the Bay Area and I’m sure you’re well aware of Elizabeth Holmes and the Theranos debacle.

Zubin Damania:

Yeah.

Robert Pearl:

We had Tyler Schultz on our Fixing Healthcare podcasts a couple years ago. And of course there were numerous TV shows and books about what happened. As you know, the attorneys are battling over possible retrial. But I’m fascinated by the question, how much of the deception did she know versus how much was a subconscious shift in her brain that made her see reality different than it was? Of course no one including herself probably knows the answer. So your opinion is as valid as anyone else’s. What are your thoughts?

Zubin Damania:

I love my opinion being as valid as anyone else’s. That’s really empowering, also completely terrifying. Yeah. So with her it’s fascinating. There clearly had to… Again, again, and let’s just pretend that I know what I’m talking about because again, you can’t get in someone’s mind. This is a fallacy in itself, the mind reading policy. But I’ll say this, just looking at this in human nature, self-deception is powerful. She had every motivation to self-deceive and every motivation to then, by self-deceiving, actually be able to easily deceive others because she believes what she’s saying. And she’s got to convince George Schultz, she’s got to convince pretty smart people who’ve been around the block and she managed to do it and it got to be that she believed it herself. And yet you can actually have this cognitive dissonance where you believe that stuff and you’re still trying to cover things up and yo know there’s stuff going on and that’s totally squirrelly and all that can coexist.

And I think with her, it’s a great example and I think there are a lot of people in the startup space and the tech space who are going through that. In a way they know, oh this business model’s never going to work. It’s a pipe dream, but if we just keep believing it, we’ll create a Steve Jobs reality distortion field and people will just go along for the ride and at some point things will work out. And that false optimism it’s actually a very left brain. The left brain is very optimistic because it just thinks it’s right and it can self deceive all day long. And then the right hemisphere goes, wait a minute, but it’s quiet. So I suspect there was something like that going on.

Robert Pearl:

Yeah, people’s desire to see the world differently than if they could be impartial. It’s just so prevalent. What about Anna Sorokin, the probably fake heiress made famous on the Netflix show, Inventing Anna. Here’s someone who’s spending money, throwing a hundred dollar bills around, convincing the world that she is incredibly rich when she’s basically on the verge of bankruptcy. Look at how many people, I don’t know if you watched the show, but how many people she was able to deceive. She’s in prison right now, but I don’t even know if she knows whether she’s a real heiress or a fake.

Zubin Damania:

It’s a great story. And again, it speaks to we create reality in our minds, in her mind, whatever she believes. And that reality distortion actually feeds out to other people, because we’re social. So it doesn’t surprise me at all. In fact, there have been con people throughout history that have pulled this off and continue to pull it off. Say what you will about, say a cryptocurrency, take two stances on, it’s a real thing, it’s deflationary, all these great things about cryptocurrency. And then, but you could also say, well this is a group think led by a few really loud people on social media that has taken people as the Dutch tulip bulb craze did. And if that’s true, then that’s a same self-deception. These people actually believe this. I know a lot of them and maybe they’re right, but if they’re not right, this is a huge self-deception and on a social level.

Robert Pearl:

We should probably spend an entire show on cryptocurrency.

Zubin Damania:

I know. We’ll get canceled for sure man. These guys are vicious, they’ll kill us.

Robert Pearl:

Because it’s a lot more than just the scarcity and fear of missing out on the soaring of the dollars as it was in the Netherlands during the tulip bulb inflation rate of the time. But the crypto has its own notion that somehow there’s this evil force out there that is manipulating the media, that is controlling our lives and that we the populous need to take it out. And we’re going to do that by using the blockchain technology that underlies cryptocurrency so that every voice becomes equal and equally important. So it has this aura of media three or whatever you want to label it to be, that drives not just the economic analysis of the various currencies, but the value, the mission, the purpose, the higher meaning for these dollar bills.

Zubin Damania:

Yes, yes. And what’s interesting, so there’s a moral crusade involved, there’s a deep set of beliefs, there’s a sense of belonging. You see it with the crypto bros on Twitter and all these guys that are, and mostly guys actually that are doing this thing. And I tell you, I know a lot of them, they are truly passionate about the woes of our current economic system. And what’s interesting is money is such a human construction anyways, it’s like when the dollar’s not backed by gold, what is it backed by? Well, the faith of the US government. So what is cryptocurrency backed by? Well the faith of the masses that believe it’s worth something. So it’s fascinating and I have to say this, and I’ll say this to immunize myself against, attacked by the crypto bros. I have no idea what the answer is. I’m not an economist. It’s just a fascinating unfolding and a social group think unfolding too on all sides of it.

Robert Pearl:

I don’t know if you’ve ever heard of a teacher named Ron Jones. He taught-.

Zubin Damania:

I haven’t.

Robert Pearl:

Oh, he taught at Cooley High School in Palo Alto in the 1960s. And he was a history teacher and his focus at the time was on fascism and Nazi Germany. And to teach the ethics, the values, the things that happened at the time, he started his class a movement that he called the Third Wave. On day one of the module he insisted that students stand when they spoke with him and always begin with Mr. Jones to demonstrate strength through discipline. On day two he said they had to salute with a cuffed hand to the opposite shoulder to show strength through community. On day three told the class that they were special and that certain others who didn’t belong were trying to pretend to be members, but they had to be stopped. And this was stray through action.

By day four, the in group had gone from 30 students to 200 and harm was being inflicted on the out group. And, of course, they had to stop the project. In three days he had taken literally hundreds of students and gotten them to get behind a movement which had no value and was oppressing others. I think that’s the same phenomenon we’re seeing now in so many of these tribal areas that you’re describing.

Zubin Damania:

Yes. Again, and I believe all of it, it’s a social group think kind of thing that you can push through, especially if you have a charismatic leader and you don’t even need that honestly. Now with social media, the charisma is all virtual and you can do all kinds of things. Yeah, Robbie, that’s why just understanding even the nature of how we think and what our minds do and what even is consciousness is, I think a fundamental piece to avoiding falling into these traps. And even then you’ll fall into these traps. In fact, in these spiritual circles where you have these gurus, man, these things can devolve into cult-like craziness with all kinds of abuse and misbehavior among the teachers very, very quickly. Even in these groups that are purporting to be enlightened and awake and oh, we understand the nature of reality. Yeah. Okay, let’s see how that goes. Because again, we’re humans.

Robert Pearl:

There’s an expression that where the pie gets smaller, the table matters deteriorate. As the pressures are about to mount in healthcare, how do you see tribalism playing out?

Zubin Damania:

Healthcare is going to implode at the current rate of growth because it’s going to drag down everything. It’s a self-limiting process right now. It’s got no future in this current configuration. And when that becomes apparent, I think either the early adopters of the next phase of healthcare, whatever health 3.0 that I call it, I think will start to run with it and it’ll just go, or again, it’s going to be a bunch of Al Bundy’s sitting around the table with their hands down their pants burping, and the table manners will have degraded to that level because they’ll all be clawing for whatever’s left and it’s going to be really ugly. And I think we’ll see maybe some combination of that, I think. But again, as the eternal optimist, you’re already seeing these bright spots emerging. You’ve pointed them out, I’ve pointed them out. I think that’s just going to become essential and that’s just going to be the next phase. But yeah, who knows? Who knows?

Robert Pearl:

I have to say you’re not doing a great job of cheering me up today. In fact, I would say that I’m a bit more optimistic than you because I actually think there’s a range of technological solutions that actually could be the answer. But we’ll say that also for the next show. An idea that our view is right has killed hundreds of millions of people across history. One of my favorite anecdotes, and it’s a tragic historical story, comes from the 14th century. I don’t know how familiar you are with this history, but in 1349, the world was in the infamous black plague. And the leading experts from the government, science and academia of Western Europe came together to devise a plan to save the population. I realize by this time the black plague gets spread from the Eastern Mediterranean through most of Eastern Europe. It had killed hundreds of thousands of people over the previous three years.

And those coming to the conference decided that they wanted to stop it from ravaging Western Europe. And they said that research had demonstrated that the plague was derived from fleas, which was correct. And then they made the assumption that since dogs carried fleas, by eliminating dogs, they could eliminate fleas and end the plague. So edicts were passed to each nation to kill all the dogs. But of course, as we know now, the fleas that carried the plague weren’t the ones in the back of dogs, but the ones carried by rats. And without dogs roaming the street, the rat population and the flea population soared. By three years later, nearly one in three people in the world had died of the plague. I wonder if 50 years from now people will look back at how we treat various diseases at the conclusions that we have reached in areas maybe such as maybe cancer or even heart attacks with similar disbelief about how ignorant we were.

Zubin Damania:

A thousand percent. They’re going to, there’s no doubt that they’re going to. They’re going to look at this and there’s a great scene in one of the Star Trek movies, I think it’s Star Trek four, where they go back in time to the 20th century and Bones, the doctor is seeing a patient who shows up in the hospital because they’re trying to rescue Checkov who’d fallen and had a head injury. And they’re trying to drill burr holes in Checkov’s head to relieve the pressure. And Checkov is like burr holes. You’re drilling big holes in his skull, man. Barbarians. And he’s applying this 23rd century or 25th century medicine to this and he’s just like, these people are barbarians. Woman comes up and says, I’m on dialysis doctor. And he gives her a pill and says, take one of these and call me in the morning. And the next scene she’s walking and fine and everything’s perfect.

And I think that contrast of what the future paradigm of medical care is and what we’re doing now it’s huge chasm between it. And that’s why I think we really need to almost think completely differently. What we’re doing with this, oh, there’s a drug that finds a receptor and it does this or cancer is this. It’s like, no, no, no, no, it’s way more complex than that and we need a complexity science that fits that. And then where does the mind fit into that? Where does the placebo effect fit into that? Where does expectation, the fact that we create our reality fit into that? How do we merge those things? I think we’re going to look back and go, dude, this was primitive at best. Like, Gilligan’s Island primitive.

Robert Pearl:

My sense, Zubin, is that in medicine, both physicians and patients crave simple answers to complex problems, that it’s our fear that drives and alters our perception, that all of us are at risk of embracing approaches that can seem reasonable, but ultimately prove worthless. How can people as patients, as doctors, as caregivers, as nurses, minimize the probability of falling into that trap?

Zubin Damania:

I think we have to start change shifting a culture and the way we talk about things can’t be, take a pill and call me in the morning. It can’t be just steal heels and just cut this out and you’ll be better. It’s got to be realistic. It’s got to be relationship based. If you’re going to help a patient on their own hero’s journey, as their mentor, as their helper, you have to actually help them create that reality. And some of it is mind created, which means setting expectations, your bedside manner, your connection with them, your relationship, how you treat your peers and your colleagues actually, they pick up on that and your colleagues pick up on that, which changes how they treat the patients and the general level of stress and connectivity and connectedness. So all of that I think has to happen. And actually I think in many ways nurses can lead that because they’re right there with the patient in that relationship. Sometimes we can be a little detached.

Robert Pearl:

I love it. And when you start leading the parade, I’ll be marching right behind you. Jeremy, your question for us.

Jeremy Corr:

So we’re hearing that the COVID vaccine is likely going to be added to the vaccine schedule for children, which would make it a requirement for them to get to attend public schools. We’re also hearing the CDC is pushing ahead on getting the Omicron boosters approved in children as young as five, while not allowing the clinical trial data to be public. Many respected experts such as Marty Makary and Vanay Prasad have been very critical about how all of this is being handled. One of the most respected vaccine scientists in the world in Dr. Paul Offit is even raising red flags about the lack of transparency and how government agencies and big pharma are cutting corners to get this approved.

What are both of your thoughts on what is happening, what is the long term harm of what is happening in terms of vaccine hesitancy for the tried and true vaccines that are already part of a child’s vaccine schedule and people’s faith in the CDC, FDA, NIH overall and increase the levels of tribalism in the country? And also, to sum it up, if you were to be asked to be the next head of the CDC, FDA, NIH, et cetera, what would you do to restore public faith in the organization?

Zubin Damania:

I love these easy questions. These are softball. Okay, so I’ll take a stab at this one. And I’ve had Paul on my show, I’ve had Marty on my show, I’ve had Vanay on my show, I’ve had people who are more aligned to give mandates for childhood vaccines. This is my take on this, a vaccine mandate implies a couple of necessities. One is that the thing that you’re mandating, because you’re trading off again these moral values. One is liberty versus oppression. So you’re saying, okay, I’m going to take away this liberty to decide whether or not to take this vaccine because the greater good of care versus harm and fairness versus cheating is important. So by vaccinating a five year old against coronavirus in school, we’re somehow going to prevent other children from getting sick or teachers from getting sick. There’s going to be a community benefit.

And so the argument for the community benefit is not that it prevents transmission because it barely does if at all, maybe initially, but then it wears off. That’s just the nature of a respiratory virus like Coronavirus. The argument would be, well, we prevent schools from having absenteeism, you prevent other issues like the rare death or disability healthy child from COVID. But the question then is, well, do you mandate that? And when the majority, actually the vast majority of children have had exposure now to coronavirus or vaccine, mostly coronavirus, is it necessary to do that? And what’s the cost of doing that? So the psychological reactance against the loss of autonomy for parents is real because of our tribalized split society.

So the actualization of this mandate may be that you create more vaccine hesitancy for other childhood vaccines, which are absolutely essential for the collective good, where you need a certain level of vaccination to prevent transmission like measles and mumps, et cetera. So that’s my take is I think mandating this for children right now is not going to accomplish an improvement in overall public health, but may have the opposite effect even though the intention is good.

Jeremy Corr:

And then to ask you to sum up the other parts, what are your thoughts on the whole lack of transparency with the clinical trial data and even like Paul Offit raising the flags about them wanting to approve that?

Zubin Damania:

I think that to a degree everything’s been politicized. So yes, it’s in the best interest of whoever’s in power right now to actually have lower case numbers and so on and have people vaccinated and they believe in that. And I think that’s fine. I think the lack of, it’s very easy to tell Pfizer and Moderna, Hey, you have the money, you have a lot of government money. Do a good human trial on these, because this is not flu vaccination, this is a different virus, it’s a different scenario, flu vaccination, and Paul Offit makes a good distinction between the two. You can’t just then say, Okay, this is going to… And because the main question is hospitalizations, severe disease and death. And we don’t have good evidence with a BA.4-5 vaccine in humans, that those issues are actually improved. You may reduce infection for a transient period of time, but then is that worth a mandate, especially for children?

So it is concerning I think, in my mind. But again, it’s also concerning that there are people saying, Oh, this thing is causing cancers and it’s causing infertility. It’s not. So it’s just empowering, I think people to be even more divided about this.

Robert Pearl:

My sense, Jeremy, is that if we had all the data, we would find that the vaccine is safe and it does help reduce the rare 220 children have died under age five from COVID in a couple of years. So it’s not that it’s going to be negative or somehow data’s going to be hidden, that’s going to say that there actually is tremendous risk. But I’m a big believer, and if I led any of these agencies, that’s what I would do in telling the truth. And I think that what people are reacting to and intrinsic in your question is that a mandate doesn’t make sense in this particular circumstance, or if it does, I can’t fully explain it. And what I mean by that is the following. A polio mandate makes sense. Why is that? Because polio is a horrible, terrible, lethal disease that is easily spread amongst children. And a vaccine, from my viewpoint, not the old oral ones, but the current variety is safe and the problems are so much less than the consequences for children who get sick.

Similarly, measles is one of the most contagious diseases, and there are well defined significant problems that children have who develop the disease, including one of my great grandparents, not grandparents, but children of my grandparents who died actually from measles as a young child. So those diseases have a logic. What’s missing in this situation is the logic of mandating it in young children, their risk is very small and you could mandate a lot of things that would have a more beneficial effect than this particular vaccine. Is it possible that the vaccine mandate would improve the health of the nation? It’s possible, worth debating, but that type of question is different than a mandate of the child who’s going to get the vaccine because we mandate vaccines for the individual, not for the bigger society.

Now, experts can disagree upon how effective those vaccines are, whether that mandate for the individual is appropriate given the risks of the vaccine. In this case, risks are very low, but the benefits are equally low. And I think sitting in people’s minds and the critics you’ve described is this idea of why is it being mandated? What is the truth? Is it really being mandated for the people receiving the shots, or is it being mandated for other reasons? And that’s where I have the problem, because I’m not aware of vaccines that we mandate outside of a healthcare setting that is designed to protect other individuals surrounding them. And that’s why I think the skepticism and the lack of confidence in these agencies exists. And every time you cut a corner, you create a problem in medicine and that leads to more negative than positive, more harm than benefit.

Jeremy Corr:

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