he's interviewed by bloomberg school of public health epidemiologist doctor emily gu. >> doctor offit i'm so happy to be talking with you today. >> the pleasure is mine, thank you very much. >> obviously the themes in your book are very relevant to what we're going today in the pandemic and i know you said you started writing the book around the time the pandemic began but can you tell us where the idea for the book came from and why

this book now? >> i think the emotion for this book actually came from thefact that i am a child of the 50s. i remember the polio epidemic . what i remember from that is one, how devastating and that yearly epidemic was. how much it affected my mother. we were not allowed to go to swim in a public pool. my aunt my two first cousins have these plastic pools in the back so salt made a polio vaccine and he made it by refining it and activating it with a chemical so you were inoculated with a whole guild poliovirus. it is a he vaccinated 700 children in the pittsburgh area and he found it to be safe and an immune response that he felt comfortable with being protected and this is coming up now on the fda vaccine advisory committee and we are going to consider on tuesday several thousand child studies for the 5 to 11-year-olds so i'm gettingto that in this context . so he didn't want to, he was happy. he said i got up, tells his wife donna i've got.

but nonetheless heat the march of dimeswanted to do a big study. he didn't want to do that. he didn't want to inoculate children with a placebo vaccine during polio season . but nonetheless that was what was done he had 420,000 children got the vaccine, hundred thousand placebo. the vaccine was declared by you later by the person who hated that trial safe , and effective in those three words where the headline of everynewspaper in the united states . church bells rung at synagogues, portland sort of stopped to announce that over the loudspeaker in and it was over the voice of america and at last polio had been conquered. how do we know it was effective? we don't it was effective because 16 people died in that study in the placebo group. 36 children were paralyzed in the study. i mean, those were first and second graders in 1950.

i was a first and second grader in the 1950s but for the flip of a coin those children could have livedlong fulfilling lives but didn't . that's something we don't ever realize which is the human price that we pay for knowledge and is coming up now with regard to these vaccines that wereconsidering next tuesday for the 5 to 11 years old . >> i was reminded over and over again while reading her book just how grateful i am that i'm alive and raising kids now and not in the 50s or not in previous times where there was so many diseases that killed kids. in particular the story about diphtheria and how it strangles kids is very compelling. are there any diseases of the past that you would compare to children? >> one would be polio. polio like covid is largely

an asymptomatic infection. most children with polio at a mild intestinal illness. therewas a summer intestinal virus . one of every 200 people infected with polio had vastly developed paralysis. it was frightening because you didn't know who was shedding the virus. everybody therefore became a potential person from whom you could contract that virus that's similar to this virus. what made it different than say sars one which raised his head in 2002 or mers. is that those viruses when the infected you cause you to have pretty severe illness so you knew it was infected area you could put a moat around those people and effectively stop what was a potential pandemic. not this virus. 50 percent of the people who get infected typically catch it fromsomeone who never had symptoms and that was polio. same thing . >> you also give many examples in the book how things went wrong. and how in the development of

vaccines and therapeutics. how those tragedies gave rise to new policies and new organizations that within the us government to ensure safety and efficacy of medical products. so where are we today and trust with those institutions and if we've gone awry which i think many would argue that we have, there are many who mistrust these organizations to keep our best interests at the forefront. where do we go inrestoring trust ? >> i wish i had a clearanswer for that . i think we are a cynical and tedious sort of conspiracy theoryladen society . we don't trust. i'm not sure where that came. my guess would be sometime

around watergate when we realized that there were people saying things and doing things that weren't necessarily in our best interest . there was a lossof intensity certainly for me of with watergate. but howdo you regain that ? look at the current situation . lookat the pandemic . there was a vaccine. we isolated that virus in january 2000 and sequenced it so now you have a virus 11 months later you had two large clinical trials of the vaccine or the pfizer vaccine , 40,000 people, 30,000 people showing the vaccinewas remarkably effective, more effective than you would imagine . 95 percent of them initially but not absolutely effective not absolutely safe so send things move forward. now thousands of people can be affected, billions, hundreds of millions get the vaccine and then you find out things you wish you knew beforehand. you find out the vaccines

cause inflammation of the heart muscles, you find the johnson and johnson vaccine, the vector virus vaccine is a rare cause of something called prognosis. which which is blood clots. including blood clots in the brain which can be fatal. there's a handful of people who died as aconsequence of the j and j vaccine . so the point is you have systems in place now that can actually detect events as rare as that bloodclotting phenomenon . which is one for 500,000 people work with you the myocarditis problem which is one for 50,000 people so these are extremely rare and it's only because of the sort of tragedies of the past that led to the systems that allow us to monitor vaccines in this case approval . so again i think you're right . we deal with an enormous level of distrust and it's remarkable 65 million people in the us continue to not get this vaccine despite the fact that the evidence is that you

can save your life couldn't be clearer. >> as someone in the scientific medical community, what do you think our role is and mitigating to the public and what advice would you give to other researchers about what they can do to play their part to promote trust in the system and make those systems trustworthy? >> i think the purpose for me in writing this book is to let people know that you learn as you go. youalways learn as you go. you're always at some level building airplane while it's in the air and i feel like that's true now . and that has to be understood but i think what happens. you can read my book the other way which is that here's a series of tragedies which resulted in an honest amount of harm. so therefore you can't dismiss it but that's the process.

knowledge is always hard earned and enduringly associated with the human price and that has to be understood and when people make a choice there are no risk free choices. they're just choosing to take different risks so the goal of that is in as informed a way as possible to take the lesser risk. a nice researcher said and i think he's right over the next few years are going to have to choices which are get vaccinated or get infected and get infected is not the better choice sothat's the purpose of the book is to get people to understand that we learn as we go getting back to this meeting i'm going to have where the advisory committee next tuesday . we will consider a trial in 5 to 11 years of a few thousand children and then we're about to make a recommendation fora few million children, tens of millions of children when do you know everything . you never know everything.

the question is when you know enough to move forward and that's really the history of medical advances. the fact is we live 30 years longer than we did 100 years ago because of thenine medical advances i talk about in the book but they are hard earned and they will always be hard earned . people make the argument let me wait until the learning curve is over but the learning curve is never over . >> as you say in the book day in and day out where making decisions in the face of uncertainty whether we acknowledge it ornot . i like your analogy of the three bridges. to talk about the context of decision-making, or decision-making in the context of uncertainties. can you talk a little bit about the three bridges analogy ? >> i guess the let's suppose you have a certain disorder and you want to try a therapy

that is well tested. that you know that it's well tested and so you're willing to then walk over that bridge because you know that it's well tested. starting bridge. but now you know your, the therapy is relatively new. it's a therapy or a new biological or whatever. it's now you want to do that and the degree to which you want to do that is only to the degree that you're being chased by a lion. if you'rebeing chased by a lion you're willing to go over that rickety less tested bridge . it's kristin barnhart who was the first person to do a human to human transplants said that. the person he translated was a man named lewis was kamsky. he was in desperate need of a heart and he was willing to be the first person to receive a human heart to heart transplant because he didn't have much longer to live so the decisions get a little easier in that case .

but look at the 4000 people currently waiting for a heart transplant today . 1300 will die while waiting. you don't know whether or not you're going to be one of those 1300 so would you be willing to be one of the first to try a pig heart where pigs can be genetically engineered so you won't need immunosuppressive therapy. realize within the last 48 hours there was a successful kidney transplant where the person who received the transplant received the transplant of a paid kidney and it went well so you want to get that shot, you want to try that for try a well-worn bridge if you will of getting heart transplant knowing that you'll live probably 15 years on average after that or try the big part heart because you're scared you may be one of the 1300 who dies while waiting. it's always at some level you're always risking and when you said earlier was right. we don't like to pay for what we're dealing with

uncertainty and we always are . >> we always are and unfortunately our human brains are well evolved to think about risk and that uncertainty. when the pandemic first began , these examples you give are individuals making decisions about whether to take a new treatment or get the pig heart or wait and see if you are able to get a human heart transplant.early in the pandemic, i think we were making those decisions more as a collective at a population we needed to cross the bridge that may be uncertain but there was a lion chasing us. how do you compare that individual patient decision-making about whether or not to take an intervention or the decisions

we were facing as a humanity early in the pandemic? >> that's a great question. so for example last september october the kaiser family foundation did a poll of the united states citizens of america and asked the question would you get a vaccine before the vaccine came out. if you'd asked me that question i probably would have said no but let me wait to see the data. i'm a skeptic to everybody who sits around the advisory committee table is a skeptic, let's see the data. now you've tested it in let's say the pfizer vaccine in 40,000 adult. 40,000 adults got this vaccine and it was 95 percent effective at preventing really any illness, mild moderate or severe and 100 percent in preventing severe illness. now that's at least 20,000 it was a placebo, 20,000 people got vaccinated.

you want to be one of the first to get that vaccinated or wait until a few million doses are out ? marie selman was either the primary researcher who won nine of the 14 vaccines that we currently give to children said it best. he said i never breathe a sigh of release on until the first million doses are out there because sometimes you find out things you wish you'd known earlier. at which case you risk getting that infection because the infection is so common and this is what we've been there with the 1215-year-old recommendation and now are going to have to 5 to 11-year-old. do you want to wait until a few million children have been vaccinated knowing every week as we know hundred 50,000 and 250,000 children are infectedwith the virus children are kept for more than a quarter of current infections as this delta variant has reached down into that susceptible age group .

about 600 children have died. i was on service last week in the hospital of philadelphia and there were plenty of children in their intensive care unit . you want to wait for don't you and i think this is the do you want to wait till more of the population are vaccinated or get the vaccine knowing that a few thousand children were tested in that5 to 11-year-old study by pfizer is enough . when do you know enough to move forward and it's a hard question to answer and practically only know the answer in retrospect. >> exactly. there are some examples of particularly treatments for cobit that received emergency use authorization early on. hydroxychloroquine and convalescent plasma therapy or are two examples. that were used and you know, now we know they don't work and may even cause harm in some patients. and looking back on those decisions early in the pandemic , how critical should we be knowing that

they were making decisions in the face ofuncertainty . how critical should we be in that retrospective analysis knowing what we know today. >> frankly, even prospectively those were bad decisions. i really do feel like the fda was not at its best during that time. i think they really succumbed to what was a lot of arm-twisting bythe administration . it was an administration that was looking for a magic medicine. the hydroxychloroquine and never been shown to work to either prevent this illness. convalescent plasma data were very weak and when you had some fda commissioners standing up in front of the american public setting 35 out of every hundred people are infected with this virus will have their life by convalescent plasma i don't know what data he waslooking at because that certainly wasn't the data that were available . so i think that was one that scared me frankly. when i see doctor emmanuel

wrote an op-ed in the new york times physically saying hearing about an october surprise as we headed to november 3 elections i was afraid that sort of the administration would reach his hand into the operation and the lockable vaccines that hadn't finished phase 3 trials especially two months after last dose to make sure there was no safety problem and if you were going to go two months after the last dose was going to take you bought beyond election day but that did happen and i think the fda did stand up and it's been a lot better but it's been so hard about this is that you are making decisions with far fewer data than you normally would because we're in the middle of the pandemic. >> absolutely. you mentioned there the encroachment of politics into medical scienceand public health . and clearly some negative examples. can you think historically of any good examples of politics interfering in science and

public health? are there good examples out there? >> i guess what i would say a good example is let's go back to the from administration. i think his decision to put $24 billion into this effort i think the name operation worksheet is not the best choice. i think it scared people that with the safety guidelines were being crunched. but you know, what they did there was they basically mass-produced a vaccine at risk meaning they didn't wait for the third phase 3 trials to seewhether the vaccine work . they built the building, they mass-produced the vaccine and if it doesn't didn't work there were going to throw the vaccine away but this way when you saw the trial were successful you could roll it right off the shelves and i think that was an example of the government taking over programs that were great. on the other hand if you see

the government on the other side, there would be the swine flu vaccine story of 1976. there was an outbreak of basically h1 and one influenza, so-called swine flu in fort dix around that time and fort dix new jersey and the thinking was this could be apandemic but it wasn't . there was enough information that probably would be advisors that told president for don't watch this program but he did. the government paid for that vaccine. it was a short-lived program, 40 million people got that vaccine and it was found to have an unfortunate side effect called an ascending paralysis that can be rare, maybe one for 100,000 people is rare. that was a programthat was disastrous in many ways . >> what do you think about the politics at an international scale around the pandemic and particularly vaccines . what has worked in your opinion and what should we

avoid next time. >> it's interesting the level of nationalism. so china has a vaccine made by pharma which is this whole inactivated viral vaccine. that's their strategy they pay in a vaccine of people who areallies of people with china at that vaccine . russia has a vaccine to the astrazenecavaccine . which is a so-called vector virus vaccine and there's two doses of that and that's what you get there you're in russia. the astrazeneca vaccine which is from iron primarily united kingdom vaccine. here the moderna vaccine is a us vaccine. it was a us company so that the us product. it's interesting how it played out. i talk about that a little bit with anesthesia in and that chloroform was a european invented phenomenon

and even though it was much more dangerous than two other anesthetic agents either and nitrous oxide it was sort of perpetuated much longer i think because there was this kind of nationalistic sense of pridethat they were the ones who'd invented it . >> you think that nationalists sense of pride is also driving vaccine use. i imagine so. even though some of these vaccines have worked better than others it seems that countries who have developed vaccines aresticking with it . >> it certainly seems that way. yes. it's interesting. youwould think it would not necessarily be that way. with the vaccine in china activated viral vaccines were better . would we use that vaccine to the exclusion ofsay the visor or johnson and johnson vaccine ? is not inherently better but hadn't been that way would we

have been different or in china if you look at the for example the pfizer vaccines as compared to the vaccine, the whole inactivated vaccine used in china itlooks like it's better but nonetheless they are using their vaccine . >> perhaps at this stage in the game where vaccine supplies are still fairly constrained maybe there isn't much choice there but maybe things will shift once that's no longer such an issue. >> i think you're rightand certainly this virus is going to be with us a while. and is more vaccines come into play , the journal of medicine has a vaccine which is a purified protein. it is augmented with a powerful accident, roughly 90 percent effective those over 55 years of age and we'll see how that plays out. it was going to happen is you have more and more experience with this vaccine now 1 billion people havebeen vaccinated in this role of more than 7 billion people .

find out there may be differences in the safety profiles or there will be differences in the safety profiles. differences in the capacity of these different vaccines to protect against their variance as more and more arrive . there will be differences in the capacity for duration of immunity so i think are going to learn as we go and see how it plays out. >> i'm sure it will be learning a lot more. no doubt. so when we talk about the vaccines that work. and as you already mentioned i think we've got so lucky. there was no reason to believe we would have such safe effective vaccines but when we talk about vaccines and media and the general population in lay terms we talk about how well vaccines work but of course scientists don'tmeasure whether or not vaccines work . we measureefficacy . safety , effectiveness. if it prevents infection so

does the vaccine prevent infectiousness, does it prevent death, does it prevent swelling so we have all these myriad of outcomes. that we think about with vaccines and it gets distilled into this general concept of whether or not the vaccine works. so there's a lot of nuance out there. should we be concerned about that loss of nuance. and if so why. >> it's been interesting to see this the way this plays out. i was fortunate to be part of a team at children's hospital philadelphia that created the strain that became the rotavirus vaccine. i certainly got to watch that vaccine from bench to bedside and i'm only all too grateful that the people who work indicating that vaccine are not the people who are communicating.

i think there have been at least three major communication errors with this vaccine in terms of whether you're getting the first is use of breakthrough. if you're given a vaccine and you have a file, mildly symptomatic infection or an asymptomatic infection you want, that's the goal. the goal of this is to protect against serious illness. the kind that causes you to seek medical attention. that's the goal. it's the rare vaccine that prevents asymptomatic infection or mild asymptomatic infection when brett kavanaugh has an asymptomaticinfection that carried through is a breakthrough . it's sort of dams this vaccine unfairly. the second major communication error and" occurred at the same time associated with that provincetown vaccine, thousands celebrate july 4, 80 percent are vaccinated but nonetheless there is an outbreak involving 346 people

. most had asymptomatic infection which was sadly turned a breakthrough. four were hospitalized. the hospitalization rate was 1.2 percent. that's as good as you're going to do. nonetheless it was carriedout as a breakthrough . hospitalizations is a breakthrough but the mild infections were. the third communication error what was when president biden stood up at the podium in august and said we are going to have a booster dose available for all americans over 18 on september 20. thus sending the message that people who've gotten two doses of mra and in a vaccine were not fully immunized. soi think we have an excellent vaccine . that continues to have excellent protection including the delta variant all the way up to the present time you would never know by the way is communicated because everybody is scurrying to get this sort of cash in on this booster loses

that we created where i think we scared people. we created this third dose fever and if we want to get on top of this pandemic, that's not the issue. i can tell you at the hospital of the university of pennsylvania when people adults come into our hospital and are in the intensive care unit it's not that they haven'tgotten a third dose, it's that they haven't gotten any doses and until we get on top of that not going to get ahead of this pandemic . >> i share your perspective. and you know, i think sometimes it's hard to pull back and see the forest for the trees but if a new disease emerged today, that has hospitalization and mortality rate of vaccinated people we would not have to shut the world down for that. so i think those areimportant messages for getting back to a post pandemic world . so i want to ask you about

your experience living in this pandemic where everyone is interested in vaccines and more people i'm sure while i would guess consider themselves to be experts in vaccines, there was a meme going around early on that interchange me about the armchair epidemiologists in a pandemic. did you have the same phenomenon of armchair vaccine are just and are you familiar with that concept? >> yes, i certainly am. >> ..

march we put the flu strains for september right at the six-month production cycle. a group of neurologists sit around talking about what flu strains are circulating. it's not being televised on c-span. nobody's asking us for our opinion. it's never breaking news. it was great. suddenly you're in the spotlight all these fda backs it up advisors are in the spotlight. the arm chair virologists i get a lot of e-mails from people telling me how awfully wrong i i am about whatever it is i most recently said. >> there's a lot of people in that club. what do you wish that the arm chair virologists at their new? what to do most often get wrong?

>> the thing that hardest for people to grasp, you alluded to it is a notion of relative risk. i don't think we get that. it's hard to communicate risk. for example, the risk is one of 50,000. the risk of guillain-barré syndrome after ginger vaccines one in 120,000. these are extraordinarily rare event. nonetheless you can see people making policy decisions based on these rare risks. there's not a vaccine i can think of that doesn't have a serious risk. they all do. measles vaccines, and lowering of the plate associate with bleeding and roughly one in 30,000 people. the polio vaccine was a cause of polio that occurred in 2.4 million doses. we don't make policy based on that. that's the thing that the hardest to watch.

we struggle with trying to communicate because people don't look at it that way. as you said earlier our brains are not constructed that way. the problem when we crawled out of ocean to the land, our hippocampus was too late to the game. new york state lottery wants to sell its tickets for a 14 million to one shot it doesn't with a simple phrase, it could happen to you. that's way people see these rare adverse events. >> right. if we evolved with an excellent sense of relative risk we probably wouldn't need formal training and a few like epidemiology, would we? that would come built in. >> right. at the very least we could be better about educating about the scientific method how it works

at the elementary school level. i remember as a child mr. wizard, what before your time,, mr. wizard was a guy, my black and white television set in 1950s and 1960s would always be standing next to like a 12-year-old child who he would then explain scientific concepts like how you create a vacuum by putting in the milk bottle, aflame and that would suck a soft-boiled egg into the bottle. he used flashing lights to represent radiation and you could be a member of the mr. wizard science club which meant you got a little kit and you got his books and it was great. i don't know if anything analogous to that today. science was in many ways celebrated and there were far more time devoted to science and technology on television then or even in the newspapers and there is now. the pandemic changes that largely. we need to be better educated

about the scientific method and how that works. science is losing its place as a source of truth, becoming another voice in the room. >> sadly, i think you're probably right. maybe we can use the pandemic as a way to reengage young minds in science and the scientific endeavor. i know i've definitely gotten more e-mails lately from high scores were interested in careers in science. we can hope i guess that may be that's one good thing that comes out of this. >> we can always so. i have been impressed by the young. i've been a number of webcasts or podcast with a variety of people in their late teens, early 20s and really interested in getting it right. it is encouraging so i take heart in that. >> we have to find a victories, recognize and where find them at least. i want to get back to the

concept of risk, and i think there are some people who have been living for quite some time in ways, believing the pandemic is over. there's nothing about this pandemic to have a major impact on their life. there are some people even today who could never imagine the into the pandemic or going back to what they did before out of fear. i would guess your summer in between. can you tell us a little bit about how you think about the end of the pandemic what other signposts we should be looking for based on the evidence in based on science on went the pandemic will be over, knowing that code will go away but at some point will become a manageable endemic disease what do you think? what do you think about when the pandemic ends?

>> i think you're right. i think the pandemic part will i think in hopefully relatively soon in the united states. remember that we are only as good as the world as we learn from this pandemic. what happened in china affected the rest of the world. in terms of herd immunity, what percentage of the population needs to be protected either from vaccination or natural infection to significantly slow the spread of this virus. that's based on two factors. when is a contagious and is virus, so-called contagious miss index which is somewhere between five and nine beaning five infected and i go out into the world and see everybody i come in contact with sick settable i will look infect five to 99 the people. the second is vaccine effectiveness against contagious. if you plug things into the formula based on those factors it's the petabyte effectiveness.

you're probably at least the low to mid 90% range from what you need to have in terms of protection. it's almost close to what you see with measles vaccine. you need to be in the low to mid 90% range. we are probably at 75%. whatever, 57% of u.s. is fully vaccinated. there is at least 100 million people a been infected and is overlap but we probably at 75-80%. we're starting to see dumpers come down but that is happened before. if we can vaccinate another 39 people i think we can get on top of this but you're right this virus isn't going away for a while and as long as it exists in the world we need to make sure we're a highly protected population. look at the polio vaccine. we still give children a polio vaccine every in this country. we haven't had polio in his country since 1970s, for 50 years. why? because polio still exist and they came to sort of light in a hospital recently when we're

taking ensure from afghanistan. afghanistan polio is still an endemic. sadly our residents and interns are thinking that this person be shedding polio? it brought into stark contrast. >> we have the luxury of that thinking about polio very much these days, don't wait? at least in the u.s. >> right. >> i wanted to turn to another recurring theme in your book. i really enjoyed the stories about the people and their humanity. their human fragility come both the patients that you described in many of the vignettes as well as the scientists themselves. and you talk in particular about some scientists who had really severe moral failings and how

that was their scientific contributions were marred by their human failings. and in today's society where we are all judged increasingly i think, we know more about each other's personal lives than ever before, what role should there be when evaluating a scientific discovery, the person themselves and their personal lives? how should we wrestle with those in a reasonable, productive way? >> right. that's a great question. when you publish a a scientifc paper there's always a level of trust. you assume the person isn't making up data. the way that gets ferreted out, if you will, is it has to be reproducible. other people in different parts of the world working with

different populations then show the same thing and the truth emerges. but you're right the scientific process is flawed in the sense it's a human endeavor and humans are flawed. you have to have those, that kind of truths emerge think associated with other people doing it. one thing that was worth writing in the book is you can't legislate it away. you can put as many systems in place to make sure things don't happen but they always happen. for me one of the most emotional stories because of it was the jesse story. just because that happened -- jesse was a 19-year-old man who had an enzyme deficiency, one he was lacking which enabled and which made it much more difficult for him to confer food -- convert food into energy swing to take as many as 30 pills a day. he would be uniquely susceptible to being cured by gene therapy and the gene therapy that was

years was very similar to like the j&j astrazeneca vaccine. it was replication defective adenovirus. adenovirus is a common cold virus. you can render it so it can't reproduce and you can put the gene and it at this board lack. he was given that product, that gene is part of an experiment and he had essentially like a sepsis like central were his immune system was overreacted and his blood pressure dropped and he basically died of what look like sepsis but it from an overactive immune immunod nobody knew why that was. eventually they did figure it out that it was one particular protein, and immune system that was overwhelmed. that and the so-called car t therapy where you can take someone's t-cells which is an immunological self out of their body and engineered so it can kill you to cells, another phenomenon. one girl named emily whited

received at the therapy and ship the same sentence he had, jesse, except this time he knew what had happened to jesse. this time you at a monoclonal auto body that could neutralize that protein data gone out of control. out of that tragedy came this remarkable story of emily whited who would eventually this at the white house and take pictures with obama and her picture was everywhere. jesse was in. we celebrate our victories not our failures but because of jesse we learned much. there were so many things put in place after his death sort of legislatively to try to prevent it from happening again but it did happen again with the retrovirus so-called gene therapy that was used in france, where this particular virus happen to insert itself right in front of a a gene that increae risk for leukemia. you always learn and there's always at some level of tragedy

and that knowledge. at some level people need to know this. it's so hard to accept that. you would like to think you know everything but we never know everything. >> humility. humility has got to stay front and center in all of these endeavors. >> that's the right word by the way. that is exactly the right word, humility. when we were at the beginning of this pandemic and some of the ceos of pfizer, moderna and others say after they've done a phase one trial of ten or 15 people then starts on about how they could mass-produce millions of doses can you were just shuddering. be humble. nature gives it secrets up slowly, grudgingly and invariably with the human cost. be humble. that's where that struck me but you're right humility is the word. >> it's just key and i don't, it's hard for me to imagine not

being humble in the face of all this. yeah, i really appreciated that point that you made. another cognitive bias that you highlighted a can't remember if it was that story on another in the book but i think it's commonly referred to as outcome bias where we judge a process based on the outcome. if the outcome is good we assume the process was good. the outcome is bad we assume the process was bad or inherently flawed, which isn't always the case. the example you just gave highlights that to some extent. what are some of that outcome bias? what you see that happening out in the pandemic, if at all? >> the question is to be made wise by your experiences and not just nervous by then.

the first and the product that was developed so-called dash of a product of the german dye industry in the 1930s was a breakthrough product. it could treat meningitis. now you can treat pneumonia. you can treat gonorrhea, a variety of whole broad spectrum back to because of this amazing the drug. it was available as as a powr a tablet form but it wasn't easily ingested by children because they are not so good at taking tablets or powder. one company, then massengale company of tennessee suspended that process which was palatable and solubilized this particular drug. the problem was diethylene was fatal to kidneys. when this product was in release there was like 240 gallons of it released, 100 people died, 34 but more children and it froze

people about this drug. what they didn't understand initially it wasn't the drug. it was a way in which the drug was suspended and so the workpeople early on he said i'm not going to take that route because the drug could kill people whereas it wasn't the drug. same thing with diphtheria antitoxin. by the way that a elixir disaster led to the 1938 food drug cosmetic act rfs story michael harris has famously said, drug regulation in the trinity is built on tombstones and that's always true and it was true with this sort of tetanus disaster where diphtheria was generated in horses, would save children's lives www.three but this particular horse was infected with that does soviet tetanus toxin into bloodstream and so 13 children in st. lucie died of tetanus when you're given a diphtheria diphtheria antiserum to treat their get through and many people stopped giving get syria and to sarah and the watch children die from diphtheria because they were scared of the

anti-syria. the lesson was we shouldn't take antiserum from horses that have tetanus. it's odd that we take the wrong lesson sometimes because you can fix the problem. >> right, right exactly. exactly. thinking about the discussion that antibiotics and just how revolutionary they were in saving lives, the advancements in anesthesiology and anesthetics you talk about how many people now remember the days when had to undergo surgery without anesthesia cracks we are a pretty pampered people these days. i think sometimes we forget. these were major advancement that improved the longevity and quality of human lives but, of course, there are downsides even to those. these are all tools and we see

now at a microbial resistance threatening human health, the real crisis in opioid addiction, people who were treated for pain and then became reliant on those drugs and suffer as a consequence. it's a reminder that these are tools. they can be used for good but there's always some possible downside. >> you have to be careful how you use them. you bring up the ship at that body resistant. when i was in high school or read a book by sinclair lewis written in the 1920s and ten netbook a doctor is working with bacteria phage therapy. that's viruses that can enter bacteria and kill them. bacteria means eat so these viruses could actually kill bacteria. that's all you had to do was a 1920s. there were not antibiotic ship. we use that therapy novichok

hospital in philadelphia in certain children for infected say with strains of pseudomonas that a complete resistant to antibiotics and mostly to see that in patients with cystic fibrosis. that's because we have overuse animatics, and now we have children who are constantly requiring antibiotics who were infected with bacteria that are resistant to all commercially available drugs there what we do we do bacteria-based therapy like back to where we were 100 years ago on this. >> what's old is new again. >> right. >> i'm sure you're aware of these efforts even before the pandemic there was a lot of discussion about how to better prepare for emerging infectious diseases, particularly in terms of developing vaccines. i think the outbreak of people in west africa was a good

example of how we had vaccines that seem to work well in animal models that it never been trialed in humans. when we are faced with a large outbreak we had possible tools but there really weren't developed well enough to be used in people and that's for a good reason. usually we don't invest in vaccines unless we can see y through to getting them licensed which means knowing when and where people are going to get sick so we can design trials. so there's a push that a change that paradigm and to try to develop vaccines. for some of these emerging infections, because of that even some of the covid vaccine, the covid-19 vaccine we have were already in development because of this new push. but it seems a different endeavor to start testing vaccines in humans for diseases

that are not common and engaging people in discussions about participating in those trials even if they may not personally be at risk for those diseases now. i'm a big proponent of that and i think we can gain a lot by doing that kind of research but i wanted your thoughts on this new paradigm shift in vaccine development. >> i think it's actually what amazes me is when faced with this pandemic, the sars covid to pandemic and we ended up going to novel technology. as much expense as we had with vaccines like hepatitis b, what we went to worthy mrna or these vector virus and the genetic vaccines. the reason is there a much easier because you need the one

gene. you didn't, it was in many ways because you knew the genuine interest in, interest in the gene that coded for the surface protein. in many ways it was a fastest vaccines to make easier than the others. that sort of surprising but what really surprised me negatively was how bad we were at handling this pandemic come just with a simple things like making sure we can have adequate testing and adequate quarantining and masking and social distancing, the kinds of things that could've gotten us at a much better control of the pandemic as was true in china books are in south korea or treat japan or australia. we were one of the worst countries. we have 4% of the world's population of about 20%% of the world's deaths. i wouldn't have imagined we would've been a technological advance as we are to have done that. we always claimed his american exceptionalism but we were far from exceptional there. >> i think, well, we will see how we end up with mortality

totals globally. i think we do sometimes fall prey to these comparisons because we are actually better at identifying death that a lot of other places and we were may be more transparent about reporting them. the could be some of that in there. but you're right, i think that there was obviously initially obviously initially some reluctance to engage and take action. many of the countries that you just mentioned were on the ball maybe get a much better job at those initial public health interventions had a lot more previous experience with emerging diseases and outbreaks than we have been . when was the last time the average american has a allies impacted by an emerging infection? it's probably been sometime.

>> the 2009 swine flu pandemic was expected to be frank are much harder hitting bandit was in this country. we didn't have nearly as many deaths as he had anticipated also suffer from the fact that lesser like 50 different governments come each date makes it hard of national policies i think released it seemed to. >> absolutely. whatever we talk about the response and yes, it's always a patchwork bigotry hard to make generalizations except to say it's so complex, i absolutely agree. you are a prolific author and have so much expense communicating what you do every day to lay audience. some of these really key, important medical and scientific discoveries. what advice would you have for

others who may be interested in writing a book? would you advise it, and what advice would you have on being successful? >> sure. i mean, i enjoy writing such fun for me to do that. if you want to write a a book probably the best thing you can do is have your idea, writing outlines with that idea is, talk with the proposal and then when you have your proposal the best thing is to find an agent who can represent your book and it's easy to find a whole list of them, a literary marketplace, a book and now it's online and then find someone who's in line with a way of thinking and see if you can get a publisher. that's not the way i did it and us with. of wrote was a book called the cutter incident which went through this horrible tragedy that occurred with the polio vaccine and i wrote the book and that i wrote a proposal and then i got an agent. because i didn't want anybody to tell me not to write it, that

was the thing. i don't recommend it. if you're going to try to me to get assigned to the public do in long format shows like this. i was on pyongyang inside politics at noon and there you have at most you have four minutes to try and educate people about difficult scientific concepts. imagine -- i was part of a two day booster meeting a week ago or so ago as the fda and i listen to pfizer for committee so you have hours and hours of flight and discussions, get that down to about two minutes. it's hard, , really hard to do t but these kind of programs are great because you to develop themes. >> on the big proponent of long form conversations as well. i've never been good at getting a point across in four minutes so i'm sympathetic. i really enjoyed the conversation today, so thanks so

much. >> thank you. >> for embarking on this long form conversation. >> thank you. it was fun. i really enjoyed it. >> thanks again for all of your wisdom and sharing these stories from our history. really, they are especially pertinent today and really great reminders of what we have ahead of us honestly the length storis

from the underground edited by uli beutter cohen. uli beutter cohen is a new york-based documentarian ours have a book review. she is belonging to time and place the writing and photography. she is a sought after speaker and panelist, her work is been featured in print, onto the online bike new york magazine, esquire, beau, literally every publication you ever heard of. uli beutter cohen was in brooklyn you can find her at the ubc atub