interview program with relevant guest hosts. interviewing top authors about their latest work. >> the themes are relevant for today and the pandemic. 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 the fact

that i am a child of the fifties and i remember the polio epidemics. and what i remember from that is one, how devastating that pandemic or that yearly epidemic was, how much it affected my mother. you know, we were not allowed to go to, you know, swim in a public pool. me and my two first cousins would swim in these little plastic pools in the back. and so jones salk make a polio vaccine. made it by taking the virus, growing it up, purifying it and inactivating it with a chemical. so you are inoculated by whole killed polio virus. he tested it and found it sob safe and induce a immune response he felt comfortable would be protective. this is coming up now. and on tuesday we're going consider a several,000 child study for the 5-11 year old. so he was happy. this is it. i've got it.

tells his wife don narks eureka. i've got it. but nonetheless the march of dimes wanted to a big study and that broke his heart. he didn't want to do that and knockout children with a placebo vaccine during polio but nonetheless that was what was done. so we had 420,000 children got vaccine and 220 thousand got placebo and --. church bells rang out. synagogues held meetings. announced to america, all of europe. polio can be conquered. >> 16 children died in the study, all in the placebo. 36 children were paralyzed that study. 34 in the placebo group. those were first and second graders in the 1950s. i was a first and second grader

in the 1950s put for the flip of a coin they could have lived long, fulfilling lives but didn't. and i think don't ever realize which is the human price invariably paid for knowledge and coming up now with regards to these vaccines we're going to be considering next tuesday for the 5-11 year olds. >> i was reminded over and over again while reading your book just how grateful that i am alive and raising kids now and not in the 50s or not in previous times. where there were so many diseases that killed kids. in particular, the story about diphtheria and how it strangles is very compelling. are there any diseases of the past that you would compare to covid-19 and children? >> well one would be polio. polio, sars-cov-2 largely asymptomatic infection. most children with polio were

had a mild intestinal illness. it was a summer intestinal virus. only about 1 of every 200 infected with polio, primarily children, would actually develop paralysis. that is why it was so frightening. it was frightening because you didn't know who was contagious and shedding the virus. so everybody became a potential person from whom you could contract that virus. that is very similar to this virus. what made sars-cov-2 different than sars 1 which raised its head in 2002 or mers which raised its head 10 years later. is those when they infected you caused you o have pretty severe illness. so you knew who was infected. and you could quarantine those people and effectively stop the pandemic. not this virus. 50% of the people typically catch it from someone who never had symptoms. and that was polio. same thing. >> okay. and you also give many examples of how things went wrong and how

in the development of vaccines and therapeutics and how those tragedies gave rise to new policies and new organizations within the u.s. government to ensure safety and efficacy of medical products. so where are we today 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 in restoring that trust? >> i wish i had a clear answer for that. i think we are a cynical, litigious sort of conspiracy theory laden society. we don't trust. i'm not sure where the break

came. my argument would be probably sometime around watergate when you realize behind the curtain there were people saying things and doing things not in our best interest. loss of innocence, some ways. certainly for me associated with the watergate. how do you regain that. look at the current situation. there was a vaccine, we isolated that virus in january of 2020 and sequenced it so now you have the virus in hand. 11 months later you had two large clinical trials with the moderna vaccine and pfizer. 40,000 people, 30,000 people showing the vaccine was remarkably effective. more than you would imagine. 95% effective initially and remarkably safe but not absolutely effective and not absolutely safe. then things moved forward. thousands of people get the vaccines. hundreds of thousands. millions. hundreds of millions get the vaccine and then you find things you wish you knew beforehand. the mrna vaccines are a rare

cause of myocarditis. inflammation of the heart muscle. the johnson and johnson vaccine, vectored is a very rare cause of thrombosis with thrombocytopenia which means blood clots and could be fatal. and handful of people who have died of consequence of the j.j. vaccine. point is you have systems in place now that can actually detect events as rare as that blood clotting phenomena of the j.j. vaccine which was 1 per 500 thursday people. and the myocarditis 1 per 50,000 people. those are extremely rare and only because of the tragedies in the past that led to the systems that allow us to monitor vaccines in this case postapproval. but again, i think you are right. i think we deal with an enormous level of distrust. it is remarkable that 65 million people in the united states continue to not get this vaccine despite the fact that the evidence that it can save your

life couldn't be clearer. >> as someone in the scientific medical community, what do you think our role is? in communicating to the public. and a 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 purpose for me in writing this book, to let people know that you learn as you go. you always learn as you go. you are always at some level building the airplane while it is in the air. and i feel like that's true now. and that, that that has to be understood. but i think what happens -- i mean you could sort of read my book the other way. which is that here is a series of tragedies which resulted in enormous amount of harm. and so therefore you can't trust science your medicine. but that is the process.

that is the process of knowledge. knowledge is hard earned and very associated with a human price and i think that has to be understood. and when people make a choice they should realize there are no risk free choices. there are just choices to take different risks. so the goal then is as dispassionate way as possible and informed as o possible choose the lesser risk. when people don't want to risk getting the vaccine. well they are risking getting the disease. and a researcher said and i think he's absolutely right. over the next few years you can get vaccinated or get the natural infection and natural infection is not the better choice. i think we learn -- going back to this meeting i'm going have next tuesday. you know, we'll consider a trial in children 5-11 years of age. we'll have a few thousand children and then we're about to make a recommendation for a few minute children. tens of millions of children. when do you know everything?

you never know everything. the question is when to do you know enough. when do you think, you know, enough to move forward and that is the hilz of medical advances. we live 30 years longer than a hundred years ago. because of the nine medical advances in this book that they are hard earned and will always be hard earned. people make the argument let me wait until the learning curve is over. but the learning curve is really never over. >> and as you say in the book, we're always day in and day out ( making decisions in the face of uncertainty, whether we acknowledge it or not. i really liked yourage analogy of the three bridges to talk about the context, decision making in the context of uncertainties. can you talk a little bit about the three bridges analogy? >> well i guess the -- let's suppose you have a certain disorder and you want to try a

therapy that is -- that is well-tested. you know, that you know that it is well-tested and you are willing then to walk over that bridge because, you know, that it is well tested. as the sturdy bridge. you're good. but now, you know, you're -- the therapy is relatively new. as the new enthalpy or a new biological, whatever. it is, you know, now do you want to do that? and the degree to which you want to do that is only to the degree that you are being chase bade leon. if you are chased by a leon, then you are willing to cross that more rickety less-tested bridge that if you are not tested by a leon. christian barnhart said that, first to do a person to person heart transplant. the person he transplanted 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, you know, look at the 4,000 people currently waiting for a heart transplant today. 1300 of them will die while waiting. you don't know whether or not you are going to be one of those 1300. so would you be willing to be one of the first or the first to try a pig heart where they can be engineered so you don't need immunosuppressive therapy? do you want to try that? in the last 48 hours there was a successful kidney transplant where the person received it of a pig kidney and it went well. so do you want to try that? or do you want to try the well-worn bridge, if you will, of getting a heart transplant knowing you will live probably 15 years on average after that transplant or do you want to try the pig heart or maybe one of the 1300 who dies while waiting. at some level you are always gambling. and what you said earlier is exactly right.

we don't like to deal with uncertainty but we always are. >> we always are. and unfortunately our human brains aren't well evolved to think about risk and that uncertainty. when the pandemic first began, you know, well, these -- these examples you give are of individuals, right, making decisions about whether to take a new treatment or get the pig heart or wait and see if you, you know, are able to get a human heart transplant. early in the pandemic i think we were making those decisions more as a collective and 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 with the decisions we were facing as a humanity early in the pandemic? >> great question. perfect question. and so, for example, last september, october, the kaiser family foundation did a polling of the united states citizens or americans and asked the question, would you get a covid-19 vaccine so it was before the vaccine came out. 30% said yes they would. if you had asked me that question i probably would have said no. let me wait to see the data. i'm a skeptic. i think everybody who sits around the fda advisory table is a skeptic. let's see the data. now you have tested it. and let's say the pfizer vaccine in 40,000 adults. 40,000 adults have gotten this vaccine. it was 95% effective at preventing, you know -- really any illness. mild, moderate or severe illness and virtually 100% of preventing severe illness. now that means 20,000, placebo controlled study. 20,000 have gotten the vaccine. 20,000. do you want to be one of the

first to get the vaccine? or do you want to wait until a few million doses are out there? the father of modern vaccines, man named maurice hillman, sailed it best. he said, "i never breathe a sigh of relief until the first three million doses are out there. because ro sometimes you find out things you wish you would have known earlier. so do you want to wait? which case you risk getting an infection because the infection is so common. but we've been there with the 12 -- now we're going to have the 5-11 year old recommendation. do you want to wait until a few million children have been vaccinated knowing that every week between 150,000 and 250,000 children are ifkted with the virus. the children account for more than a quarter of the infections. 2,000 children are hospitalized every week and about 600

children have died. so do you want to wait or don't you? and i think this is the, you know, do you want to wait till more of the population are vaccinated or do you want to get the vaccine knowing that the few thousand children tested in that 5-11 year old study by pfizer is enough? when do you know enough to move forward? and as the hard question to answer. and you practically only really know the answer in retrospect. >> right, exactly. and there are some examples of particularly treatments for covid-19 that received emergency use authorization early on. hydroxychloroquine and convalescent plasma therapy are two examples that were used. and, you know, now we know well -- work and may even cause harm in some patients and looking decisions early in the pandemic how critical should we

be knowing that they were making decisions in the face of uncertainty? 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 twist being i the administration. an administration that was looking if are a magic medicine. the hydroxychloroquine had never been shown to work to either treat or prevent this illness. convalescent plasma data were very week and when you have the fda commissioner standing up saying 35 out of every hundred people infected with this virus will have their life saved by convalescent plasma. i don't know what data he was looking at because that certainly wasn't the data available. so i think that was awful and it scared me. i -- frankly.

when i see can dr. ezekiel emmanuel wrote an op ed in the "new york times" basically say, fearing the october surprise as we headed to the november 3rd election last year. i was afraid the administration would reach its hand into operation warp speed, pull out a couple vaccines that hadn't finished trials -- and if you were going to go two months -- beyond the election date. but i think the fda did stand up there and since then its been a lot of better. but you know what's so hard about this is you are making decisions with far fewer data than you normally would. because we're in the middle of a pandemic. >> yeah. absolutely. and you mention there the encroachment of politics into medical science and 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? >> well i guess what i would say, a good example let's go back to the trump administration. i i this the decision to put 24 billion dollars into this effort. the name operation warp speed i don't think was the best choice and scared people the safety guidelines would be crunched or time lines etc. but what they did there was they basically mass produced the vaccines at risk. they didn't wait for finishing of the -- the phase three trials to see whether the vaccine worked to be see whether it was safe. they built the building and mass produced and if it didn't work or was unsafe they were just going to throw it away. but this way when you saw the trials were successful, you could roll it right off the shelves. and i think that was an example of the government taking over a program that was great. on the other hand, if you want

to see the government on the other side, it would be the swine flu vaccine story in 1976. there was a outbreak of basically h one n one influenza. swine flu influenza in fort dix around that time. >> it was a short lived program, probably 40 million people got the vaccine. it was found to van unfortunate side effect called guillian-barre syndrome. rare, maybe a hundred thousand people but it was real. that was a program that was --. >> what do you think about the politics an international scale around the pandemic and particularly vaxes?

what has worked in your opinion. >> interesting the level of nationalism. china has a vaccine made my sinopharm. and people in china get vaccinated. -- and people allies with china get that vaccine. russia has a vaccine shar to the astrazeneca and johnson and johnson vaccine. a verdict virus vaccine, two doses and that is what you get if you are in russia. the astrazeneca vaccine was primarily united kingdom and some other european countries but here the moderna vaccine is a u.s. vaccine. the research was done at national institutes of health. and that is a u.s. product. so it is interesting how its play out. there is definitely a nationalism. i talk about it with anesthesia and chloroform was a european

invented phenomenon and even though it was much more dangerous than two other anesthetic agent, ether and nitrous oxide it. perpetuated in europe much longer i think because of a nationalistic sense of pride that they were the one who is'd invented it. >> do you think that nationalist sense of pride is also driving vaccine use? i imagine so. right? even though some of these vaccines work better than others. it seems that countries who have developed vaccines are sticking with theirs. >> it certainly seems that way. yes. i completely agree. it is interesting and you would think it wouldn't necessarily be that way. for example, the vaccine in china -- were better. would we use that vaccine? to the exclusion of the -- pfizer moderna or johnson and johnson?

it's not clearly better but -- china, for example, the moderna or pfizer vaccines compared to the one in china, it looks like it is better than that. nonetheless they are using their vaccine. >> and perhaps at this stage in the game where vaccine supplies are still fairly constrained, maybe, you know, there isn't much choice there. but maybe things will shift once that's no longer such an issue. >> i think you are right and certainly this virus is going to be with us for a while. and as more and more vaccines come into play, new england journal of medicine this past few weeks have a novavax vaccine, a sort of purified proteinagemented with a powerfulage minute. and we'll see how that plays out. i think what's going to the happen over time is you have more and more experience with this vaccine. about a billion people now have been vaccinated in this world of more than 7 billion team.

i think you are going to find there will be differences in the safety profiles. there will be differences in capacity of the different vaccines to protect against different variants as more and more variants arise. there will be differences in capacity for duration of immunity. so i think we're going learn as it goes and we'll see how it plays out as international level. >> i'm sure we'll be learning a lot more. there is no doubt. so we talk about these vaccines that work. and as you already mentioned. i think we got so lucky, there was no reason to believe that 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't measure whether or not vaccines work. we measure efblgsy, safety,

immunogenicity, effectiveness so we have all these things we think about but it's distilled into this whether or not this vaccine works. there is a lot of nuance lost there. should we be concerned about that loss of nuance? and if so, why? >> so its been interesting to see this way -- the way this has played. i was fortunate enough to be part of a team at children hospital of philadelphia that created a strain that became the road virus vaccine. got to watch that go from bench to bedside and all too grateful the people who were communicating that vaccine are not the people who are

communicating this vaccine. i think there have been at least three major communication errors with this vaccine in terms of what you are getting at. i think the first is use of the term "breakthrough." if you are given a vaccine and you have a mildly symptomatic infection or asymptomatic infection, you won. that's the goal of this vaccine. the goal of this vaccine is protect against serious illness. the kind that causes you to seek medical attention or goth hospital or the icu. that is the goal. it is the rare vaccine that prevents infection. so when brett kavanaugh, for example, who is fully vaccinated has an asymptomatic infection that is carried out as a breakthrough in the -- breakthrough implies failure so i think it damns this vaccine unfairly. and second major communication error and both occurred same time. province outbreak. thousands get together. celebrate july 4th. nonetheless an outbreak

involving 346 people most who had astomt ig or mildly symptomatic infection which was sadly termed a breakthrough. four were hospitalized. a rate of 1.2%. that is excellent. it is as good as you are going to do with a vaccine. nonetheless of the carried as a breakthrough. the third error i think 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 years of age on september 20th. thus sending the message that people, for example, who'd gotten two doses of mrna vaccine or one dose of -- were not fully immunized. so i think we have an excellent vaccine that continues to have excellent protection against serious disease including delta variant, including all age groups right up to the present time but you would never know by the way it is communicates because everybody is scurrying to get this sort of, cash in on

this booster palooza that we've created where i think we've scared people and created this third dose fever. if we really want to get on top of this pandemic, that is not the issue. i can tell you at the hospital of the university of pennsylvania in philadelphia when people, adults come into our hospital are in the intensive care unit it is not because they haven't gotten the third dose. it is because they haven't gotten any doses and until we got that we're not going to have a major impact on this pandemic. >> i share your pertinentive on those issues. i think those are important messages for getting back to a postpandemic 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 -- well, i would guess consider themselves to be experts in vaccines. there was a meme going arnold early on that entertained me about the armchair epidemiologist in the pandemic. you have the same phenomena armchair vaccinologists and are you familiar with that concept? >> yes, i certainly am. it is certainly an odd time. you know, suddenly, like, you know, i'm on television all the time. which to me means, a virologyist asked to be on television a lot probably a sign of the pock

lipts. just so weird. >> nobody is in the audience certainly it is not televised on cspan. nobody is asking for our opinion afford. it is never breaking news. it was great. and now suddenly you are in the spotlight. you know, all these fda vaccine advisors are in the spotlight. but you are right. in terms of the armchair epidooemgs or the armchair virologist i get a lot of e-mails from people telling me how awfully wrong i am about whatever it is i've most recently said. >> yeah there are a lot of people in that club. what do you wish that the armchair virologist out there, what do they most often get wrong?

>> well, i think -- the thing that's hardest for people to grasp. you sort of alluded to it earlier, is the notion of relative risk. i don't think we get that. you know, and it is hard to communicate risk. so, for example, the risk of myocarditis is 1 in 50,000. guillian-barre is 1/120,000. the severe clotting risk 1/500,000. extraordinarily rare events. nonetheless you can see people making policy decisions based on these rare risks. there is not a vaccine i can think of that doesn't have a rare serious risk. they all do. measles vaccine can cause thrombocytopenia. a low platelet count associated with bleed. and polio -- influenza -- but we don't make policy on that. and i think that's the thing

that is hardest for me to watch. we so struggle with trying to communicate because it's -- people don't look at ate that way. just as you said earlier. our brains are just not construct -- i think the problem is when we crawled out of ocean on the land, assuming we all believe in evolution that our amygdala and hippocampus were far better developed than the cerebrum which came late to the game. too late. when the new york state lottery wants to sell tickets for a 14 million to one shot. it does it with a simple phrase q it could happen to you. and that's the way people see these rare adverse events. >> right. and i think if we evolved with an sense of relative risk we probably wouldn't need formal training in a field like epidemiology. would we? that would just come built in. >> at the very least we could probably do better about

educating about the scientific method how it works at the elementary school level. i remember as a child, mr. wizard, well before your time but mr. wizard in my black and white television in the 150s and 60s would always be standing next to 10, 11, 12 year old child and explain various scientific concepts. how you can create a vacuum but pitting in a milk bottle a flame and that would suck like a soft boiled egg into the -- he used flashing lights to represent radiation and you can be a member of the mr. wizard science club and you got a kit and books and it was great. i don't know of anything analogous to that today. science was many ways celebrated and there was certainly far more time devoted to science and technology on television and then in the newspapers than there is now. i think obviously the pandemic changes that largely but we need

to be better educated about the scientific method and how that works. science is i think losing its place as a source of truth. its becoming just another voice in the room. >> sadly. i think you are probably right. but, you know, maybe we can use the pandemic as a way to reengage young minds in science and the scientific endeavor. and i now i've definitely gotten more e-mails lately from high schoolers who are interested in careers in science. so we can hope i guess. but maybe that is one good thing this comes out of this. >> we can always hope. i am impressed by the young though. i've done a number of web casts or pod casts with a variety of people in late teen, early twenties and they are just really interested in getting it right. and it is encouraging. so i'm -- to take heart in that. >> have to find victories. yeah. recognize them where we find them at least.

so i want to get back to the concept of risk and, you know, i think there are some people who have been living for quite some time. but in ways, you know, believing that the pandemic is over. like there is nothing about this pandemic that's gonna have a major impact on their life. there are some people even today who can never imagine an end to the pandemic or going back to what they did before out of fear. i would guess you are somewhere in between. can you tell us a little about how you think about the end of the pandemic. what are the sign posts that we should be looking for. you know, based on the evidence, on science.

>> the 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 is based on two factors. one is the contagiousness of the virus. the index is somewhere between 5 and 9. meaning if i'm infected and go out into the world i'll infect five to nine more people and then the sec thing is vaccine effectiveness but really against contagiousness. if you plug things into the formula based on those two factors r naught one minus r

naught divided by effectiveness, you are probably at least the low to mid-90% range for what you need to have in terms of protection. really almost close to what you see with measles vaccine. you need to be low to mid 90% range. we're probably right now at about 75%. 57% in u.s. is fully vaccinated. at least a hundred million people who have been naturally infected and there is overlap but i we're probably at 75, 80% now. we're starting to see numbers come down but that's happened before so hard to make too much heart in this. i think if we can vaccinate another 30 memo people i think we can get on top of this. but this virus isn't doing 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 div a polio vaccine in the country. we haven't it had it in this country for fifty years. why do we do it? we do it because polio still exists in the world. and i this that came to slight in our hospital recently when we

were taking in children from afghanistan. afghanistan polio still endemic. and now suddenly our residents and interns are thinking wait, could this person be shedding polio virus asymptomatically. it brought it into the stark contrast. >> we have the luxury of not thinking about polio not very much these day, don't we? at least in the u.s. >> right. so i wanted to turn to another recurring theme in your book. i really enjoyed stories about the people. and their humanity. their human fragility. both the patience that you describe and 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, you know, scientific contributions were marred by their human failings. and in today's society where we are all judged increasingly i think, you know, we know more about each other's personal lives than ever before. what role should there be for, you know, when evaluating a scientific discovery? the person themselves and their personal lives. how -- how -- how should we wrestle with those in a -- in a reasonable productive way? >> right. that's a great question. when you publish a scientific paper --. you assume that the person is making up data. the way that gets ferreted out, if you will, is that it has to be reproducible. other people working in different parts of the world,

working with different populations of people, if it is a clinical study then show the same thing and then a truth emerges. but you are ( but you are right. the scientific process is flawed in the sense it is human endeavor and humans are flawed. so you have have those sort of, that kind of truth emerge thing associated with other people doing it. one thing important in writing the book is you can't really legislate it in a way. uj 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 i lived it was the jess gel finger story. because that happened at penn and i was at -- when that was happening. so jesse was a 19 year old man who had an enzyme deficiency. one liver enzyme he was lacking which enabled -- which made it much more difficult for him to convert food into energy so he had to take as many as 30 pills every day. but it was just one gene. so he would be uniquely susceptible to being cured by

gene therapy. the one used was very similar to like the j.j. and astrazeneca vaccine. it was a replication defective adenovirus. adenovirus is a common cold virus. you can render so it can't reproduce itself and then you can put the gene in this boy lacked. and he was given that product, that gene as parts of an experience and he had essentially like a sensic like syndrome, where his immune system was overreacted and his blood pressure dropped and he basically died of what looked like bacterial sepsis but it was really an overactive immune response and nobody why that was. and eventually they did figure it out and one particular protein and immune system overwhelmed him. and with that, then the so called car t therapy where you can take someone's t cells out of the body and engineer it so can kill cancer cells.

this is another penn phenomena. one girl received that therapy and she had the same symptoms jesse had. except this time you knew what happened to jesse. and this time you had a monochromal antibody to neutralize that interleukin 6 protein that had gone out of control. out of that gelsinger tragedy came this remarkable story of emily whitehead who would visit the white house and take pictures of with obama. and her picture was everywhere. jesse's picture wasn't. we celebrate the victories not the failures because because of jesse we learned much. so this mention put in place after his death legislatively to try and prevent it from happening again. but it did happen again with a retrovirus so called gene therapy used in france. this particular viersz happened to ensirt in --. so you always learn. and there is always at some

level tragedy in that knowledge. and i just think at some level people need to know this. and though it is so hard to accept that, obviously. you'd like to think we know everything. but we never know everything. >> humility. humility has got stay front and center in all of these endeavors. >> exactly 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 and moderna and others. say, you know, after they have done a phase 1 trial of 10 or 15 people then started talking about how they could mass produce millions of doses, just shuttering, thinking be humble. nature gives it sequence up slowly, grudgingly and invariably with human cost. be humble. that is where that struck me. but humility is the world. >> it is just key. and i don't -- yet it is hard

for me to imagine not being humble in the face of all this. so i really appreciated that point that you made. another positive bias that you highlighted. i can't remember if it was that story or another in the book. but i think it is commonly referred to as outcome bias, where we judge a process based on the outcome. so if the outcome, 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. and i think the example that you just gave is, you know, highlights that to some extent. what are some, you know, some of the outcome bias? where do you see that happening now in the pandemic, if at all? >> so the question is to be made wise by your experiences and not

just nervous by them. i think that, you know, the first antibiotic that was developed. a product of the german dye industry in the 1930s. it was a breakthrough product. it could treat meningitis. now you can treat pneumonia. you can treat gonorrhea. a broad spectrum because of this amazing drug. and so it was available as a powder or tablet form. but it wasn't easily ingested by children because they are not so good at taking tablets or powders. and so one company resuspended that product in di-ethylene glycol which was palatable and the problem was di-ite lean glycol was fatal to kidneys.

initially it wasn't the drug. it was the way the drug was suspended so there are people early on saying i'm not going to take that drug because the drug could kill people. where as it wasn't the drug. and same thing with diphtheria ana toxin and that -- by the way that disaster --. historian michael harris famously said. drupg regulation in the united states is built on tombstones and that is always true and it was true this w this sort of tetanus disaster in the early 1900s. but this particular horse was infected with tetanus. so -- in his bloodstream and 13 children in st. louis died of tetanus when they were given a diphtheria anti-serum to treat it and many people stopped giving the anti-sera and watched

children die of diphtheria because they were scared of the anti-sera. is lesson is don't take diphtheria from horses with tetanus. because you can fix the problem. >> right. exactly. and thinking about the discussion about antibiotics and just how revolutionary they were and saving lives. the advancements in anesthesiology and anesthetics you talk about. you know, how many people now remember the days of when you had to -- surgery without anesthesia. we're a pretty pampered people these days. i think sometimes we forget. and so these were major advancements that improve the longevity and quality of human lives. but of course there are

downsides even do those. these are all tools and see now anti-microbial resistance threatening human health. the real crisis in opioid addiction, people treated for pain and then suffer and become reliant on those drugs as a consequence. a reminder these are tools, they can be used for good but there are always possible downsides. >> right you have to be careful how you use them. bring up the antibody resistance. a book in the 11920s, a doctor work the bacteria phage therapy. viruss that can enter bacteria and kill them. the viruses could actually kill bacteria. that is all you had. it was the 19 to 20s. there were antibodies yet.

we use it now at children's hospital of philadelphia and serve children effects with strains of pseudomonas completely resistant to antibiotics. because overused antibiotics, used them injudiciously. now we have children constantly requiring antibiotics who are infected with bacteria who are resistant to all commercial antibiotics. it's like back to where we were a hundred years ago on this. >> what's old is new again. so 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 in west

africa was a good example of how we had vaccines that seemed to work well in animal models but had never been trialed in humans. when we were faced with a large outbreak, we had possible tools, but they 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 a way through to getting them licensed, which means knowing when and where people are going to get sick so we can design trials. and so there's a push now to change that paradigm and to try to develop vaccine candidates, therapeutics as well for some of these emerging infections. because of that, even some of the covid-19 vaccines that we have were, you know, already in development because of this new push. but it seems a different endeavor to start testing

vaccines in humans for diseases that aren't 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. i want to ask you your thoughts about this shift in vaccine development. >> what amazes me is when faced with this sars-cov-2 pandemic, with as much experience as we've had with vaccines, hepatitis b or human papilloma vaccines, in many ways genetic vaccines were much years to do because you

needed that one gene. in many ways it was because you knew the gene you were interested in, the gene with the surface protein. in many ways it was the fastest vaccine to make, easier than the others. so i think that sort of surprised -- but i think what really surprised me negatively was how bad we were at handling this pandemic, simple things, making sure we could have adequate testing and quarantining and masking and social distancing, as was true in china, japan, australia, we were one of the worst countries. we have 4% of the world's population and about 20% of the world's deaths. it surprised me. i wouldn't have imagined we would have been, as technologically advanced as we are, to have done that. we always claim this sort of american exceptionalism but we were far from exceptional there. >> hmm. well, i think -- well, we'll

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

>> right. well, the 2009 swine flu pandemic was expected to be frankly much harder hitting as it was in this country, we didn't have nearly as many deaths as anticipated. we also suffer from the fact that we have sort of 50 different governments. each state has its own government which makes it hard to have kind of national policies or at least it seemed to. >> absolutely. whenever we talk about the response of the u.s., it's always a patchwork, right? it's hard to make generalizations except that it's so complex, i absolutely agree. you are a prolific author and have so much experience communicating what you do every day to a lay audience. and 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. it's fun for me to do that. i think if you want to write a book, probably the best thing you can do is have your idea, write an outline for what that idea is, come up with a proposal. then when you have your proposal, the best thing is to find an agent who can represent your book. and they're easy to find a whole list of them, the so-called literary marketplace is a book you can get online. find someone in line with your thinking and see if you can get a publisher. that's not the way i did it, the first book i wrote was "the cutter incident," about the polio vaccine, i wrote the book, then wrote the proposal, then

found an agent. because i didn't want anybody to tell me not to write it. if you're going to try to communicate science to the public, do it on long format shows like this. i was on john king's show, "inside politics," at noon. there at most you have four minutes to try and educate people about difficult scientific concepts. i mean, you know, imagine -- i was part of a two-day booster meeting last -- a week or so ago at the fda. and then the advisory committee for immunization practice. you have hours and hours of slides and discussion for that. get that down to about two minutes. it's really hard to do it. but these kind of programs are great because you get to develop themes. >> i'm a big proponent of long form conversations as well. i've never been good at getting a point across in four minutes. i'm sympathetic. i really enjoyed the

conversation today. so thanks so much for embarking on this long form conversation. >> thank you. it was fun, i really enjoyed it. thanks so much. >> thanks again for all of your wisdom in sharing these stories from our history. really, they're especially pertinent today and really great reminders of what we have ahead of us, honestly, with vaccines and therapies for covid. >> thank you. >> "after words" is available as a podcast. visit c-span.org/podcasts or search c-span after words on your podcast app. was this and other interviews at booktv.org. click the "after words" button at the top of the page. weekends on c-span2 are an

intellectual feast. every saturday american history tv documents america's story. and on sundays, "book tv" brings you the latest in nonfiction books and authors. funding for c-span2 comes from these television companies and more, including cox. >> cox is committed to providing eligible families with connection. cox. bringing us closer. >> cox along with these television companies supports c-span2 as a public service. up next on "book tv," hudson institute senior fellow melanie kirkpatrick talks about her biography of the influential and popular 19th century godey's lady's book editor, sarah josepha hale. and the belief that ai machines

will one day take over the planet. and later, dr. paul offit of the children's hospital of philadelphia discusses the risks associated with medical innovation. for more schedule information, visit booktv.org or consult your program guide. here's medicalny kirkpatrick on the importance and influence of the godey's lady's book periodical. >> it's a cliche to say that life can change in a single instant but saying so doesn't make it any less shattering when it strikes in your own life. for the pregnant young mother in the hills of central new hampshire the moment arrived in september 1822 when it began to snow. sarah was a new englander born and bred and snow didn't usually faze her but this was different. it was too early in the season for the first snow. leaves were still on the trees and she stood at her front door