The Peter Attia Drive - #100 - Sam Harris, Ph.D.： COVID-19—Comprehending the crisis and managing our emotions

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay, here's

00:00:48.080 today's episode. Welcome back to another special episode of the drive podcast, where we're really

00:00:55.300 focusing on the COVID-19 pandemic. My guest today is my good friend, Sam Harris. Sam's been on the

00:01:02.220 podcast in the past, as you may know. And we spend quite a bit of time on this episode talking about

00:01:06.360 really two things. One is really talking about lessons learned. I offer some thoughts in response

00:01:11.640 to Sam's questions around what I think is happening, what I think is going to happen. And at the time of

00:01:16.540 this recording, which was Monday morning, as you'll tell, I was not especially optimistic,

00:01:21.860 especially in New York. And again, this is less of me interviewing Sam as it is a discussion.

00:01:28.460 And then of course, we turn to talk about something that I think is equally important,

00:01:31.960 which is how do we, as people sitting here watching this slow motion or fast motion train

00:01:38.900 wreck in different parts of the world and different parts of the country, how do we manage ourselves,

00:01:43.980 manage our own emotions, our thoughts, and our responses to it? And some of you may have noticed,

00:01:49.180 I put something up on social media last week where I just had a really, really bad day and

00:01:53.400 did a bunch of stuff that I was pretty ashamed of as a dad. And that sort of prompted part of that

00:01:58.180 discussion. So without further delay, let's get to this episode. And I think you'll enjoy the

00:02:03.320 discussion today with Sam.

00:02:04.860 I am here with my friend, Peter Atiyah. Peter, you are a top flight physician and you have a

00:02:16.960 background in finance. I can't imagine you had much to think about in the last few weeks.

00:02:21.180 Yeah, very little.

00:02:23.960 This has been, I'm sure everyone feels this way. This, this has been a period of time unlike any other

00:02:30.440 in our lifetimes. There's really no analogy. Early on, I said 9-11 was an analogy, but

00:02:36.900 in truth, this is really nothing like 9-11.

00:02:41.020 Yeah, I actually had the same thought, which was, you know, I remembered where I was during 9-11. It's

00:02:47.200 obviously everybody who's old enough can remember exactly where they were on that moment. And then,

00:02:51.400 of course, in the hours, days, and weeks that followed. But yeah, it is actually kind of different.

00:02:56.860 And this has sort of an expanding array of confusion, at least for me. And also somewhere

00:03:03.200 in the back of your mind, you have to realize now that between SARS-1 and MERS, and now SARS-CoV-2,

00:03:11.120 it's not like coronaviruses are going away.

00:03:13.720 Right. Yeah. And the idea that we are so fundamentally surprised by this and caught backfooted

00:03:23.580 is frankly scary. Bill Gates pointed this out some weeks ago that this was perhaps the most

00:03:30.960 predictable disaster. And we knew this was coming. I think he even gave a TED Talk in 2015 on this topic.

00:03:37.540 And everyone has been sounding this alarm in infectious disease for years. And yet, I'm not

00:03:45.680 even sure that after this, we will allocate the appropriate resources to have a network of virus

00:03:54.800 detection or clamp down on the crazy bad eating practices in China. I mean, I just, I feel like 1.00

00:04:02.580 once this is over, and we rebound, and we, in the best case, we have a successful antiviral treatment

00:04:09.040 and a vaccine and the economy is booming again, I just feel like we're ready to go to sleep on this

00:04:15.980 again. It just, we appear so masochistically short-sighted in the way we focus on risk. I just,

00:04:26.000 I'm to say nothing of our inability to think about something like climate change in light of what's

00:04:31.260 going on here. I mean, just the idea that a slow-moving emergency is something we could orient to when

00:04:36.200 we can't even get our head together when we have Italians Skyping us and giving TV interviews where 1.00

00:04:43.440 they're bursting into tears telling us about what's coming. And we're still debating whether

00:04:48.600 we can keep Disney World open. Yeah, it is sort of sad when you put it that way because

00:04:54.020 it's sort of like the marshmallow problem everybody knows, which is most of us really aren't wired to

00:04:59.900 make short-term concessions in exchange for long-term payoffs. And this one is not that hard

00:05:08.860 because it's only a few years in the future. In other words, it's within our lifetime. It would

00:05:13.660 be hard to make the case that within our lifetime, we won't experience this again. Whereas presumably

00:05:18.440 one can say, well, climate change is still from a disaster standpoint, 50 years away.

00:05:23.200 The analogy to climate change is interesting to me because it is still abstract. The promise of

00:05:29.420 disaster is still something that seems debatable to many people, even most people. It is hypothetical.

00:05:36.320 It's based on models. We can see it sort of arriving, but even there we can't attribute any one storm or

00:05:44.680 any one heat wave to climate change in any rigorous sense. But in this case, we see the wave of contagion

00:05:55.240 crashing on the hospitals in the countries of Europe. We're literally getting, we see the faces of

00:06:02.740 doctors who in their all too infrequent downtime are telling us what's happening. And I just, I see this

00:06:11.920 through the lens of my personal relationships a lot now because I have a range of people in my life

00:06:17.600 who have different enough information diets and political convictions and economic biases and

00:06:28.660 incentives that lead the confirmation bias knobs to be tuned differently. And so I've spent a lot of

00:06:36.080 time having to convince people one-to-one to take this seriously. And it's, it's been an amazing

00:06:44.680 experience because these are by and large, very smart people and you can show them the article that

00:06:49.720 just got under your skin and it doesn't work and, or at least doesn't work as I think it should. And so

00:06:58.140 it's just been very interesting to see the kind of the layers of denial and obfuscation present

00:07:06.000 themselves and to have to kind of punch through them. I mean, even in oneself, I just noticed it's

00:07:10.520 been disorienting to look back over the course of a week where, you know, a week now seems like it's

00:07:17.060 about a year long and see the, what was at the beginning of the week felt to be kind of an extreme

00:07:24.520 measure or, you know, a pessimistic hot take now seem like, Oh, okay. That was, I'm glad I was on

00:07:33.640 the, on the threshold of being rational. Then I seem a little late, you know, in retrospect,

00:07:38.460 it's just psychologically, it's very interesting to watch. Yeah, you're right. I was saying to my

00:07:43.660 wife recently that each day seems to take, they just, they go by so quickly, but because it's seems

00:07:51.080 like I'm doing the same thing every day. There's no, there's no difference between Sunday,

00:07:54.120 Monday, Tuesday, Saturday, right? It's all Wednesday. It's just all the same day every

00:07:58.020 day. And it goes by at alarming pace, but week to week, when I think about last Monday or two

00:08:06.120 Mondays ago, we were on our second day of quarantine. That seems like months ago to your point. You know,

00:08:12.560 I want to go back to something you said a second ago, because it's something I've been struggling

00:08:16.980 with, which is another challenge that is unique to the human condition. So if we struggle with

00:08:24.540 appropriate discounting, I think we also struggle with understanding what, how to put uncertainty

00:08:31.460 bounds on estimates. You've probably played this game before. It's a fun game to play where you take

00:08:37.400 20 questions for which there are known answers. And you ask a person each question and you say,

00:08:42.600 look, give me a range that has a 95% confidence that it contains the answer to this question.

00:08:50.780 And after 20 of these questions, they should have correctly captured the answer within their range,

00:08:57.060 19 out of 20 times. I've never seen anybody who can get close to it, by the way, because they're,

00:09:02.100 you know, really hard facts. Like what is the distance from the sun to Mars? Most people wouldn't

00:09:08.220 know that off the top of their head. And you sort of say, well, it's between this many miles and that

00:09:11.740 many miles. And so it sort of speaks to, I think, one of the challenges of communicating things like

00:09:19.840 climate change and pandemics to people, because error bars aren't a sexy part of scientific

00:09:26.480 communication to the lay person. But there's sort of nothing that you can talk about as a projection,

00:09:33.880 let alone a measurement in science where it's backwards looking, that doesn't have an error bar on it.

00:09:39.920 And yet so much of what we talk about is binary. It's on this date, New York hospitals will be

00:09:47.480 overrun. We're going to see this many cases with this percentage of them being fatal. But if we sort

00:09:54.480 of force ourselves, and I'm just as guilty of this, by the way, as anybody, because it's just good

00:09:58.420 shorthand to be able to rattle off numbers. But if you really had to start putting error bars on those

00:10:03.680 things, like, well, we're 90 or 95% confident that it's this to this, I think that would be a better

00:10:10.760 way to communicate this stuff. And I think it would be a little less alienating to people who are more

00:10:17.860 naturally skeptical.

00:10:20.100 Yeah. And there might be a role for something like betting markets and prediction markets. And just when

00:10:25.540 you put things in terms of bets for people, it sharpens up their sense of probability.

00:10:32.060 I've actually found myself consciously anchored to some clearly unscientific ways of thinking

00:10:41.460 that have strangely seemed useful. One of the reasons why I feel like I've been a few memes here,

00:10:48.820 which I think have been frankly confusing for people. And one is the flu is worse than coronavirus.

00:10:56.220 It's either just like the flu, or the flu is worse. The flu kills 50,000 people a year in the U.S.

00:11:02.560 rather often. And if we were tracking that on an hourly basis, we would never leave our houses.

00:11:10.540 And the flu kills kids, too, rather often. So we've now been enrolled in this vast social panic,

00:11:17.940 delusion, and we're just not seeing it. And so the analogy to the flu among those who use it

00:11:24.560 seems to be totally clarifying. And yet it has always struck me as just flat wrong. And it has

00:11:32.420 by a sheer accident, which has just primed in me, there's just a starkly unscientific way of

00:11:41.120 thinking about this, which is I just happened to know one person who caught the virus fairly early,

00:11:47.740 one of the guys who got it in Italy and came back to Los Angeles among a group of, I think it was 13

00:11:53.880 skiers. I knew a guy who was in a group of five of them. And he and at least one of his friends

00:12:01.120 quickly got sick enough to be hospitalized and then put on ventilators and induced comas. So I knew like

00:12:08.500 a group of five where 40% of fairly young, I mean, you know, 50 year old fit guys without any

00:12:15.640 comorbidities, non-smokers, 40% wound up in the ICU fighting for their lives. This is not a statistical

00:12:23.920 sample. And yet, it has seemed anchored to that fact, I have just heard every comparison with flu

00:12:31.840 sounding delusional. And I don't even know how to characterize the reasoning bias or error I'm

00:12:40.820 making there. But it's actually seemed somewhat analogous to someone saying, I've got 10,000 marbles

00:12:48.440 in this urn and either 1% of them or 50% of them are black. You know, reach in and pull out a few. If 0.98

00:12:57.180 you reach in and you pull out two of five being black, you feel like, okay, well, I'm not quite 1.00

00:13:01.820 sure what's going on in the rest of that urn. But somehow I think betting on 50% is sounds more

00:13:07.220 reasonable. So I don't know what you think about that. But that that's been just an accident in my

00:13:12.080 own view of this from, you know, now going back a few weeks. And it's just, it's changed the way in

00:13:19.460 which I've dealt with some of these, these memes that we've all been processing. So I've sort of

00:13:24.320 thought of it a little in a slightly different way, which is there's the beast, you know, versus the

00:13:29.860 beast you don't. And the beast, you know, is pretty bad. I mean, nobody is discounting the severity of

00:13:37.500 influenza, but there are a couple of things to understand, which is influenza comes in a very

00:13:44.280 predictable wave and it has a seasonal variation to it. But that mortality that you describe, let's even

00:13:53.040 just look at the global mortality. It's spread out across a year and it's fairly uniform. So the rate

00:14:01.160 at which it is changing is not enormous. We are still in a period of non-linear geometric slash

00:14:10.200 exponential growth, at least of new cases. And by extension, therefore hospitalizations, critical

00:14:17.180 care hospitalizations and death. So there's no evidence yet that we are on the backside of that

00:14:23.760 curve where that has stabilized. So we don't yet know what the absolute potential for mortality is

00:14:33.540 from this virus because it's in its infancy. So it's, it's sort of like there's a person who

00:14:40.900 works on a job where they make a hundred thousand dollars a year plus or minus 10,000, depending on

00:14:47.240 their performance bonus. And then there's someone working at a startup who's making $10,000 a year,

00:14:53.200 but has a whole bunch of equity in the company. Well, who's worth more? Well, it depends on what

00:14:58.220 that equity is worth, right? That could very easily dwarf the value of that hundred thousand

00:15:04.000 dollar a year. And so, I mean, again, maybe not a great analogy, but I think you get the point,

00:15:07.760 there is this geometric component to this disease that is not present in influenza. And so as of today,

00:15:17.960 if you could freeze the world and not one more person is going to get this disease, yeah, we may

00:15:24.620 look back and say this was dwarfed by influenza, even within a calendar year, but we can't say that.

00:15:31.320 So to me, the real point is how can we take as many steps as possible to freeze this thing

00:15:41.360 selectively? And that's really, to me, the challenge, right? As we sit here recording this

00:15:46.160 today, the stock market's got to be down 30% on the year, if not more, no one's going to look at

00:15:52.240 this and say the cost of trying to arrest this was not enormous. And there were lots of really smart

00:15:58.000 people out there saying the cost was too great. I really think that that's a, I think that's a

00:16:03.080 pretty good argument. So the question is not just for this opportunity, but for the next one, not if,

00:16:10.160 but when, what is a smarter way to go about locally addressing these problems without global economic

00:16:18.760 calamity? Right. Yeah. And barring a great system of monitoring and a great system of producing

00:16:26.380 antivirals and vaccines, I'm not sure what the fix is that protects the economy. I actually want to say

00:16:34.680 a few things about this notion that the cure might be worse than the disease, because that's cropping up

00:16:40.800 a lot now. I mean, we've been, you know, you and I have been locked down for two weeks or so,

00:16:46.120 but most people it's at least a week less than that. And we're already hearing of this, you know,

00:16:53.760 quarantine essentially beginning to fray and people are saying, this is crazy. We need to find some

00:17:00.020 other way of doing this. The economy is imploding and I definitely share the concern that the economic

00:17:09.000 damage could be as bad or worse than anything the virus can do. I mean, I'm, I'm, I'm certainly worried

00:17:15.780 about that. I'm worried that we might tip into a depression. I'm worried about the, the loss of social

00:17:21.600 cohesion that could follow upon that. None of that's trivial. And I think it's, we have to guard

00:17:27.740 against that. And hopefully the government will ram through a, a stimulus package that is appropriately

00:17:33.680 targeted and takes away the immediate pain and shores up businesses of various sizes. But it's

00:17:40.760 interesting to say, so when you hear the arguments of people, again, it comes back to the, often to

00:17:45.000 the flu analogy. Listen, we're, we're all hiding in our houses and only a few thousand people have died

00:17:51.920 in the United States at this point. I mean, this is crazy. The flu has already killed 22,000 people

00:17:56.780 this year. What the hell are we doing? And there's kind of just this, this global faith that

00:18:04.580 our healthcare system won't be overwhelmed. We'll be able to handle it. The virus is just going to

00:18:10.160 peter out on its own by some dynamic that is just running against its apparent exponential growth.

00:18:18.460 It's just that I've talked to smart people who just think there's this natural life cycle of a,

00:18:23.940 of a coronavirus or, you know, any cold virus that it just kind of peters out and you don't have to do

00:18:30.220 much of anything about it. Again, these people are not doctors or much less epidemiologists, but

00:18:35.000 they're smart business people who are, want to get the economy started again. And one thing I would

00:18:41.140 point out is that no one, to my knowledge, is running the opposite program of happy talk, which is to say

00:18:50.680 no one is saying as we're in our homes watching the economy fall off a cliff, that there's nothing

00:19:00.220 to worry about economically. I mean, listen, this is businesses fail all the time. We have our

00:19:06.080 chapter 11 and chapter seven laws for a reason. There isn't actually any wealth destruction going

00:19:11.680 on because even if the Dow goes to zero, we have our buildings and our roads and our factories and

00:19:17.940 our laboratories. Are you noticing any of these things disappear? No, they're all there. People, it's

00:19:23.580 just that there is no real wealth destruction here. This is just, this is all a fantasy, right? I mean,

00:19:29.600 you could say something in that vein that would be analogous to the kinds of things that are being

00:19:34.980 said about the coronavirus so as to mollify or to attempt to mollify economic fears. But I think most

00:19:41.740 people would recognize that it was delusional and I haven't heard anyone say it. I mean, everyone is

00:19:46.720 worried about what could happen to the economy and rightly so. But is there something in your cognitive

00:19:53.020 toolkit around thinking about the health side of this that can help? They can actually arm people

00:20:00.580 who are arguing that we should just let everyone get sick, essentially. I mean, keep the 80-year-olds 0.99

00:20:04.980 and the 70-year-olds maybe in their houses, but let's just go out there and get herd immunity. I mean,

00:20:10.520 the UK was briefly on this path. I'm not sure what they're doing today, but they did a 180 and,

00:20:16.260 you know, maybe they're going to do a 180 back. But I just feel like the shelter in place mode that

00:20:21.940 most of humanity is in at the moment, or at least attempting to be in, is beginning to unwind even

00:20:29.160 only after about a week. And the idea that we're going to maintain this for months if needed seems

00:20:35.560 fairly far-fetched. So I'm wondering what you're thinking about that. I'll come to that in a second,

00:20:39.920 but I'll throw out one more analogy on why the influenza comparison is not great. And unfortunately,

00:20:46.580 it's got its own political ramifications to it. So it's not a great analogy, but none of them are.

00:20:52.100 You could almost think of influenza like the number of people who die in traffic accidents

00:20:57.380 every year, which is frankly a lot higher than most people realize. Until you really scrutinize those

00:21:04.180 data, you'd be surprised at how devastating it is, what the odds are of a person dying in a

00:21:09.900 car accident. And when 9-11 happened, a lot of people said, look, why are we getting all bent?

00:21:17.260 I mean, no one said this in the immediate after fact, but for understandable reasons,

00:21:20.920 there became a lot of political fatigue around the war on terror. And a lot of people said, wait a

00:21:25.820 minute, why are we doing all of this? 3,000 people died on 9-11 and that's tragic, but do you know how

00:21:31.800 many more people die in traffic accidents? And that's true, but it again misses the non-linearity

00:21:38.740 of terrorism. Now, again, I'm not even here to try to broach this discussion of whether our approach

00:21:45.320 to a post-9-11 world was the right approach or what could have been done different. But if you're,

00:21:50.040 you know, a reasonable student of history, you could at least conclude that 9-11 had to be countered

00:21:57.040 with a much more severe response than just the number of lives lost, as tragic as that was.

00:22:03.720 It's the potential for what could happen if this situation's not rectified. And again,

00:22:09.740 I think that's the issue here, which is not to discount how tragic influenza is, because it is,

00:22:16.700 but to realize how much of an unknown we're dealing with right now. And then how do you balance that with,

00:22:24.140 there's a way to immediately put this thing to rest if you could wave a magic wand, which is,

00:22:28.780 you shut the world down. And then of course, what's the right way to thread that needle?

00:22:33.460 And now to your question.

00:22:34.500 Well, actually, could we linger on that one point first? I mean, why haven't we been able to

00:22:39.840 communicate that solution better than we have? Because we know we're sort of stumbling into

00:22:47.760 some mode of shutdown that risks cratering the economy. Why hasn't anyone articulated

00:22:55.740 the total lockdown that only lasts a few weeks? I mean, that just seems like, let's just talk about

00:23:03.340 the biology of that for a second. I mean, that barring some crazy property of this virus that I

00:23:10.340 think, I mean, I haven't heard anyone allege, if we all sheltered in place for what, three weeks,

00:23:18.580 this would burn itself out. I mean, you'd have the sick people still in hospitals

00:23:22.220 getting treated and recovering or not. But everyone who's got this thing, if you denied

00:23:29.960 them contact with anyone else, this thing would evaporate.

00:23:35.480 Yeah, maybe call it four weeks to include the 95th percentile. It's a non-normal distribution.

00:23:42.140 But yeah, you'd say four weeks of total lockdown, you could burn this thing out. And by the way,

00:23:47.960 that's effectively what happened in the second wave in China. That's the best estimate of what

00:23:52.500 really happened there. But you see, that's a political solution, not a scientific solution.

00:23:57.960 The steps that China took to be able to make that happen, I just don't see how you could do in a free

00:24:04.600 society like the United States. I mean, Governor Newsom, how many days ago, basically said,

00:24:11.460 you got to shut this down, people. Don't leave your house unless it's absolutely essential.

00:24:17.200 And I mean, I just saw the newspaper today. It's like people are running around the beach and

00:24:22.000 playing patty cakes and doing this, that, and the other thing. And I'm sensitive to it. I get it. I

00:24:26.780 mean, they're saying, hey, I'm not going to be defeated by this thing or whatever the logic might

00:24:30.400 be. It's not the approach I would take. But the point is, they're not even listening to the closest

00:24:36.460 thing we have to a directive shy of enacting the police. So I just don't think we can do it.

00:24:42.400 And that gets back to my point about the 95% confidence interval. I'm really starting to think

00:24:46.720 that what we should have been doing all along was not thinking of the United States as one

00:24:52.240 homogeneous entity, but rather thinking of each city as its own country. Because even within Italy,

00:24:59.680 I talked about this on social media recently, even within Italy, it looks totally different,

00:25:05.400 right? Milan to Sicily to Rome have not one thing in common, not one. So Milan, you had almost 2,200

00:25:14.280 deaths out of 10 million people. That's a 2% mortality, not case fatality, total fatality to

00:25:22.240 the population, 0.02%. I mean, that's staggering, right? And in Rome, 31 deaths on 6 million, Sicily,

00:25:30.060 three deaths in 5 million. So the mortality on a per-population basis was 40 times higher in Milan

00:25:37.340 than Rome and 300 times higher in Milan than Sicily. So even within Italy, it doesn't make

00:25:43.780 sense to think of it as Italy is horrible. No, it's like basically which part of Italy got a head 0.99

00:25:49.900 start on this? There's all these analogies. The one I like to use is they're all cars driving towards

00:25:54.620 the edge of a cliff. Some of them are going faster. Some of them have more people on and they're

00:25:58.780 heavier. Some of them have worse tires and some of them are on lousier surfaces and they apply the

00:26:03.220 brakes at a different point in time. They're not all going off the cliff at the same time and some

00:26:07.660 of them aren't going to go off a cliff. And so in retrospect, I wish I was smart enough to think of

00:26:13.180 that a month ago. I wish our policymakers had a thought of that a month ago. And maybe we would

00:26:18.840 have had a better shot at containing this if we'd been more directed towards where is there going to

00:26:24.180 be grotesque mismatches between supply and demand. And obviously New York is now. That is unambiguously

00:26:31.840 the case in New York as of right now. Right. So we're recording this on Monday the 23rd. And

00:26:38.660 yeah, I think we're all expecting to learn a lot from the experience in New York over the course of

00:26:46.340 the next week. What's your sense of the likelihood that we're going to discover that New York at least

00:26:52.660 is much more like Italy than it is like South Korea? Well, and again, I would say Milan more than

00:27:00.020 anything else in Italy. So we've built a couple of models on this and then we've even had, we've been

00:27:05.940 really fortunate that some really great inbound people have just come to us and shared their models

00:27:10.480 and then let us put our assumption there and theirs and vice versa. It kind of comes down to the

00:27:15.440 following. How many people in New York do we know are positive? And as of this morning,

00:27:22.700 the most conservative estimate I can find is about just under 11,000. And that's probably what we're

00:27:29.800 where we were last night. So it's probably closer to 12,000 based on something Cuomo said this morning.

00:27:36.160 Okay. So that's how many people we know have the infection. So then the first question is,

00:27:41.100 what is the population that is infected for whom yet we don't have confirmation? So in other words,

00:27:48.900 what's the known to unknown positives? This is where lots of models are spitting out unbelievable 1.00

00:27:55.220 numbers and they're based on several different things. They're based on looking at historical data

00:28:01.400 within New York and looking at what is the number of people in the hospital tell you as a leading

00:28:07.200 indicator for the lag on infection. They're also based on the Wuhan data. So we have a very clear

00:28:14.200 case of the up and down cycle of infections in China. And so we are basically modeling approximations

00:28:23.500 based on at any point in time, when you go T minus one, two, three, four, five, six, seven days,

00:28:29.800 what did you see in the past that helps you understand the future? Now, the problem with this,

00:28:34.380 before I go any further, Sam, as you know, is you can't just use straight up linear regression to

00:28:39.800 solve this problem because if you do, you need a new model for every day because there's just no

00:28:46.560 linear extrapolation from across the span of say five days. It just doesn't work that way. It's

00:28:51.640 changing way too quickly. You use these things called vintage models and you start to have to

00:28:56.120 look at first and second derivatives of change and things like that. So then we pivot to another

00:29:00.300 question. So that whole series of questioning tries to get at the situation of what is going to be

00:29:05.300 the number of infected people. And by the way, I've thrown in some really conservative estimates,

00:29:10.640 which is take R not to zero. In other words, pretend for a moment that you have enacted draconian

00:29:18.580 enough measures that not one more person in New York who's infected will infect another person.

00:29:24.720 Now, is that true? Based on what my friends in New York who are looking out their windows are

00:29:29.840 telling me, not a chance. But I like to sometimes play the what you have to believe game, which is

00:29:35.700 let's make it as good as it gets. Before we go down that path, what do we think makes New York

00:29:41.860 such a hotspot here? Is it the fact that this is just urban density and a very active subway system?

00:29:49.440 What would you attribute the problem to in New York? I think it's everything including that and

00:29:54.980 bad luck. I don't think there's anything about Milan that makes it any better or worse than Rome.

00:29:59.700 So I reject the idea that the climate in Milan is more suitable for this than Rome. I think that's

00:30:04.960 just noise. I think the issue is bad luck. So it's, this is a stochastic problem. People were going to

00:30:12.020 distribute from the epicenter of infection to different places and they got there at different periods of

00:30:16.740 time. And again, the growth is so non-linear that if one city got a 10 day headstart over another,

00:30:24.960 it's a totally different world because remember the other cities get to see that response and enact

00:30:30.240 measures to slow it down. In other words, everybody's generally applying the brakes at the same time.

00:30:35.300 But imagine if one person had a one minute headstart of pushing on the accelerator towards the cliff.

00:30:41.520 We need a different analogy for what goes down in Florida when they get to preview everyone's

00:30:46.920 horror, then declare their world open for spring break.

00:30:50.580 Yeah. Well, no, but that's the person who watches everybody apply the brakes and says,

00:30:55.260 somehow I'm immune because I have a parachute on my car.

00:30:58.220 Yeah. Maybe I can fly.

00:30:59.640 Yeah. So, so I think New York just had a bad headstart and then it's the perfect storm of

00:31:06.180 population density, subways and proximity. And truthfully, I mean, based on what I'm hearing

00:31:12.640 from everybody I know in New York, there's a little bit of a cultural difference as well,

00:31:17.020 right? A little bit of a, Hey, we're New York, right? Like we've got this thing. We survived nine

00:31:21.460 11. This thing is not going to be that bad. So sort of a, whatever, all of these things sort of

00:31:27.240 combine, I think to just have enough kindling and oxygen and fuel to make this thing have burned from a

00:31:35.740 little bit of a, you know, a dull ember into kind of a big fire. So that's the supply side of the

00:31:41.040 equation. So you were giving me an R naught of zero.

00:31:43.720 Yes. I'm giving you an R naught of zero. And I'm saying, what's the most conservative estimate for

00:31:48.800 how many people are infected relative in total relative to the ones we know. And I've never seen

00:31:54.380 an estimate that's more conservative than five X. So for every person who we know is infected,

00:31:59.900 only five X more are actually infected. So that would place your New York infections at 50,000

00:32:07.100 people by the most conservative estimate, by the way, the estimates that I've seen range from five

00:32:12.820 to 40 X. So let's just take the lower bound, the five X are not as zero. That's 50,000 people are

00:32:21.240 infected. Now we ask the question, how many of those people require an ICU? And I think that's the more

00:32:26.620 important question than how many of those people require a hospital bed. Cause we can make shift 0.93

00:32:31.140 hospital beds pretty well. ICUs are a little harder to make shift. So let's start on the,

00:32:37.080 the availability. So the stock number of ICU beds in New York city, which basically is going to service

00:32:42.560 not just New York city, but the Hamptons going to service the surrounding area. You've got at baseline

00:32:47.960 about a thousand ICU beds. Now we've estimated from discussions, we basically know people at almost

00:32:53.820 every hospital directly and indirectly, we think they can repurpose 2000 beds. So you could take

00:33:00.180 all the surgical ICUs and say, we're not doing elective surgery. So let's repurpose those and get

00:33:05.400 those ready for medical and pulmonary ICU. You're still going to probably occupy 25% of your beds for

00:33:12.240 non COVID patients. Remember people still have heart attacks and strokes and the things that require ICU

00:33:17.660 care. So let's say you've got 1500 ICU beds, and maybe you can stretch this up to 2000 from a capacity

00:33:27.640 standpoint, because you can start to double ventilate patients that are of the same size that

00:33:31.620 have the same ventilator requirement. So now you then ask the question, how many of those at a minimum

00:33:38.720 50,000 patients who were infected, not growing at all, how many require an ICU? Well, if you look at

00:33:45.800 everything in Italy, it's about 4.8, 4.9%. And if you look at the numbers in New York today,

00:33:52.780 they're almost 5%. So let's just be really conservative and say it's 4%. Well, if 4% of

00:34:00.580 those patients are going to require ICU care, I mean, you're already talking about over 2000 beds.

00:34:09.180 Yeah. You're full up already.

00:34:11.360 So that when you play the, what you have to believe for New York, not to get overwhelmed,

00:34:15.320 you really have to come up with some conservative estimates. And we're losing faith in that game.

00:34:21.780 And therefore we think that there needs to be a really important strategy of mitigation in New York

00:34:27.920 and that every other city like Miami, like San Francisco, like Los Angeles, and like Seattle,

00:34:34.520 who are next in the crosshairs, needs to be pushing the brakes a little harder. And also thinking about

00:34:40.780 how you would bolster capacity should the unknown to known infections be higher than we're estimating.

00:34:48.120 Do you think we're going to get a good sense of the mortality associated with all of the other

00:34:53.840 non-COVID conditions that got shoved aside or otherwise handled badly in the wake of this? So

00:35:03.120 people who are electing to delay cancer surgeries say, or, or as you say, they have routine or more

00:35:11.440 routine emergencies like strokes and heart attacks, and either they are reluctant to go to the hospital

00:35:17.720 or they go and the beds aren't there. I mean, is that, is that all being modeled?

00:35:23.720 We have not been looking at that internally. I trust that it will be looked at. And I mean,

00:35:30.340 I've seen it indirectly just through our patients, right? I'll give you the silliest example,

00:35:34.140 which is not life-threatening, but we haven't drawn labs on a patient in two weeks. And I don't

00:35:39.740 know when the next time is that we will draw labs on a patient. Okay. That's a trivial example, but

00:35:44.800 you start to think about what can and can't be done. We've got two patients that are in need of a

00:35:51.120 dental procedure right now. One of them chipped his tooth and needs a root canal. We're kind of

00:35:55.520 on the fence about whether or not he should go and do that right now. Yeah. Yeah. No, I've been

00:36:00.680 thinking about that just personally when I see what is how we live and how other people live and what

00:36:06.480 we let our kids do. I mean, I just, I'm basically viewing everything that runs any risk of physical

00:36:13.860 injury as we're sort of out in the wilderness right now, not close to a hospital. And because,

00:36:18.960 you know, we don't want to go to a hospital unless absolutely necessary. So I want to do those

00:36:24.340 things or not do those things that I wouldn't want to do if I were a thousand miles away from

00:36:28.800 medical attention. Yeah. I'm just thinking about like, we just got a puppy, God, like maybe four

00:36:35.860 or five weeks ago. And I mean, she's as cute as all hell, but she didn't finish her vaccinations. 0.70

00:36:41.840 I'm just worried like, Oh God, I hope nothing goes wrong with her. Cause I sure as hell don't want to

00:36:45.400 have to go and take her out to the vet. And secondly, I have two young kids. Two of my three

00:36:51.360 kids are in that age group where they can do really stupid things and get bit by dogs. If you're not

00:36:55.780 watching them, they can yank a dog's tail or do something dumb. And so, I mean, that's constantly

00:37:00.960 in the back of my mind, which is watching those kids like a hawk when they're with her, because if

00:37:06.200 one of them gets bit by her, yeah, we're going to the urgent care. I'd rather do a root canal on myself

00:37:11.480 right now than have to take one of my kids into urgent care to get some IV antibiotics for a 1.00

00:37:16.840 significant dog bite. Yeah. Yeah. No. And it's amazing to see people who are not, or apparently

00:37:24.060 not making any of those accommodations. You know, I've seen people, cause you can obviously get out

00:37:30.780 of your house and we're not locked down in, in that sense. It's not crazy to be out hiking or as long

00:37:37.180 as you can stay away from people, but, you know, seeing people mountain bike and I mean, it just,

00:37:42.380 I'm just picturing, you know, all the people who take a fall on a mountain bike or one of these

00:37:47.660 scooters, then having to deal with the aftermath and like, you just, you know, why add that to the

00:37:53.120 risk profile of the moment? It's, I mean, I, yeah, I'm embarrassed to admit the number of times a day

00:37:58.860 I do that calculation with everything I'm doing of don't let this be the moment you break something

00:38:05.160 and have to go in and get taken care of. So I want to pivot to something else, Sam,

00:38:11.420 because by the way, you and I could have this discussion an hour every day and it never gets

00:38:16.320 old to me, but, but there's something I want to pivot to where just on a personal level could use

00:38:21.260 your help. And I know a lot of other people can as well, which is our minds are running amok at the

00:38:28.720 moment. And there are a few people who I think have been able to articulate the nature of the mind

00:38:35.680 and how we are not our thoughts. And yet right now, so many of my thoughts are unpleasant.

00:38:43.180 They've permeated my dreams. I've never had more sort of disturbing dreams than I've had in the last

00:38:50.020 two weeks, I think. And they're not always related to this, but they're just disturbing dreams in general.

00:38:56.940 And I know that part of that is my mind playing out anxiety as I sleep. How have you dealt with

00:39:04.020 that? As you know, based on having spent many years practicing meditation and, and seeing the mind

00:39:13.200 through that lens, I have some tools, which I, you know, now default to, which are incredibly helpful.

00:39:20.620 So it's, if you understand the mechanics of your own mental suffering, if you understand how anxiety

00:39:29.700 arises from the first person side, I mean, not understanding it as a matter of neurophysiology, but

00:39:36.560 just actually able to witness it as a matter of experience moment to moment, that allows you to get off

00:39:45.360 the ride whenever you can remember to. Now, the devil's in the details of just how infrequently

00:39:51.480 you managed to do that, depending on, on how much this, this skill has been ingrained in you. But,

00:39:59.360 and there really is, for most of us, there's no alternative, but to practice it. First, you have to

00:40:04.200 learn it, and then you have to practice it. And then it becomes somewhat like any physical skill.

00:40:09.720 You have someone who is completely untrained and unfit, and you put them in the gym, and they,

00:40:14.980 and they have a fair amount of work to do to get even anything that's sort of acceptable in terms of

00:40:20.940 fitness and preparation for real physical stress. And then you have people who, they're Olympic

00:40:27.520 athletes, or they're jujitsu world champions, or they're people who have taken some domain of physical

00:40:33.820 training to a point where their default setting physically under stress is amazingly different

00:40:41.300 than people tend to be. And there is a mental component to that. It's possible to be really

00:40:49.080 resilient. Obviously, I don't count myself among the, the super athletes here, but I've done enough

00:40:55.420 practice so that when my wheels begin to spin and am suffering unnecessarily, whether it's from

00:41:03.380 anxiety or some other negative emotion, I can let it go. If it's pointed out to me by someone else,

00:41:10.620 or I just happen to notice it, I can drop the problem. That doesn't mean I don't pick it up

00:41:15.800 again. I mean, then the thoughts come back, and you don't notice them, and it just feels like you

00:41:21.200 worrying about getting sick in the middle of the night or whatever it is. And, but the question is,

00:41:26.440 how long does it take to puncture that with a clear scene of the nature of mind? And for me,

00:41:34.940 progress really is a matter of, it's not a matter of banishing any particular emotion or pattern of

00:41:41.640 thought from your experience for all time. I mean, that's an unrealistic goal. It's a matter of getting

00:41:47.900 more and more agile in the face of these arising thoughts and emotions so that you, so that their

00:41:55.560 time course is drastically shortened, or at least the time it takes you to puncture them by, in this

00:42:02.880 case, the state of mind would be called mindfulness. But mindfulness really is just clear attention to

00:42:11.600 what experience is like in the present. It's not, you know, some mystical piece of software that you

00:42:17.700 have to get downloaded into you that you don't have. It's just, it actually is just a non-distracted,

00:42:24.080 non-reactive, clear scene of, let's say, the physiology of anxiety. I mean, just feeling the

00:42:30.880 energy in your body of anxiety. The moment you can merely feel it without judgment, without reaction,

00:42:37.720 without contraction, without thinking about all the reasons why you, it's intolerable or, you know,

00:42:43.680 or thinking more about the reasons why it's justified. If you just become willing to feel it

00:42:48.920 in the moment, it loses its psychological content. For the moment you can merely feel it,

00:42:55.160 it has no more psychological content than any other analogous feeling in the body does, you know,

00:43:01.820 indigestion or pain in your back or itching on the surface of your skin. I mean,

00:43:06.980 all of these things can be unpleasant, but they don't mean anything really, or that, or at least

00:43:11.640 it's a further action of thought to link them up with some future state of the body or the world,

00:43:18.780 which caches out their meaning. So anyway, I can talk more about what mindfulness actually is and

00:43:23.380 how to practice it, but that's how I view this ongoing experience. I keep puncturing it with

00:43:29.640 just clear attention and it really does help. No question.

00:43:34.060 You said something on one of your podcasts, I think it was last week, you said it,

00:43:38.220 and I'm paraphrasing, but look, it's not about getting rid of fear, but rather kind of letting

00:43:43.100 an emotion like fear go when it no longer serves its purpose.

00:43:47.240 Yeah. I mean, you want to feel fear when it's appropriate and useful to feel it and you want

00:43:54.080 to be able to release it the moment there's no point to it. And the punchline here though, is that

00:44:01.780 95%, 99%, I mean, the vast majority of moments in which we feel fear or anxiety or shame or regret or,

00:44:13.920 you know, any classically negative emotion, most of those moments are wasted. I mean, most of those

00:44:20.800 moments, in most of those moments, the negative emotion is driving us to no good purpose. In fact,

00:44:27.720 it's actually undermining our ability to recognize the happiness we're capable of in this moment,

00:44:34.740 because in fact, nothing is wrong in this moment. So it's great to feel anxious when it's goading you

00:44:42.460 to do something useful. But as a goad, its utility is delivered in those first few moments very often.

00:44:50.540 I mean, it's at the boundary of sort of the known and the unknown where you're trying to figure out

00:44:54.800 what to do. I mean, around this COVID pandemic, I'm feeling anxiety when I don't know what I should

00:45:01.620 be doing. How do we get groceries into the house? What should I be doing there? I mean, do we eat salad

00:45:07.300 anymore? Or is this a vector for disease? How do I wipe down a box? Or do I wipe down a box that was

00:45:15.300 just delivered? How long does the virus live on cardboard? How long does it live inside a box that

00:45:21.560 I open? Now I'm taking something that's packaged in plastic out of that box. Am I a lunatic for thinking

00:45:27.400 any of these thoughts? All of that uncertainty is the basis for a durable state of anxiety. But once I

00:45:35.340 figure out what I think is true and what I should be doing, well, then there is no utility to the

00:45:42.500 anxiety. And then just do the thing you think you should be doing. And the moment uncertainty

00:45:48.060 reimposes itself, the moment I read an article which says, oh, actually, you know, coronavirus can

00:45:54.260 get in in this other way that you hadn't been accounting for. Well, then, okay, then I'll get

00:45:59.840 anxious over that, but only for as long as it takes me to decide what my new policy is. And

00:46:07.140 you can either do something about it or not. If you can do something about it, the anxiety

00:46:12.260 is pointless. I mean, it should have a very short half-life. And the truth is, if you can't do

00:46:17.880 something about it, the anxiety is pointless and should have a short half-life. So in either case,

00:46:23.260 you want this punctate experience of what's essentially an orienting response to danger.

00:46:29.640 And the dangers are real. This is not a cartoon we're in. We're making potentially life and death

00:46:35.580 decisions for ourselves and other people. But you don't have to remain in this state of anxiety,

00:46:42.380 even if these decisions are actually very significant.

00:46:46.880 Yeah. There aren't many examples I can point to in the last two or three years, which is about the

00:46:54.400 period of time that I've been familiar with mindfulness-based meditation, where it's been

00:46:59.880 more true to realize that what's happening in the moment is rarely that bad, but what's going on in my

00:47:09.320 mind is often much worse. And in the case of what's happening now, it's usually more forward-looking

00:47:15.620 than backwards-looking. Obviously, there are periods in our lives when we can suffer more based on the

00:47:21.720 backwards-looking emotions that tend to be more depressive and dysthymic. But here, it's really

00:47:27.760 this forward-looking anxiety that can be devastating. And yet, I put something up on Twitter the other

00:47:33.620 day, and I was like, you know, it sort of occurred to me that I had just reached my new record in 12

00:47:39.140 years, longest period of time not traveling. And it's sort of funny because you're not going to meet

00:47:44.740 someone who hates traveling more than me, Sam. I hate it. I hate airplanes. I hate airports. I hate

00:47:50.440 being away from my home. And for someone who hates it so much, I do it an awful lot. And so for all the

00:47:56.340 uncertainty and everything that's going on right now, it's been a long time, and it might be a long

00:48:01.940 time before I travel again. There's huge value in that. And certainly, if I appreciate it in the

00:48:07.460 moment that I'm in, and yet, so often, I'm hijacked by my fear of uncertainty.

00:48:14.160 Yeah. Well, I mean, one thing you're pointing to there are the many silver linings that many of us

00:48:20.480 have found in this circumstance. And people are reporting this on social media, just listing the

00:48:27.920 things that are surprisingly nice about quarantine, essentially. And the general circumstance, the

00:48:36.440 reason why we're all doing this isn't nice. But yeah, many people are discovering that there's a

00:48:42.540 kind of a hard reset of their value system, and they're spending more time with family, and there's

00:48:49.320 quality time of a sort that they haven't touched before or haven't touched in a long time. I totally

00:48:56.060 share the less travel epiphany. I mean, it's just, I sort of had that even before this and decided to

00:49:02.600 just cancel a lot of travel, and just in general, I like it about as much as you do. But yeah, there's,

00:49:09.080 especially for those of us who are so fortunate to more or less be able to do what we were doing

00:49:16.160 before, from home, in isolation. I mean, that obviously, there are people for whom their careers

00:49:24.500 were completely zeroed out the moment they were told to stay home. And there's a ton of

00:49:29.640 financial anxiety that comes with that, and everyone's feeling the financial anxiety to some

00:49:34.440 degree. But some of us, I count myself among the luckiest here, we're in a position to just

00:49:41.160 either where everything was already distributed, or we were in a position to make it distributed

00:49:47.260 without really missing a step. And that's just sheer luck in many cases, because there are certain

00:49:54.360 things you just can't build from home, and certain things you need never even think about going into

00:49:59.800 an office to accomplish. So yeah, I mean, there's a lot that many of us are discovering about just how

00:50:06.500 out of balance our lives became when everything was normal. And I think it's worth, insofar as any of

00:50:14.740 those lessons seem like things we want to hold on to, it's worth taking stock of them.

00:50:19.740 Have your kids voiced any sort of concern about this? And how have you talked with them about it?

00:50:26.660 Well, my oldest is 11, and she's definitely old enough to worry about it, and to understand

00:50:32.980 how non-normal this situation is. My six-year-old is pretty oblivious to it. I mean, she has a general

00:50:42.120 sense of what we're up to, but I don't get the sense that it's making her anxious at all. I mean,

00:50:47.980 as you know, the core ethic in my life, and this translates into the family, is honesty. My daughters

00:50:57.000 know that we will never lie to them, and we never find ourselves having to lie to them, but that

00:51:04.760 doesn't mean we tell them everything. And my oldest daughter will ask a question to which I know she

00:51:10.180 really doesn't want the answer. It's just going to make her anxious. And so I'll basically just

00:51:17.240 acknowledge in that moment that there's a door that's locked that she's trying to open, but

00:51:22.280 there's no point in opening it. I'll tell her what she needs to know there. And that's not the same

00:51:28.160 thing as saying, oh, there's nothing to worry about, or giving her some dishonest answer that totally

00:51:34.400 assuages her anxiety. But it's a stronger foundation for a relationship. I mean, she knows,

00:51:40.480 because the thing is, she knows now that when I say something is not worth worrying about, it's not a

00:51:47.660 risk, or she's fine. She knows I'm not bullshitting her. And in other moments where I can't say that

00:51:53.760 honestly, I don't say it dishonestly. I just give her, I give her more of the, or attempt to give her

00:52:00.360 more of the adult grade tools of dealing with probability and risk. And whether it's working

00:52:07.260 or not, I mean, I don't have the counterfactual to go on, but at the very least, she knows we don't

00:52:13.020 lie to her. And that's, to my eye, that's a nice place to be. Have you struggled yourself with just

00:52:19.560 irritability or you're one of the least irritable humans I've ever met. So that's a pretty,

00:52:25.340 it's a pretty high bar for you to tell that to my wife. Well, exactly.

00:52:28.860 Because you'll get a big laugh out of her. Well, that's the litmus test, right? So what

00:52:32.240 would your wife say has been the impact of the uncertainty, the fear, all of the things we've

00:52:38.700 just discussed? How has that impacted someone like you who, for most of us, we would aspire to have

00:52:44.820 sort of the degree of separation from thought and reaction that you have through, again, years of

00:52:51.400 practice. Yeah. Well, again, it's not that I don't get angry or anxious or uptight or have a negative

00:53:01.560 reaction to things. I do. And by tendency, I tend to be that sort of person. I mean, I'm sort of on the

00:53:08.280 anger, annoyed, pessimist channel more than, certainly more than the opposite, right? I mean,

00:53:15.860 no one has ever accused me of being too joyful or Pollyannish. So yeah, I mean, I can definitely be

00:53:24.280 a buzzkill and can be in a bad mood and can be irritable. The difference is that if she calls me

00:53:31.680 on it, I can actually pull the brakes or get off the ride or just whatever metaphor you want for like

00:53:39.400 the actual stoppage of the problem emotionally. And this is not a matter of bearing down on yourself

00:53:46.440 or repressing it or doing some maneuver, which just bottles up the rage or something. It's not that it's

00:53:54.920 I can actually just let it go. That's just garden variety mindfulness taken to a certain level. In my

00:54:04.020 case, it's, I mean, if you know anything about how I view meditation practice and the nature of mind and

00:54:11.860 the illusoriness of the self and free will and all of these other, you know, nested topics.

00:54:16.660 There's a pretty good app that I would recommend for people to help understand how you think about

00:54:21.580 some of those things. What's it called again?

00:54:23.400 This conversation is brought to you by the Waking Up app.

00:54:26.360 Yeah.

00:54:26.980 Though we eschew sponsors on this podcast.

00:54:28.860 Yeah. So, so, I mean, I taught, there's a lot to say about that, but the net result is it's possible

00:54:35.660 to cut through the illusion there in a way that allows you to truly stand free of whatever

00:54:45.300 emotional reaction you're having at that moment, whether it's anger or sadness or, or anything. And

00:54:52.500 you recognize that consciousness is just this open space in which everything is appearing on its own

00:54:58.700 and there is no durable self riding around in the middle of it. There's just, just consciousness

00:55:05.280 in its contents and everything is in its own place. And, and consciousness actually isn't even harmed

00:55:12.060 by that awful mind state that you were anchored to a second ago. There's just the energy of what used

00:55:21.080 to be anger essentially passing through. And your, your freedom from a problem in the next moment isn't

00:55:28.140 actually even predicated on that energy leaving yet. It's just in fact true that when you're no

00:55:34.520 longer identified with the stream of angry thoughts, the peripheral physiology of anger dissipates very,

00:55:41.020 very quickly. I mean, over the course of seconds, 15 seconds at the most, whereas, and the thoughts

00:55:47.920 disappear more or less instantly. If you, if you break the spell, all of this, the time course of all

00:55:54.640 of this falling off is pretty quick, but the truth is the moment you break the spell, even while the,

00:56:00.480 the body is still incandescent with the, the physiology of anger or anxiety or whatever,

00:56:07.520 you're free even in that first moment. And that can take some doing to recognize that. And that's why,

00:56:14.080 that's the reason why one would practice meditation. But having brought your practice to that point where

00:56:19.600 you can actually do that. Yeah. I mean, that the thing Anika would say about me is that

00:56:24.580 I can actually, when push comes to shove, I can stop being an asshole and I can stop on a dime

00:56:33.520 whether or not, and whether or not I do it in that moment, it can be influenced by some other factors.

00:56:42.640 And so personally, the most stressful stuff that happens for us in, in, in this situation is if

00:56:49.840 we're not on the same page with respect to something we're trying to decide. Again, I mean,

00:56:54.760 we're talking about the, the boundary of between the, the known and the unknown and trying to decide

00:57:00.120 what we should do about the unknown, right? So if we can't agree about whether or not, whatever,

00:57:07.600 to have someone over to the house, say under these conditions, right? Going to decide to,

00:57:12.600 to have her mom over, but how's her mom living? Is her mom actually locked down? Is her mom,

00:57:18.380 wasn't your mom just at the supermarket and told you that such and such happened? Whatever it is,

00:57:23.280 I mean, this is kind of hypothetical, but in that situation, if she is, if I'm trying to convince her

00:57:29.240 to be more risk averse than she in fact is, or vice versa, that's where I'm going to tend

00:57:36.440 just to get caught in my own sense of urgency, then my stress will be just largely what I'm

00:57:43.760 communicating, right? And I'll be uptight and she'll be annoyed at just how I'm having the

00:57:49.400 conversation. And even in that moment, she could, if she actually said, okay, listen, this is, we can

00:57:56.660 talk about this, but I don't like who you are right now. I don't like the way you're talking about

00:58:01.060 this. That is something that as long as we can keep working to solve the problem at the level of

00:58:08.240 the problem, I could drop the emotional contagion in that moment, which is an immense help. But

00:58:15.840 the place where I get what really is my kryptonite is when the door gets closed to actually solving the

00:58:23.320 problem. When I want to keep talking about something or keep trying to figure, I feel like

00:58:27.940 there's something to figure out and she or someone in the world is shutting me down there. It's very

00:58:34.720 easy for me to just feel like, okay, the emergency signals are still appropriate here. It would be

00:58:40.580 inappropriate to be no longer anxious because the house is on fire and we're fighting about whether

00:58:45.900 to use the fire extinguisher. But that's the exception, right? I mean, that's-

00:58:49.940 Yeah, I'm very rarely in that situation, but that's where my gears truly grind. And again,

00:58:55.460 you still want to be the person who can find the gear that allows for grace under pressure.

00:59:02.740 You do want to be the smooth Navy SEAL operator rather than the panicked grunt who's just firing

00:59:12.880 his weapon in all directions. And so there's always an argument for unhooking from the heightened emotion

00:59:19.780 in a situation once you're orienting to the problem.

00:59:23.520 You touched on something there that I think is so helpful and doesn't get enough, I think,

00:59:27.620 appreciation, which is the importance of having a spouse that understands the exercise and knows how

00:59:34.360 to help you. In my case, I mean, that's something I feel really grateful for. I posted something on

00:59:39.720 social media a week ago. It was really sad. It was actually my birthday of all days. And the night

00:59:47.520 before I had just absolutely berated my daughter for leaving the lights on, she left like every

00:59:54.280 single light on in the hallway. It's just a dumb pet peeve of mine that normally I just turn them off

00:59:59.680 or just make some smart aleck remark like, hey, Olivia, you know, the light fairy is not working

01:00:04.100 today. Maybe you could turn the lights off. But on this day, I just went nuts. And then the next

01:00:09.820 morning, which again is my birthday, I'm on a conference call basically from six o'clock in the

01:00:15.760 morning till 10 o'clock in the morning, one call after another. And my five-year-old just cannot

01:00:21.460 understand for the life of him why I'm working on my birthday. He thinks your birthday is the day you

01:00:26.440 get to play. And he keeps trying to come in the office and play. And finally, after like the fourth

01:00:33.280 time, I just explode on him. Well, two things, right? One is not a lot of mindfulness in that

01:00:40.000 experience. Two, you then, at least for me, you cycle into a horrible place of shame where now you

01:00:46.760 are doing that backwards looking thing that we just talked about. Again, I said most of it is

01:00:50.960 anxiety, but then the shame is very backwards looking, equally unproductive. And you sort of

01:00:56.260 spoil the rest of the day, but through a different mechanism, not by lashing out, but by detaching.

01:01:02.400 And that's actually for me, my kryptonite is when I get in that place, I just, I pull back so far

01:01:08.320 and it's equally troublesome. But then fast forward a two, three days. And I've reflected a lot on that

01:01:16.640 experience and like, how did you get there, man? How is it in the span of 14 hours, you lose it on

01:01:22.060 two kids. So yesterday, my same five-year-old who's obsessed with Lego. And there are these train Legos

01:01:29.640 that are very elaborate. They take a long time to put together. And I've told him like 400 times,

01:01:33.900 you got to be careful with this thing. Well, sure enough, he drops it. It smashes into 50 pieces.

01:01:39.740 And the next morning, which is Sunday morning, I wake up to put it together.

01:01:44.680 And I don't know if you've ever done this with Lego. If you remember when you were a kid,

01:01:48.200 sometimes it's just easier to take the whole thing apart, all 500 pieces and start from scratch,

01:01:52.300 then try to take the 50 that came off and figure out where they go. But lead us to say, this is a ton of

01:01:57.660 work. And at one point, I actually pull out a video to check something. And by now he's awake

01:02:03.400 and he starts yipping at me. Like the video is too loud that I'm trying to watch to fix his Lego.

01:02:10.800 Admittedly, he's being totally obnoxious. And I'm just about to explode on him and basically say,

01:02:16.560 what do you think I've been doing here for the past hour, buddy? And my wife looks at me and she goes,

01:02:22.020 take a breath. And it was perfect, right? I just stood up. I went over to him and I said,

01:02:26.720 Reese, I don't like the way you're talking right now. You're being really rude. And dad's been up

01:02:32.140 for an hour before you even got up trying to fix the toy you broke. So I'd appreciate it if you'd

01:02:37.780 talk a little nicer. And afterwards, my wife was like, look, you did it, man. Like you weren't the

01:02:42.160 biggest jerk on earth. But my point is, she was the one who helped me there. Like, yeah, the practice

01:02:49.880 that I had helps, but I'm still at the point where I need that cue sometimes from somebody else

01:02:55.000 to just give me one more pause before I lose my mind.

01:03:00.420 Yeah, no, that's great. That is the virtue of, certainly one of the virtues of good company

01:03:04.460 and having someone who shares your values. I mean, one thing I would add is that even when you

01:03:11.340 totally screw up, you've blown up at your kids or someone else, and you're now feeling ashamed

01:03:19.500 by what you did, you know, your lack of compassion or resilience or mindfulness or however you're

01:03:26.680 judging yourself for the previous misstep, and you just feel bad about it and bad about yourself,

01:03:34.260 again, that is no less an opportunity to cut through the illusion of self than any other moment.

01:03:42.400 It's like in this video game, that's just the next screen, right? This is the next boss fight. Now

01:03:48.460 you're fighting the boss of shame. And it's no more real, ultimately. And yet, it's an appropriate,

01:03:58.240 again, like anxiety, as a signal, it can be an appropriate guide to action. So for me, if that

01:04:05.240 happens to me, if I do something that I'm subsequently ashamed of or embarrassed by, the signal for me

01:04:13.620 there is how I want to use that information is I want to repair the relationship if I feel like I've

01:04:21.180 done any kind of damage. And therefore, it becomes a goad to very likely an apology. And it's not,

01:04:30.340 and again, given my view of free will, I mean, it's interesting to just understand the psychology of

01:04:34.680 this. Because, you know, as you know, I think free will is an illusion. I think there's just makes

01:04:38.880 absolutely no sense to think that one could have done or should have done otherwise previous moment,

01:04:45.600 or at least thinking that isn't really thinking honestly about the past. What it is, is it's kind

01:04:52.280 of an aspirational thinking, which is in fact directed at the future. It's like, given what just

01:04:58.860 happened, I recognize that I'm not the person I want to be. I'm the person who lost his mind when,

01:05:06.900 you know, in this case, my kid came into the room and interrupted me during a conference call. I'm not

01:05:12.000 satisfied being that person. And this person is now in my past. This person is very likely to show up

01:05:18.680 again in the future. What I want to do now is make that less likely. And also, I want to repair

01:05:25.160 any damage I've done. In this case, an apology can really be healing. I don't know if you have an

01:05:31.820 experience of apologizing for these kinds of missteps and feeling that actually the net result

01:05:41.240 is in fact even better than zero. It's not just a matter of getting back to zero, but you can

01:05:48.380 actually get past zero to your, in this case, your child understands that you can get angry, and it's

01:05:57.020 okay, and it's okay to express it. And grownups can apologize. And the kid can be empowered with their

01:06:04.560 own judgment of when you were in the wrong. I mean, so like, whenever I've found myself apologizing to,

01:06:11.800 this is more true of my older daughter than my younger, because again, she's, she's a barbarian. 0.98

01:06:16.600 She's, she's completely clueless. But my older, you know, it's like, if she thinks I'm in the wrong,

01:06:22.520 and she's right, that's a message I want her to, to be able to internalize, right? So like, if I

01:06:29.120 say or do something inappropriate, it makes her feel bad. And I recognize that. And then I subsequently

01:06:35.440 apologize. I want her to actually take the win of having been right and having understood the

01:06:44.700 situation. Her emotions were an appropriate guide to those previous moments. What I want to communicate

01:06:51.620 in making my apology is that I was absolutely wrong. And my commitment to her is to not be that

01:06:58.760 way again. And if I'm that way again, and she calls me on it, I'm going to see that, again, that I'm going

01:07:04.940 to see she was right. It just seems like it's, it's a healthy dialogue. And again, the real toxicity

01:07:11.500 in all of this is in the duration over which we're caught. If this is all happening quickly,

01:07:18.500 it's fine. If it's taking hours and days and weeks and months to sort out these problems, well, then

01:07:25.660 you have a very unhappy life. Again, it's not a matter of never feeling shame again. It's just

01:07:30.640 how long are you going to be stuck there? And for me, really the only tool is, is mindfulness on

01:07:37.380 that front. Yeah. It, which really comes back to the idea of anxiety, fear can be constructive,

01:07:43.140 but for most of us, they overstay their welcome. Yeah. I would put shame in precisely that bucket

01:07:50.740 because it's not, it's a very toxic emotion, but arguably the most toxic emotion, but it's not that

01:07:59.720 it's never appropriate. I don't think you would want a mind. That was incapable of shame.

01:08:05.380 Incapable of shame. I mean, that is a, the door to sociopathy is definitely left ajar there. I mean,

01:08:12.280 even if you're, there's some meditation masters and gurus who, whose talents as meditators, I really,

01:08:20.200 I can't doubt, but whose careers have completely spiraled out of control and essentially self-immolated

01:08:30.320 for precisely this reason. I mean, there's a kind of enlightened sociopathy certain people have

01:08:37.000 acquired and shamelessness really is, is the, the master variable so far as I can tell. It's like

01:08:44.180 there are people who have immense charisma and an immense sense of personal wellbeing based on how

01:08:52.280 much contemplative practice they've done. And they very easily attract students and set up

01:08:59.460 organizations and begin teaching. And the crucial piece is probably a doctrine that's easily found

01:09:07.240 within Buddhism and, and other Eastern traditions that enshrines a kind of theocratic hierarchy.

01:09:13.380 which justifies misuses of power rather often, but the shamelessness component of all of this,

01:09:22.000 it seems to me to be very, very risky, if nothing else. I mean, it is the, it is the thing that is

01:09:28.780 causing the downfall or has caused the downfall of many otherwise fairly impressive people.

01:09:35.380 Yeah. There's no doubt about that. Sam, what are you most optimistic about right now? I mean,

01:09:40.820 I feel like you and I have been on the phone almost every other day for the past two weeks. I think

01:09:46.420 we were both, I think independently, frankly, came to very similar conclusions probably three weeks

01:09:52.660 ago that at the time seemed probably reactionary. A lot of the time when we are talking, we're sort of

01:10:01.020 shaking our head in a little bit of frustration over a lack of perceived response. Is there something

01:10:07.360 that you are more optimistic about today than you were three or four days ago? Optimism bias is not

01:10:13.380 a bias I have in, in much quantity, but I have to think that there are certain errors of judgment

01:10:21.500 that will become less common here. I mean, just what had become very common in this prior age of the

01:10:31.180 earth that existed as recently as three weeks to a month ago is a fairly systematic denigration of

01:10:39.360 expertise. The experts don't know anything. What we need are reality TV show stars running the world. 0.98

01:10:48.500 And it's actually, frankly, it's not just on the right, it's on the left. I mean, when you look at

01:10:51.860 the anti-vax movement, I mean, just, I don't know how the anti-vax movement will find new adherence

01:10:57.940 in the coming months and years. I mean, perhaps I'm selling delusion short and it will, but it just,

01:11:04.520 it should be just thrillingly obvious to everyone right now, no matter what their commitment to the

01:11:11.480 anti-vax movement, that what everyone wants at this moment is a vaccine for coronavirus. I mean, this

01:11:19.720 is just, there's no, how anyone could demur on that point, I just don't, don't know. And you're not

01:11:26.760 hearing a lot from those people. I feel like there's a certain style of imagining that we can

01:11:34.060 do without science and real data and real knowledge. And everyone with their humanities degrees can just

01:11:42.020 criticize everything all the time. And there's no difference between the people who are just making

01:11:49.220 stuff up and the people who can actually get things done in some conformity with the principles of

01:11:55.340 physics, chemistry, and biology, and reality as it is at large. I feel like that has to unravel

01:12:03.180 to some degree. And I'm hoping we can secure those gains when this all blows over. But again, whether

01:12:11.000 that's, whether I'm truly optimistic about that or not, I don't know. Well, actually, I think that is

01:12:17.280 actually, that's a pretty optimistic thought, actually. I also, like you, don't know how,

01:12:21.820 what the half-life is on this pain and the realization that science is, is important. And

01:12:29.200 there are a lot of unsexy things that we need a government to be able to do that are really

01:12:35.660 convenient to forget about until you need them. And yeah, that's the other species of myth that I

01:12:41.820 think has been knocked down a peg or two or, or entirely this, just this, this libertarian idea.

01:12:48.560 In several ways, I consider myself a quasi-libertarian. I mean, just insofar as I think

01:12:53.560 we should cede to the private sector, everything that can be best accomplished there. But it's just

01:12:59.640 now painfully obvious that we need government to do certain crucial things. And minimal government

01:13:07.600 cannot be a sacred principle anymore. I mean, we just, we need to figure out what we need government

01:13:13.100 for, and then we should shore it up as much as we need to on all of those fronts. And pandemics

01:13:19.100 are not something that we want a merely private piecemeal response to.

01:13:24.680 Yeah. This is the perfect example of how a public-private partnership is going to be essential.

01:13:30.400 There are absolutely parts of this that are going to be best addressed for future pandemics in the

01:13:36.480 private sphere. But there are things that just the natural owner to the risk is, is the government.

01:13:41.060 And, and by the way, it's not just federal, it's local. I mean, I think that's the other

01:13:44.640 thing we're seeing is this is as much a local issue as it is a national issue. It's actually

01:13:49.800 probably, I think more a local issue, frankly. And therefore, like I said, it's really at the

01:13:54.840 outset of the discussion, it's more relevant to me how New York handles New York right now

01:13:59.060 than what Washington tells New York. And in the future, I think that's one area where I think

01:14:04.940 we will learn that lesson. I think that's, I'm optimistic that in the future cities will take

01:14:11.540 on some more of that risk stratification and planning such that when we're waiting for the

01:14:18.780 CDC to develop a test, guess what? We're not going to wait for the CDC to develop the test

01:14:24.020 because we saw that that test was already developed in China two months earlier. We're going to procure

01:14:29.780 the test directly. I mean, little things like that. So it's sort of the, it is more of a

01:14:34.520 federalist view. It's like, let's kind of empower these, let's decentralize some of these things as

01:14:39.780 well. Yeah. Yeah. I mean, clearly we need to be more flexible, certainly under duress like this.

01:14:46.880 That's one thing I'm, I'm not optimistic about, but I just, it's more aspirational and has the form

01:14:53.000 of a prayer at this moment. I just think we have to capture all the lessons we're learning as we go

01:14:59.180 here. I mean, there's just so much that has gone wrong. And in most cases, it seems so unnecessary

01:15:07.200 to have, have screwed up in precisely the ways we have. And so I just feel like, I think I said this

01:15:12.880 somewhere, there should just be a Google doc for this entire crisis that people are adding to. And

01:15:19.220 because it's, it's, yeah, it's, it's been amazing to witness. I mean, just the, the apparent thinness of

01:15:28.660 our institutions. And just as you keep punching through layers of ineptitude, what is going to

01:15:36.060 actually stop the problem? It's been fascinating and unnerving to watch. And also there's a layer of

01:15:42.120 political controversy, you know, perpetual political controversy that has interacted so unhelpfully

01:15:48.680 with this, that you have an emergency and it's a healthcare emergency and now an economic emergency,

01:15:55.900 but there has been a political emergency running on top of this now for three years and it's distorting

01:16:04.500 everything. And people just have to learn to think apparently incompatible thoughts simultaneously

01:16:12.680 because they're only seeming incompatible when you're a political dogmatist, right? So I'll give

01:16:19.520 you one example that keeps coming up. Trump is showing a, an aptitude for weaponizing this phrase,

01:16:27.120 the Chinese virus. This is a bright shiny object that he's, he's dangling in front of Democrats so

01:16:34.120 that they can seize on it and castigate him as a xenophobe or a racist and thereby ignore all the other

01:16:41.220 things he's done wrong, which are far more deplorable and therefore politically actionable and worth

01:16:48.640 campaigning on. He's dangled this truly innocuous thing, whether he's a xenophobe or a racist or not.

01:16:55.300 The reality is, is that this virus did originate in China and it was born of absolutely bizarre and

01:17:03.840 unacceptable cultural practices of eating bats and other wild species and housing them together still 0.64

01:17:11.900 living so that they can brew up their various xenovirus cocktails. And these are based on just

01:17:19.460 patently insane beliefs about animal spirits and energies and traditional cures for whatever it is,

01:17:27.620 insomnia, erectile dysfunction, or anything else that people are trying to treat with tiger bones

01:17:33.260 and rhino horn and bats. And I mean, it's all colossal and colossally dangerous bullshit.

01:17:40.100 And castigating the Chinese for it is not a sign of racism or colonialism or anything else. It's

01:17:49.040 self-preservation. And so China has to be held responsible for these shitty traditions that it 0.99

01:17:57.360 hasn't managed to purge. And it's undoubtedly, it's not only China, but it's certainly mainly China. And on top of 0.75

01:18:05.680 that, they have an authoritarian government that tried to conceal the gravity of this outbreak, and did

01:18:13.480 effectively conceal it to some degree, at least for some time, and failed to give the world adequate warning in a

01:18:21.500 collaborative way that we have to figure out how to achieve globally. So Trump, whatever he means by the

01:18:28.420 Chinese virus, he would be right to mean those two things. And the world has to get its head straight 0.93

01:18:34.580 vis-a-vis China on those two points. So for the Democrats to just cry racism and xenophobia, when he

01:18:42.640 uses this phrase, is to utterly miss the point and to be successfully gamed politically. But of course, what the

01:18:50.880 Democrats are actually worried about is also obviously true and worth worrying about. It's completely insane

01:18:58.020 to absorb the facts I just put forward about China. And on that basis, be a xenophobe. Because first of all,

01:19:08.300 the virus is now global. It emerged in China, but now it's just as much the Italian virus, or the New

01:19:13.860 York virus. So it's everywhere all at once. And also, most Chinese people have zero responsibility 1.00

01:19:20.480 for any of this, because they're not running their authoritarian government, and they're not eating

01:19:25.580 bats. And presumably, most Chinese people are as horrified by bat eating as I am. So racial animus

01:19:34.160 makes absolutely no ethical sense here. Democrats are right to worry about that. So you can hold these truths

01:19:41.420 in buffer simultaneously, and not be deranged by it. But we don't have a politics, or even a journalistic

01:19:50.740 community, frankly, that is showing much aptitude for that. So it's, there's many needles like that, that we

01:19:57.160 increasingly have to thread. And whether I'm hopeful we're going to do that or not, I don't know. But it's just the

01:20:02.300 imperative to do it is coming to us hourly. I am less hopeful on that one, Sam. I'm more hopeful on

01:20:09.260 the, hopefully the scientific community now has some of the ammunition it needs to make sure that

01:20:15.000 we have the right type of vaccine program in the future. Again, coronaviruses are a family of viruses,

01:20:22.140 they can be targeted with vaccines that can target both common and uncommon components to them. In other

01:20:29.080 words, there are going to be pieces that are retained throughout them. So you can have sort of

01:20:33.600 antiviral therapies that might have efficacy against a family of them. And then of course,

01:20:38.840 secondarily, there are even vaccines that look like they might have efficacy against some of those

01:20:43.640 common chains of the virus. So if I'm going to be optimistic about anything, I just have to believe

01:20:48.220 we're not going to emerge from this with our head in the sand about an approach to the next round of

01:20:54.400 this, which again, not what people want to hear about today, because that doesn't really address

01:20:58.940 the situation at hand. If I'm going to close with one thing I'm optimistic about, hmm, definitely.

01:21:06.860 Before you give me any happy talk, let me drive you further into the darkness. What are the prospects

01:21:13.160 in your view that a vaccine isn't really in the cards in the way that it hasn't been for AIDS or

01:21:22.720 some other viruses? I mean, it's just hard to create a vaccine for certain viruses. And

01:21:28.260 maybe even immunity, herd immunity among born of those who have caught it and not been too harmed by

01:21:35.780 it. Maybe that isn't even in the cards in the way that it doesn't appear to be for flu because it

01:21:43.020 mutates so often. I mean, obviously we have a flu vaccine, but we need a new one every year.

01:21:47.540 What if we get, what's the prospect that we're going to get doubly unlucky here? And it's just,

01:21:51.640 it's going to be very hard to come up with a vaccine. And even if we had one, we'd have to

01:21:57.360 have a new one every year. So I do think it will be harder to vaccinate against this than it is

01:22:02.700 something like polio or measles or smallpox. But part of that's also technical. It's the nature of

01:22:09.380 the coronaviruses. They sort of behave a bit more like RSV viruses, which to create enough immunity,

01:22:16.780 you have to create a larger exposure basically. And the risk of the vaccine is higher. So anytime

01:22:24.360 you vaccinate somebody, there's a risk that they get sick from the vaccine. And the perfect vaccine

01:22:29.900 would be the vaccine for which you have no risk from the vaccine and you get perfect immunity.

01:22:36.100 Obviously nothing is there. So we now look at gradations of how close we get to that.

01:22:40.260 And my discussions with a couple of virologists and people in this space say, we have to sort of

01:22:47.400 caveat our optimism around how long it will take to make a vaccine for this and how safe it will be.

01:22:55.200 And this gets into the question of, would you take a vaccine that had a 0.1% mortality? It would be

01:23:03.740 very difficult to make that case unless you're over, I don't know what age. You wouldn't even

01:23:08.260 necessarily just say over 70 if you believe, because even though the mortality over 70,

01:23:12.780 once you have it is high, you have to be multiplying that by the probability that you

01:23:16.840 would contract it. So it's going to really come down to the technical challenges of making this

01:23:22.060 vaccine safely. And again, for a bunch of technical reasons that I don't actually understand

01:23:27.360 completely, this mirrors the type of virus for which vaccines have historically not been a great

01:23:33.820 alternative because of the risk reward trade-off. So ironically, everything I just said about the

01:23:38.760 anti-vax movement is going to go completely out the window because there will be legitimate

01:23:42.440 concerns that this vaccine perhaps could be more dangerous than your usual vaccine that is.

01:23:48.220 Well, I think it's a different argument. So I think the anti-vax argument is the fear of

01:23:52.060 unknowns like vaccines cause autism and things like that. Here, large clinical trials will give you

01:23:59.020 very clear safety profiles. It's like, look, and I'm making up 0.1% like for effect, right? I can't

01:24:05.480 imagine it could be that high, but 0.1% of people get really, really sick for two weeks and 0.001% of

01:24:13.080 people require hospitalization and 0.0001% of people die. I mean, if you knew that, well, then that's a

01:24:20.560 very legitimate discussion, whether you're pro-vaccine or anti-vaccine. I mean, that is the type of

01:24:25.420 discussion we need to have around vaccines. The discussion we don't need to have around vaccines

01:24:29.980 is let's go back to one stupid paper written by some guy who completely falsified data.

01:24:36.280 The paper was retracted. The guy has been disbarred from ever writing another paper in the history of

01:24:41.360 his life, but a couple of knuckleheads, celebrity idiots pick up on it and turn it into an entire

01:24:47.780 message that is completely false. I mean, those are different statements. I consider myself who is

01:24:53.140 in favor of vaccine, but also thoughtful about, they absolutely pose risk. There's nothing that

01:24:59.500 doesn't pose a risk. So anyway, that's a whole other topic.

01:25:04.100 Actually, but just to illuminate that, I mean, that's another example of being able to thread the

01:25:09.440 needle on a very difficult to discuss, but important topic and very few people can do it. So

01:25:17.280 if you're worried about the social consequences, the consequences to public health of the anti-vax

01:25:25.000 movement, you're someone who's very likely going to be uncomfortable hearing a doctor say anything

01:25:32.040 about the legitimate risk of vaccines as a medical intervention. But of course, almost anything we do

01:25:39.340 to our bodies poses some risk. I mean, you know, taking ibuprofen poses some risk of actual death.

01:25:46.600 So we have to be able to acknowledge these things. I mean, people know when we're lying to them. So

01:25:53.060 as you point out, we need a more sophisticated conversation about risk and what is acceptable

01:26:00.080 there, you know, just kind of the micro mortality points we are willing to accrue given the benefits,

01:26:07.200 proffered benefits of doing anything, whether it's skiing or getting on an airplane or getting

01:26:13.000 vaccinated. And we owe it to ourselves to be able to have the sophisticated version of that

01:26:18.840 conversation in public, as opposed to just hammering one side of the ideology space and denigrating the

01:26:27.180 other. There are often right answers, even when there's probabilistic uncertainty in any individual

01:26:33.340 case. They're prudent things to do and they're idiotic things to do. And we can make those judgments

01:26:39.020 even when some percentage of people have a very bad experience doing whatever it is, skiing, getting

01:26:46.060 vaccinated, or anything else that has a non-zero risk of bad outcome.

01:26:51.780 That's absolutely right. There is a reincarnation, which I don't believe in. But if there is, and I get to

01:26:56.280 come back for another ride, I want to dedicate my life to teaching risk management to people.

01:27:01.420 I would love to sort of make a career out of coming up with ways and tools to help people

01:27:09.280 think through what we're talking about now, because I think it is such an essential

01:27:13.920 way to go through life and appreciate the nuance and uncertainty that is much more present than we

01:27:21.460 are led to believe. Yeah. We also just have to acknowledge that the answers on paper, I mean,

01:27:28.000 the probability of death or injury in one circumstance may not actually seem better or worse

01:27:38.420 or rationally what we know it to be because of some, you know, superficial differences in the

01:27:45.280 situation that just we can't emotionally correct for. I mean, some things just seem sketchier than

01:27:52.140 other things, even if on paper, they're not. And some aspects of human psychology here that we have

01:27:58.360 to figure out how to navigate around. And I think we do that, we have to do that at the level of public

01:28:06.040 policy. I mean, the public policy really does have to be driven by statistics, and what is known for

01:28:13.380 large groups of people to bear out in terms of risk of injury and death. And yeah, and then people are

01:28:20.700 still afraid to get on an airplane just because they're afraid to fly and they're never afraid to

01:28:25.120 drive. Let the people who are doing policy acknowledge how much more dangerous our roads

01:28:31.080 are than our skies are. But there are some ways in which we have to triangulate around human psychology

01:28:36.740 to get right answers made actionable. Yeah. Sam, I love that I get to call you up and bug you every

01:28:44.120 day. Yeah, likewise. I'm glad we were able to have a conversation today that we can share with

01:28:49.080 everybody. I hope it's helpful. I know at this point, information overload is a problem. And I

01:28:56.780 think what I appreciated about the discussion we had today, it was really less about information

01:29:01.100 and new information, and frankly, maybe more about how one can process it, think about it,

01:29:06.080 and hopefully not overreact to it, but react enough to it. Yeah. And I suspect we'll have something

01:29:11.720 different to say a week from now, and maybe we might have to hop back on a call and revisit anything

01:29:15.540 we've learned. Yeah, let's just pledge to do that. I mean, if we get to a point where several

01:29:20.480 other shoes have dropped and the story has changed in some material way, let's do a round two. And not

01:29:27.580 so much for what I have to bring to it. I have a feeling my story isn't going to change very much,

01:29:32.320 but yours, I think, will on the medical front. So I'll love to hear it. Yeah. Well, thank you for

01:29:38.380 making time, Sam, and I wish you luck the rest of today. Likewise. Thank you for listening to this

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The Peter Attia Drive - March 24, 2020

#100 - Sam Harris, Ph.D.： COVID-19—Comprehending the crisis and managing our emotions

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