Michael Mina: Rapid Testing, Viruses, and the Engineering Mindset | Lex Fridman Podcast #146
the following is a conversation with michael minna he's a professor at harvard doing research on infectious disease and immunology the most defining characteristic of his approach to science and biology is that of a first principles thinker and engineer focused not just on defining the problem but finding the solution in that spirit we talk about cheap rabbit at home testing which is a solution to covet 19 that to me has become one of the most obvious powerful and doable solutions that frankly should have been done months ago and still should be done now as we talk about its accuracy is high for detecting actual contagiousness and hundreds of millions can be manufactured quickly and relatively cheaply in general i love engineering solutions like these even if government bureaucracies often don't it respects science and data it respects our freedom it respects our intelligence and basic common sense quick mention of each sponsor followed by some thoughts related to the episode thank you to brave a fast browser that feels like chrome but has more privacy preserving features athletic greens the all-in-one drink that i start every day with to cover all my nutritional bases expressvpn the vpn i've used for many years to protect my privacy and the internet and cash app the app i use to send money to friends please check out these sponsors in the description to get a discount and to support this podcast as a side note let me say that i've always been solution oriented not problem oriented it saddens me to see that public discourse disproportionately focuses on the mistakes of those who dared to build solutions rather than applaud their attempt to do so teddy roosevelt said it well in his the man in the arena speech over 100 years ago i should say that both the critic and the creator are important but in my humble estimation there are too many now of the former and not enough of the latter so while we spread the derisive words of the critic on social media making it viral let's not forget that this world is built on the blood sweat and tears of those who dare to create if you enjoy this thing subscribe on youtube review with five stars not a podcast follow on spotify support on patreon or connect with me on twitter at lex friedman and now here's my conversation with michael minna what is the most beautiful mysterious or surprising idea in the biology of humans or viruses that you've ever come across in your work sorry for the overly philosophical question wow well that's a great question you know i love the pathogenesis of viruses and one of the things that i've worked on a lot is trying to understand how viruses interact with each other and so pre all this covered stuff it was uh i was really really dedicated to understanding uh how uh how viruses impact uh other pathogens so how if somebody gets an infection with one thing or a vaccine does it either benefit or harm you from other things that appear to be unrelated to in the to most people and so one one system which is highly detrimental to humans but what i think is just immensely fascinating is measles and measles gets into a kid's body the immune system picks it up and essentially grabs the virus and does exactly what it's supposed to do which is to take this virus and bring it into the immune system so the immune system can learn from it can develop an immune response to it but instead measles plays a trick it gets into the immune system serves almost as a trojan horse and instead of getting eaten by these by these cells it just takes them over and it ends up proliferating in the very cells that were supposed to kill it and it just distributes throughout the entire body gets into the bone marrow kills off children's immune memories and so it essentially what i've found and what my research has found is that this one virus was responsible for as much as half of all the infectious disease deaths in kids before we started vaccinating against it because it was just wiping out children's immune memories to all different pathogens which is you know i think um just astounding it's just amazing to watch it spread throughout bodies we've done the studies in monkeys and and you can watch it just destroy and obliterate people's immune memories in the same way that you know some parasite might destroy somebody's brain and it's is that a evolutionary just coincidence or is there some kind of advantage to this kind of interactivity between pathogen well i think in that sense it's just coincidence uh it probably is a it's a good way for measles to uh it's a good way for measles to essentially be able to survive uh long enough to replicate in the body it just replicates in the cells that are meant to destroy it so it's uh it's utilizing our immune cells for its own replication uh but in so doing it's destroying the memories of all the other the other immunological memories so but there are other viruses so a different system is influenza and uh flu predisposes to severe bacterial infections and that i think is another coincidence but i but i also think that there are that there are some evolutionary benefits that bacteria may hijack and sort of piggyback on viral infections viruses can they just grow so much quicker than bacteria they replicate faster and so there's the system with viruses with flu and and bacteria where the influenza has these proteins that cleave certain receptors and the bacteria want to cleave those same receptors i want to cleave the same molecules that gave entrance to those receptors so instead the bacteria found out like hey you know we could just piggyback on these viruses they'll do it a hundred or a thousand times faster than we can and so then they just piggy back on and they let flu cleave all these cyalic acids and then the bacteria just glom on and in the wake of it so there's all different interactions between pathogens that are just remarkable so does this whole system of viruses that interact with each other and so damn good at getting inside our bodies does that fascinate you or terrify you i'm very much a scientist and so uh it fascinates me much more than it terrifies me but knowing enough i know just how well you know we get the wrong virus um in our population whether it's through some random mutation or whether it's this same covid19 virus and it you know these things are tricky they're able to mutate quickly they're able to find new hosts and rearrange in the case of influenza so what terrifies me is just how easily this particular pandemic could have been so much worse this could have been a virus that is uh much worse than it is you know same thing with h1n1 back in 2009 uh that terrifies me if a virus like that was much more detrimental uh you know that would be it could be much more devastating although it's hard to say you know the the human species were well i i hesitate to say that we're good at responding to things because there are some aspects that were this particular virus stars cove too and covet 19 has found a sweet spot where where it's not quite serious enough on an individual level that humans just don't we haven't seen much of a useful response by many humans like a lot of people even think it's a hoax and so it's led us down this path of uh it's not quite serious enough to get everyone to respond immediately and with the most urgency but it's enough it's bad enough that you know it's caused our economies to shut down and collapse and so um i think i know enough about virus biology to be terrified for humans that you know it can it just takes one virus just takes the wrong one to just obliterate us or or not obliterate us but but really do much more damage than we've seen it's fascinating to think that code 19 is uh as a result of a virus evolving together with like twitter yeah like figuring out how we can sneak past the defenses of the humans so it's not bad enough and then the misinformation all that kind of stuff together is operating in such a way that the virus can spread effectively i wonder i mean obviously uh a virus is not intelligent but there's a uh there's a rhyme and a rhythm to the way this whole evolutionary process works and creates these fascinating things that spread throughout the entire civilization absolutely it's um yeah i'm i'm completely fascinated by this idea of social media in particular how it replicates how it grows you know i've been how it inner how it like actually starts interacting with the biology of the virus masks who's going to get vaccinated politics like these seem so external to virus biology but it's become so in intertwined and uh and it's it's interesting and i actually think we could find out that you know the virus actually becomes uh obviously not uh intentionally but you know we could find that choosing people choosing not to wear masks choosing choosing not to counter this virus in a regimented and sort of organized way effectively gives the virus more opportunity to escape we can look at vaccines you know we're about to we're about to have one of the most aggressive vaccination programs the world has ever seen but we are unfortunately doing it right at the peak of viral transmission when millions and millions of people are still getting infected and when we do that that just gives this virus so many more opportunities i mean orders of magnitude more opportunity to mutate around our immune system now if we were to vaccinate everyone when there's not a lot of virus then there's just not a lot of virus and so there's not going to be as many you know i don't even know how many zeros are at the end of however many viral particles there are in the world right now you know more than quadrillions you know and so if you assume that at any given time somebody might have trillions of virus in them and any given individual so then you know multiply trillions by millions and yeah you know you get a lot of viruses out there and and if you start applying pressure ecological pressure to this virus that that you know when it's that abundant cloud the opportunity for a virus to sneak around immunity especially when all the vaccines are identical essentially um it takes is one to mutate and then jumps oh it takes one takes one in the whole world you know and we have to we have to not forget that this particular virus was one it was one opportunity and it has spread across the globe and there's no reason that can't happen tomorrow i knew you know it's scary i have a million other questions in this direction but i'd love to talk about one of the most exciting aspects of your work which is uh testing or rapid testing you wrote a great article in time on november 17th this is like a month ago about rapid testing titled how we can stop the spread of kobe 19 by christmas let's jot down the fact that this is a month ago so maybe your timeline would be different but let's say in a month so you've talked about this powerful idea for quite a while throughout the covid 19 pandemic how do we stop the spread of covad19 in a month well we uh we use tests like these you know so so the only reason the virus continues spreading is because people spread it to each other this isn't this isn't magic yes um and so there's a few ways to stop the virus from spreading to each other and that is uh you either can vaccinate everyone and vaccinating everyone is a way to immunologically prevent the virus from growing inside of somebody and therefore spreading we don't know yet actually if this vaccine if any of these vaccines are going to prevent onward transmission so so that may or may not serve to be one opportunity certainly i think it will decrease transmission but the other idea that we have at our disposal now we had it in may we added in june july august september october november and now it's december we still have it we still choose not to use it in this country and in much of the world and that's rapid testing that is giving it's empowering people to know that they are infected and giving them the opportunity to not spread it to their loved ones and their friends and neighbors and whoever else we could have done this we still can today we could start we have millions of these tests these tests are uh simple paper strip tests they are uh inside of this thing is just a little piece of paper now and i can actually open it up here there we go so this this is how we do it right here we have this little paper strip test this is enough to let you know if you're infectious with somewhere around the order of 99 sensitivity 99 specificity you can know if you have infectious virus in you if we can get these out to everyone's homes build these make 10 million 20 million 30 million of them a day you know we make more bottles of dasani water every day we can make these little paper strip tests and if we do that and we get these into people's homes that they can use them twice a week then we can know if we're infectious you know is it perfect absolutely not but is it near perfect absolutely you know and so if we can say hey the the transmission of this is you know for every 100 people that get infected right now they go on to infect maybe 130 additional people and that's exponential growth so 100 becomes 130. a couple days later that 130 becomes uh another another 165 people have now been infected and you know go over three weeks and 100 people become 500 people infected now it doesn't take much to have those hundred people not infect 130 but infect 90. all we have to do is remove say 30 40 of new infections from continuing their spread and then instead of exponential growth you have exponential decay so this doesn't need to be perfect we don't have to go from 100 to zero we just have to go and have those hundred people infect 90 and those 90 people infect you know 82 whatever it might be and you do that for a few weeks and boom you have now gone instead of 100 to 500 you've gone from 100 to 20. yes it's not very hard and so the way to do that is to let people know that they're infectious i mean i've we're a perfect example right now i i this morning i used these tests uh to make sure that i wasn't infectious is it perfect no but it reduced my odds 99 i already was at extremely low odds because i spent my life quarantining these days well the interesting thing with this test which uh with the testing in general which is why i love what you've been espousing is it's really confusing to me that this has not been taken on as it's one an actual solution that's those available for a long time there's there doesn't seem to have been solutions uh proposed at a large scale and a solution that it seems like a lot of people would be able to get behind there's some politicization or fear of other solutions that people propose which is like lock down and there's a worry you know especially in the american spirit of freedom like you can't tell me what to do the thing about tests is it like empowers you with information essentially yes so like you it's it gives you more information about your like your role in this pandemic and then you can do whatever the hell you want like it's all up to your ethics and and so on so like and it's it's obvious that with that information people would be able to protect their loved ones and also do uh do their sort of quote-unquote duty for their country right it's protect the rest of the country that's exactly right i mean it's just it's empowerment but you know this is a problem we have not put these into action in large part because we have a medical industry that doesn't want to see them be used we have a political and a regulatory industry that doesn't want to see them be used that sounds crazy why wouldn't they want them to be used we have a very paternalistic approach to everything in this country you know despite this country kind of being founded on this individualistic ideal pull yourself up from your bootstraps all that stuff uh when it comes to public health we have a bunch of ivory tower academics who want data that you know they want to see perfection and we have this issue of letting perfection get in the way of actually doing something at all you know doing something effective and so we keep comparing these tests for example to the laboratory-based pcr test and sure this isn't a pcr test but this doesn't cost a hundred dollars and it doesn't take five days to get back which means in every single scenario this is the more effective test and we have unfortunately a system that's not about public health we have entirely eroded any ideals of public health in our country for the biomedical complex you know this medical industrial complex which overrides everything and that's why you know i'm just can i swear on this podcast yes i'm just so fucking pissed that these tests don't exist meanwhile and everyone says you know how we couldn't make these you know that we could never do it that would be such a hard a difficult problem meanwhile the vaccine gets we've we have at the same time that we could have gotten these stupid little paper strip tests out to every household we have uh developed a brand new vaccine we've gone through phase one phase two phase three trials we've scaled up its production and now we have ups and fedex and all the logistics in the world getting freezers out to where they need to be we have this immense we see with when it comes to sort of medicine you know something you're injecting into somebody then all of a sudden people say oh yes we can yeah but you say oh no that's that's too simple a solution too cheap a solution no way could we possibly do that it's this faulty thinking in our country which you know frankly is driven by big money big you know the only time when we actually think that we can do something that's maybe aggressive and complicated is when there's billions and billions of billions of dollars in it you know and i mean on a difficult note because this is part of your work from before the corvaid it does seem that i saw a statistic currently is that 40 percent would not be taken off americans would not be taking a vaccine some some number like this so you also have to acknowledge that all the money that's been invested like there doesn't appear to be a solution to deal with like the fear and distrust that people have i bet i don't know if you know this number but for taking a strip like a rapid test like this i bet you people would say like the percentage of people that wouldn't take it is in the single digits probably i completely think so and you know there's a lot of people who don't want to get a test today and that's because it gets sent to a lab it gets reported it has all the stuff and in our country which teaches people from the time they're babies you know to keep their medical data close to them we have hipaa we have all these we have immense rules and regulations to ensure the privacy of people's medical data and then a pandemic comes around and we just assume that all that the average person is going to wipe all that away and say oh no i'm happy giving out not just my own medical data but also to tell the authorities everyone who i've spent my time with so that they all get a call and are pissed at me for giving up their names you know so people aren't getting tested and they're definitely not giving up their contacts when it comes to contact tracing and so for so many reasons that approach is failing uh not to even mention the delays in testing and things like that and so this is a whole different approach but it's an approach that empowers people and takes the power a bit away from the people in charge you know and that's what's that's what's really grating on on i think public health officials who say no we need the data so they're effectively saying if i can't have the data i don't want the individuals i don't want the public to have their own data either which is a terrible approach to a pandemic where we can't solve a public health crisis without actively engaging the public it just doesn't work and uh you know and that's what we're trying to do right now which is a terrible approach so first of all there's a you have a really nice informative website rapidtest.org information on this i still can't believe this is not more popular it's ridiculous okay but uh our our uh one of the uh faqs you have is a rapid test too expensive so can can cost be brought down like i pay i take a weekly pcr test and i think i pay 160 170 bucks a week no i mean it's criminal absolutely we can get costs this this thing right here cost less than a dollar to make with everything combined plus the swabs you know maybe it costs a dollar fifty could be sold for uh frankly it could be sold for three dollars and still make a profit if they want to sell it for five this one here this is a slightly more complicated one but you can see it's just got the exact same paper strip inside this is really it doesn't look like much but it's kind of the cream of the crop in terms of these rapid tests this is the one that the us government bought and it is doing an amazing job it has a 99.9 uh sensitivity and specificity so it's really it's really good and so essentially the way it works is you just you use a swab you put the once you you kind of use the swelling yourself you put the swab into these little holes here you put some buffer on and you close it and uh and a line will show up if it's positive and a line won't show up but it's negative it takes 5-10 minutes this whole thing the this this can be made so cheap that the us government was able to buy them by 150 million of them from uh abbott for five dollars a piece you know so anyone who says that these are expensive we have the proof is right here this one at its you know it was abbott did not lose money on this deal you know they got 750 million dollars for buy for selling 150 million of these at five bucks a piece um all of these tests can do the same so anyone who says that these should be you know unfortunately what's happening though is the fda is only authorizing all of these tests as medical devices so what happens when you if i'm a medical company if i'm if i'm a test production company and i want to make this test and i go through and and the fda at the end of my authorization the fda says okay you know you now have a medical device not a public health tool but a medical device and that affords you the ability to charge insurance companies for it why would i ever as a you know in our capitalistic uh economy and and sort of infrastructure why would i ever not sell this for thirty dollars when insurance will pay pay for it or a hundred dollars you know it might only cost me 50 cents to make but but by pushing all of these tests through a medical pathway at the fda they what what extrudes out the other side is an expensive medical device that's erroneously expensive it doesn't need to be inflated in cost but the companies say well i'd rather make fewer of them and just sell them all for thirty dollars a piece then make tens of millions of them which i could do and sell them at a dollar uh marginal uh uh profit you know and so it's a problem with our with our whole medical industry that we see tests only as medical devices and uh you know what i would like to see is for the government in the same way that they bought 150 million of these from abbott they should be buying you know all of these tests that they should be buying 20 million a day and getting them out to people's homes this virus has cost trillions of dollars to the american people it's closed down restaurants and stores and you know obviously the main streets across america have shut have shuttered it's killing people it's killing our economy it's killing lifestyles and and this is an obvious solution to me this is exciting this is like this is a solution i wish uh like in april or something like that uh to launch like the larger scale manufacturing deployment of uh tests doesn't matter what test they are it's obviously the capitalist system would create cheaper and cheaper tests that that would be hopefully driving down to one dollar so what are we talking about in america there's i don't know 300 plus a million people so that means you want to be testing regularly right so how many do you think is possible to manufacture will be the ultimate goal to manufacture per month yep so if we want to slow this virus and actually stop it from transmitting achieve what i call herd effects like vaccine herd immunity hurt effects are when you get that r value below one through preventing onward transmission if we want to do that with these tests we need about 20 million to 40 million of them every day uh which is not a lot in the united states in the united states so we could do it there's other ways you can have two people in a household uh swab each other you know swab themselves rather and then mix you know put the swabs into the same tube and onto one test so you can pool so you can get a a 2 or 3x gain inefficiency through pooling in the household you could do that in schools or offices too where everyone just uses a swab you have a there's two people like i mean even if it's just standing in line at a public testing site or something you know you could just say okay these two are the last people to test or swab themselves they go into one one thing and if it comes back positive then you just do each person and you know it's rapid so you can just say to the people one of you is positive let's test you again um so there's ways to get the efficiency gains much better but let's say i think that that the optimal number right now that matches sort of what we can produce more or less today if we wanted is 20 million a day right now one company that i don't have their test here but one company is already producing five million tests themselves and shipping them overseas it's an american company based in california called inova and they are giving 5 million tests to the uk every day not to the you know and this is just because there's no the federal government hasn't authorized these tests without the support of the the government so yeah so essentially if the government just puts some support behind it then uh then yeah you can get 20 million probably easy oh yeah this i mean just here i have three different companies these they all look similar well this one's closed but these are three different companies right here this is a fourth abbott you know this is a fifth this is a sixth these two are a little bit different do you mind if in a little bit would you take some of these or yeah let's let's do it we can we can uh we can absolutely do that so you have a lot of tests in front of you uh could you maybe explain some of them absolutely so there's a few different classes of tests that i just have here and there's more tests there's many more different tests out in the world too these are these are one class of tests these are uh rapid antigen tests that are just the most bare bones paper strip tests these uh this is the type that i want to see produced in the tens of millions every day it's so simple you know you don't even need the plastic cartridge you can just you can just make uh make the paper strip and you could have a little a little tube like this that you know you just dunk the paper strip into you don't actually need the plastic which i'd actually prefer because if we start making tens of millions of these this becomes a lot of waste so i'd rather not see this kind of waste be out there and there's a few companies quadel is making a test called the quick view which is just just this it's uh they've gotten rid of all the all the plastic and for people who are just listening to this we're looking at some very small tests that fit in the palm of your hand and they're basically paper strips fit into different containers and that's hence the comment about the plastic containers these are just injection molded i think and uh you got it they're um you know they can build them at high numbers but then they have to like place them in there appropriately and all this stuff so it is a it is a bottleneck or some somewhat of a bottleneck in manufacturing the actual bottleneck uh which the government i think should use the defense productions act to build up is the there's a nitrocellulose membrane laminated membrane on this that allows uh the the material the the the buffer and with the swab mixture to flow across it so the way these work they're called lateral flow tests and you take a swab you swab the the front of your nose you dunk that swab into some buffer and then you put a couple drops of that buffer onto the lateral flow and just like paper if you dip a piece of paper into a cup of water though the paper will pull the water up through capillary action this actually works very similarly it flows through somewhat a capillary action through this nitrocellulose membrane and there's little antibodies on there these little proteins that are very specific in this case for antigens or proteins of the virus so these are antibodies similar to how to the antibodies that our body makes from our immune system but they're just printed on these um lateral flow tests and they're printed just like a little a line so then you you slice these all up into individual ones and if there's any virus on that buffer as it flows across the antibodies grab that virus and it creates a little reaction with some colloids in here that cause it to turn dark just like a pregnancy test um one line means negative it means a control strip worked and two lines mean positive means uh you know but if you get two lines it just means you have virus there you're very very likely to have virus there and so uh so they're super simple this is it is the exact same technology as pregnancy tests it's uh the technology this particular one from abbott this has been used for other infectious diseases like malaria and and actually a number of these companies have made malaria tests that do the exact same thing so they just co-opted their the same form factor and uh and just change the antibodies so it picks up sars cof2 instead of other infections is it also the abbott one is it also strip yep yeah this abbott one here is uh there's the in this case instead of being put in a plastic sheath it's just put in a cardboard thing and literally glued on i mean it's it looks like nothing you know it's just it looks like a like i mean it's just the simplest thing you could you could imagine the exterior packaging looks very apple like this nice it does yeah yeah yeah so it's nice and it comes in this is the this is how they're packaged you know so and they don't have to you know this these are coming in individual packages against again because they're really considered individual medical devices but you could package them in you know bigger packets and stuff you you want to be careful with humidity so they all have a little um one of those humidity removing things and oxygen removing things um so that's that this is one class these antigen tests if we could just pause for a second if it's okay and uh could you just briefly say what is an antigen test and what other tests there are out there like categories of tests sure just really quick so the testing landscape is a little bit complicated but it's but i'll break it down there's really just three major classes of tests uh we'll start with the first two the the first two tests are just looking for the virus or looking for antibodies against the virus so we've heard about serology tests or maybe some people have heard about it those are a different kind of test they're looking to see has somebody in the past does somebody have an immune response against the virus which would indicate that they were infected or exposed to it so we're not talking about the antibody test so i'll just leave it at that those uh they actually can look very similar to this or they can be done in a laboratory those are usually done from blood and they're looking for an immune response to the virus so that's one everything i'm talking about here is looking for the virus itself not the immune response to the virus and so you there's two ways to look for the virus you can either look for the genetic code of the virus like the rna just like the dna of somebody's human cells or you can look for the proteins themselves the antigens of the prot of the virus so i like to differentiate them if you were a a pcr test that looks for rna in let's say let's say if we made it against humans it would be looking for the dna inside of our cells that would be actually looking for our genetic code uh the equivalent to an antigen test is sort of a a test that like actually is looking for our eyes or our nose or physical features of our body that would uh delineate okay this is this is uh michael for example in and so so you're either looking for this a sequence or you're looking for a structure uh the pcr test that a lot of people have gotten now and they're done in labs usually are looking for the sequence of the virus which is rna this test here by a company called detect this is one of jonathan rothberg's companies um he's the guy who helped create modern day sequencing and all kinds of other things so this detect device that's the name of the company this is actually a rapid rna detection device so it's almost it's like a pcr-like test and we could even do it here it's really it's it's a beautiful test in my opinion it works exceedingly well it's going to be a little bit more expensive so i think it could confirm could be used as a confirmatory test for these is there a greater accuracy to it um yes i would say that there is a greater accuracy there's also a downfall though of pcr and tests that look for rna they can sometimes detect somebody uh who is no longer infectious so you have the the rna test then you have these antigen tests the antigen tests look for structures but they're generally only going to turn positive if people have actively replicating virus in them and so what happens after an infection dissipates you have you've just gone from having sort of a spike so if you get infected maybe three days later the virus gets into exponential growth and it can replicate to trillions of viruses inside the body your immune system then kind of tackles it and beats it down to nothing but what ends up in the wake of that you just had a battle you had this massive battle that just took place inside your upper respiratory tract and because of that you've had trillions and trillions of viruses go to zero essentially but the rna is still there it's just these remnants in the same way that if you go to a crime scene and blood was was was sort of spread all over the crime scene you're going to find a lot of dna there's tons of dna there's no people anymore but there's a lot of dna there same thing happens here and so what's happening with pcr testing is when people go and use these exceedingly high sensitivity pcr tests people will stay positive for weeks or months after their infection has subsided which has caused a lot of problems in my opinion it's problems that the cdc and the fda and doctors don't want to deal with but i've tried to publish on it i've tried to you know suggest that this is an issue both to new york times and others and now it's unfortunately kind of taken on a life of its own of conspiracy theorists thinking no um they call it a case stomach they say oh you know pcr is it's detecting people who are no longer who are right false positive but they're not false positives they're they're late positives no longer transmissible i think the way you uh like what i saw on rapid tests.org i really like the distinction between diagnostic sensitivity and contagiousness sensitivity that's it's so that website is so obvious uh that it's painful because it's like yeah that's what we should be talking about is how accurately is the test able to detect your contagiousness and you have different plots that show that actually there's you know um that antigen test the tests we're looking at today like rapid tests actually really good at detecting contagiousness absolutely it all mixes back with this whole idea that of the medical industrial complex you know in this country and in most countries we have almost entirely defunded and devalued public health period you know we just we just have and uh and what that means is that we don't even we don't have a language for it we don't have a lexicon for it we don't have a regulatory landscape for it and so the only window we have to look at a test today is as a medical diagnostic test and and that becomes very problematic when we're trying to tackle a public health threat in a public health emergency by definition and this is a public health emergency that we're in and yet we keep evaluating tests as though the diagnostic benchmark is the gold standard where if i'm a physician i am a physician so i'll put on that physician hat for a moment and if i have a doc if i have a patient who comes to me and wants to uh know if their symptoms are a result of them having covid then i want every shred of evidence that i can get to see does this person currently or did they recently have this infection inside of them and so in that sense the pcr test is the perfect test it's really sensitive it will find the rna if it's there at all so that i could say you know yeah you have a low amount of rna left you might have been you said your symptoms started two weeks ago you probably were infectious two weeks ago and and you have lingering symptoms from it but that's a that's a medical diagnosis it's kind of like a detective recreating a crime scene they want to go back there and re re create the pieces so that they can um assign blame or whatever it might be but that's not public health in public health we need to only look forward we don't want to go back and say well was this person are there symptoms because they had an infection two weeks ago in public health we just want to stop the virus from spreading to the next person and so that's where we don't care if somebody was infected two weeks ago we only care about finding the people who are infectious today and unfortunately our regulatory landscape fails to apply that knowledge to evaluate these tests as public health tools they're only evaluating the tests as medical tools and therefore we get all kinds of complaints that say this test which detects 99 plus you know 99.8 percent of of current infectious people uh on by the fda's rubric they'll say no no that's it's only 50 percent sensitive and that's because when you go out into the world and you just compare this against pcr positivity most people who are pc are positive in the world right now at any given time are post infectious they're no longer infectious because you you might only be infectious for five days but then you'll remain pcr positive for three or four or five weeks and so when you go and just evaluate these tests and you say okay this person's pcr positive does the rapid antigen test detect that more often than not it's no but that's because those people don't need isolation you know they they're post infectious and this is a it's become much more of a problem than i think uh even the fda themselves is recognizing because they are unwilling at this point to to look at this as a public health problem requiring public health tools we'll definitely talk about this a little bit more because the concern i have is that like a bigger pandemic comes along what are the lessons we draw from this and how we move forward let's talk about that in a bit but sort of can we can we discuss further delay of the land here of the different tests before us absolutely so i talked about pcr tests and those are done in the lab or they're done essentially with with a rapid test like this the detect and we can even try this in a moment it goes into a little heater so you might have one of these in a household or one of these in a nursing home or something like that or in an airport or you could have one that has 100 different outlets this is just to heat the tube up these are the rapid tests they are super simple no frills you just swab your nose and uh you put the swab into a buffer and you put the buffer on the test so we can use these right now if you want yeah and we can try it out and all the tests we're talking about they're usually swabbing the nose like that's the that's still that i mean yeah there are some saliva tests coming about and they these can all work potentially with saliva they just have to be recalibrated uh but these these swabs are really not bad this isn't the the deep swab that goes like way back uh into your nose or anything this is just the uh just a swab that you do yourself like right in the front of your nose um so if you want to do it yeah do you mind if i sure yeah yeah why don't we start with this one because this is uh this is abbott's binex now test and it's really it's pretty simple this is this the swab from the abba test that's correct that's the swab from the abba test so what i'm going to do to start is i'm going to take this buffer here which is uh this is just the buffer that goes on to this test so this is a brand new one i just opened this this test out i'm going to just take six drops of this buffer and put it right onto this test here two three four five six okay and now you're going to take that swab open it up yep and now just wipe it around inside the into the front of your nose do a few circles uh on each nostril that looks good this always makes me want to sneeze yeah okay now i'm going to have you do it yourself um i'm getting emotional hold it parallel to the test so put the test down on the table yep and then go into that bottom hole yep and push forward so you can start to see it in the other hole there you go now turn if it's once it hits up against the top just turn it uh three times one two three and sort of yep and now you just close so pull off that adhesive sticker there and now you just close the whole thing and and that's it that's it now what we will see uh is we will see a line form what's happening now is the the buffer that you put in there is uh now uh moving up onto the paper strip test and it has the material from the swab in there and so what we'll see is a line will form and that's going to be the control line and then we'll also see the the ideally we'll see no line for the actual test line and that's because you should be negative so one line will be positive and two lines will be negative it's very cool there's this uh purple thing creeping up onto the control line that's perfect that's what you want to be seeing so you want to see that so right now you essentially want to see that that blue line turns pink or purpley color there's a blue line that's already there printed it should turn sort of a purple pink color and ideally there will be no additional line for the sample and if there is that's the 99 point whatever percent accuracy on that means i have i'm contagious that would mean that you're likely contagious or you likely have uh infectious virus in you what we can do because one of the things that um that my plan calls for is because sometimes these tests can get false positive results it's rare maybe one percent or in the case of this binex now this abbott test point one percent so one in a thousand one five hundred something like that can be falsely positive what i recommend is that when somebody is a positive on one of these you turn around and you immediately test on a different test you could either do it on the same but for for as good measure you want to use a separate test that is somewhat orthogonal meaning that it shouldn't turn falsely positive for the same reason this particular test here this detect test because it is looking for the rna and not the antigen this is an amazingly accurate test and it's sort of a perfect uh gold standard or confirmatory test for any of these antigen tests so one of the recommendations that i've had especially if people start using antigen tests before you get onto a plane or you know as what i call entrance screening if somebody's positive you don't immediately tell them you're positive go isolate for 10 days you tell them let's confirm on one of these on a detect test that is a because it's completely orthogonal it's looking for the rna instead of the antigen there's no reason no biological reason that both of these should be falsely positive so if one's falsely positive and the other one is negative especially because this one's more sensitive uh then i would trust this as a confirmatory test if this one's negative then the antigen test you know would be considered falsely positive it does look like there's only a single line so this is very exciting news that's right yep it says wait 15 minutes to see both lines but in general if somebody's really going to be positive that line starts showing up within a minute or two um so you want to keep the whole we'll keep watching it for the whole 15 minutes as it's sitting there but uh i would say you're knowing that you've had pcr tests recently and all that you know the odds are pretty good odds are very packaging very iphone like i'm i'm i'm digging this sexy packaging i'm a sucker for good packaging okay so then there's this there's this test here which is you know this is another you know it's funny this let me open this up and show you this is a really nice test it's another antigen test works the exact same way as this essentially but what you can see is it's got like lights in it and a power button and stuff this is called an alum test which is you know fine and it's a really nice test to be honest but it um but it has to pair with an iphone and and so it's good as i think that this is going to become this is there's a lot of use for this from a medical perspective you know where you want good reporting this can because it pairs with an iphone uh it can immediately send uh send the report to a department of health whereas these paper strip tests that they're just paper they don't report anything unless you want to report it okay so i'm going to just pick it up and pick it apart and so you can see is there's like fluorescent readers and little lasers and leds and stuff in there you can actually see the lights going off wow and there's a paper strip test right inside there but you can see that there's like a whole circuit board and and all this stuff right and so this is the kind of thing that you know the fda is looking for um for like home use and and things like that because it's kind of foolproof like you you can't go wrong with it it pairs with an iphone so you need bluetooth so it's going to be more limited it's a great test don't get me wrong it's as good as any of these but you know when you compare this thing with a battery and a circuit board and all this stuff it's got its purpose but you know it's not a public health tool i don't want to see this made in the tens of millions a day yeah and thrown away um ga likes that kind of stuff fba loves this stuff you know because they can't get it out of their mind that this is a public health crisis you know we need we need i mean just look at the difference here something like flashing lights is essential got batteries it's got a bluetooth thing it's a great test but you know it's to be honest it's not any better than this one yeah and so you know i i want this one um it's nice and all the form factor is nice but and it's really nice that it goes to bluetooth but it goes against the principle of just uh 20 million a day exactly the easy solution everybody has it you can manufacture and probably you could have probably scaled this up in a couple of weeks oh absolutely these companies i mean the rest of the world has these they can be scaled up they already exist you know sd biosensors one company's making tens of millions a day not coming to the united states but going all over europe going all over um southeast asia and east asia so they exist the us is just you know we can't get out of our own way i wonder why somebody i don't know if you were paying attention but somebody like an elon musk type character so he was really into doing some like obvious engineering solution like this uh at home rapid test seems like a very elon musk thing to do i don't know if you saw but i i had a little twitter conversation with elon musk does he not like what was he do you know what his thoughts are on rapid testing well he was using a slightly different one one of these but that requires an instrument called the bd veritar and he got a false positive or no i shouldn't say he didn't necessarily get a false positive he got discrepant results he did this test four times he got two positives two negatives um but then he got a pcr test and it was a very low positive result so i think what happened is he just tested himself at the tail end of and this was actually right before he was about to send those it was the day of essentially that he was sending the astronauts up to the space station the other day so he used uh he was using these rapid tests because he wanted to make sure that he was good to go in and um he got discrepant results ultimately they were correct but you know two or negative two are positive but what what really happened once he got his he shared his pcr results and they were very low positive so really what was happening is my guess is he found himself right at the edge of his positivity of his infectiousness and so you know the test worked out was supposed to work it probably had he used it two days earlier it would have been screaming positive you know he wouldn't have gotten discrepant results but he found himself right at the edge by the time he used the test so the pcr would always pick it up because it's still because it will still stay positive then for weeks potentially but the rapid antigen test was starting to to falter not in a bad way but just he probably was really no longer particularly infectious and so it was kind of when it gets to be a very low viral load it becomes stochastic it's fascinating there's this duality so one you can think from an individual's individual perspective it's unclear when you take four and a half are positive half a negative like what are you supposed to do but from a societal perspective it seems like if just one of them is positive just stay home for for a couple days for for a while so when you're a ceo of a company you're launching astronauts to space you may not want to rely absolutely on the antigen test as a as a thing by which you steer your decisions of like 10 000 plus people companies but us individuals just living in the world if you can if it comes up positive then you make decisions based on that and then that scales really nicely to an entire society of hundreds of millions of people and that's how you get that virus to stop spreading that's exactly right you don't have to catch every single one and and the nice thing is that these will these will catch the people who are most infectious so with the elon musk it generally that test we don't have the counter factual we don't have his results from three days earlier when he was probably most infectious uh but my guess is the fact that it was catching two out of the four even when he was down at a ct value a really really very very low viral load on the pcr test suggests that it was doing its job and you just wanna and the nice thing is because these can be produced at such scale uh getting up getting one positive doesn't immediately have to mean 10 days of isolation that's the cdc's more conservative stance to say if you're positive on any test stay home for 10 days and isolate but here people would just have more tests so the recommendation should be test daily if you turn positive test daily until you've been negative for 24 48 hours and then go back to work and the nice thing there is you know right now people just aren't testing because they don't want to take 10 days off they're not getting paid for it so they can't take 10 days off do you know what uh elon thinks about this idea of rapid testing for everybody so i i understood i need to look at that whole twitter thread so i understand his perhaps criticism of uh he had like a conspiratorial tone for my vague look at it of like what's going on here with these tests uh but what does he actually think about this very practical to me engineering solution of just deploying rapid tests to everybody it seems like that's a way to open up the economy in april well to be honest i've been trying to get in touch with him again i think take somebody like elon musk with the engineering prowess within his ranks you know to easily easily build these at the tens of millions a day he could build the machines from scratch you know a lot of the companies they buy the machines from south korea or taiwan i believe uh we don't have to like we can build these machines they're simple to build get put somebody like elon musk on it you know take some of his best engineers and say look the us needs a solution in two weeks build these machines you know figure it out he'll do it he could do it this is a guy who who is literally he has started multiple entirely new industries he has the capital to do it without the us government if he wanted to and you know what it would the return on investment uh and for him would be huge but frankly the return on investment in the country would be hundreds of billions of dollars because it means we could get society open so i know that he his first experience with these rapid tests was confusing which is um how i ended up having this twitter kind of conversation with him very briefly but i think that if if he understood sort of a little bit more and i think he does i really really love to talk to him about it because i think he could totally change the course of this pandemic in the united states single-handedly you know he loves grand things yeah i think out of all the solutions i've seen this is uh this is the obvious like engineering solution to uh at least a pandemic of this scale i i love that you say the engineering solution so this is something i've been really trying to i'm an engineer uh you know my previous history was all engineering and that's really how i think um i then went into medicine and phd world but um but but i i think that the world like one of the major catastrophes or one of the major problems is that we have physicians making the decisions about public health and a pandemic when really we need engineers this is an engineering problem and so what i've been trying to do i actually really want to you know start a whole new new field called public health engineering you know and so i've been i'm loving it eventually i want to try to bring it to mit and get mit to want to start a new department or something um that's that's a doubly awesome idea that okay i love this i love every aspect i love everything you're talking about now a lot of people believe because vaccines started being deployed currently that you know we are no longer in need of a solution we're no longer in need of slowing the spread of the virus to me as i understand it seems like this is the most important time to have something like a rapid testing solution can you kind of break that apart uh what's the role of rapid testing current in the next you know what is it three four months maybe is even more this the vaccine rollout isn't going to be as peachy as everyone is hoping you know and i hate to be the deputy downer here but um there's a lot of unknowns with this vaccine you've already mentioned one which is there's a lot of people who just don't want to get the vaccine uh you know i hope that that might change as things move forward and people see their neighbors getting it and their family getting in there and it's safe and all we don't know how effective the vaccine is going to be after two or three months we've only measured it in the first two or three months which is a massive problem which we can go into biologically because there's reasons to very good reasons to believe that the efficacy could fall way down after two or three months we don't know if it's going to stop transmission and if it doesn't stop transmission then we're not then there's you know herd immunity is much much more difficult to get because that's all based on transmission blockade and uh and frankly we don't know how easily we're going to be able to roll it out some of the vaccines need really significant cold chains have very short half-lives outside of that cold chain uh we need to organize massive uh uh numbers of people to be able to distribute these most hospitals today are saying that they're not uh equipped to hire the right people to be even administering uh enough of these vaccines and then a lot of the hospitals are frustrated because they're getting much lower smaller allocations than they were expecting so i think right now like you say right now is the best time you know besides three or four or five or six months ago right now is the best time to get these rapid tests out and we need to i mean the country has the capacity to build them we have we're shipping them overseas right now we just need to flip a switch get the fda to recognize that there's more important things than diagnostic medicine which is the effectiveness of the public health program when we're dealing with a pandemic they need to authorize these as public health tools or you know frankly the president could you know there's a lot of other ways to get these tests to not have to go through the normal fda authorization program but maybe have the nih and the cdc give a stamp of approval and if we could we could get these out tomorrow and that's where that article came from you know how we can stop the the spread of this virus by christmas we could you know now it's getting late and so uh we have to keep updating that time frame maybe putting christmas in the title wasn't i should have said how we can stop the spread of this virus in a month yeah it would be a little bit more timeless but uh but we could do it you know we really could do it and that's the most frustrating part here is that uh we're just choosing not to as a country we're choosing to bankrupt our society because some people at the fda and other places just can't seem to get their head around the fact that this is a public health problem not a bunch of medical problems is there a way to change that policy wise so this is this is a much bigger thing that you're speaking to which i i love in terms of the uh mit uh engineering approach to public health is there a way to push this is this is this a political thing like where some andrew yang type characters need to like uh start screaming about it is it uh more of an elon musk thing where people just need to build it and then on on twitter start talking crap to the politicians who are not doing it what it what what what do you what are the ideas here uh i think it's a little both uh i i think it's political on the one hand and i've certainly been talking to congress a lot talking to senators are they receptive oh yeah i mean that's the crazy thing everyone but the fda is receptive i mean it's it's astounding i mean i advise you know informally i advise the president and the president-elect's teams i talked to congress i talked to senators governors you know and then all the way down to you know mayors of towns and and things and um i help i mean months ago i held a roundtable discussion with mayor garcetti as the mayor of l.a and i brought all the uh all the companies who make these things this was in like july or august or something i brought all the companies to the table and said okay how can we get these out and unfortunately it it went nowhere because the fda won't authorize them as public health tools um the nice thing is that this is one of the nice and frustrating things this is one of the few bipartisan things that i know of and like you said it's it's a real solution yeah lockdowns aren't a solution they're they're a emergency band-aid to a catastrophe that's currently happening they're not a solution and they're definitely not a public health solution if we're taking a more holistic view of public health which includes people's well-being it includes their psychological well-being their financial well-being you know just stopping a virus if it means that all those other things get thrown under the bus is not a public health solution it's a it's a it's a myopic or or very uh tunnel visioned approach to a viral virus that's spreading uh this is a simple solution with essentially no downfall you know there is no nothing bad about this it's just giving people uh a result and it's bipartisan you know the most conservative and the most liberal people everyone just wants to know their status you know nobody wants to have to wait in line for four hours to find out their status on monday uh a week later on saturday you know it just doesn't make any sense it's a useless test at that point and everyone recognizes that so why why do you think like the mayor of la why do you think politicians are going for these um from my perspective like kind of half-assed lockdowns which is not so i have seen good evidence that like a complete lockdown can work but that's in in theory it's like communism in theory can work like theoretically speaking but it just doesn't at least in this country we don't i think it's just impossible to have complete lockdown and still politicians are going for these kind of lockdowns that everybody hates that's really destroy really hurting small businesses um like why are they going big businesses and yeah all businesses uh but like basically not just hurting yeah they're destroying small businesses right uh which is going to have potentially i mean long-lasting yeah i've been reading as i don't shut up about the the rise and fall of the third reich and you know there there's economic effects uh that uh take a decade to you know there's going to be long lasting effects that may uh may be destructive to the very fabric of this nation so why are they doing it and why are they not using the solution is there is there any intuition i mean you've said that fda has a stranglehold i guess on this whole public health problem is that is that all it is that's honestly it's pretty much all it is um the companies so the somebody like mayor garcetti or governor baker cuomo newsom any of the uh dewine i i've talked to you know i've talked to a lot of governors in this country at this point uh and and of course the federal government including including the president's own teams you know and and uh and the heads of the nih the heads of the cdc about this the problem is the tests don't exist in this country at the level that we need them to right now to make that kind of policy to make that kind of program they could but they don't and so what that means is that when mayor garcetti says okay what are my actual options today despite these sounding like a great idea he looks around and he says well they're not authorized you know they don't exist right now for at-home use and from his perspective he's not about to pick that fight with the fda and it turns out nobody is why why are people afraid of it seems like a easy structure to fight it's like well it's not a so they don't see it as a fight they think that the fda is the end-all be-all everyone thinks the fda is the end-all be-all and and so they just def everyone is deferential including the heads of all the other government agencies because that is their role but what everyone is failing to see is that the fda doesn't even have a mandate or a remit to evaluate these tests as public health tools so they're just falling in this weird gray zone where the fda is saying look we evaluate medical products that's the only thing that i meant like tim stenzel head of in vitro diagnostics at the fda he's doing what he's what his job is which is to evaluate public uh which is to evaluate medical tools unfortunately um this is where i think the cdc has really blundered they haven't made the right distinction to say look okay the fda is evaluating these for doctors to use and all that uh but you know we're the cdc and we're the public health agency of this country and we recognize that these tools uh require a different authorization pathway and a different use this is a difference to medical devices and public health and i guess fda is not designed for this public health especially in emergency situations and they they they actually explicitly say that i mean when i go and talk to tim you know he's a very reasonable guy but when i talk to him he says look we don't we just do not uh evaluate a public health tool if you're telling me this is a public health tool great go and use it and uh and so i say okay great we'll go and use it and then uh the comment is but you know does it give a result back to somebody i say well yes of course it gives a result back to somebody it's being done in their home so well then it's defined as a medical tool can't use it so it's stuck in this gray zone where we unfortunately there's this weird definition that any tool any any test that gives a result back to an individual is defined by cms centers for medica medicaid services as a medical device requiring medical authorization but then you go and ask it gets crazier because then you go and ask seema verma the head of cms you know okay can these be authorized as uh as public health tools and not fall under your definition of a medical device so then the fda doesn't have to be the ones authorizing it as a public health tool and sema verma says oh well we don't we don't have any jurisdiction over over uh point of care and uh and sort of rapid devices like this we only have jurisdiction over lab devices so it's like nobody has ownership over it which means that they just keep they stay in this purgatory of of not being approved and so this is where i think frankly it needs a president it needs a presidential order to just unlock them to say this is more important than you know having a prescription and in fact i mean really what's happening now because there is this sense that tests are public health tools even if they're not being defined as such the fda now is pretty much not only are they not authorizing these as public health tools what they're doing by by authorizing what are effectively public health tools as medical devices they're just diluting down the practice of medicine right i mean his answer right now unfortunately is well i don't know why you you want these to be sort of available to everyone without a prescription we've already said that a doctor can write a whole prescription for a for a whole college campus it's like well if you're going in that direction then that's no longer medicine having a doctor write a prescription for a college campus for everyone on the campus to have repeat testing now now we're just in the territory of of eroding medicine and eroding all of the legal rules and reasons that we have prescriptions in the first place so it's just everything about it is just destructive instead of just making a simple solute solution which is these are okay as public health tools as long as they meet x and y metrics go and cdc can put their stamp of approval on them what do you think uh sorry if i'm stuck on this yeah your mention of mit and uh public health engineering right i mean it has a sense of i talked to computational biology folks it's always exciting to see computer scientists start entering the space of biology and there's actually a lot of exciting things that happen because of that trying to understand the fundamentals of biology so from the engineering approach to public health what kind of problems do you think can be tackled what kind of disciplines are involved like do you have ideas on this uh in this space oh yeah i mean i can speak to to one of the major activities that i want to do so what i normally do in my research lab is develop technologies that uh can take a drop of somebody's blood or some saliva and profile for hundreds of thousands of different antibodies against every single pathogen that somebody could be possibly exposed to so this is all new technology that we've been developing more from a from a bioengineering perspective but then i use a lot of the mathematics uh tools to a interpret that but what i really want to do for example to kind of kick off this new field of what i consider public health engineering is to create maybe it's a little ambitious but create a a weather system for viruses i want us to be able to open up our iphones plug in our zip code and get a better sense get a probability of why my kid has a runny nose today is it coved is it a rhinovirus an adenovirus or is it flu and you know we can do that we can start building the rules of virus spread across the globe both for pandemic preparedness but also for just everyday use in the same way that people used to think that predicting the weather was going to be impossible of course we know that's not impossible now is it always perfect no but does it offer does it you know completely change the way that we go about our days absolutely you know i i envision for example right now we open up our iphone we plug in a zip code and if it tells us it's going to rain today we bring an umbrella so you know in the future it tells us hey you know there's a lot of stars cove too in your community instead of grabbing your umbrella you grab your mask you know we don't have to have masks all the time but if we know the rules of the game that these viruses play by we can start preparing for those and you know every year we go into every flu season blindfolded with our hands tied behind our back just saying i hope this isn't a bad flu season this year why don't i mean this is you know we're in the 21st century you know it's becoming you know i mean we have the tools at our disposal now to not have that attitude this isn't like 1920s you know we can we we can just say hey this is going to be a bad flu season this year let's act accordingly and with a targeted approach you know we don't uh for example we don't just use our umbrellas all day long every single day in case it might rain we don't board up our homes every single day in cases of hurricane we wait and if we know that there's one coming then we act for a a small period of time accordingly and then we go back and we've prepared ourselves in like these little bursts to not have it uh ruin our days i can't tell you how exciting that vision of the future is uh i think that's incredible and it seems like it should be within our reach the just these like weather maps of viruses floating about the earth and and it seems obvious it's one of those things where right now it seems like maybe impossible and then looking back like 20 years from now will wonder like why the hell this hasn't been done away earlier though one difference between weather maybe i don't know if you have interesting ideas in this space the difference between weather and viruses is it includes the collection of the data includes the human body potentially and that means that there is some as with the contact tracing question there's some concern about privacy yeah there seems to be this dance that's really complicated um you know with facebook getting a lot of flack for basically misusing people's data or you know just whether it's perception or reality there's certainly a lot of reality to it too where they're not good stewards of our private data so there's this weird place where it's like obvious that if we do if we collect a lot of data about human beings and maintain privacy and maintain all like basic respect for that data just like honestly common sense respect for the data that we can do a lot of amazing things for the world like a weather map for viruses is there a way forward to gain trust of people um or to do this to do this well do you have ideas here how big is this problem i think it's it's a central problem there's a couple central problems that need to be solved one how do you get all the samples that's not actually too difficult i'm actually i have a pilot project going right now with uh getting samples from across all the united states uh tens of thousands of samples every week are flowing into my lab and we process them so it's taking the so it's taking like one of the basically uh the this biology here in chemistry and converting that into numbers that's exactly right so what we're doing for example there's a lot of people who go to the hospital every day a lot of people who donate blood uh people who donate plasma so one of the projects that i have i'll get to the privacy question in a moment but this so what i want to do is the the name that i've given this is global a global immunological observatory you know there's no reason not to have that good name i've said you know instead of saying well how do we possibly get enough people on board to send in samples all the time well just go to the source you know so there's a company in massachusetts that makes 80 percent of all the instruments that are used globally to to collect plasma from plasma donors so i went to this company heminetics and said you know is there a way you have 80 percent of the global market on plasma donations uh can we start getting plasma samples from healthy people that use your machines so that hooked me up with this company called octopharma an octaform has a huge reach and saddle and offices all over the country where they're just collecting people's plasma they actually pay people for their plasma and then that gets distributed to hospitals and all this stuff is anonymous plasma so i've just been collecting anonymous samples um and we're processing them in this case for covid antibodies to watch from january up through december we're able to uh watch how the virus uh entered into the united states and how it how it's transmitting every day you know across the u.s uh so we're we're getting those results uh organized now and we're gonna start start putting them publicly on online soon to start making at least a very rough map of covid but that's the type of thinking that i have in terms of like how do you actually capture huge numbers of specimens you can't ask everyone to participate on sort of a i mean you may maybe could if you have the right tools and you can offer individuals something in return like 23andme does you know that's a great way to get people to give specimens and they get results back so with these technologies that i've been building along with some collaborators at harvard we can come up with tools that people might actually want so i can offer you your immunological history i can say give me a drop of your blood on a filter paper mail it in and i will be able to tell you every infectious disease you've ever encountered and maybe even when you encountered it roughly i could tell you do you have covet antibodies right now do you have lyme disease antibodies right now flu tripoli and all these different viruses also peanut allergies you know milk allergies anything you know if it if your immune system makes a response to it we can detect that response so all of a sudden we have this very valuable technology that on the one hand gives people maybe information they might want to know about themselves but on the other hand becomes this amazingly rich source of big data you know to enter into this global immunological observatory sort of mathematical framework to start building these maps these epidemiological tools but you asked about privacy and absolutely that's essential to keep in mind uh first and foremost so privacy can be uh you can keep these samples 100 anonymous uh they are just when i get them they show up with nothing they're literally just tubes i know a date that they were collected and a zip code that they're collected from or or or even just sort of a county level uh id uh with an irb and with ethical approval and with the people's consent we could maybe collect more data but that would require consent but then there's this other approach which i'm really excited about which is certainly going to gain some scrutiny i think but we'll have to figure out where where it comes into play but i've been recognizing that we can take somebody's immunological profile and we can make a biological fingerprint out of it and it's actually stable enough so that i could take your blood let's say i don't know who you are but um you sent me a drop of blood a year ago and then you send me a drop of blood today i don't know that those two blood spots are coming from the same person they're just showing up in my lab uh but i can run the our technology over the and it just gives me your immunological history but your immunological history is so unique to you and the way that your body responds to these pathogens is so unique to you that i can use that to tether your two samples i don't know who you are i know nothing about you i only know when those samples were came out of a person but i can say oh these two samples a year apart actually belong to the same person yeah so there's sufficient information that immunological history to to match the samples that's well for from a privacy perspective that's really exciting does that generally hold for humans so you're saying there's enough uniqueness yep to match yeah because it's very stochastic even twins so this i believe you know we haven't published this yet we will soon you have a twin too right i do have a twin i have an identical twin brother which makes me interested in this uh he looks very much like me that works [Laughter] and you know dna can't really tell us apart but this tool is one of the only tools in the world that can tell twins apart from each other could still be accurate enough to say this blood you know it's like 99.999 percent uh uh accurate to to to say that these two blood samples came from the same individual and it's because it's a combination both of your immunological history but also how your unique body uh responds to a pathogen which is random uh the way that we make antibodies is is uh by and large it's got an element of randomness to it how the cells when they make an antibody they chop up the genetic code to say okay this is the antibody that i'm going to form for this pathogen and you might form if you get a coronavirus for example you might form hundreds of different antibodies not just one antibody against the spike protein but hundreds of different antibodies against all different parts of the virus so that gives this really rich resolution of information that when i then do the same thing across hundreds of different pathogens some of which you've seen some of which you haven't um it gives you an exceedingly unique fingerprint that uh that is sufficiently stable over years and years and years to essentially give you a barcode you know and and i don't have to know who you are but i can know that these two specimens came from the same person somewhere out in the world that's so fascinating that there's this trace your life story in the space of viruses in the space of uh pathogen like like these or you know because there's this entire universe of these organisms that are trying to destroy each other and then your little trajectory through that space leaves a trace yep and then you can look at that trace that's fascinating and that i mean there's okay that data period is just fascinating and the vision of making that data universally connected to where you can make like infer things and uh and just like with the weather is really fascinating there's probably artificial intelligence applications there start making predictions start finding patterns exactly we're doing a lot of that already and and that's how had we had this going you know i've been trying to get this funded for years now and i've spoken to governments you know everyone says cool idea not going to do it you know why do we need it and of course now you know i mean i wrote in 2015 about this um why we would why this would be useful and of course now we're seeing why it would be useful had we had this up and running uh in 2019 had we had it going we were drawing blood from you know or getting blood samples from hospitals and clinics and blood donors from new york city let's just say you know that could have we didn't run the first pcr test for coronavirus until probably a month and a half or two months after the virus started transmitting in new york city so it's like with the rain we didn't start wearing umbrella or taking out umbrellas exactly for two months getting wet but different than the rain we couldn't actually see that it was spreading right now and so andrew cuomo had no choice but to leave the city open you know there were hints that maybe the virus was spreading in new york city but you know he didn't have any data to back it up no data and so it was just week on week and week and he didn't have any information to really go by to allow him to have the firepower to say we're closing down the city this is an emergency we have to stop spread before it starts uh and so they waited until the first pcr tests were coming about and then the moment they started running a pcr test they find out it's everywhere you know and so that was a disaster because of course new york city you know it was just hit so bad because nobody was you know we were blind to it we didn't have to be blind to it the nice thing about this technology is we wouldn't have with the exact same technology we had in 2017 we could have detected this novel coronavirus spreading in new york city in 2020 not because we changed not because we are actually actively looking for this novel coronavirus but because we would see we would have seen patterns in people's immune responses using ai or just frankly using our just the raw data itself we could have said hey it looks like there's something that looks like known coronavirus is spreading in new york but there's gaps you know there's for some reason people aren't developing an immune response to this coronavirus that seems to be spreading to these normal things that you know and it just looks the profile looks different and we could have seen that and immediately especially since we had an idea that there was a novel coronavirus circulating in the world we could have very quickly and easily seen hey clearly we're seeing a spike of something that looks like a known coronavirus but people are responding weirdly to it our ai algorithms would have picked it up and just our basic heck you could put you could have put it in an excel spreadsheet we would have seen it yeah so some basic visualization would have shown exactly we would have seen spikes and they would have been kind of like off you know immune responses that the shape of them just looked a little bit different but they would have been growing and we would have seen it and it could have saved tens of thousands of lives in new york city so to me the fascinating question everything we've talked about so both the huge collection of data at scale just super exciting and then the kind of obvious at scale solution to the current virus and future ones is the rapid testing can we talk about the future of viruses that might be threatening the uh our very existence sure so do you think like a future natural virus can um have an order of magnitude greater effect on human civilization than anything we've ever seen so something that either kills all humans or kills i don't know 60 70 percent of humans so some like something something um we can't even imagine is that is that something that you think is possible because it seems to have not have happened yet so maybe like the entirety whoever whoever the programmer is of the simulation that sort of launched the evolution for the big bang seems to not want to destroy us humans or maybe that's the natural side effect of the evolutionary process that uh humans are useful but do you think it's possible that the evolutionary process will produce a virus that will kill all humans i think it could i don't think it's likely and the reason i don't think it's likely is um well on the one hand it hasn't happened yet uh in part because mobility is is uh is a recent phenomena people weren't particularly mobile uh until uh fairly recently uh now of course now that we have people flying back and forth across the globe all the time the chances of global pandemics has escalated exponentially of course and so on the one hand that's part of why it hasn't happened yet we can look at things like ebola you know ebola we don't we haven't generally had major uh ebola epidemics in the past not because ebola wasn't transmitting and infecting humans but because they were it was largely affecting and infecting humans in disconnected communities so you see out in uh in rural parts of africa for example uh in western africa you might end up having isolated ebola outbreaks but there weren't connections that were fast enough that would allow people to then spread it into the cities of course we saw back in 2014-15 a massive ebola outbreak that wasn't because it was a new strain of ebola but it was because there's uh new inroads and connections between the communities and people got it to the city and so we saw it start to spread so that should be a little bit for you know foreshadowing of what's to come and now we have this pandemic we had 2009 we have this uh there is a benefit um or there is sort of a natural check and this is a kind of latka voltaire predator prey dynamic kind of systems ecological systems and mathematics that uh if you have something that's so deadly people will respond uh more maybe with a greater panic a greater sense of panic which alone could you know destroy humanity but at the same time like we now know that we can lock down we know that that's possible and so if this was a worse virus that was actually killing 60 of people as infecting we would lock down very quickly my biggest fear though is let's say that was happening you need serious lockdowns if you're going to keep things going so the only reason we were able to keep things going during our lockdowns is because it wasn't so bad that we were still able to have people work in the in the in the grocery stores still people working the shipping to get the food onto the shelves so on the one hand we could probably figure how to stop the virus but can we stop the virus without starving you know and i'm not sure that that if this was uh another acute respiratory virus that say had a slightly say it transmitted the same way but say it actually did worst damage to your heart but it was like a month later that people start having heart attacks uh in mass you know it's like not not just one-offs but but really severe well that could be a serious problem for humanity um so so in some ways i think that there are lots of ways that we could end up dying at the hand of a virus i mean we're already seeing it just i mean my fear is still i think coronaviruses have demonstrated a keen ability to destroy uh or to to create outbreaks that can potentially be deadly to large numbers of people flu strains though are still by and large my concern so you think the bad one might come from the the flu the influenza yeah they the the replication cycle they're able to genetically recombine in a way that coronal viruses aren't they have segmented genomes which means that they can just swap out whole parts of their genomes no problem repackage them and and then boom you have a whole antigenic shift not a drift what that means is that any on any occasion any day of the year you can have boom a new whole new virus that didn't exist yesterday and now with uh farming and and industrial livestock uh we're seeing animals and humans come into contact much more just the the uh the opportunities for an influenza strain that is unique and deadly to humans uh increases all the while tren transmission and mobility has increased it's just a matter of time in my opinion what about from immunology perspective of the idea of engineering a virus so not just the virus leaking from a lab or something but actually being able to understand the protein like the everything about what makes a virus enough to be able to figure out ways to uh um maybe targeted or untargeted attack by a first community yeah yeah is there is that something uh obviously that's somewhere on the list of concerns but is that anywhere close uh of the like the top 10 highlights along with nuclear weapons and so on that we should be worried about or is the natural pandemic the really the one that's much greater concern i would say that the former that man-made viruses and genetically engineered viruses should be right up there with the greatest concerns for humanity right now uh you know we know that the tools for better or worse the tools for creating a virus are there you know yeah we can do it um i mean heck you know the human the human species is no longer vaccinated against smallpox i didn't get a smallpox vaccine you didn't get a smallpox vaccine at least i don't think and uh you know so if somebody wanted to make smallpox and and uh distribute it to the world in some way uh it could be exceedingly deadly and uh and and detrimental to humans and that's not even um that's not even sort of using your imagination to create a new virus that's one that we already have unlike the past when smallpox would circulate you had large fractions of the community that was already immune to it and so it wouldn't spread or it would spread a little bit slower but now we have essentially in a few years we'll have a whole global population that is susceptible let's look at measles we have an entire i mean measles um i have uh you know there are some researchers in the world right now which for various reasons are working on creating a measles strain that evades immunity it's not for bioterrorism at least that's not the expectation it's for using measles as an oncolytic virus to kill cancer and the only way you can really do that is if your immune system doesn't you know if you if you take a measles virus and there's you know we don't have to go into the details of why it would work but it could work measles likes to target um potentially cancer cells but to get your immune system not to kill off the virus if you're trying to use the virus to target it you maybe want to make it blind to the immune system but now imagine we took some virus like measles which has an r out of 18 transmits extremely quickly and now we have essentially let's say we had a whole human race that is susceptible to measles and this is a virus that spreads orders of magnitude easier than this current virus uh imagine if you were to plug something toxic or detrimental into that virus and release it to the world so it's possible to be both accidental and intentional absolutely yeah an accident so mark lipstick is a good colleague of mine at harvard uh we're both in the he's the director of the center for communicable disease dynamics where i'm a faculty member um he's spoken very very forcefully and and uh and he's very outspoken about the dangers of gain of function testing where in the lab we are intentionally creating viruses that are exceedingly deadly uh under the auspices of trying to learn about them so that if the idea is that if we kind of accelerate evolution and make these really deadly viruses in the lab we can be prepared for if that virus ever comes about naturally or through unnatural means the concern though is okay that that's one thing but what if that virus got out on somebody's shoe just what if you know if the if the uh dead if the effects of an accident are potential potentially catastrophic is it worth taking the chances just to be prepared a little bit for something that may or may not ever actually develop and so uh it's a serious ethical quandary we're in how to both be prepared but also not uh cause a catastrophic mistake as a small tangent there's a recent really exciting breakthrough of alpha 2 of alpha fold 2 solving protein folding or achieving state-of-the-art performance on protein folding and then i thought proteins have a lot to do with viruses it seems like being able to use machine learning to design proteins that achieve certain kinds of functions will naturally allow you to use maybe down the line not yet but allow you to use machine learning to design basically viruses maybe like measles like for good which is like to attack cancer cells but also for bad is that is that uh is that a is that a crazy thought or is this a natural place where this technology may go i suppose as all technologies can which is for good and for bad do you think about the role of machine learning in this oh yeah absolutely i mean alpha fold uh is amazing you know it's an amazing algorithm a series of algorithms and it does demonstrate to me it demonstrates just just how powerful you know everything in the world has rules we just don't know the rules you know we often don't know them but you know our brain has rules how it works everything is plus and minus there's nothing in the world that's really not at its most basic level positive negative you know it's all obviously it's all just charge and and that means everything you can figure it out with enough computational power and enough in this case i mean machine learning and ai is just one way to learn rules uh it's an empirical way to learn rules and it's but it's a profoundly powerful way and certainly now now that we are getting to a point where we can take a protein and know how it folds uh given its sequence we can reverse engineer then we can say okay we want a protein to fold this way what does the sequence need to be we haven't done that yet so much but it's just the next iteration of all of this so let's say somebody wants to develop a virus it's going to start with somebody wanting to develop a virus to to defeat cancer something good you know and so it would start with a lot of money from the federal government you know for all the positives that will come out of it but we have to be really careful because that will come about there's no doubt in my mind that we will develop we're already doing it we engineer molecules all the time for specific uses oftentimes we take them from nature and then tweak them but now we can supercharge it we can accelerate that the pace of discovery to not have it just be discovery we have it be true ground-up engineering let's say you're trying to make a new molecule to stabilize somebody with some retinal disease right so we come up with some molecule that can improve the stability of somebody with retinal degeneration uh you know just a small tweak to that to say make a virus that causes the human race to become blind you know i mean it sounds really conspiracy theoryish but uh but it's not you know it's we're learning so much about biology and there's always nefarious reasons i mean heck look at how ai and you know just google searches those can be um you know they are every single day being leveraged by nefarious actors to take advantage of people to steal money to do whatever it might be eventually probably to create wars or already to create wars and i mean i don't think there's any question at this point behind disinformation campaigns and so it's being leveraged this thing that could be wholly good you know it's always going to be leveraged for bad and so how do you balance that as a species i'm not quite sure well the hope is as you mentioned previously that there's some that we're able to also develop defense mechanisms and there's something about the human species that seems to keep coming up with like ways to just just like on the deadline just at the last moment of figuring out how to avoid destruction i think i'm like eternally optimistic about the human race not destroying ourselves but you could do a lot of things that would be very painful yes well we're doing it already you know just i mean we are seeing how our regulation today right we did this thing it started as a good thing regulation of medical products but now it is uh you know unwillingly and unintentionally harming us our regulatory landscape which was developed wholly for good in our country is getting in the way of us deploying a tool that could stop uh our economies from having to be sort of sputteringly closed that could stop deaths from happening at the rate that they are and it's um you know i think we will come to a solution of course now we're going to get the vaccine and it's going to make people lose track of like why we even bother testing which is a bad idea but um but we're already seeing that we have this amazing capacity to um to both do damage when we don't intend to do damage uh and and then also to pull up when we need to pull up and you know stop complete catastrophe and so uh it's we are an interesting species in that way that's for sure so there's a lot of young folks undergrads grads uh they're also young uh listen to this so is there you've talked about a lot of fascinating stuff that's like there's ways that things are done and there's actual solutions and they're not always like intersecting do you have advice for undergraduate students or graduate students or even people in high school now about a life about career of how they might be able to solve real big problems in the world how they should live their life in order to have a chance to solve big problems in the world it's hard i i struggle a little bit sometimes to give advice because the advice that i give from my own personal experience is necessarily distinct from the advice that would make other people successful i have um unending ambitions to make things better i suppose and i don't see i don't see barricades where other people sometimes see barricades um now even just little things like uh when this virus started i'm a medical director at brigham a women's hospital and so i oversee or helped to oversee molecular virology diagnostics so when this virus started wearing my epidemiology hat and wearing my sort of viral outbreak hat i recognized that this was going to be a big virus that was important at a global level even if the cdc and who weren't ready to admit that it was a pandemic it was obvious in january that it was a pandemic so i started trying to get a test built at the brigham which is one of harvard's teaching hospitals i you know the the first uh encounters i had with the upper administration of the hospital were pretty much no why would we do that that's silly who are you you know and i said well okay don't believe me sure um but i kept pushing on it uh and then uh eventually i got them to agree it was really um only a couple of weeks before the biogen conference happened we started building the test i think they started looking abroad and saying okay this is happening sure like maybe he was right but then i went a step further and i said um we're not going to have enough tests at the hospital and so uh so my ambition was to get a better testing program started and um and so i figured what better place to scale up testing than the broad institute broad institutes is amazing you know very high throughput high efficiency research institute that does a lot of genomic sequencing things like that so i went to the broad and i said hey you know there's this coronavirus that's obviously going to impact our society greatly can we start modifying your high efficiency instruments and robots for coronavirus testing everyone in my in my uh orbit in the hospital world just said that's ridiculous you know how could you possibly plan to do that it's impossible you know and and to me it was like the most dead simple thing to do right it didn't it but the the higher ups and the people who think about you know the i think one of the most important things is to recognize that most people in the world don't see solutions they just see problems and it's because it's an easy thing to do thinking of problems and how things will go wrong is really easy because you're not coming up with a brand new solution and this to me was just a super simple solution hey let's get the broad to help build tests every single hospital director you know told me no like it's impossible my own superiors the ones i report to in the hospital said you know mike you know you're a new faculty member your ideas you know probably will would be right but you're too naive and young to to know that it's impossible right you know obviously now the broad is the highest uh throughput laboratory in the country and yes you know and so i think my recommendation to people is as much as possible get out of the mode of thinking about things as problems sometimes you piss people off i could probably use a better filter sometimes to try to like be not so upfront with certain things but but it's just so crucial to always just see to just bring like think think about things in new ways that that other people haven't because usually there's something else out there and and one of the things that has been most beneficial to me which is that my my education was really broad it was engineering and physics and uh well and then i became a buddhist monk for a while and so that gave me a different perspective but then it was medicine and immunology and and now i've brought all of it together from a mathematics and biology and medicine perspective and policy and public health and i think that you know i'm not the best in any one of these things i i recognize that there are going to be geniuses out there who are just worlds better than me at any one of these things that i try to work on but my superpower is bringing them all together you know and just thinking and that's i think how you can really change the world um you know i don't know that i'll ever change the world in the way that i hope um but that's how you can have a chance yeah that's how you can have a chance exactly and um and i think it's also what uh you know this to me this rapid testing program like this is the most dead simple solution in the world and this literally could change the world it could change the world it could change and it is you know there's countries that are doing it now the us isn't but i've been advising many countries on it and and i would say that you know some of the early papers that we put out earlier on a lot of the things actually are changing you don't always unless you really look hard you don't know where you're actually having an effect um sometimes it's more overt than than other times in april i published a paper that was saying hey with the pcr values from these tests we need to really focus on the ct values the actual quantitative values of these lab-based pcr tests at the time that all the physicians and laboratory directors told me that was stupid you know why would you do that they're not accurate enough and and of course now it's headline news that you know florida they just mandated reporting out the ct values of these tests because there's a real utility of them you can understand public health from it you can understand better clinical management uh you know that was a simple solution to a pretty difficult problem uh and it is changing the way that we approach all of the lab testing in this country is starting to it's taken a few months but it's starting to change because of that and you know that was just me saying hey this is something we should be focusing on got some other people involved and other people and and now people recognize hey there's actual value in this number that comes out of these lab-based pcr tests so sometimes it does grow fairly quickly um but i think the real answer if my only my only answer i don't know what you know i recognize that everyone some people are going to be really focused on and have one small but deep skill set i go the opposite direction i try to bring bring things together and um but the biggest thing i think is just don't see problem don't don't see barriers like just see like there's always a solution to a barrier if there's a barrier that literally means a solution to it that's why it's called a barrier and just like you said most people will just present to you only be thinking about it and present to you with barriers and so it's easy to start thinking that's all there is in this world yeah and just think big i mean god you know there's nothing wrong with thinking big elon musk thought big and you know and then thinking big builds on itself you know you you get a billion dollars from one big idea and then that allows you to make three new big ideas and there's a hunger for it if you think big and you communicate that vision with the world all the most brilliant and like passionate people will just like you'll attract them and they'll come to you and then it makes your life actually really exciting the people i've met at like tesla and uh neurolink i mean there's just like this fire in their eyes they just love life and uh it's amazing i think to to be around those people i have to ask you about what was the philosophy the journey that took you to becoming a buddhist monk and what uh what were what did you learn about life what did you take away from that experience how did you return back to harvard and the world that's unlike that experience i imagine yeah well i was at dartmouth at the time um uh well i went to sri lanka i was already pretty interested in developing countries and sort of under-resourced areas and uh i was doing a lot of engineering work and i went there but i was also starting to think maybe health was something of interest and so i went to sri lanka because i had a long interest in buddhism as well just kind of interested in it as a thing which aspect of the philosophy attracted you i would say that the thing that interested me most was um was really this idea of kind of a butterfly effect of like uh you know what you do now has ripple effects that extend out beyond what you can possibly imagine both in your own life and in other people's lives and in some ways buddhism has none in some ways in a pretty deep way buddhism has that as part of its underlying uh philosophy in terms of rebirth and sort of that your actions today propagate uh to others but also propagate to to sort of uh what might happen in in your circle of what's called samsara and rebirth and um i don't i don't know that i subscribe fully to this idea that uh we are reborn uh which always was a little bit of a of a debate internally i suppose when i was a monk um but it but it has always been it was that and then it was also meditation um at the time i was a fairly elite rower i was you know rowing at the national level and um and rowing to me was very meditative it was um you know just there's even if you're on a boat with other people it's i mean on the one hand it's like the extreme of like a team sport but it's also the extreme sort of focus and concentration that requires um that's required of it and so i was always really into just meditative type of things i was doing a lot of pottery too which was also very meditative and and so buddhism just kind of really really there are a lot of things about meditating that just appealed and so i moved to sri lanka planning to only be there for a couple of months but then i was shadowing in this medical clinic and there was this physician who was just really i mean it's just kind of a horrible situation um frankly this guy was trained decades earlier he was an older physician and he was still just practicing like these fairly barbaric approaches to medicine because he had he was a rural town and he just didn't have a lot of um he didn't have any updated training frankly and so you know i just remember this like girl came in with like shrapnel in her hand and his solution was to like air it out and so he was like without even numbing her hand he was uh uh like cutting it open more with this idea that like the more oxygen and and stuff you know and it just i think there was something about all of this and i was already talking to these monks at the time each i would be in this clinic in the morning and i'd go and uh my idea was to teach english to these monks in the evening uh turned out i'm a really bad english teacher so they just taught they they allowed me just to sit with them and and meditate and they were teaching me more about buddhism than i could have possibly taught them about english or being an american or something um and uh and and so i just slowly i just couldn't take i like couldn't handle being in that clinic so more and more i just started moving to you know spending more and more time at this monastery and then after about two months i was supposed to come back to the states and i decided i didn't want to so i moved to this monastery in the mountains um primarily because i didn't have the money to like just keep living so living in a monastery is free yeah and so i moved there and just started meditating more and more and then months went by and and i it just really gravitated i i gravitated to the whole to the whole notion of it i mean it became it sounds strange but you know meditating almost just like anything that you've put your mind to became exciting you know it became like there weren't enough hours in the day to meditate and i would do it for you know 18 hours a day 15 hours a day uh just sit there and you and like i mean i hate sleeping anyway um but i wouldn't want to go to sleep because i felt like i didn't accomplish what i needed to accomplish in meditation that day which is so strange because there is no end you know but it was always but there are these uh there are these steps that happen during meditation that are very prescribed in a way buddha talked about them you know and these are ancient writings which exist i mean the writings are real they're thousands of years old now and um you know so whether it was buddha writing them or whoever you know there are lots of different people have contributed to the to these writings over the years and um but they're very prescribed and they um they tell you what you're going to go through and i didn't really focus too much on them uh i read a little bit about them but your mind really does when you actually start meditating at that level like not an hour here and there but like truly just spending your days meditating it becomes kind of like this other world where it becomes exciting and uh and you're actively working you're actively meditating not just kind of trying to quiet things that's sort of just the first stage of trying to get your mind to focus most people never get past that first stage especially in our culture could you briefly summarize what's waiting beyond the stage of just quieting the mind is yeah it's hard for me to imagine that there's something that can be described as exciting on there yeah it's it's an interesting question so i would say um so the first thing the first step is truly just to like be able to close your eyes focus on your breath and not have other thoughts enter into your mind that alone is just so hard to do like i couldn't do it now if i wanted um but i could then and um but once you get past that stage you start entering into like all these other you go through kind of i went through this like pretty trippy stage which is a little bit euphoric um where you just kind of start not hallucinating i mean it wasn't like some crazy thing that would happen in a movie where but definitely just weird you start getting to the stage where um uh you you're able to quiet your mind for so long for hours at a time that um like for me i started uh getting really excited about this idea of mindfulness which is part of um it's part of buddhism in general but it's part of tehran and buddhism in particular for this in this way which was um uh you take uh you start focusing on your daily activities whether that's sipping a cup of tea or walking or you know sweeping around uh i lived in on this mountainside and this cottage thing is built into the rock and um you know so every morning i would wake up early and sweep around it and stuff because that's just what we did um and you start to you meditate on all those activities and one of the things that was so exciting which sounds completely ridiculous now was just um almost learning about your daily activities in ways that you never would have thought about before so what is entire what what's what's involved with like picking up this glass of water you know if i said okay i'm just going to pick i'm going to take a drink of water to me right now it's a single activity right you just but um during a during meditation it's not a single activity it's a whole series of activities of like little engineering feats um and feelings and it's it's gripping the water and it's feeling that the glass is cold and it's lifting and it's moving and dragging and dragging and and you start to learn a whole new language of life and that to me was like this really exhilarating thing that um it was an exhilarating component of meditation that there was never enough time it's kind of like learning a new computer language like it gets really exciting when you start coding and all these new things you can do you you learn how to much to experience life in a much richer way and so you never run out of ways to go deeper and deeper and deeper in the way you experience even just the the drinking of the glass of water that's that's exactly right and what becomes kind of exhilarating is um you start to be able to predict things that you never or i don't even know if prediction's right word but i always think of the matrix you know or where um i forget who it was somebody was shooting at neo and he like leans backwards and he dodges the bullets um you know in some ways when you start breaking every little action that your hands do or that your feet do or your body does down into all these little actions that make up one what we normally think of as an action all of a sudden you can start to see things almost in slow motion i like to think of it very much like a language the first time somebody hears a foreign language uh it sounds really fast usually you don't hear the spaces between words and um and it just sounds like just like a stream of consciousness it just sounds like a stream of noises if you've never heard the language before and as you learn the language you hear clear breaks between words and it starts to gain context and and all of a sudden like that what once sounded very fast slows down and it has meaning that's our whole life there's this whole language happening that we don't speak generally but if you start to speak it and if you start to learn it and you start to say hey i'm picking up this glass is actually 18 little movements then all of a sudden like it becomes extremely exciting and exhilarating to just just breathe you know breathing alone in the rise and fall of your abdomen or the way the air pushes in and out of your nose becomes almost interesting and what's really neat is is the world just starts slowing down and um i'll never forget that feeling and it's the if there was one euphoric feeling from meditation i want to gain back but i don't think i could without really meditating like that again and i don't think i will um was this like slow motion of the world it was finding the spaces between all the movements the same way that the spaces between all the words happen and then it almost gives you this new appreciation for everything you know it's like it was really amazing and so i think um uh it came to an abrupt end though when the tsunami hit i was there in the indian ocean tsunami hit in 2004 and it was like this dichotomy of being a monk and and you know just meditating in this extraordinary place um and then the tsunami hits and kills 40 000 people in a few minutes on the coast of this really small little country in sri lanka and um you know then i i it like my whole world of being a monk came crashing down uh when i go to the coast and i i mean that was just a devastating visual sight an emotional sight but the strangest thing happened which was that everyone just wanted me to stay as a monk you know people in that culture they wanted to the monks largely fled from the coastlines of those you know and um and so then there i was and people wanted me to be a monk they wanted me to stay on the coast but be a monk and not help like not help in the in the way that i considered helping uh they wanted me just to keep meditating so they could bring me donna like like offerings and get and have their sort of karmic responsibilities um uh attended to as well and so uh that was really bizarre to me it was like how could i possibly just sit around while all these people half of everyone's family just died and so in any case i stopped being a monk and i moved to this refugee camp and lived there for another six months or so and just stayed there not as a monk but tried to raise some money from the us and tried to like i didn't know what i was doing frankly i was 22 and uh and i don't think i appreciated at the time how much of a role i was having in the in that community's life but but it's taken me a long many years to process all of this since then but uh i would say it's what put me into the public health world see living in that refugee camp and that difference that happened you know from being a monk to being in this devastating environment just really changed my whole view of what sort of why i was existing i suppose well so there's this richness of life in a in a single drink of water that you experience and then there's this power of nature that's it capable to take lives of thousands of people so given all that the absurdity of that let me ask you and the fact that you study things that could kill the entirety of human civilization what do you think is the meaning of this all what do you think is the meaning of life this whole orchestra we got going on does it have a meaning and maybe from another perspective as how does one live a meaningful life if such is possible well you know from what i've seen uh i don't think there's a single answer to that by any stretch one of the most interesting things about buddhism to me is that the human existence is part of suffering which is very different from judeo-christian existence which is that human existence is something to be is a very different you know it's something to it's a there's a richness to it in buddhism it's just another one of your lives and it but it's your opportunity to attain nirvana and uh become a monk for example and meditate to attain nirvana uh else you kind of just go back into this i'm sorry the cycle of of suffering and so you know when i look at i mean in some ways the notion of life and what the purpose of life is you know they're kind of completely distinct this sort of western view of life which is that this life is the most precious thing in the world versus this is just another opportunity to try to get out of life i mean the whole notion of nirvana and in buddhism it getting out of this sort of cycle of suffering is to vanish you know what if you could if you could attain nirvana you know throughout this life the idea is that you don't get reborn and so when i look at these two you know on the one hand you have christian you know christian faith and other things that want to go to heaven and like live forever in heaven then you have this other whole half of humans who uh want nothing more than to get out of the cycle of rebirth and just poof you know not exist anymore the cycle of suffering yeah and so how do you reconcile those two and i guess do you have both of them in you do you basically oscillate back and forth i don't think i i think i just i look at us in a i think we're just a bunch of proteins um that you know we form and we they work in this really amazing way and they might work in a bigger scale like there might be some connections that we're not really clear about but they're still biological i believe that they're biological how do these proteins become conscious and why do they want to help civilization by having at home rapid tests at scale well i think um i i don't have an answer to that one but i i really do believe i would it's just you know this is just an evolution of uh consciousness i don't i don't personally think is my feeling is that we're a bunch of pluses and minuses that have just gotten so complex that they're able to make rich feelings rich emotions and and i do believe though you know on the one hand i sometimes wake up some days um my fiancee doesn't always love it but you know i kind of think we're all just a bunch of robots with like pretty complicated algorithms that we deal with yeah um and you know in that sense like okay if the world just blew up tomorrow and no nothing was liv you know nothing existed the day after that it's just another blip in the universe you know but at the same time i don't know so that's kind of probably my most core basic feeling about life is like we're just a blip and we may as well make the most of it while we're here blipping [Laughter] but it's one hell of a fun blip though it is it's it's an it's an amazing uh uh you know blink of a of a of an eye in time michael this is you're one of the most interesting people i've met one of the most interesting conversations important ones now i'm going to publish it very soon i really appreciate taking the time i know how busy you are it was really fun thanks for talking today well thanks so much this was a lot of fun thanks for listening to this conversation with michael minna and thank you to our sponsors brave a fast browser that feels like chrome but has more privacy preserving features athletic greens the all-in-one drink that i start every day with to cover all my nutritional bases expressvpn the vpn i've used for many years to protect my privacy on the internet and cash app the app i use to send money to friends please check out the sponsors in the description to get a discount and to support this podcast if you enjoy this thing subscribe on youtube review it with five stars on upper podcast follow on spotify support on patreon or connect with me on twitter at lex friedman and now let me leave you with some words from teddy roosevelt it is not the critic who counts not the man who points out how the strong man stumbles or where the doer of deeds could have done them better the credit belongs to the man who actually is in the arena whose face is marred by dust and sweat and blood who strives valiantly who errors who come short again and again because there is no effort without error and shortcoming but who does actually strive to do the deeds who knows great enthusiasms the great devotions who spends himself in a worthy cause who at the best knows in the end the triumph of high achievement and who at the worst if he fails at least fails while daring greatly so that his place shall never be with those cold and timid souls who neither know victory nor defeat thank you for listening and hope to see you next time