Announcer:
0:00
Welcome to MedEvidence!, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts. Hosted by cardiologist and top medical researcher, Dr. Michael Koren.
Dr. Michael Koren:
0:11
Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence!, and I have a very, very special guest today, Dr. Anthony Fauci. Tony Fauci needs no introduction, but I'm just going to mention a few things about his storied career. D r. Fauci is a physician expert in infectious diseases, in allergy and immunology. He was director of the National Institute of Allergy and Infectious Diseases for most of his career. He's been an advisor to seven presidents, from the Reagan administration to the Biden administration, and he's currently a distinguished university professor at Georgetown University. Tony, welcome to MedEvidence!
Dr. Anthony Fauci:
0:55
Thank you very much, Michael. Good to be with you.
Dr. Michael Koren:
0:57
We appreciate you being here.
Dr. Michael Koren:
0:59
So I just want to start by telling the audience a little bit about MedEvidence!, and really what we're all about is we're trying to help people get credible information about healthcare matters. We actually started this a little bit before the pandemic and we found that in the internet age there's so much information out there that people don't know what's real and what's not, and a lot of the information comes from a very narrow viewpoint. And what we find in MedEvidence! is that when two knowledgeable physicians talk to each other, people can glean credible information. And that's what we'll do today is we'll just have a little talk about your career, but I really want to start out by saying that I read your memoirs and it was fabulous. I thoroughly enjoyed reading your memoirs.
Dr. Anthony Fauci:
1:44
Thank you,
Dr. Michael Koren:
1:44
It's a terrific read. Anybody that wants to read about Tony's just absolutely stunning career in his role in so many health care crises and so many crises where the government had to interface with infectious disease problems, read this book. It's just absolutely fabulous and I have to say that it resonated for me personally, Tony, because we kind of have some similarities in our background.
Dr. Michael Koren:
2:08
I just mentioned this to you before we started taping, but I grew up on Staten Island and you grew up in Brooklyn. You're a Yankees fan, I'm a Mets fan, so we'll have to negotiate that a little bit. But we were both house officers at University of Cornell. I'm a cardiologist, but I actually was the principal investigator for COVID-19 vaccine studies here in Northeast Florida for Moderna and Pfizer and was a sub-investigator for Novavax. So even though I'm a cardiologist, I became a pseudo-expert in vaccines and virology because there was a need for people that ran clinical trials to be part of these studies. So I did that and I used to joke when I was recruiting patients that I had the same job as Dr Fauci. 20 years after you. So that gave me great credibility in the community and I do appreciate that.
Dr. Anthony Fauci:
2:57
Glad I could help, Michael.
Dr. Michael Koren:
2:59
It was terrific. So let me just start with really just an observation. You have an incredibly thick skin, like just reading your book and seeing the criticism that you received over many years from both the left and the right over the years and always stayed cool and calm and reasoned and just present the facts. How do you do it? I don't think I could do that just to keep my cool all the time well.
Dr. Anthony Fauci:
3:27
Well, Michael, what what I have developed over the years is, um, the ability to focus like a laser on what your mission is, what your goal is, um, and to pay attention in some respects, for the nuggets of truth in the people who criticize you, but always stay by your fundamental principles of evidence, of data, of facts, and maintain your integrity.
Dr. Anthony Fauci:
4:02
I think you can probably relate to that, because when people ask me to describe where that came from, it came, you know, from my childhood, my training in the Jesuit schools, in which it was always high degree of integrity, transparency, empathy, etc.
Dr. Anthony Fauci:
4:20
But I learned that ability to focus on what the issue is in my training as a physician in the same hospital that you trained in. When you were in a room with a patient and you were the person that was responsible for that patient's well-being, you focused totally on what your mission is to do whatever you can to alleviate the suffering and maybe even save the life of the patient you're dealing with. When you integrate that into the way you do everything else in life, you can handle the slings and the arrows without necessarily just rejecting them, but listening to see if there's a kernel of truth in those, and particularly with the AIDS activists, which I'm sure we'll get into that, although they were very critical of the government's effort and the academic community's effort, they had a lot of things that made sense and we ultimately embraced them and what turned out to be a criticism turned out to be a collaboration.
Dr. Michael Koren:
5:26
Interesting, so interesting. Yeah, I guess people need scapegoats and certainly when they're frustrated and there's a crisis, they're going to want to blame somebody. But I have to admire you how cool and calm and collected you were during all those things. So let's just jump into some of the controversy. We're both both New York guys, so we're straight shooters. We get right into it. So people want to know was the COVID-19 virus, was that a lab leak, or was that a virus that came from an animal reservoir that eventually infected humans? So you do address that in your book and I'm curious to see what your thoughts are. Sure, and how do we figure that out?
Dr. Anthony Fauci:
6:08
Well, I'll give a synoptic version of what I said in the book, and that is in order to be open and honest about things we don't know definitively. But let's look at data. Since we are scientists and physicians, let's look at the data. So between 75% and 80% of all the new infections emerge from an animal reservoir. That is pretty impressive, number one.
Dr. Anthony Fauci:
6:36
Number two we do not know whether it came from a lab somewhere in China or whether it was a natural occurrence from an animal reservoir. Recall SARS-1 in 2002, which was shown very clearly in the wet markets of China, where the animal-human interface inappropriately gets together, where you bring in animals from the wild, and it was felt that it was a bat which harbors these coronaviruses to a civet cat, to a human. If you look at the situation in Wuhan and you look at where are the data, the data of there being a lab leak are zero. There's none. I mean there is an extrapolation. Well, it happened in Wuhan and there were labs in Wuhan, so therefore it must have come from a lab.
Dr. Anthony Fauci:
7:27
Well, maybe it did, but there's no evidence that it did. Yet some very qualified, internationally recognized evolutionary virologists from Australia, Canada, the European Union, the U. K. and the United States have made it very clear that when they went and looked at the data they felt comfortable but not definitive. They felt that the data strongly suggests it came from an animal interface. But I have always said I keep an open mind Until we get definitive data. Always keep an open mind. But if you look at the data that we have right now and what the evolutionary virologists think, they strongly favor it being a natural jump from an animal species to a human.
Dr. Michael Koren:
8:27
Which is the way these things usually happen. Is there another example of a lab error that caused a pandemic or an epidemic that you know of?
Dr. Anthony Fauci:
8:33
No, not a lab error. There have been lab accidents, but it never, ever resulted in a pandemic like this.
Dr. Michael Koren:
8:41
Right, right so common things happen commonly. This is something that does happen in nature, where viruses come from an animal reservoir to humans through some change in the genetics of the virus.
Dr. Anthony Fauci:
8:53
Exactly so.
Dr. Michael Koren:
8:55
You mentioned the Wuhan Province Virology Institute and that is also a little bit of a controversy. I guess they had a small sum of money that came indirectly through NIH, and you do mention that in the book and I don't know if you want to clarify that for people that may be listening to us.
Dr. Anthony Fauci:
9:14
Yeah, it was $120,000 a year grant from a portfolio that's $6.3 billion, so it's like pencil dust, as it were, compared, and it was to a group that had been collaborating with scientists in China who have done actually very, very good research.
Dr. Anthony Fauci:
9:37
But the nature of the grant was to study the surveillance of screening viruses that are in the environment to determine whether or not they actually can infect humans Not to make them infect humans, but to determine if they can.
Dr. Anthony Fauci:
9:53
The thing that gets lost in a lot of the finger pointing is that the viruses that were studied under the NIH sub-grant were evolutionarily so far distant from SARS-CoV-2 that any evolutionary virologist will tell you that it would be impossible to have those viruses turn into SARS-CoV-2. Even if you tried to do it, you couldn't do it but nonetheless, because there was an NIH grant that funded research from a really good lab that actually was the lab that proved the origin of the original SARS in 2002, that because there was, that it immediately extrapolated, purely on no data, that, oh, it must have come from that lab. But if you show the viruses to the evolutionary virologist, they'll say that you have to have a virus that's close enough as an original virus for you to be able to manipulate it to become something that is COVID, and it's so different that you wouldn't be able to do it, even if you wanted to do it.
Dr. Michael Koren:
11:09
Right, so interesting. But again, the point that this was such an incredibly small grant, I think is really important that most people don't particularly understand. And it didn't come directly from the NIH, it came through, I guess, a subcontract.
Dr. Anthony Fauci:
11:24
Exactly.
Dr. Michael Koren:
11:26
So let's change subjects just a little bit, but staying on COVID, I remember when we were first looking at this again here in Northeast Florida, we were watching when the pandemic would hit us. It was hitting other parts of the country first, as you recall, New York and Seattle being two places where it hit pretty hard, and we were spared until maybe about April or May of 2020. But there was a lot of debate about whether or not COVID-19 would be a one and done thing like MERS, or it'd be something that becomes a seasonal virus like influenza. So I think we kind of have the answer to that question, but maybe you can extrapolate a little bit more on what you see is going to happen with COVID moving out in the future. Will it be something that has severe manifestations or will it continue to be less of a concern in the future?
Dr. Anthony Fauci:
12:13
Well, it certainly will not have the extraordinary devastating impact that it had during the first two years, when we had people dying at such a horrible rate that the morgues in the hospitals couldn't handle the bodies.
Dr. Anthony Fauci:
12:30
I mean that's extraordinarily unlikely that that will ever happen again because we now have five years of experience of people who have either been already infected and reinfected and vaccinated multiple times that, although COVID is still circulating and likely will be more negatively impacting health than influenza, particularly among vulnerable people, the idea of all of a sudden having another explosive pandemic is extraordinarily unlikely because of the baseline amount of immunity.
Dr. Anthony Fauci:
13:10
For example and I'll give you a very cogent example we have new variants. Remember, we started off with the ancestral strain, then we had alpha, beta and then delta. We had in the spring and right before 2021. Then in November of 2021, we had Omicron and since then we've had multiple, multiple derivatives of Omicron, and so the virus is still a SARS-CoV-2 with a different variant. But the different variants are similar enough in some respects to what most of us have been either exposed to or vaccinated against that, except for the very vulnerable - the elderly, the morbidly obese, those with underlying conditions - the chances of it being a widespread pandemic are extremely low, particularly if people continue to get their booster vaccines.
Dr. Michael Koren:
14:13
Well, thank you for that great explanation. I think there's still concerns out there and unfortunately, either people will poo-poo it and say it's nothing to be worried about, or become overly concerned, and you'll have some patients that want to get their booster every three months and other people that say it's not necessary at all. So I think there's a happy medium in there.
Dr. Anthony Fauci:
14:36
Well, I'm glad you said it that way, there is a happy medium. I mean people, particularly the elderly and those with underlying conditions. One of the things we know about immunity to coronaviruses and we've known that for decades for the common cold coronaviruses that the immunity that you get is not highly durable like the immunity you would get from a measles infection or a measles vaccination, which is measured minimally in decades and maximally for a lifetime. That kind of immunity you don't get with SARS-CoV-2. What you do get, which is good, is that when you get vaccinated or infected, you have a degree of immunity that may not protect you against another infection but clearly protects you against severe disease. And I'll give you a typical example, Michael, is that you know you already gave away my age when you said you were chief resident 20 years earlier than I was Right now. I just passed my 84th birthday.
Dr. Michael Koren:
15:45
C.
Dr. Anthony Fauci:
15:45
So, I'm at high risk of, if I get infected with COVID, to get a serious outcome. But I have been vaccinated with the original vaccine with the three, four, five doses and I've been infected three times. The last time I was infected, and the time before
Dr. Anthony Fauci:
16:10
was extremely mild. It was a URI (upper respiratory infection). I'm wondering, if I didn't get vaccinated, what that first infection would have been like. For me it could have been life-threatening. So that's what I mean by the immunity that most people have may not protect them against an infection, but it will protect them against severe disease, except if they are profoundly compromised, like people with underlying conditions.
Dr. Michael Koren:
16:43
And there's also a nice paper in the New England Journal several months ago about vaccines protecting people against long COVID.
Dr. Michael Koren:
16:50
So I think that's also something we should make sure people understand.
Dr. Anthony Fauci:
16:53
Exactlym, that's another benefit, that's another benefit,
Dr. Michael Koren:
16:55
Which is an interesting phenomenon. So you mentioned a little bit about my introductory comments about quote "my job 20 years after you were chief resident at New York Hospital. I served as the third year chief resident at New York Hospital and we were joking about this before, but we used to do morning report on the fourth floor of the old hospital building. You may remember that, and they had all the pictures of the chief residents that were shown in the conference room and I just happened to sit right across from your picture so I used to stare at you. I'm not being creepy now, but I used to stare at you in Morning Report and, as it turns out, that was during the height of the AIDS crisis and I think that was your initial claim to fame was your incredibly important contributions to solving that crisis.
Dr. Michael Koren:
17:43
So I want to jump into that a little bit, and I've only met you once before. Very briefly, you gave grand rounds, I believe, at New York Hospital and you were very gracious to me as a house officer to answer a few of my questions. They were probably stupid questions at the time, but you were very, very gracious. But it was a rough go. It took a long time to go from identifying this disease to being able to control it and probably about a decade, I think is fair to say and so maybe a few comments about what that experience was like, and then maybe, and your comments about whether or not we'll ever get a vaccine to protect people against HIV disease.
Dr. Anthony Fauci:
18:22
memoir Michael had when I left my chief residency in 72, I had several years of a '72 successful career developing therapies for autoimmune inflammatory vasculitises that took diseases that had close to 100% mortality, like granulomatosis with polyangiitis, which we used to be Wegener's granulomatosis, and we did the types of studies, clinical trials like you're involved with with cardiology, and we showed that if you use a modified therapeutic regimen that I developed with my mentor, sheldon Wolfe, that you could induce 93% Sheldon. So I did that for multiple years from 72 to 81.
Dr. Anthony Fauci:
19:11
When 1981 came and I saw the first cases in the New England Journal of Medicine, but even before that in MNWR with the CDC, first the five gay men from LA in June of '81, and then in July 23 gay men I mean why all gay men? We didn't know. I knew it was sexually transmitted, I knew it was infection but I didn't know what it was. So I decided and that was the turning point of my career much against the advice of my mentors, I turned away from this very successful trajectory in my career and said I'm going to start admitting these desperately ill, almost exclusively young gay men. And when I say desperately ill because, remember, we didn't have an HIV test because we didn't know it was HIV. So the only way people would present would be when they had advanced disease leading to clinical manifestations.
Dr. Michael Koren:
20:12
Right, we used to call it GRID,
Dr. Michael Koren:
20:14
Gay-Related Immune Deficiency. Back then yeah.
Dr. Anthony Fauci:
20:16
I mean, we didn't have a name and we didn't have an etiology until 1983- 1984. We didn't have any therapy until 1987. And we didn't have the combination that dropped the viral load to below detectable until 1996- 1997. So, getting back to your specific question, those years for me, as I described painfully in the memoir, were unusual, unique and the dark years of my career, because virtually every patient I took care of would go on and die a terrible death, with very few exceptions. And, as you know, as physicians we're trained as healers and we were healing nobody. We were putting Band-Aids on hemorrhages and the frustration of even treating the opportunistic infections. It was like whack-a-mole you treat the pneumocystis, they get CMV, you treat the CMV.
Dr. Michael Koren:
21:20
I remember those days yeah.
Dr. Anthony Fauci:
21:23
And it was very, very frustrating. The only thing that got me through it was the bravery of, and the courage and the dignity of, the patients who suffered through that. But the other side of that coin was the truth of the importance of basic and clinical research to solve difficult life-threatening problems. Because we went from nothing in 1981 to getting an etiologic agent, to getting the first drugs, better drugs and right now, as you know, someone comes in recently infected with HIV. You put them on a single pill once a day and you could get the viral load durably below detectable. I mean, no one would have imagined that that would have happened when we were struggling in 1981, '82, '83, and '84. But I think it's a testimony to the importance of investment in basic and clinical biomedical research.
Dr. Michael Koren:
22:26
No doubt, but we still don't have a vaccine, so any thoughts whether that will happen in our lifetime?
Dr. Anthony Fauci:
22:34
You know I'm cautiously optimistic.
Dr. Anthony Fauci:
22:37
But it is not going to be easy, Michael, because of all the infections that I've dealt with in my 55-year, 56-year career, this is the only infection in which the immune system does not adequately respond to the pathogen in question. And it's important because, as you learned in medical school and as I learned and also during our house staff training, the best way to make a vaccine is to mimic natural infection without hurting the patient. The only trouble is natural infection does not induce the kind of immunity that clears the virus. So what vaccinologists are doing now is trying to develop a platform and an approach to engage the B-cell repertoire to make a response that's even better than natural infection, but to do it before the person gets infected. And we've not been successful. And we've been trying. The first vaccine trial that we did at the NIH was in 1987. And it's been a long time since. And unlike COVID, which you know, the body makes a pretty good immune response against a coronavirus, we had a vaccine in 11 months.
Dr. Michael Koren:
24:01
Yeah, unbelievable.
Dr. Anthony Fauci:
24:02
The answer to your question is I'm very cautiously optimistic. We will, but it is not going to be easy by any means.
Dr. Michael Koren:
24:12
Yeah, and just to elucidate one thing you said for the lay audience B cells are the immune cells that make antibodies Right, and HIV hides in the T lymphocytes, which are cells responsible for cellular immunity, and that's why it's been such a tricky virus to deal with, right, yeah, so let's move to something. We have limited time, so I'm fascinated. This is wonderful stuff, but I want to just move to a couple of other items that I know that you're passionate about and I'm curious to see your approach about. And obviously, one of the big issues that has come up with the whole response to COVID-19 was this trade-off between personal rights and what is needed from a public health standpoint and you've had to deal with this your entire career and it's been a huge issue. And, of course, all this controversy about who should wear a mask, who should get vaccines, et cetera, et cetera.
Dr. Michael Koren:
25:08
And just in general, one of the things I like to mention to people is, if you remember, when Neil Armstrong came down from the moon after Apollo 11, and he was the most famous person on the planet and should be celebrating and reuniting with his wife the first thing he had to do was go to quarantine for 21 days because of the concern about a microbe that was not from the earth coming to the earth. So this concept of trade-offs is such an interesting one. It's such a tension and certainly it played itself out during the whole COVID-19 pandemic and the politics beyond it. So maybe just give us a little bit about your philosophy and some of the things that helped you with your education and your advice to various administrations.
Dr. Anthony Fauci:
25:54
Yeah, well, as a physician, scientist and a public health person, I personally feel but I'm not the last word I personally feel that we have both a personal responsibility for our own health, that of a family, and we have a societal responsibility because we are part of a society. And the idea is that sometimes you have to do things that are for the benefit, not only to yourself, but for the whole society. However, in this arena that we're dealing with of profound divisiveness, of questioning of scientists and public health principles, it's something we have to re-examine and re-look at, because it was clear that when there was, you know, the mandates for children to get childhood vaccines has saved millions and millions and millions of hospitalizations, severe illnesses and death. We know that. So the question is if everybody decides they don't want their child to be vaccinated, I don't want to mandate. There's no doubt we've seen that in other countries you will get the resurgence of a disease that you have eliminated, like measles, like polio. Now, that went along pretty well in society because people remembered the horror of polio, like when I was a kid, you know they wouldn't let us go swimming in Coney Island because they were afraid of our friends that we saw get paralytic polo. And the same thing with measles, a terrible disease.
Dr. Anthony Fauci:
27:47
Right now people have a very, very much divisive attitude about somebody telling me what I don't want necessarily to do and if it has a negative effect on society., in some respects, you're saying too bad. Well, I understand that, and I don't think physicians should be the only one to decide that. I think that's a dialogue we have to have at the societal level. I mean, what are we willing to give up for the society's benefit versus insist on for our own somewhat libertarian feeling about ourselves? And I'm telling you honestly, I don't have the total answer to that. I know how I feel as an individual, but there are many people who feel differently, who feel they don't have a societal responsibility. I feel we do.
Dr. Michael Koren:
28:42
Yeah, interesting, and then you can put it back on people. So you mentioned in your book and I think most people can identify with this, is that you're on an airplane and somebody is clearly sick next to you. What right do you have to protect yourself? Can somebody use their authority to put a mask on that person or ask that person not to fly in the first place? And so it's inevitable that we'll be interacting with other people and there have to be rules on those type of interactions, correct?
Dr. Anthony Fauci:
29:13
Absolutely yeah, and that's a big bone of contention among most people. You have no right to tell me what I'm going to do with myself.
Dr. Michael Koren:
29:24
Tricky issues, which gets us into this whole concept of optics, and you cover this in your book and I found this fascinating. And you got this both from the left during the HIV/ AIDS days and from the right in the COVID-19 era, of people who would absolutely criticize you and say incredibly mean and unwarranted things and really scapegoat you, and then they would call you either hours or a few days later and say, hey, Tony, we're still good. You mentioned this in your book when there was an activist named Larry Kramer who did the Nightline show with back in the day and he was a bit critical but he called you right afterwards and he was so happy that he did the show with you and he was saying hey, Tony, we did great. And more recently, with Donald Trump, he had situations where there was criticism but Donald Trump would call you. President Trump would call you and say Tony, we're still buddies, aren't we?
Dr. Michael Koren:
30:40
And so this whole concept of optics in politics and in the public space versus
Dr. Anthony Fauci:
30:44
Well, Michael, you just deal with it. And you try to understand where the person is coming from. So with Larry Kramer, I knew that he felt he needed to shake the cages and kick the tires to get people to do more. He liked me and at the end of the book, right before he died, we said to each other how much we loved each other after decades of fighting back and forth.
Dr. Michael Koren:
30:58
Antagonism yeah
Dr. Anthony Fauci:
31:00
Yeah antagonism and he's, you know, a wonderful person, a firebrand guy who would, you know, be very iconoclastic, but at the end of the day he meant well. You know, as I describe in that chapter in the book and the title of the chapter, when it was myself and President Trump was love me, love me not. And it was-
Dr. Anthony Fauci:
31:25
I had a very good relationship with him and you know, understandably, he would want it so badly for the, for the outbreak to go away, because that a lot of implications politically for him. It was an election year for him. It was an election year. So he would get upset when I would be saying things that was somewhat, if not directly, contradictory to him. So he would get upset with me, but at the end of the discussion, you know, he fundamentally respected me as I did him and he would say you know we still okay. I mean, I'm pissed off at you, but are we still ok?
Dr. Michael Koren:
31:58
Yeah Interesting.
Dr. Anthony Fauci:
31:59
That's why that chapter is a unique chapter in the book.
Dr. Michael Koren:
32:02
It's a fabulous chapter and I find it incredibly ironic that Operation Warp Speed was such an incredible success. Getting a vaccine within a year of identifying the virus was just amazing, and obviously President Trump had a big part in pushing that through and I would consider it the number one accomplishment of his first administration.
Dr. Michael Koren:
32:25
And despite that, a lot of people who are supporting him now reject the product of that incredible effort, and it's such an incredible irony.
Dr. Anthony Fauci:
32:40
Yeah, no it's an irony, and Michael, it's a profound paradox. You know, because of the divisiveness in society about physicians and health care providers and public health, people like myself telling people they should get vaccinated. The pushback against it negates, in some respects, one of the most important things that the Trump administration did they got us the vaccine. You should be celebrating that, not talking against it.
Dr. Michael Koren:
33:11
Yeah, really just quite remarkable, amazing accomplishment and such an unexpected downstream effect of that accomplishment I just can't even put it together, quite frankly. So let me ask you a final question Anything you would have done differently in retrospect when you think about your advice during COVID-19 or the way you articulated very important public health messages.
Dr. Anthony Fauci:
33:38
You know, Michael, of course. You know, it's one of those things. If you're dealing with a static situation, you could go back and say well, you know, I made a wrong decision here, because now I know you know nothing has changed, but it was the wrong decision. I would have done a lot of things different if I knew in January and February back then, what I know now because we were dealing with a moving target. But the one thing that people need to understand and I try to explain that in the memoir, some people accept it and say, oh, I get it, I know what you're talking about, and other people's mind is closed, don't. But it goes like this: Science is a process that gathers information, data and evidence.
Dr. Anthony Fauci:
34:37
When you're dealing with a static situation, that evidence is immutable, it's there, you've done it. When you deal with a moving target, like an evolving outbreak, the process of science tells you that you will have to self-correct Because if the scientific process, which is the information gathering part of it, if the information changes from January to March, the summer to the next year, since science is self-correcting, you have a scientific obligation to change your recommendations to change your guidelines. And that's exactly what happened with things like masks, with things like distancing, with things like understanding aerosol spread, with things like understanding that people spread the virus half the times or more when they're asymptomatic, which you know. You can get some asymptomatic spread with other infections, like flu, but not to the extent that we see with SARS-CoV-2. So if, on January 1 of 2020, if we knew all of that, we would have done some things different.
Dr. Michael Koren:
36:00
Yeah, absolutely, Absolutely.
Dr. Michael Koren:
36:03
But I would also say is that when we glean information from the clinical trials, even when things change, there's still lessons that can be applied.
Dr. Michael Koren:
36:12
So, for example, as I mentioned, I was part of the vaccine studies for Pfizer and for Moderna and in those vaccine studies we showed a 95% efficacy rate, which was just absolutely stunning. And just so people understand that, these are studies where people either get an active vaccine or they get a placebo, and then people come to our office and they either have COVID or not. And if you look at it from the standpoint of 95% effectiveness, that means that of 100 people that came to our office, only five were vaccinated. The other 95 actually were not vaccinated. So that's a staggering degree of effectiveness, and so we know the thing works. And then the other thing is looking at the tradeoffs for side effects, which were actually quite modest. So that lesson can still be applied. I believe and I think that's one of the things that I find a bit frustrating is that people don't necessarily understand that there's a slight change in the recommendations based on an evolving virus or other elements of evolving healthcare environment. That doesn't take away that important lesson of the clinical trial.
Dr. Anthony Fauci:
37:22
I agree completely, Absolutely. And you know, one of the things that is so important is what people get concerned about, that they want the virus, the vaccine, excuse me, to completely protect them against infection, which it does for a while, not as well as against severe disease. But the protection against infection wanes much more rapidly than the protection against severe disease. So they get confused. They say, well, I got the vaccine and I wound up getting COVID, so you're giving me false information. No, you might be dead if you didn't get the vaccine. That's the point.
Dr. Michael Koren:
38:08
Yeah, yeah. And then I'll share with you one anecdote that you'll get a kick out of. So in October of 2020, when I was in the midst of running these clinical trials, I went to my gym. I like to exercise, as I know you do, and I usually go in the evenings. But at one time I went during the afternoon and at that time there were sessions at the gym where you had to wear a mask and other sessions where masks were optional. And I used to go later at night when masks were optional and it was a large gym, we were socially distanced.
Dr. Michael Koren:
38:39
But one time time I went for a mask mandatory session and I walk into the gym and I was told you have to wear a mask for this. I said that's fine, of course I have masks in my car. I go to my car, pull out my mask, and I had a paper mask and I had an N95 mask. So I bring them both in and I wanted to see if the difference in pore size between the two masks would affect my ability to do the stationary bike. I was doing a little internal experiment.
Dr. Michael Koren:
39:08
So during the course of my exercise I switched from a paper mask to an N95 mask in back and I was criticized by the monitor that I had to wear the mask all the time.
Dr. Michael Koren:
39:15
They don't like the fact that I was changing masks even though I wasn't necessarily putting anybody at risk, certainly and so I explained that I happen to know a little bit about this area and I was explaining what I did, but they had their rules and this whole concept of just throwing rules out and throwing out mandates and people not necessarily liking that. So, interestingly, after that, a woman comes up to me, clearly representing the right, and says, yeah, this whole COVID thing is going to go away as soon as the election is over, and her assumption was that this was all being manipulated to make Donald Trump seem less popular at the time, in October of 2020. And I said, no, no, this is a really serious problem. And I started explaining, and I started explaining the difference between masks, et cetera, and she seemed to be okay with that. Literally five minutes later, tony, somebody comes up to me and looks at me and says you know what the problem of this pandemic is?
Dr. Michael Koren:
40:07
It's people like you that refuse to wear their mask.
Dr. Anthony Fauci:
40:12
Yep you can't win Michael
Dr. Michael Koren:
40:13
Right.
Dr. Michael Koren:
40:14
So I felt a little bit like you, just on a very small level, but I felt like you. But one thing in closing I want to say that I can speak to your motivation. I know about your training and, for example, you went back to New York Hospital after doing your fellowship at the NIH because of your loyalty to the institution, because of this idea that you can do something really important for patients by harnessing the power of the system and being chief resident, as you mentioned in your book, involves being on call every other night and literally just working your ass off, quite frankly, and being involved in codes, et cetera. But it's not completely selfless. There's some incredible ego gratification to know that you can take the power of a system not for your own personal needs, but using the power of the system to help people, and I know that, ultimately, was what motivates you. So I just want to say that for the record.
Dr. Anthony Fauci:
41:07
Well, thank you so much, Michael.
Dr. Anthony Fauci:
41:08
I appreciate that, thank you.
Dr. Michael Koren:
41:11
So, tony, this has been a delight for me. Thank you so much for being part of MedEvidence! and truly appreciate it. And again, this is a fabulous memoir. I loved it and I'd recommend it to all of our listeners and viewers to take a look at this. I think you'll really enjoy it and glean some really, really important insights. Tony, thank you very much for being part of MedEvidence! Thank you so much, Michael. Good to be with you.
Announcer:
41:34
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