Pandemic: Coronavirus Edition

Para-Science vs Science: What's the Difference?

July 08, 2020 Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger Season 1 Episode 33
Pandemic: Coronavirus Edition
Para-Science vs Science: What's the Difference?
Pandemic: Coronavirus Edition
Para-Science vs Science: What's the Difference?
Jul 08, 2020 Season 1 Episode 33
Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger

Stephen, Mark, and Matt's longest episode yet and NOT because we are getting long-winded! Lot's to cover this week: COVID cases rising but mortality rates decreasing, the effectivity of masks, airborne particles, horseshoe crabs, fall semester fears, smell checks vs. temperature checks, and distinguishing between science and para-science. Man alive! Enjoy this one!

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Show Notes Transcript

Stephen, Mark, and Matt's longest episode yet and NOT because we are getting long-winded! Lot's to cover this week: COVID cases rising but mortality rates decreasing, the effectivity of masks, airborne particles, horseshoe crabs, fall semester fears, smell checks vs. temperature checks, and distinguishing between science and para-science. Man alive! Enjoy this one!

We offer transcription now! Caution, it is AI transcription so please excuse AI errors.

  • Download here -
  • See it on the podcast website here -

Can you Rate and Give us a Review in Apple Podcasts?

Please consider supporting us to help upgrade our equipment and offload our editing responsibilities:

  • Give monthly (as little as $5 a month) on our Patreon Page -
  • Give a one time gift through Venmo at @mattboettger
  • Give a one time gift through PayPal here:

Matt's Other "Living the Real" Podcast:

  • Download Matt's FREE Quarterly Momentum Plan Template here.
  • Subscribe to Matt's Living the Real Podcast:
  • Learn more about Matt's 3-M framework here:

Things Discussed on Episode:

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[00:00:00] Matt Boettger: [00:00:00] You were listening to the pandemic podcast. We equip you to live the most real life possible. And the face that he is crises. My name is Matt Botkin. I'm with my good friends, dr. Steven Kisler epidemiologist, the Harvard school of public health and dr. Mark Kissler, a doctor with university of Colorado hospital.

[00:00:13] Hey guys. Welcome back. The trio is here. How's it going? That's right. 

[00:00:17] Mark Kissler: [00:00:17] Good, good. It's good to see you. 

[00:00:19] Stephen Kissler: [00:00:19] It's good. It's good 

[00:00:20] Matt Boettger: [00:00:20] be back. It feels good. You know, I was telling Mark and Steven a couple. What was it last week off the air? The like, Oh my gosh. Maybe I said this already on the air. And if I did, I'm sorry.

[00:00:29] I feel like it's Groundhog day on the repeat. I don't know what's going on. What's real. What's not real. That we were like, Oh my gosh, it'd be so good. Sunday. We're all gonna be together physically. I mean, it's weird that we haven't been together physically been 33 episodes and that I'm probably gonna be teary-eyed when I see you guys physically, because it'll be great.

[00:00:43] So we're all getting there. Let's do an episode live like at a bar or someplace. That'd be so cool. And then I thought like, Oh yeah, by definition, our jobs are over. If we go to a bar and do a podcast together on COVID because either a we're going against CDC policies, which it within word or [00:01:00] hypocrites, or Hey.

[00:01:01] We're done we're over that. We're over the mountains. So 

[00:01:03] Mark Kissler: [00:01:03] let's, I will look forward to the day when we can do a concluding podcast to the bar of crowded bar. That's what I'm looking 

[00:01:09] Matt Boettger: [00:01:09] for to be awesome. Yes. We know we're just so popular. I think we'll just do a mile high stadium or something like that. Huge.

[00:01:17] Okay. So much to talk about. It's been a week. There's tons of news for some reason. It's a particular one. Maybe July 4th. I have no idea, but we have a lot to talk about. We always need reviews. Thank you so much for those who left them. If you can't leave a couple minutes, just check the show notes and get the link right there to just leave a couple minute review or even just click the stars, whatever you think is worthy as well.

[00:01:37] dammit podcast, always looking for a financial support to help us pay off all the awesome equipment that we have to make things streamlined easy. So we can edit, get this thing published on time. It into your lovely ears. if you're not into one, a monthly recurring payment, Venmo, PayPal, just one time gift, be so grateful for that.

[00:01:57] That's all in the show notes. And also [00:02:00] just, I said last week I have, my momentum, quarterly plan template. You can check out for free, go to live in the matters. Pick it up. you'll get a series of emails to walk you through the process so you can do something great. This quarter, make 2000.

[00:02:14] 20 something worthy and memorable in maybe a really awesome way and not so much a, a dreary way at times. Okay. Let's get in. We have a lot to cover. I have a lot of in the news, we're gonna do a deep dive on parasites. This is gonna be great. this is where I kind of take a back seat once again. And I just probe Steven and Mark about all the good stuff of parasites and what that really means and how we can decipher just talking to you guys about how there's some things I read and I, we have a pandemic podcast and I remember like, Oh, sounds good.

[00:02:45] It sounds persuasive. And if it's me, I mean, Lord knows who's, you know, everybody else in the world, that's feeling the same way to have all this information. Okay. Let's get started. First thing, coronavirus cases are rising, which is really obvious, but [00:03:00] apparently deaths are falling. So, Steven, what's the issue with this?

[00:03:03] Is this, are we in a new transition? how have we beat coronavirus? Is something bigger in play? 

[00:03:07] Stephen Kissler: [00:03:07] Oh boy. So I think there's a couple of things behind this. and so, yeah, so I think certainly from the beginning of the outbreak, you know, one of my colleagues said that actually one of the. Well, the infection fatality rate in any given place is actually often not so much a measure of the severity of the illness, but basically how much testing we're doing.

[00:03:27] Because if we're going out and finding more, doing more tests than your, basically your denominator, you're dividing the number of deaths by the number of cases. If you have more cases, that's going to deflate the fatality rate, basically. So one, one reason why we're sort of seeing lower fatality rates is partly because we're just doing more testing.

[00:03:43] So we're catching a lot more of the cases that are less severe. that's kind of on the pessimistic side of the spectrum on the optimistic side, I think we are probably getting better at treating it, you know, and our hospitals are not as overwhelmed in many places. And so, so I think there probably have been advances in the care for patients as well. [00:04:00]

[00:04:00]the one that worries me the most is that we just haven't seen them yet. So, we know very well that there's this delay between cases and severe illness and then ultimately death. and you can actually see this in many places, like look at New York city. the, the New York times, for example, has these metrics where you have a graph of the number of cases over time and the deaths over time.

[00:04:20] And the, the cases started rising about three weeks before you were saw any detectable rises in the deaths. And unfortunately we've started seeing these spikes in different places around two to three weeks ago getting started. So, so my fear is actually that we just. Haven't seen them yet. and that it's just takes a lot of time for a person to progress through these stages of illness.

[00:04:39]so I think that that's something we'll have to be paying very close attention to as we move forward. there's, there's this real temporal aspect to this epidemic, right. And things don't always happen at the same time. And that can cause you to draw false conclusions from the data that's in front of you.

[00:04:53] So I think we need to be really mindful of that. 

[00:04:54]Matt Boettger: [00:04:54] Okay. And of those three options, which one are you honoring? If you're a betting person you feel [00:05:00] like has the most weight, is it the more, the lag time do you think is probably the issue 

[00:05:03]Stephen Kissler: [00:05:03] I do. Yeah. I think, I think that that's the biggest, probably the biggest factor, although all three of them are playing a role 

[00:05:09] Mark Kissler: [00:05:09] for sure.

[00:05:10] Sure. 

[00:05:10] Matt Boettger: [00:05:10] Okay. So hospitals struggled to contain COVID-19 spread inside their walls. Mark, have you experienced this? Is this something that's just kind of a. A news headline or is this maybe a potential problem? That's always been or new? 

[00:05:24]Mark Kissler: [00:05:24] what I suspect, so I haven't read that particular article. but what I suspect that they're referring to is the fact that certain hospitals are having to reach out to neighboring institutions or to other facilities to help.

[00:05:35] To how some of the patients. and so there was conversation, especially during the peak, of our patient load. in April, when we were having that, we were talking about if we were going to need to maybe have some adult patients over at the children's hospital, that's on our campus. I know that's been happening in Houston right now at my.

[00:05:53]the institution that I trained at, and in Texas children's has been having some adult patients in their hospital [00:06:00] facilities. and, there's even been some conversations about, especially the patients for, for who have to stay, but who are medically stable. but maybe can't return to their rehab facility or nursing home or something like that because the COVID COVID positive state.

[00:06:14] Status where those patients could be cared for in a safe and effective way. That's not in as resource intensive of a setting as the hospital. So yes, there were definitely conversations about that here. and, it's happening in certain other places and, you know, places are having to flex a little bit as the waves come and go in terms of patient volumes.

[00:06:35]and so. yeah, it is something, you know, I think that we've seen in has been a big conversation amongst hospital leadership. 

[00:06:42]Matt Boettger: [00:06:42] Okay, great. 90% of those who died from virus had other illnesses, at least as so I'm not sure what the point his article was. It kind of was a little bit shocking to me. 99%.

[00:06:53] I saw the breakdown of this. Is this anything like new information? Does this have any kind of guidelines for us? Does [00:07:00] this do anything for us in the U S. Or is this just kind of headlines again? 

[00:07:04] Mark Kissler: [00:07:04] I mean, it is, it's very much a headline, right? It's very much, kind of geared towards that. And the, the immediate temptation is to extrapolate like, well, what does that mean?

[00:07:12]I think it can mean a couple of things. One is that, you know, I'm not sure what percentage of individuals who die of any cause have other comorbidities, but it's a lot, you know, generally. So like just the general population. it's, it's much more rare to die of something with no other.

[00:07:28] Comorbidity. and also, you know, I think it is helpful in the sense, is this something that we know, right. But individuals with certain comorbidities are more susceptible to severe COVID-19 infections. that's been a constant throughout the course, but it's also potentially helpful in explaining some of the different mortality rates in different morbidity rates, in different degree of illness that we see amongst different populations and geographic locations and things like that.

[00:07:53] And so I think, you know, it's, it's worth remembering. it's kind of a reminder. It's a little bit of, it seems to be a little bit more of a [00:08:00] sensational statement of something that we already know. and, you know, I think the, the risk would be kind of flying then immediately to the conclusion of what we just, just let them go.

[00:08:10] They were sick anyway. 

[00:08:12] Matt Boettger: [00:08:12] It 

[00:08:12] Mark Kissler: [00:08:12] got it. And it's like, I mean, there, there are a lot of chronic illnesses that we. Live with lots of people live with, you know, young people, young, healthy people live with chronic illnesses too. And so, you know, I think, in some ways that can be a little bit misleading in, in certain ways.

[00:08:28] So, 

[00:08:29] Matt Boettger: [00:08:29] but it's helpful to realize that when you first read this article, my, my initial kind of reaction is. This is a qualitatively different virus. But what you're saying is no, it's not qualitatively. It may be quantitatively, right? Most things are associated with degrees, already have comorbidities already around them.

[00:08:44] This might have a different threshold by which it impacts the community, but it's the same theme of other. 

[00:08:51] Mark Kissler: [00:08:51] Yeah, fatalities. Yeah. 

[00:08:53] Matt Boettger: [00:08:53] Great. next one. We're gonna hammer through these cause I wanted to get to the pair of science stuff will be fun. Visual demo shows that effectiveness of mask [00:09:00] and distancing.

[00:09:01] I just wanna riff on this for a second because I have friends who really think mass, which is a political statement. We know that there is a, in the government, a lot of. Different disagreements on the, on the purpose or the weight or the value of masks what's going on right now? I, you know, at the, in March we were kind of talking very loosely about mass and like, ah, don't wear a mask.

[00:09:20] And we, now we realized to which were mass because, we realized because AC is the Matic presymptomatic. but now, and there also, wasn't a lot of research on masks, but now a lot is being invested now as fat at a very fast pace, where we at on the mask, to what extent do we see. Providing value to prevent the spread of this virus, Steven.

[00:09:38] Stephen Kissler: [00:09:38] Yeah. So I think you're right. There's There is evidence that suggests that masks are probably helpful in reducing the spread of illness. And I think this might actually, get into some of the, the pair of science discussion that we're talking about in a moment. But I think a lot of the, the disagreements and arguments that I'm seeing right now are coming, fundamentally from two places.

[00:09:59] One of them is what [00:10:00] do we accept as evidence? And the second is how do we act. In the face of evidence that we were given. So amongst a lot of the camps that, that, Well, really our attempt to be against wearing masks tend to really focus on, really gold standard randomized control trial type of evidence, really solid evidence.

[00:10:18] And in addition to that, suggest that we have basically a mandate to not change our behavior until there is evidence to support the change and that, unless there is strong evidence to support a change in behavior, then we ought to continue behaving as we have already. Now on the other hand, another way of, sort of on the other side of the spectrum are people who, have sort of this proliferative notion of evidence and that there are different shades of evidence.

[00:10:41] So for example, you, you, you mentioned these videos and pictures of how people spread droplets, right? Like that's not a randomized controlled trial, but, but that is a certain type of evidence that suggests that, droplets don't spread as much or as far when you're wearing a mask. And so. Sure that doesn't tell us directly how much transmission is going to be reduced by wearing a mask.

[00:11:00] [00:10:59] But it does suggest a very plausible mechanism by which masks could reduce the spread of disease. And then in the face of that evidence, the decision is, well, we have this balance of benefits and risks, and we recognize that while there isn't necessarily this solid, you know, Unequivocal evidence that masks will absolutely reduce spread.

[00:11:19] There is a very strong reason to believe that they might. And if you weigh that with the risks of wearing a mask, it seems like that probably, you know, Perspective really outweighs, you know, it's basically like, well, we might as well try, you know, right. It's like we might as well give it a shot. And so it's a different way of reading the evidence and a different way of a different philosophy, really about how to respond to the evidence that you see.

[00:11:42]and so that's, that's really what I am seeing right here is, and I think that that can explain a lot of the, a lot of the divides and disagreements that we've seen throughout the epidemic. 

[00:11:49] Matt Boettger: [00:11:49] Hmm, kind of when you first start off with Theo, there's just like a courtroom scene, kinda just like this, like innocent until proven guilty where it's just like no Intel, Intel.

[00:11:57] It's, it's absolutely proven that it completely [00:12:00] mitigates the spread of this virus. And I am not going to take it, which is one, one way to look at it, but also prevents the opportunity to 

[00:12:09] Mark Kissler: [00:12:09] at 

[00:12:09] Matt Boettger: [00:12:09] least lower it a little bit by, by taking on some benefits of it. Right. Again, it's it's complicated and it's ah, it's okay.

[00:12:16] It's okay. It's complicated. which I think a lot of these, the lot of these, headlines I'm Steven, Mark, you talked about this off the recording are, or kind of aligned in this area. The problems of all of these are just that, the complexity of that, we're all looking for this, this little bucket that we can put ourselves in.

[00:12:32] And it just, it's just not faring well for us to put these things in buckets and it's causing divide. I look at this, this next one, which is again, it's the same reminds me of, okay. So. Little tangent, my wife and I were Dan at the time we were looking at the ocean, it was beautiful, romantic, captivating.

[00:12:49] And we were talking about how could anybody ever look at an ocean and say, Oh, This is nauseated. Like you just couldn't right. And so then we came this new line in this, [00:13:00] that spirit of like, ER, look at the ocean, like same wave, different day, you know, like this is like this idea of like that. It's just like this kind of mentality of, of, of seeing this.

[00:13:12] So, I don't even know where I'm going with this. I totally got into the bit. Where was I on this? Where was I going? We 

[00:13:17] Mark Kissler: [00:13:17] know. Well, I share you in that bewilderment. Okay. I can stand with you on that 

[00:13:24] Matt Boettger: [00:13:24] point. I was going to land this plane and they was going to skyrocket our rates, but we're done. So 

[00:13:31] Mark Kissler: [00:13:31] let me think.

[00:13:32]I mean, you were, you were talking about probably the. I'm seeing kind of the same patterns over and over again. Is that, is that where you were at? Is it, I dunno, maybe so. I don't know. We're going to let it go 

[00:13:43] Matt Boettger: [00:13:43] in this episode. I'm going to come right back to it. 

[00:13:45] Mark Kissler: [00:13:45] I'll remember we're going to land that really 

[00:13:47] Matt Boettger: [00:13:47] we're landed.

[00:13:47] I promise you guys stay tuned. This is, this is, this is my, this is my hanging lip cliffhanger to keep people into the end. This is my cliffhanger. 

[00:13:56] Mark Kissler: [00:13:56] So 

[00:13:58] Matt Boettger: [00:13:58] stay tuned. [00:14:00] So. Related to this, this idea of the complexity and it's complicated. The hydroxy hydroxychloroquine helped save coronavirus. Patients study shows just a few weeks ago.

[00:14:09] Mark, you were just chatting about how, Hey, Oh, this is a big news came about. That's not really that effective. And now we're seeing this and know it is effective. It seems to contradict what's going on here. 

[00:14:20] Mark Kissler: [00:14:20] Yeah. So, I have not, I'll do a deep dive on this study and maybe we can talk about it next week, in, because this is the first time that, it's kinda hit my radar, but I did do kind of a, cursory look at it before we talked.

[00:14:32] And so a couple of things about this study, that are, interesting. So it's a. Pretty big study. It's, multi-center both of which it's a little over 2000 patients. it looks like we're included. And so we've talked about that, that, you know, as we're building higher rigor of scientific evidence, having multicenter trials, having large numbers of patients involved tend to be helpful.

[00:14:51] It is an observational study. So that was something we talked about last time that we really need prospective randomized control trials to determine causation, rigorously and [00:15:00] observational retrospective studies can determine some. Correlation. And it seems at least to my gloss of this, that if they had a pretty decent effect size, with this population.

[00:15:09] And so, so this is, what I, what I see here are a couple of things. this to me is very typical of kind of the March of our scientific understanding. so we have small studies. We have. Observational studies. We have conflicting evidence between the study that was done here and a study that was done there.

[00:15:26] We look at the methods and over time eventually redevelop enough of an understanding, or we do a big enough. Randomized controlled trial to really establish a standard of care. And what we saw early with the hydroxychloroquine evidence was that they were not, you know, necessarily excellently design studies, that there were some issues with some of the methodology or they were small or things like that.

[00:15:48]and so again, we didn't have sort of a Steven was talking about that body of compelling evidence to. Totally change our clinical practice. with regards to that, does that mean necessarily [00:16:00] that there is zero effect size? Not necessarily. also does it mean that the effect is as big as was shown in this most recent study in all populations?

[00:16:08] Probably not. Or maybe not and so more. And this is, this is just how. Science unfolds. it's often unfolds with less public scrutiny. and what's interesting to me, I think in particular about the hydroxychloroquine question is how there seemed to be these teams that have been declared where there's like, there's the hydroxy chloric when Treme and the like, Oh, hydroxychloroquine doesn't work team.

[00:16:33] And, and that adds this whole other layer on top of what is. You know, at least in my side, kind of a typical progression of how we understand therapeutic options, where it's like, Oh, you know, we scored one for the hydroxyl glory continuum or be like, you know, it's like somebody sitting on the, you know, the penalty box on the, you know, and it's just like, I don't know if that's particularly helpful.

[00:16:57]I guess I don't, I don't feel like it's particularly [00:17:00] helpful. I find it interesting. I guess if you, if you can find something that's painful or interesting at the same time, you know, that's I guess, but, but it's not particularly helpful because I think it serves to obscure sort of the nuance about how do we make these difficult clinical decisions.

[00:17:15]and do the best by our patients. You know, I don't want to put every sick patient on every single drug that's been mentioned as potentially having a therapeutic benefit, because that could do harm, you know, put somebody who's already sick on a bunch of new medications that they've never seen before.

[00:17:32] I want to pick the one that has the best effect size, and the most, you know, it at their point in illness and. That just takes a little bit higher resolution data than, than we have. we're getting there we're in a much, much better place than we were in March and April. and this is, this is the process we're just in that process.

[00:17:50]Matt Boettger: [00:17:50] Yeah, I, I created so white hydroxy chloride Quinn pursuit. It just feels like it's a loaded particular. treatment. [00:18:00] It there's a lot of politics behind this. It's like, it's like whoever wins whatever's underneath that associate with whatever platform is, is underneath, that wins the entire platform, right?

[00:18:10] There's this fight for. And so it's a weird reality and he could see, again, it's the whole parasites were kind of already got unfolding. This reality of. There is this March towards advocating the necessity that hydro hydro KMSA hydroxy chloroquine wins the day, which means everything else behind that banner wins the day as well.

[00:18:30] And we're trying to fight for that, and this is creating the complexity of the whole situation. So, yeah, I, it's amazing how this keeps showing up and there's this internal fight for ideologies. 239 scientists call on who to recognize coronavirus as airborne weeks ago, couple months ago, we talked about there's an airborne and the particles.

[00:18:50] And, and now we're seeing this kind of. A Renaissance of going deeper into whether this might be airborne. Is this something we should be concerned about Mark? 

[00:19:00] [00:18:59] Mark Kissler: [00:18:59] just to kind of recap what we had talked about before. So when we talk about, in a clinical sense, droplet spread versus airborne spread droplets are typically larger particles that spread, over shorter distances that gravity grabs them.

[00:19:12] And. Drag them down to the floor more easily. They don't float in the air as long, and requires sort of a different level of personal protective equipment, to prevent the transmission. Whereas airborne particles are smaller. They hang in the air much longer, and kind of require a higher degree of protection.

[00:19:30] There are things that can be done, that aerosolize. Pathogens that are typically spread with droplets. and so if you have a droplet spread a disease and then you're doing something like a positive pressure, so we call it BiPAP or CPAP, which is a, essentially a mask that's put on the, provides a back pressure that helps with breathing, intubation procedures, even the procedure of SWAT, a nasal swab for the testing can aerosolize the secretions.

[00:19:57] Coughing sneezing can create, you know, more [00:20:00] aerosolized particles, but I would think of it more of as, as a, as a spectrum, you know, that they're in a droplet disease, that's predominantly spread through large respiratory droplets. Some particles can be smaller and linger in the air longer. And particularly if there's a lot of aerosolizing things going on at the time.

[00:20:18]and so, It's much less kind of E we think of this as an either or category, but there are instances in which, both can be true. And as we're making tough decisions around scarcity of resources and things like that, and also just kind of the practical nature of how do we prevent spread within the communities.

[00:20:38] I think it's important to. Remember that there is a little bit of a continuum between those categories. and so, yeah, so like, so we'll a cloth face mask, protect the wearer against something that is aerosolized in a, not as effectively, but does it prevent the number of viral particles that that person is transmitting into the atmosphere that could potentially [00:21:00] protect other people?

[00:21:01] And so, again, that's just the nuance nuances of the conversations around how this is spread. I don't know. Steven, do you have anything to add to that? 

[00:21:07]Stephen Kissler: [00:21:07] No, I think it's exactly that you can think about it from the epidemiological scale, for sure too, that, a lot of the. Distinctions that I've seen are, or, or, confusion that I've seen is, you know, is this important to spread as the question?

[00:21:21] And it's like, well, what do you mean by spread? And what do you mean important? could you get it through an aerosolized viral transmission? Absolutely. is that route predominant? Like if we were able to stop all droplet spread, would the aerosolized spread still be able to sustain epidemics? Probably not.

[00:21:36] You know? And so it's like from an epidemiological perspective, yes. Droplets are probably the most important route of spread, and are the ones that are really driving epidemics. But nevertheless, you know, there is this other route that still can cause infections for sure. 

[00:21:50]Matt Boettger: [00:21:50] Great. So I think for me, This doesn't really have a practical implication when it comes to new CDC guidelines or anything like that.

[00:21:57] I mean, the fact that the, who might [00:22:00] recognize this is not going to change really anything that we're practically doing? 

[00:22:02]Mark Kissler: [00:22:02] No, I don't want to see it. It was a big change. Great. 

[00:22:06] Matt Boettger: [00:22:06] Well, here's some really good news for all of you who are not horseshoe, crabs. So listening. So apparently horseshoe, crabs blood is the key to making COVID-19 vaccine.

[00:22:17] Mark Steven. I don't think they had a clue about this. I saw it on this. I just, I do this for inspiration for all of you who are human beings and not crab crabs. She's listening to this podcast right now that be thankful you're a human and not a crapshoot, a horseshoe crab. Cause, they are about to be, to be mined.

[00:22:34] Mark Kissler: [00:22:34] I needed another reason for that. 

[00:22:37] Matt Boettger: [00:22:37] The inspirations to be thankful to be human. Right. There's another one. But outside of that inspiring note of our humanity and not being a horseshoe crab, is there anything here that you guys know about the, what this is coming from? Dead silence. So  

[00:22:56] Mark Kissler: [00:22:56] outside my scope.

[00:22:58] Matt Boettger: [00:22:58] That's fine. We're good. [00:23:00] Just a moment. Okay. A couple more small things now, coven 19 outbreak, university of Washington, Greek row. I think this really kind of hints of this idea of the complexity of fall when school resume is particularly with. I think it's a universities. I mean, any, any school is going to have it, but a universities we know it's the time for exploration, Hangouts, connection, those kinds of things.

[00:23:25]I, I can't imagine college students wearing masks to their parties, that kind of stuff. So I expect in the midst of the natural tendency that we're seeing with rises and cases among States that a university towns like Boulder, Colorado, I think in particular for me in my mind, cause it's a small town.

[00:23:43] It's a small town that when, when college comes, it's nearly doubled the size of the town. Right. so that's a large population coming in that has a different kind of culture right behind it. so I imagine this fall is going to be, Steven, are there, is that kind of similar expectations you guys are seeing [00:24:00] or talking about at Harvard?

[00:24:01]Stephen Kissler: [00:24:01] Yeah, definitely. I think, yeah. we're watching these sorts of things pretty closely. I, at any time you bring a lot of people together. There's, you know, a very good chance of an outbreak is getting started again. So I think that you're at universities in the fall, or especially a big point of concern.

[00:24:16] Matt Boettger: [00:24:16] Yeah. Okay. I saw this article. It was interesting fever checks. Can't catch all, which is, I think common sense, common COVID-19 cases, but smell tests might help. Mark w you know, what, what, what kind of a process would this be and how could this help? 

[00:24:31] Mark Kissler: [00:24:31] Yeah, so again, one of the weird things about this virus is that it seems in a lot of cases to affect taste and smell, as well as.

[00:24:39] You know, our typical upper respiratory or lower respiratory tract, infectious symptoms like cough, fever, chills, and then also the GI stuff. So diarrhea is all that we know. this is interesting to me in the sense that, so something I like to think of when I'm making diagnostic decisions in the hospital, are the likelihood ratios that are associated with various.

[00:24:57] Tests or maneuvers that we do. [00:25:00] So for instance, if you have somebody who comes in with a cough, there's a lot of things that can cause a cough and I can start to narrow my differential, based on the likelihood ratio of various tests. and so, you know, say I'm trying to figure out if it's an ammonia, or if maybe they have too much.

[00:25:15] Fluid on their lungs because they have a heart problem. and there's different things that I can do, you know, and you know, every physical exam maneuver has more or less a likelihood ratio, every lab test, every radiology study, no, these aren't necessarily perfectly defined, but you can get a general sense of, is this a good test that helps to narrow the differential diagnosis?

[00:25:34] So does that, that kind of concept. Makes sense. The thing that's interesting to me about the likelihood ratios is that you can actually stack them. So if you have multiple tests in a row and you know, the likelihood ratio of each and the, you know, so you have a positive test here, and then the next test you do is also positive.

[00:25:54] Now you can stack the likelihood of arriving at the proper diagnosis. And so [00:26:00] that's what I see going on here. Sure fever is not going to catch everybody and it never would. but if you stack another test that has a good, a favorable likelihood ratio, and that's also, you know, positive or negative in a way that's helpful.

[00:26:11] Now, all of a sudden we're gaining more resolution in terms of our ability to catch what's going on or see somebody who potentially is early in the course of illness and might benefit from that. Going to work that day. so it's good. It seems like sound, sound advice. You know, I think implementation is going to be tough.

[00:26:28] I don't know if we get like male scratch and sniff out to like everybody or what, but yeah, 

[00:26:35] Matt Boettger: [00:26:35] but definitely tricking with like a scratch to sticker. 

[00:26:37] Mark Kissler: [00:26:37] Right. Well, I'm sure the boys love it. Right. Thankfully it didn't smell of freshly cut grass. There we go. 

[00:26:45] Matt Boettger: [00:26:45] That's more cute. That's more humane. Yup. Okay. That's yeah.

[00:26:49] That's that's good. So, okay. Before we get into the deep dive, your third grade teacher. We talked about last week. Emailed us. Thank you, Kirsten for emailing. it's good to hear from her. 

[00:26:58] Mark Kissler: [00:26:58] I heard some great stories. It's so [00:27:00] great to hear. It's just like really, it reminds me of a lot of the good memories that I had in that class.

[00:27:05] And also at the elementary school in general, I just had a, the teachers, there were super awesome and supportive. and she's, you know, one of the examples of the, the best of the best. So it was super cool to get back in touch with her this way. 

[00:27:18] Matt Boettger: [00:27:18] But yeah, it's been fun to read them and I will obviously read it for the, keep their humility, but a you learned, I learned a lot, these, these, these two cats are incredibly intelligent, smart people that even at kindergarten, I think they were probably reading college level, you know, literature, that kind of stuff.

[00:27:34] So, yeah. 

[00:27:38] Mark Kissler: [00:27:38] So there's a practical wisdom component. 

[00:27:42] Matt Boettger: [00:27:42] Those those two go together, guys. I mean, really smart people oftentimes get lost. So 

[00:27:49]Mark Kissler: [00:27:49] I hope my wife's listening to this episode. We'll talk about that. It's a running, running issue in our families.

[00:27:58] Matt Boettger: [00:27:58] But she had some good questions. [00:28:00] She, she is a teacher, to teach, teaches homeschool stuff and science, and I don't know all the just sort of, but she has some concerns coming up this fall, that I want to throw. She, one thing is, is struggling with the idea of students or teachers getting sick and what to do.

[00:28:12] And I could see that, I mean, it's fall. Kiddos are going to get sick and they're going to have, like you just said, I think it's a great segue, that stackable thing they're going to have all the symptoms, the runny nose, the cough, the, you know, th the, the diarrhea, you just closed up shop every time that happens.

[00:28:26] Otherwise, you're going to get nowhere. So she's looking for some guidance of like, what do we do when we see a student or a teacher gets sick and still keep our classes going? Any, any, any insight? 

[00:28:38] Mark Kissler: [00:28:38] yeah, I think I'm interested to hear about Stephen's thinking. Cause I think there's a couple questions here.

[00:28:43] One of them is, w how much are we concerned about the transmission that's going on amongst pediatric populations? In general and what that's going to do potentially for populational rates. because as we've talked about, this is kind of a somewhat unique pathogen in the way that it affects kids. and so I [00:29:00] think I'm interested in hearing that, and I think we can riff a little bit on some of these things, maybe see when you've been involved in some specific conversations with that, you know, I've seen some of what.

[00:29:08] Our Denver public school district is doing based on the recommendations of our local public health experts. but it seems like this is something where if one is in a position to be making these decisions, that you should seek out a lot of different opinions and a lot of different models about how this is going on, and then try and adapt that best you can to what makes sense, given your own constraints and things like that.

[00:29:28] So I think that there, this is one of those tricky things where there may not be one. Best answer for the specific situation that you're in. But if you see what all the, you know, all the school districts around you are doing, what some of the experts, you know, like from public health, places like Steven or recommending things like that, then maybe it can come up with something that's as good as possible.

[00:29:48]given the, you know, all of the things that we have to weigh, in this time. So, I don't know, Steven, you have any thoughts initially just about kinda like schools and how to handle. Things like sick kids, social distancing in the [00:30:00] classroom, stuff like that. 

[00:30:01] Stephen Kissler: [00:30:01] Right. I mean, definitely like, depending on the size of the school or the organization, I mean, there, there are different opportunities to have conversations with, with probably, I mean, in this case, probably the parents and sort of just like the level of risk that you, as a small community, Are willing to deal with.

[00:30:15] And, and what sorts of communication do you want when someone does become infected and what sort of provisions will there be for students who, you know, if their parents decide they want to take them out of class for a while, for it, to, for the protection of their family? Like how, how do we deal with that?

[00:30:28] And so I think, you know, every action that we have is going to come along with some level of risk, whether it be from infection, with COVID or something else. And so I think, just being up front about that fact, and then just thinking about sort of like, what, what are the levels of risk that we're willing to tolerate and what sorts of behaviors can we, Can we then partake in, given those levels of risk and how can we allow people to sort of also, choose which levels of risk they are comfortable with within this broader community to allow like broad participation.

[00:30:55] So, I, yeah, I think that that's, That's one way of looking at it. I do hope [00:31:00] that over the next few months, you know, people are really getting their heads together to think in particular about how to bring schools back safely. and there's just a, some work that recently came out. Actually it was, led in part by a professor at CU Boulder, Dan Larimer, shout out to him.

[00:31:14]and with collaborators back here at, Harvard school of public health and talking about how, Yeah, there, there are very cheap tests for COVID the paper based tests, but their sensitivity is really bad. So, you might take the tests and still get a negative, even if you're infected. But the idea is that it's this similar to what Mark was talking about, about building up, you know, sort of, the, the increase in, in these likelihoods that if you're taking the test repeatedly, if these tests are being done every day or every three days, and everybody in the community is doing, then you can still catch outbreaks very early.

[00:31:43] And then you can make decisions based on that. And so this sort of like paradigm of rapid cheap testing, even if the accuracy isn't that great, is one thing that is really being considered and I'm, I'm hoping there will be an ability to sort of bring these sorts of things into implementation in schools and universities.

[00:31:57] This fall to sort of [00:32:00] help us constrain outbreaks before they get too large. 

[00:32:02] Matt Boettger: [00:32:02] Hmm, is there before we go to the next question, is there anything like the CDC, I mean, Brock, you were saying there schools who are attacking this problem, but it seems like this is like a, a national problem that needs to be addressed at some central location saying exactly what you said.

[00:32:16] Steven. That's a great idea incorporated with two or three other things can help really limit the amount of transmission. Is there, is there any place you guys are aware of? That's like, I mean, Harvard, do you guys have a plan that you're there doing research or does somebody. Have something that we can present in the show notes or something like here's an idea by what you can engage an educational system and mitigate the transmission and a pretty easy way at one, two, three way.

[00:32:41]Stephen Kissler: [00:32:41] Yeah. I don't know. I don't have any resources off the top of my head, but I do know where I would look for them. So I'll do a little bit of research into that after the podcast 

[00:32:48] Matt Boettger: [00:32:48] and see some of the show notes and or those we'll talk about next week, at least put it in next week. Yeah. next one, she was talking about the idea that a lot more people using bleach and sanitizers.

[00:32:57] I see it on Facebook. all these kinds of alcohol [00:33:00] exposures, a lot of chemicals, her concern is will this bring a rise in cancer later on? Yeah. Is there, is there a threat to this? 

[00:33:07] Mark Kissler: [00:33:07] I tend to think of the risk of, bleaches and alcohols to be more of a, kind of a short term exposure risk. So with things like ingestions, or, you know, if you were to aspirate some of it and you get some inflammation in the lungs or.

[00:33:21]things like that. I do these, these are not substances they're, you know, there are substances that we know are really carcinogenic, and longterm exposure to those can create an increased rate of cancers, but in terms of the sanitizing chemicals, particularly bleaches and alcohols, I think of those more in terms of just the, the immediate risk, you know, that they can be kind of caustic or your.

[00:33:44] Irritating, you know, kids, you have to always watch, make sure they don't put things in their mouth and stuff like that. but it's less, less a risk. you know, they're not known to be highly carcinogenic chemicals, that we're using. So, you know, the chance of causing [00:34:00] cell transformations that lead to cancer later, is a much lower risk.

[00:34:03] It's not really something it's not at the level of a risk that I would even worry about. Okay, 

[00:34:09] Matt Boettger: [00:34:09] great. Which will lead to the last question, which is similar. And I think her concern about masks mask wearing for a long period of time. I know I've had a couple people, share the same concern and why they're not wearing massive, heard that a longterm mass can create tons of lung issues down the road.

[00:34:23] And that five, 10 years from now, we're going to have this, a new epidemic of lung issues that are gonna be chronic. and then on top of this talks about, you know, Yeah, try to get kindergarten is where mass all day. They just, they use them as puppets, right? They're not good for them around their face. So, one of the longterm effects of this, it is this something that could be concerning down the road.

[00:34:40]Mark Kissler: [00:34:40] Yeah. I mean, I think there's, so the short term effects, I'm just anticipating what it's going to look like to have my kids trying to wear a mask all day long. And we were like, we're going to need like eight masks a day. You know, they're going to get ketchup on them and they're going to like drop them accidentally in the gutter.

[00:34:57] Like this is just going to be a thing it's going to be tough, [00:35:00] you know? and, and again, I think. Remembering that a mask is not the only or magic bullet. but this is just one in the chain of all the things that we try to do to help each other out. and you know, it's one of the things that's, that's uncomfortable that we can hopefully tolerate a little bit and every time we do, maybe it helps them.

[00:35:18]and it's not going to be the single variable that changes. You know everything. but as much as we can do it, it could be potentially helpful, you know, in the school settings. We'll see. I've seen a lot of conversations about the risks, you know, that this poses a bigger health risk than infectious diseases.

[00:35:33]and, so I think where I have seen, I was trying to figure out where that was coming from, you know, where this idea, cause we have like surgeons wear masks all day long at work. You know all the time and that's not something like it's not as a free see higher rates of chronic lung disease necessarily, and you know, that kind of population.

[00:35:52] So I'm just kind of trying to figure out what the concern of the mask is. And it seems what I've seen is at least it's coming down to the ideas of, lower [00:36:00] oxygen levels being inhaled or higher levels of carbon dioxide. and so those are two kind of classic. Pulmonary issues, right. Hypoxia and hypercarbia as we call them.

[00:36:09]and, so yeah, it is bad, you know, to not get enough oxygen or to get too much carbon dioxide in general, but there are ways that our body compensates for slightly reduced levels of those. So the way I think about like a hypoxia, I actually, to be honest with you, I think of hypoxia the low oxygen levels as a much lower.

[00:36:26]it's, it's almost negligible with the masks because the is you think, you know, if you think about it, you're sucking in the room, air through the mask and it's not filtering out oxygen molecules. So the percentage of oxygen molecules that get in, through the mask are the same as. Or on the outside of the mask.

[00:36:42]and even if it was a little bit lower, it would be comparable to maybe going to altitude or something. Cause that's another common scenario in which we encounter fewer. Oh, two molecules floating around is just when we go to, to altitude. And we tend not to worry about that when we go up for weeks at a time even, because our body compensates [00:37:00] for a lower level of, inhaled.

[00:37:02] In a fractional oxygen hypercarbia is a little bit of a different issue. So we breathe out carbon dioxide and the mask potentially can trap some of that in the area, close to our nose and our mouth where we're breathing it in. And we're recycling that more. one of the ways that our bodies, when we're healthy compensates for that is you just increase the amount that you're breathing.

[00:37:22]and so by increasing your tidal volume or your respiratory rate, your. Blowing off more carbon dioxide and you can help to compensate in our body does a really good job when we're healthy of compensating for that. and making sure that we maintain a safe physiologic level of carbon dioxide in our bodies.

[00:37:40] There are certain individuals, especially those who have very, very severe like chronic obstructive pulmonary disease or emphysema or something like that who are already hypercarbic at baseline for whom having a mask on. It has a theoretical risk of maybe pushing them a little bit more over the edge in that direction.

[00:37:58]but these are folks that I think of [00:38:00] generally, as you know, these are individuals who are very sick from a respiratory standpoint to begin with. and you know, for them weighing the risks and benefits, those might be individuals who might have to focus more on really, close social distancing, or, sorry.

[00:38:14] That's a little misleading on a very attentive social distancing, right. Because they don't want to get it. At all because of the baseline lung disease. I guess I, I tend to think of the degree, the amount that we're wearing masks and the amount that we can breathe through the masks and sort of the permeability of the cloth and paper masks that we're talking about using most of the time is not posing a big risk and kind of a global populational hypercarbia.

[00:38:38]lung issues showing up in the next few years, that seems less likely, given sort of, you know, everything that we've seen and what we understand about masks, 

[00:38:48]Matt Boettger: [00:38:48] correct. Steven, anything to add about that epidemiology? Nope. I, Yeah, you have to like it, it seems, yeah. Kind of just kind of strange for this kind of information being presented at.

[00:38:57] It was concern I've drunk. So I'm like, I make [00:39:00] my surgeon like I, man, I would never want my surgeon to be lightheaded at any point.

[00:39:07] I really want him to be particularly on his game on that day. 

[00:39:11] Mark Kissler: [00:39:11] And they are uncomfortable, you know, I think they there's all these other social things. Right. It feels uncomfortable. It creates this barrier in her personally. It's this thing you're wearing on your face. That's sort of a symbol of, the, I think people feel it's either a symbol of fear or it's a symbol of compliance or a symbol of like being a good citizen or simply being, you know, whatever.

[00:39:31] And so, so I think that all those things get wrapped in. You know, the one other thing I've heard mentioned is that it lowers your immune function, that it makes your immune system not work to wear a mask. And that I'm not like I can't tie a physiologic explanation to that claim. I don't know exactly where that would be coming from as far as I can tell.

[00:39:49] That's just totally false that there's no direct effect on the immune system related to wearing a mask though. That's something I've seen come up a lot of times, so. Okay. 

[00:39:58] Matt Boettger: [00:39:58] Well, speaking of Paris [00:40:00] science. so, let's, let's, let's talk about this for a few minutes because it's going three to me. So how this came about was about three weeks ago, I read an article or I didn't get it all the way through it.

[00:40:10]called lockdown lunacy, the thinking person's guide. Yeah. The thinking person's guide. Right. So, and it went through a number of facts. That's all based on science. And, I think had to do some of the footnotes behind it and I read it and even having this, this podcast was, it was rather convincing.

[00:40:26] So I threw it to Mark and Steven, they, they kind of looked it over and this is where we came. It's Mark presented the idea of talking about Paris science said, taking scientific information, right. To kind of recalculate it in such a way to present a particular conclusion. And so what I want to throw to you guys is I wonder the difference between, so I took some philosophy classes and pre the pre Socratics, and he had this idea of sophistry and this whole argument of what is true.

[00:40:48] And then you had the sofas come on. And he, they believed that pretty much the truth doesn't really exist. And it really is all rhetoric and art of persuasion. So it's kind of taking information and presented in such a way that you can persuade someone into your side. [00:41:00] And that's sophistry. And so I kind of know what's between selfestry and science, because it's hard for me even to distinguish, because when I read this stuff, it seems logical.

[00:41:08] It seems to flow. yet when we talk about things, once we get into the podcast, like, Oh, okay. I see, I see. I see. How can, how can we help our listeners? See the difference, you know, I just see, you know, ran Paul on top of this. I'm not helping the situation and, you know, understanding kind of where he's going basically saying not to trust the experts.

[00:41:28]and a lot of the reasons because you know, he proposes, or at least the article that talks about his quote unquote, is that this idea that experts has such a narrow niche by which they can many times, or maybe sometimes not include some other information that needs to be included. Or they go beyond the scope of their expertise and say things they're not qualified to say which then errors.

[00:41:48] And they make conclusions that are wrong and not comprehensive. So thus don't trust the experts. So we have don't trust the experts. We had city of Paris science people coming together. How do we know the difference [00:42:00] between Paris science and science itself? 

[00:42:02] Mark Kissler: [00:42:02] Yeah. I mean, I think that's a great. That is the, that's one of the big questions that's going on right now.

[00:42:07] And we're all trying to figure out. it's, we're just seeing the effects of that, big time. So I want to, so of science is a term that I, you guys know that I really like Marilyn Robinson, Who's kind of Novelis SAS, public intellectual, and she, derive that term in one of her books. and so I think the way that we're using the term may be a little bit less just for the sake of precision of language is a little bit different from the way that she was, she was using it.

[00:42:30]but the idea is still being that you're using scientific language and you're appealing to a certain scientific authority, but you're actually. Promoting or using that to promote something that's not necessarily a scientific, but it's really a philosophical position. but claiming that it's science says that, and this is, you know, it's, it's super tricky and this becomes very slippery, especially in matters of health and public health.

[00:42:52]and so I think we've talked a lot about the ways that this is. Complicated. I think, you know, when I look at an article, like the one that you [00:43:00] sent that kind of goes here, you know, study by study or abstract by abstract, this abstract says this, therefore, you know, and then sort of weaves together sort of a meta narrative about what is true and what is not true.

[00:43:13] I think the misleading thing is just the way that different bits and pieces of evidence are used, to create what seems to be a coherent narrative. Whereas each of those bits and pieces of evidence sort of exist in their own, in their own setting, in their own context. You know, some of them are more and less rigorous.

[00:43:30] Some of them are, speaking to slightly different problems than they might be. You know, seem to be speaking to, but then you kind of piece those together in a, in a craft delay, rhetorical way to make a case, that can seem very compelling from the outset. so that's, that's kind of naming, naming the problem and naming sort of this category of trying to flesh out what we're meaning when we're talking about.

[00:43:53]that you're using that word pair of science. So I don't know. Maybe I'll throw it to Steven for a little bit and see if he has any thoughts sort of specifically [00:44:00] about to your question, Matt, of, of how, how do you tell the difference or what does this mean? You know, even granted that a lot of our scientific decisions and policy decisions are not quite so siloed, you know, that there are a lot of things that are kind of going back and forth right now in both of those worlds.

[00:44:15]Steven, how do you approach some of those things? 

[00:44:17]Stephen Kissler: [00:44:17] Yeah. So, I mean, one thing that comes to mind is that, there's in thinking about the distinction between science and pair of science, From one perspective, we were all kind of engaged in a pair of science of sorts because they're just, just by virtue of our own histories and our own, presumptions about what constitutes evidence.

[00:44:35] We're going to favor certain types of evidence over others. we're going to simply omit bits of evidence because we don't know about them. and that will lead to the perspectives that we have as, as experts, as scientists about a certain thing. but I think that that actually calling it parasites takes one step further because I think that that implies also a certain intentionality.

[00:44:52] About it as well. and I think that that's, you know, that's again important because science and w w we, we think about sciences as, [00:45:00] as you know, this, this, Sort of it, oftentimes it's very pure thing and this thing that's based on facts, but really, really science is just another field of narrative. And we're all trying, you know, the, the only way that we can communicate science and the only way that we can interpret science is in the context of a narrative, because that's just how our minds work.

[00:45:15] And so necessarily all of us as scientists, when we're writing papers, we're writing stories, we're writing stories about what we think the evidence. It's showing us, that I think the most important thing is, is, you know, trying to, as a scientist to be your own strongest critic. and I think that there there's a certain amount of intellectual rigor and honesty that comes with that.

[00:45:32] And that's a real challenge. and something that I'm still, still very much working on and in training for. but there's, you know, the, that. The most important thing you can do as a scientist is to try to break down your own arguments. And I think that that's the best safeguard as a scientist against producing things that are like parasites.

[00:45:49]Mark Kissler: [00:45:49] Oh yeah. I want to, I want to go back to that idea of, in some of the, like the intellectual humility and stuff like that, but I want to put a little pressure or back, or just push back a little bit on this idea that science is another [00:46:00] narrative, because I think that can be misleading. You know, I think for someone who's steeped in like rigorous science, you can say that and, you know, and be kind of engaged in thinking about it that way and in a fruitful way.

[00:46:11] But I think it's important to say that there are some pretty important differences too, between science and storytelling or science. And, you know, these are the things that there are appeals to objective evidence. Right. And so I want to, I want to just make sure that, that, that we don't go too far in terms of just saying like, you know, sciences is just another story that we can tell about the world, right.

[00:46:32]Stephen Kissler: [00:46:32] Right, right. It's a, it's a, it's a story. it's a story that, that is sort of subservient to, and, and. Answers to the world in a particular way. It's like a story. It's a story that's tested and a story that changes. If, you know, if your observations don't, don't align with, with what the story is saying. So, so it's like, I think maybe a better way of saying that is that the tools of narrative allow us to communicate our science 

[00:46:58] Mark Kissler: [00:46:58] standards.

[00:47:00] [00:47:00] Stephen Kissler: [00:47:00] Right. That's that's the thing, but yeah. Yeah, that's it, it's the way of like interpreting and understanding. 

[00:47:06] Mark Kissler: [00:47:06] I like that. I liked, I think, yeah, keeping those categories a little bit distinct in the sense that, the science is this thing that, that corresponds to the world that is testable, that has a certain objectivity to it.

[00:47:18] Right. but then in translating that science immediately, you know, to a way that we understand we're already employing. The tools that we use to understand other things in our lives. the, the foremost of riches. Narrative and story. Right. and so I think it just to, just to create a little bit of distinction between those categories, if that's fair.

[00:47:39] Cool. Yeah. And so, and, and so I think, and your point, Ben is well taken that, that in what we're calling para science, there's an intentionality to creating a narrative that not doesn't necessarily the, the, the commitment there is not necessarily that it, It is an accurate representation of the world, but rather than it's the accurate representation of an idea [00:48:00] or a position, and that's kind of a different potential frame to using scientific language and writing, right.

[00:48:08] Is that fair? Is that I think, yeah. I want to make sure I know what you think, Matt. I just want to throw that, that half back to you before. Relaunch relaunching then the next part. 

[00:48:17] Matt Boettger: [00:48:17] No, that's that? I think that's great. I mean, before I go on, Steven, did anything to add you continue on before your thoughts before I have a couple of things.

[00:48:24] Stephen Kissler: [00:48:24] Yeah, maybe, maybe just one last thing, which is, you were talking about distinguishing between science and pair of science. And I think that that bearing these tools of narrative in mind can be very important because I think that sometimes the, the, the. The most obvious way that para science shows itself as in the way in which those tools of narrative are employed.

[00:48:45]and so for example, in, in, in the article that, that we were talking about here in many other articles that I think I would classify as parasites, there is sort of this notion of, of saying basically this is how things behave, and this is how this act, and this doesn't [00:49:00] act this way, and it is this and, and not this.

[00:49:02] And I think that that's a very. Unscientific way of writing. Not because it's not the style of science, but because it's not the way the world works because the world is, is basically never, you know, even see how I said that. Right. I was going to say the world isn't ever so dry, but I don't even speak in those kinds of absolutes.

[00:49:18] Right. I'm not, I'm not even so sure that the world is not absolute. That I'll say it absolutely. That the world is not absolute. Right. Like that's true. That's the kind of, of scientific sort of like that. I think science sort of shapes your mind and your world view in that way. And so as if you're reading a narrative that has those kinds of absolutes, I think that that's what starts ringing alarm bells for me, because.

[00:49:39] True scientific writing is always steeped in caveats and, complexity, because I think that that's, that that's, that's the honest, the most honest way of seeing the world. And so if you don't see that, then that's, I think it's a good clue that maybe there's something else going on. 

[00:49:54] Matt Boettger: [00:49:54] Yeah. And I think I might make the distinction between absolutes and complexity.

[00:49:58]I think that the, so, [00:50:00] so one things I'm thinking of is that the, when you come to science and the there's between science and parasites, now, again, this is out of my pay grade, but so I'm gonna use my master's here too. A story that came from this and you know, for me, I feel like Paris science, the priorities is overstory.

[00:50:16] Over science. Whereas I think science is the priorities over science over story. Now here's my, here's my best illustration I can get to this. I was, I was presenting an, a, basically a thesis for my masters and I was studying in Greek and I was trying to explain this logical transition in this book. And I, and I was trying to show that this word is Greek word.

[00:50:34] Was a, was a logical transition, and not a temporal transition. So it's all, it's all technical. Right. So I was trying to try to argue this case and I did it pretty well. And then some guy, and I didn't have the right answer to this point in time. So I looked like an idiot, but in hindsight, I'm like, Oh, I should've said this.

[00:50:48] I would have won the case. Right. So I explained my case. So this is a logical transition. But so then the guy raised his hand and says, well, if there's a logical transfer, if you're saying that this is all about a logic, what a [00:51:00] premise state, a premise B, then why is there temporal language in the first part?

[00:51:04]And if you think it's logical and I'd have an answer. And then after I was like, Oh, I'm an idiot. Of course there's temporality. Just because they call it a logical transition doesn't mean that there's not temporarily. There's actually things that deal with time in an argument. What I was trying to advocate is that the focus for the transition is a logical.

[00:51:22] Focus, not a temporal transition. Would you for money people you're thinking this makes no sense, but for the argument, it hinged on this, like for my case, it hinged on this. And I wasn't trying to say either, or I'm just saying yes, they both exist. But the enthesis, the emphasis for the person's argument as an illogical transition.

[00:51:39] And so from my mind, I'm thinking maybe this is kind of the thing. Have you been in pair of science and science? That's the emphasis. Whereas when I look at this law, this law, this lockdown lunacy article, it seems that really the focus is story. I'm trying to portray a story. Right. That, that, that, that has a particular conclusion.

[00:51:55] And I'm going to find science to try and back that, that story [00:52:00] versus the, the, the I'm going to do science and then, and do my best to do science. And then from that science, I'm going to weave and fabric a story from that data. Would that be a fair assessment or is that oversimplification? 

[00:52:12]Mark Kissler: [00:52:12] Yeah, I think that's good.

[00:52:13] I'll have to think about it a little more, but I'd like that. and especially in terms of just the initial kind of the sense, like when you're, if you're talking about practically, how do you start to make that distinction of just like, just being attentive to, questions of like John NHRA and the way that the story is being told.

[00:52:32]and in what serves, what, you know, is the science being made to serve this kind of overarching argument? or otherwise it's, it's complicated. It's super complicated, but I think, I think that could be a helpful way of thinking about it. 

[00:52:44] Matt Boettger: [00:52:44] Yeah. And I just, I think as like a story as being a thing that softens the edges of life, And it really needs to do that.

[00:52:49] Right? The purpose is, is tell a story that they, you can comprehend an edginess. You can't comprehend. So again, the best way I can explain this are my sons. I teach them paratroop okay. [00:53:00] And the reason why I teach them paratroops is because they can't really handle all the science behind some of the stuff.

[00:53:04] We just talked about camels yesterday, about how they can hold water. And for my son, they, they never drink water. They just won't drink water because cause they can go for such a long time. For him in his mind think goes such a long time. They're going wild. They just don't drink water. I can't convince him because I'm like fine.

[00:53:19] You know what we'll get to this pair. Truth is okay right now simply I have a story about a camel that goes eight or nine months without drinking water. He never drinks water. Right. So it's okay. That's the story. And as he grows, I can fill it with more science and then re re re re reformed the story in light of the science that he can comprehend.

[00:53:37] You know, I kind of thinking in that. That method again, does that, does that ring a bell to anybody or am I just in my own world right now? Loving what I'm thinking? 

[00:53:47] Mark Kissler: [00:53:47] I mean, what I, what I hear I think is what it is that we're all in it, you know, all of us, including, I think a lot of our listeners too, are in this process of, trying to engage with a lot of [00:54:00] honesty.

[00:54:00]what's going on around us. Right. And so there's lots of different ways and metaphors we can make about, how, like, how do we. Come to a collective understanding of what's real and what should we do? Right. Cause those are, those are kind of the big questions that are operative right now is like what's going on and what should we do about it?

[00:54:17]and there's huge amounts of disagreement and, and tribalism and things like that that are playing into that. Their science is playing into that there's anecdotes that are playing into that. And all of those have a certain degree of legitimacy. And we're trying to put that hierarchy together. Each of us for ourselves about like where to, who do I trust?

[00:54:33] How do I trust? What do I trust and what do I do? and so what I'm hearing, you know, I think even, even if our individual kind of metaphors or our individual grappling with that, doesn't necessarily map to, to everybody. I think we're what I'm hearing is the engagement in that process. Right. and, You know, ideally it would be great if I had, you know, a single answer about like, this is how you do that.

[00:54:53]but it, it's very much more about, I think being in that process and trying to be really, really honest and trying to get better and better at it [00:55:00] all the time. and I think being really committed to that process, as a process, it seems to me to be operative right now. So. 

[00:55:07]Matt Boettger: [00:55:07] That's great. I think we'll end on this because it's getting late and there's so much more, I'd like to, I wanted to go at the lunacy lockdown, pick a couple of the facts out to have Steven look at them.

[00:55:14] We've done this many times over that, the same kind of arguments, but just to use as an illustration in my mind, why I'm wrapping this stuff around to this kind of story priority versus science, is that in that. exposition that this, this gentleman wrote, it looks as though over and over, there is a softening of the edges of the scientific research that end up portraying in a particular case for him.

[00:55:35] And in the end, I know we say this tongue in cheek, but it actually has a serious concept. And it almost a principle I'm now living by you guys. I'm like I'm so I'm creating these core principles in my life and I think it's it's okay. It's compact. It's become a very core principle that yep, absolutely.

[00:55:49] And dah, dah, dah, dah, dah, dah, dah, dah, dah, dah, dah. And there's all these different caveats, right. And that's life and that's okay. And it's beautiful. And the more you surrender to it. I think the more freedom I feel [00:56:00] and engaging real genuine dialogue. I mean, that's, that's what I'm feeling. So we've got in now it's 59 minutes in, this is the longest episode ever.

[00:56:08] My wife is calling for me to come upstairs. She has a class that she has to go to. thanks for hanging in there, guys. It's been awesome. I love this episode fund to go deep dive on this stuff. again, you can reach out to Steven Ste PHE and KSS LER on Twitter, [email protected] Let me know how things are going your side of the world or country, wherever you may be.

[00:56:26] Check out living the matters. Get that free template and have a series of emails that will be going out or should go out automatically tell you how to get going and do something great in the next three months of this of your life. And we'll see you next week. Take care. Bye bye.