0:02

As

0:04

with all things, it looks very different in retrospect

0:06

than how it felt as it was

0:08

happening. In the early days of

0:10

the pandemic, I could see what

0:13

was going on both here in the US and in

0:15

Europe and started talking

0:17

openly about how we were far

0:19

behind. We had to clock flat footage that

0:21

we had missed a window of opportunity to really

0:23

get this virus under control. If

0:26

that voice sounds familiar, it's probably

0:28

because you've heard it before starting

0:30

in the early spring of twenty twenty

0:32

and basically ever since. My

0:35

name is Ashish Shah and I'm the COVID-nineteen Response

0:37

Coordinator for the White House. Doctor

0:39

Ashish Shah didn't intend to become

0:42

a household name. When the pandemic

0:44

began, he was head of the Harvard

0:46

Global Health Institute. But

0:48

as a public health expert, who'd spent a

0:50

long time researching pandemic

0:52

preparedness. He was in high demand

0:55

as the novel coronavirus hit

0:57

and kept on hitting. Oh,

0:59

the first few months, march

1:01

through June was just crazy.

1:04

I probably was getting about two to

1:06

three hundred media requests a day. And

1:08

basically, it would start at six AM

1:11

and go to eleven PM, initially

1:13

seven days a week until I just realized

1:16

I can't keep going. So I started taking

1:18

Saturdays off, which was good. Ashish

1:20

was on TV, on the radio, on

1:23

Twitter, basically everywhere

1:25

you looked or listened He was

1:27

filling a void that in his view,

1:29

never should have existed. I really felt

1:31

the primary source of information. good

1:33

information would be coming from CDC

1:35

on daily basis. Some ways that just

1:38

never happened. And what

1:40

initially was a couple of weeks of

1:42

media just exploded into

1:44

months and months and months. And

1:46

at some point, three, four months in,

1:49

I actually wondered is this

1:51

all

1:52

useful.

1:56

The public health responds to an emergency

1:59

like the COVID-nineteen

1:59

pandemic is

2:01

multifaceted. One aspect

2:03

is communicating with the public as

2:05

Ashish found himself doing. Another,

2:08

of course, is what to do

2:10

about the emergency. And this

2:12

is where things can get tricky for scientists

2:14

like Ashish and like myself who

2:16

rely heavily on data.

2:18

There's

2:18

no question in my mind that there were a lot

2:20

of missed opportunities for gathering

2:22

more evidence. And it means

2:24

two and a half years later, we're still making

2:26

certain policy decisions. less

2:29

than ideal data.

2:32

From the Freakonomics Radio Network,

2:34

this is Freakonomics MD. I'm

2:36

Bob Pujena. Today on the show,

2:38

my friend and former colleague, doctor

2:40

Ashish Shah, talks about making

2:42

the transition from academics to

2:45

politics. One of the things that you

2:47

realize is you can have absolutely brilliant

2:49

ideas that just cannot

2:51

be implemented. We'll discuss why

2:53

some of those ideas aren't necessarily

2:56

going as planned. And also,

2:58

what can happen when you lean into

3:00

the unknown? I think acknowledging

3:02

uncertainty doesn't create

3:04

panic, I actually

3:05

think it breeds trust.

3:21

Hey, how are you? How's it going? Good. Good.

3:23

How are you? Good. You're looking good. You know, I'm

3:25

always looking good. Yes. That's

3:27

what I say by myself. Before

3:31

he became the COVID nineteen response

3:33

coordinator at the White House or

3:35

the COVID Jar, as some people call it,

3:37

Dr. Ashish Shah had an even

3:39

more important job. You and I,

3:41

Cotai, quality of health care in

3:43

America, a super popular course,

3:46

I'm assuming the popularity was because of me

3:48

and not because of you. I just have to

3:50

say that after you left and I'm I'm

3:52

not saying this is causely related to

3:54

you leaving, the evaluations they

3:56

just went through the roof. You've never seen them so high.

4:00

I am deeply skeptical of

4:02

this. Ashish

4:04

was born in India where he lived until

4:07

he was nine. His family made

4:09

their way to Toronto and then to New

4:11

Jersey. He went to medical school

4:13

at Harvard where he also got a master's degree

4:15

in public health. After that,

4:18

Ashish spent a lot of time thinking about

4:20

American health policy and

4:22

eventually landed on two issues

4:25

that he thought were interesting and

4:27

weren't getting enough attention.

4:33

One was the public health effects

4:35

of climate change and the second

4:37

was pandemics and pandemic preparedness. We

4:39

just became concerned, convinced

4:41

that we were heading towards a pandemic and the

4:43

world wasn't ready. When the pandemic he was

4:45

convinced was coming, finally

4:47

arrived, it didn't exactly

4:49

resemble what he'd anticipated. What

4:52

I worried about, which I think many of

4:54

us who were in the field of thinking about

4:56

pandemics, what we worried about was

4:58

a really deadly influenza pandemic. And

5:02

the mental model I had of

5:04

both how we would begin, how

5:06

we would spread, and how we would respond

5:08

to it, Some of that mental

5:10

model held true and some of it was just inadequate.

5:13

As the pandemic unfolded, Ashish

5:15

was compelled to communicate. he

5:17

took to the airwaves and to social

5:19

media laying out what we

5:21

knew and what we didn't know about

5:23

COVID. He did it calmly

5:26

and plainly, and people started

5:28

not only to notice, but to rely

5:30

on him. I started saying to

5:32

friends, I ain't gonna pull back on this.

5:34

and got a response from people

5:36

that made me realize what

5:38

I was doing, what other people were doing was useful

5:41

because in the term public

5:43

health is the public and engaging the

5:45

public, helping the public

5:47

understand the moment we're in and how to

5:49

respond and how to keep themselves safe is

5:51

a really important public health intervention. It

5:53

was odd to realize that this

5:55

wasn't a side thing that I was doing, that it

5:57

was actually a really important part. of

5:59

a public health response was to communicate

6:01

directly to the public.

6:02

Ashish

6:05

left Harvard in twenty twenty and

6:07

became Dean of the school of public

6:09

health at Brown University, where

6:11

he stayed until March of this year

6:13

when he went to the White House. It's

6:15

his most public role to date and

6:17

a detour from academia. But

6:20

figuring out in which direction the country

6:22

should go next with the pandemic requires

6:25

reflecting on where we've been.

6:30

I wrote a piece at the end of January

6:32

of twenty twenty about

6:35

the novel coronavirus. And

6:37

there were parts of that piece that I go back and

6:39

read and cringe at because there

6:42

were really important issues that I

6:44

and I think many public health experts got

6:46

wrong. So most of us thought

6:48

that the things that would be determinative for

6:51

how well a country would do. is

6:53

your laboratory capacity, your healthcare

6:55

system, your ability to

6:57

manage the disease per

6:59

se. What I think I did not

7:01

appreciate, and I think a lot of people did

7:03

not appreciate. Was the importance

7:05

of issues like social cohesion

7:08

of depolarization of

7:11

a pandemic response. And

7:13

I think in that context, yeah,

7:15

this pandemic has turned out in many ways

7:18

to be much more challenging than

7:20

what I had envisioned might be something

7:22

that America deals with. if you had asked me

7:24

this question five years ago. If you had

7:26

that foresight, what do you think you would have done differently?

7:29

Because what you're referring to is on a scientific

7:31

problem per se or an operational

7:33

on how do you ensure adequate

7:35

ICU beds, ventilators,

7:38

start a process for developing

7:41

and manufacturing a vaccine,

7:43

ensuring a supply of

7:45

mass. You're almost talking about

7:47

a social problem, which in part relies

7:50

on trust. it is about

7:52

trust in my mind. There's some empirical

7:54

evidence that if you look at countries that have

7:56

done well in the pandemic versus

7:58

countries that have struggled more, by

8:00

whatever metric you want to use. Trust

8:03

in institutions and trust

8:05

in each other are

8:07

two of the major factors that really

8:09

differentiate high performing versus low performing

8:12

countries. And thinking back to

8:14

five, seven years ago, when I started

8:16

doing work on pandemic preparedness, we spend

8:18

a lot of time thinking about laboratory capacity

8:20

and healthcare workforce,

8:22

which are important. I think it would have

8:24

put a lot more emphasis on understanding

8:26

what kind of trust do populations have in

8:28

their institutions? How do you build up

8:30

that trust? How do you in the beginning

8:32

of a pandemic when there is so

8:34

much uncertainty communicate more effectively

8:37

to people, both what you know and

8:39

don't know. There's no question about it.

8:41

There was a lot of communication in the early

8:43

days that conveyed way

8:45

more certainty than people had

8:47

from our public health officials. And I think

8:49

sometimes that desire to

8:51

offer assurance, which is a very good desire can

8:53

lead people to overstate what they actually

8:55

know. And I think

8:57

acknowledging uncertainty actually

8:59

doesn't create panic I actually

9:01

think it breeds trust. So

9:03

there are a lot of lessons

9:06

here that I hope we're gonna be able to deploy for

9:08

future pandemics. I think as Francis

9:10

Collins made this point a while ago,

9:12

which is that we spent so much time

9:14

thinking about how to diagnose

9:16

disease, treat disease, but there's a

9:18

fundamental behavioral problem

9:20

that is hard to solve, which is if

9:22

you've got vaccines, if you've got treatments for

9:24

a disease, how do you get people to take

9:26

those medications? And as doctors, we

9:28

think about that a lot. And we know

9:30

adherence to medications that are lifesaving

9:33

is almost fifty to sixty

9:35

percent in some diseases.

9:37

And so we're thinking about all the

9:39

other things that had to be done, but didn't really

9:41

realize that one of the escape hatch, the

9:43

biggest one, would be vaccines. And if

9:45

we didn't lay the framework for people to say, alright,

9:47

when this comes out, I've got to be ready to go.

9:49

that sort of seems to me like a huge loss. And

9:51

I don't really know what we could have done differently

9:53

to prevent that. When I look at countries,

9:55

for instance, that are even more vaccinated

9:57

than us, and that's what's

9:59

different. You tend to see

10:01

across a broad spectrum of

10:03

political leaders, religious leaders, social

10:05

leaders, everybody fighting

10:08

over all sorts of issues, but not fighting over

10:10

vaccines, not fighting over whether

10:12

vaccines are effective and safe. That

10:14

has not been so consistent here, right? We have

10:16

seen a lot of prominent

10:18

people use their platform to

10:20

undermine vaccines for whatever

10:22

kind of reasons and gains,

10:24

but ultimately ends up making

10:26

it harder. for our country to

10:28

be as protected as it needs to be. And

10:30

so something that we need to really spend more

10:32

time thinking about is how do we

10:34

build a broader coalition of people who can

10:36

fight it out over all

10:38

sorts of policy issues. But when it comes to

10:41

key basic public health things like

10:43

vaccines and treatments, maybe

10:45

that's a bit more of a neutral

10:47

ground where we don't always have to disagree and

10:49

fight with each other.

10:50

I

10:53

remember in the initial stage of the

10:55

pandemic, and we were talking about how

10:57

your life had changed. You had entered

10:59

into a public sphere

11:01

that you hadn't been in before. The media

11:03

stuff was public. I was also spending

11:06

an enormous amount of time talking

11:08

to governors, talking to state health officials,

11:10

because the public health response really had

11:12

become a state by state response. And

11:15

a lot of leaders at the state level

11:17

were struggling to get good advice from

11:20

federal officials weren't getting the

11:22

kind of data and the evidence. And

11:24

so I would say I spent almost as much time

11:26

talking to policymakers as I did

11:28

the media. And that

11:30

continued all through the fall of

11:32

twenty. Things changed on the

11:34

public policy side after

11:36

president Biden came into office.

11:38

The calls from governors, calls from

11:40

states really slowed way down. That

11:42

changed, but obviously helping

11:44

the public. understand where

11:46

things were going, remained an important part of

11:48

what I was

11:49

doing. Had

11:53

you worked with policymakers before all

11:55

this? Yeah. I mean, but in a very

11:57

different way, right? It's funny I

11:59

often describe myself. as

12:02

a skeptical academic. And

12:04

what I meant by that was I felt like so

12:06

much of academic work just

12:08

didn't make a big difference. in the

12:10

world. And I was not interested in a

12:12

career where I built up my CV

12:14

and had a great title. I was interested

12:16

in having a career where I felt like I

12:18

moving real stuff in the world that

12:20

made a difference in people's lives. And

12:22

so in the health policy work I did for a

12:24

good chunk of my career, I a

12:26

of time in Washington talking to policymakers,

12:28

trying to understand what their

12:30

pain points were, trying to understand

12:32

where data would be useful

12:34

for them, trying to

12:36

anticipate what decisions they were gonna be

12:38

having to make and figuring out, can

12:40

I use data to help them make better

12:42

decisions? So that was always my

12:44

mindset as I did my research.

12:47

Policymakers have a different set of constraints.

12:49

They often have to make a decision

12:51

in days or weeks and not

12:53

in months or years. And

12:56

it meant what data can I generate

12:58

for them, even if it's not gonna be good

13:00

enough to be published in a major journal, what's

13:02

good enough to help them make a bit of a better

13:04

decision. I'm curious, what's it

13:06

been like to try to implement

13:09

strategy and think about the

13:11

political implications for someone like

13:13

you who's really I would say a

13:15

scientist at heart. What are the costs of

13:17

going into public health in this sort of high

13:19

profile way. I've been in this job for

13:21

about seven months. And

13:23

as you might imagine, it's unlike

13:26

anything I've done before. So in the

13:28

past, when I thought about a

13:30

policy issue, I could sort

13:32

of pontificate and think

13:34

out loud. I didn't have to worry

13:36

about constraints. I didn't have to worry about trade offs.

13:38

I didn't have to think through the

13:40

ways in which my ideas could go wrong.

13:42

I didn't have to think at all about

13:44

implementation. One

13:46

of the things that you realize is you can

13:48

have absolutely brilliant ideas.

13:51

That just cannot be implemented

13:53

because having a good idea is

13:55

important, but the constraints are

13:57

real. After the break, Ashish would tell

13:59

us about those constraints, how

14:01

he's tried to deal with them, and

14:03

when he thinks he might be out of

14:05

a job. I wake up every

14:07

morning and think there are three

14:09

three fifty Americans dying every

14:11

single day. And there

14:13

is so much work to

14:15

do to drive that number

14:17

down. I'm Bob Bugena, and this is

14:19

Free EconomicMD.

14:33

When you're an academic, you can just say

14:35

things like we should just do x. Great.

14:38

How? Now as I

14:40

think about trying to move the

14:42

needle on making sure more people are getting vaccinated

14:44

or treated, we spend a

14:46

lot of time thinking about how.

14:48

since he became the COVID nineteen response

14:50

coordinator at the White House earlier this

14:52

year, doctor Ashish Shah

14:54

has learned a little something about the way

14:56

Washington works. or

14:59

doesn't. Like, sometimes you don't have

15:01

the funding because the administration

15:03

doesn't actually just get to spend money on

15:05

whatever it wants. There are other

15:07

times where you realize you

15:09

gotta bring people along. You

15:11

have to bring agency leads along. You have to

15:13

bring stakeholders along. So you

15:15

begin to appreciate the complexity

15:18

of the country we live in.

15:20

You don't always have to get to consensus,

15:22

but you have to hear people out. It's

15:24

a very different set of

15:26

perspectives than what I had a year

15:28

ago where I could just think

15:30

about what do I think is interesting and

15:32

just tweet it. and not have to worry

15:35

about any of these issues. The

15:37

biggest of which is, how is this ever

15:39

actually gonna get done?

15:43

One big recent how that

15:46

Ashish has grapple with is how to

15:48

get people to take the bivalent

15:50

COVID booster vaccine.

15:51

This latest formulation includes

15:54

two components. The Omicron

15:56

BA4 and BA5

15:59

subvariance as well as the original strain

16:01

of the virus, which is where the

16:03

term by valent comes

16:05

from. As of early November,

16:07

when I spoke with Ashish, just

16:09

under ten percent of US adults

16:11

over age eighteen had

16:13

received the updated booster. And

16:15

even among one of the most at risk

16:18

groups, People over sixty five, uptake

16:20

has struggled. Just twenty

16:22

three percent have received the new booster

16:25

compared to more than ninety three percent

16:27

who completed their initial vaccine

16:29

series. Why

16:32

has the US struggled to get people to

16:34

take this new vaccine? it a

16:36

messaging problem? A data

16:38

problem? Something else?

16:40

There's several issues here.

16:42

One is certainly that

16:44

I think we need to continue to

16:46

do a better job at explaining to people

16:48

what the value of these vaccines are.

16:50

This is a new vaccine, and I'm

16:52

always reminded whenever companies introduce a

16:54

new product. It takes a lot for that

16:57

to take hold. And so that's

16:59

one issue. I think the second

17:01

is we've got to get

17:03

people see this differently.

17:06

People often say, well, this is your third booster,

17:08

second booster. What shot is this? you

17:10

know, when I went and got my flu shot this year, I

17:12

didn't think, oh my god, this is my twenty

17:14

eighth flu booster. I thought this is

17:16

my annual flu shot. And

17:18

I think that's where we are for most

17:20

people with

17:21

Coke. I think

17:24

if we keep plugging away at those things,

17:26

I think that'll help there's no question,

17:28

Bahoo, that one of the main

17:30

challenges has been as a

17:32

country. We don't have an adult

17:34

Xonation program. We've had to sort of stand that up in this

17:37

administration. And then last but not

17:39

least, one of the challenging

17:41

things is how many people

17:43

use their platforms to

17:46

undermine confidence in vaccines. And I

17:48

think in the long run, that ends up being a

17:50

major part of the problem as

17:52

well. So it's a combination of helping people understand it's a

17:54

different vaccine, resources to run

17:56

a real vaccination campaign, and

17:58

then fighting against a tide of misinformation

18:01

as well. you had unlimited

18:03

resources, would you generate

18:06

different evidence about

18:08

vaccines or mass or whatever

18:10

public health intervention we're talking about then

18:13

exist today. People often ask the

18:15

question, was there enough evidence for

18:17

the current bivalent vaccines? And actually, you want

18:19

to make two points on this. Point number one is,

18:21

the decision making

18:24

on vaccines rests

18:27

squarely inside the FDA. And

18:30

there are things that we have like

18:32

third rails around. And one of

18:34

them is us sitting at the

18:36

White House, getting involved in

18:38

decision making the FDA. Who is the

18:40

FDA doing this? It's a whole bunch of

18:42

career scientists. Their

18:44

assessment was we have

18:46

enough evidence to authorize

18:48

these vaccines. And in my

18:50

mind, and you and I know this,

18:52

like, you don't look at one piece of

18:54

data to make a decision, you look at the totality

18:56

of the evidence. And when you look at

18:58

the totality of the evidence on

19:00

bivalent vaccines, it's hard not

19:02

to conclude that it's a good idea to move this

19:04

forward and to authorize it. And if you're going

19:06

to give people vaccines in the fall of twenty twenty two,

19:08

that moving to a bivalent is

19:10

the best strategy. People say, well,

19:12

you know, wouldn't it have been better if

19:15

we had all this other additional data. And yeah, it would have

19:17

taken an additional, you know, four, six

19:19

months to run a large clinical trial. Do we need to

19:21

run a clinical trial every single time we update

19:23

our vaccine? I

19:25

don't think so. I'm not convinced that

19:27

if we had run a large clinical

19:29

trial, that would make a huge difference in the

19:31

uptick. My sense is that this is not so much

19:33

an evidence problem, but there's more

19:35

fundamental things at play here about human

19:37

behavior and social cohesion and trust that

19:39

are just gonna take time to

19:41

solve. What's the

19:43

future hold for COVID? Is it becoming

19:45

seasonal in your view? Is there a new normal

19:47

that we're approaching? What's your take

19:50

on? what the next year to two years looks

19:52

like. In my mind, the evidence

19:54

suggests there is a seasonality. It's

19:57

not clearly as seasonal

19:59

as influenza is. We've

20:01

seen surges in the spring and

20:04

summer, but clearly the major surges

20:06

have come in the fall and winter. It's

20:08

actually partly why I think most people will be

20:10

getting an updated COVID vaccine once a year,

20:13

because even if there is some increase of

20:15

infections in the spring and summer, for a

20:17

majority of people that fall shot will provide enough

20:19

protection against serious illness that they're not gonna

20:21

need an additional shot.

20:26

In terms of where the virus is going, I

20:28

mean, the good news here is ninety, ninety five

20:30

percent of Americans have some immunity against

20:32

this virus, either from a prior infection or

20:35

from vaccines. That

20:37

means that the risk of serious illness

20:39

is much lower, but we're

20:41

seeing a lot of very rapid

20:44

viral evolution. And that

20:46

evolution is driven by

20:48

selective pressure on the virus to evolve away from

20:50

our immunity. And

20:52

that means in my mind that continues

20:54

to pose a substantial challenge. And you know, when people

20:56

say, well, are we at a point where this

20:58

is like the flu? This is

21:00

not like the flu. if

21:02

you just look at the number people dying every day. And

21:05

right now, we're at a low of three

21:07

hundred, three fifty a

21:09

day. If you annualize that,

21:11

is hundred to hundred and fifty thousand deaths a year. That's

21:13

four or five times worse than a bad

21:15

flu season. My hope is we

21:17

keep working on improving

21:20

vaccines and treatment updates.

21:22

We continue to defang this virus, make it

21:24

less and less lethal. I think

21:26

if we do the right things and manage it

21:28

in the right way, we can really make

21:31

this a much less serious

21:33

source of morbidity and mortality for

21:35

our population. But the work here is not done.

21:37

I think if we let our foot off the

21:39

gas and just kinda let it go.

21:41

I think you're gonna see a resurgence and you're gonna

21:43

see a lot more people getting infected and a lot

21:45

more people getting sick. one of the

21:47

initial issues and it could be an issue this winter is

21:50

the health system strain. So

21:52

if we have flu RSV,

21:54

COVID, all taking

21:56

their toll this winter that could be

21:58

enormously challenging for healthcare systems. So what

22:00

is your view on pan vaccination

22:02

versus just focusing on COVID? Yeah,

22:04

it's a great question. And actually, something we spent a lot of time

22:06

thinking about. We pulled in leaders of major

22:09

health systems and all the major

22:11

medical societies into the White House in

22:13

last month. to have very

22:15

deep conversations about how we're gonna get through

22:17

this fall and winter for exactly

22:19

the reason you outline. I mean, you know,

22:21

people talk about the triple damage of

22:24

influenza RSV and SARS Co V2

22:26

or COVID. And the fourth element I

22:28

would add is a healthcare workforce

22:31

that spent that's burnt out,

22:33

that is not going to be able to

22:35

respond if you say, boy, we just

22:37

need people to work extra shifts, work more

22:39

hours. I don't know that

22:41

the healthcare workforce is gonna be able to really do that.

22:43

That combination really poses

22:45

risks. So in our messaging, in

22:47

our work, we've been very

22:49

clear that people need to get both

22:51

COVID and flu shots because we think

22:53

that's really important. In the

22:55

future, we might see RSV vaccines

22:57

actually just some data out from

22:59

Pfizer suggesting that an RSV

23:01

vaccine may be effective. Again, we'll see where that

23:03

goes. But no

23:05

question about it, that preventing people

23:07

getting significantly ill is our

23:09

number one strategy for getting through this fall and

23:11

winter because our healthcare system is going to

23:13

have a very, very hard time managing.

23:16

if all three of these viruses are raging and if people

23:18

have not gotten vaccines, it's going to

23:20

be very tough to get through this fall and winter without

23:22

some serious strains on our healthcare system.

23:24

It's impossible

23:28

for Ashish Jia or any of us

23:30

to know exactly what comes

23:32

next with COVID. We've all been riding

23:34

this wave together for nearly three

23:37

years, and making predictions feels

23:39

like a fool's errand. Something I

23:41

do know for sure is that we'll

23:43

never stop needing public health experts

23:46

like Ashish. But eventually

23:48

and maybe soon will probably stop

23:51

needing a White House COVID-nineteen response

23:54

coordinator. When? It's

23:56

a question people ask and I don't have

23:58

an answer because I actually haven't spent

23:59

that much time thinking about

24:02

it. I wake up every morning and

24:04

think,

24:04

like, there are three, three fifty Americans dying every

24:07

single day. And there

24:09

is so much work to

24:11

do to drive that number down.

24:13

there's a ton of work to do in thinking about

24:16

transition, building a

24:18

whole new generation of vaccines and

24:20

treatments, making sure that

24:22

we are, as a country, much

24:24

better prepared to manage this virus

24:27

over the long run. I would

24:29

love to work myself out of a

24:31

job. we should be doing things and institutionalizing

24:33

things in a way that COVID becomes more

24:35

and more into the background. And we, as a country,

24:37

are just able to manage it more and more effectively with

24:39

fewer and fewer deaths, and there

24:41

will come a time it'll feel like, okay, the moment is right.

24:43

That moment is not now. That's

24:46

it for today's show. I'd like

24:48

to take my friend and guest,

24:50

Ashish Shah, for making time for us

24:52

in his busy schedule. It's been a

24:54

while since we shared an audience

24:56

and it was good to catch up. And

24:58

thanks to you, as always, for

25:00

listening. Here's an idea to leave

25:02

you with. Sometimes the questions

25:04

that scientists are trying to answer

25:07

are rooted in behaviors that people care

25:09

about deeply. I'm thinking about things

25:11

like masking, school closures, and

25:15

lockdowns. There are scientific ways to

25:17

study their effects, but people's

25:19

views can impact how they

25:21

evaluate the science. Here's

25:23

an example. an example say

25:25

a new study shows masking

25:27

helps reduce spread of COVID-nineteen

25:29

in schools. If you've

25:31

supported masking in schools, Would

25:33

you be less critical of the study? Maybe even give

25:35

it a free pass. Or

25:38

instead, suppose you believe

25:40

that masks don't help

25:42

Would you be more critical of the study? It's

25:44

an interesting idea to explore. How

25:48

objective are scientists? how

25:50

objective are the rest of us. On

25:53

a completely different note

25:55

and speaking of research, We

25:57

know that people typically take advice on which podcasts to

26:00

listen to based on

26:02

recommendations from people they know

26:04

and trust. So go

26:06

find someone who knows and trusts

26:08

you and tell them to subscribe to

26:10

FreakonomicsMD. Coming

26:12

up next week, more than

26:14

six million people in the US currently live with

26:16

Alzheimer's disease, and that number

26:18

is expected to more than double by

26:21

twenty fifty. few

26:23

months ago, we told you why

26:25

effective treatments that could address

26:27

symptoms or slow disease

26:29

progression have eluded researchers

26:31

for over a century. you

26:33

know,

26:33

the time to put out the fire

26:35

is when it's on the stove, not when

26:37

the whole house is on fire. We'll

26:39

revisit our discussion with doctor Pierre

26:42

Therio. An Alzheimer's disease expert who,

26:44

like many of his colleagues, believes

26:46

that intervening before symptoms

26:48

even start could keep the

26:50

disease at bay. Are they

26:53

right? And after decades of

26:55

disappointing results, is it time

26:57

to consider new approaches? There

27:00

are lots of other shots on

27:02

goal for the treatment or

27:04

prevention of Alzheimer's disease.

27:06

We'll also tell you about some new developments in the

27:08

field of Alzheimer's research since

27:10

this episode first aired. That's

27:12

all coming up next week on free economics

27:15

MD. Thanks again for

27:17

listening. Freakonomics

27:18

MD is part of

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episode was produced by Julie Canfor

27:39

and mixed by Eleanor Osbourne

27:41

with help from Jasmine Klinger. Our

27:43

staff also includes Neil

27:45

Carruth, Gabriel Roth, Greg Ripon,

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Kelley, Catherine Mankure, Jeremy

27:53

Johnston, Daria Leonard, Emma Charell,

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Alina Coleman, Elsa Hernandez,

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and Steven Dupner.

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my video off. I

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