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The Canary in the Coal Mine: Infectious Disease, Vaccine Hesitancy, and What We Owe Each Other · Health Ethics Podcast

0:08
Speaker 1: Welcome to Health Ethics, a series of conversations with leading
0:12
Speaker 1: experts about ethical considerations associated with health and healthcare, both
0:17
Speaker 1: locally and globally. I am Brian Pilkington, Professor of Bioethics
0:21
Speaker 1: in the Department of Medical Sciences at the Hackensack Meridan
0:24
Speaker 1: School of Medicine. This series, like its predecessor, which focused
0:29
Speaker 1: on the COVID nineteen pandemic, relies on the idea that
0:32
Speaker 1: challenging ethical issues are best addressed by folks from diverse
0:36
Speaker 1: backgrounds practically reasoning together, and complements the Health Ethics series
0:41
Speaker 1: with its panel of leading experts from medicine, nursing, politics, economics, philosophy,
0:47
Speaker 1: and the law. Thank you and enjoy the episode. It's
0:59
Speaker 1: my great pleasure today to be speaking with doctor Jeffrey Bosscamp,
1:03
Speaker 1: Dean of our medical school and an expert in pediatric
1:07
Speaker 1: infectious disease. Doctor Bosscamp has served prior to being dean,
1:11
Speaker 1: as a co Chief Academic Officer of Hackensack Meridian Health
1:16
Speaker 1: and developed, promoted and organized programs for the School of
1:19
Speaker 1: Medicine promoting lifelong learning across the continuum of undergraduate, graduate
1:24
Speaker 1: and medical education. Prior to doing this work, He was
1:27
Speaker 1: Professor of Pediatrics at the Hackensack Meritean School Medicine Integray,
1:31
Speaker 1: involved in the founding of the school and conceptualized the
1:35
Speaker 1: starting of the school. He was the chairman of the
1:38
Speaker 1: Joseph M. Censari Children's Hospital and held the Marvin Gottlieb
1:44
Speaker 1: Endowed Chair in Pediatrics for fourteen years. During his tenure,
1:47
Speaker 1: the children's hospital achieved meteoric growth. Doctor Bosscamp helped lead
1:52
Speaker 1: the design and building a freestanding children's hospital on the
1:55
Speaker 1: campus of HUMC in New Jersey, and developed and recruited
2:00
Speaker 1: a faculty practice of pediatric subspecialists. Under doctor Bosscamp, the
2:05
Speaker 1: children's hospital achieved a national top fifty ranking in US
2:08
Speaker 1: News and World Reports. I could go on and on.
2:11
Speaker 1: Doctor boss Camp was the chairman of the NJ Chapter
2:14
Speaker 1: of the American Academy of Pediatrics, the Committee on Infectious Diseases,
2:18
Speaker 1: and a member of the Executive committee of that organization.
2:21
Speaker 1: Doctor boss Camp is a phenomenal advocate for children, for
2:26
Speaker 1: pediatric practice, a knowledgeable person about infectious diseases, and it
2:30
Speaker 1: really is an honor to have him on the podcast today.
2:33
Speaker 2: Jeff, thanks for joining me.
2:34
Speaker 3: Brian, thanks for hosting me. I've been a big fan
2:37
Speaker 3: of your podcasts and glad to join your cadre of
2:42
Speaker 3: distinguished guests.
2:43
Speaker 2: You're on the top of the list.
2:44
Speaker 1: So Jeff and I are going to be talking about
2:46
Speaker 1: pediatrics and infectious diseases, because he is a pediatric infectious
2:50
Speaker 1: disease specialist and sort of really thinking about what kinds
2:53
Speaker 1: of burdens and benefits different members of the communities have
2:57
Speaker 1: relative to our youngest our youngest members, and so, Jeff,
3:02
Speaker 1: the first point I want to focus on is measles.
3:05
Speaker 1: It seems like measles are back. We've seen cases in Texas,
3:09
Speaker 1: Pennsylvania recently cases in Jersey, of course, where a medical
3:12
Speaker 1: school is. So I mean, I have vague recollections as
3:15
Speaker 1: a kid of the MMR vaccine, But can you help
3:19
Speaker 1: folks understand what's going on with the resurgence of measles?
3:23
Speaker 3: Sure? Sure, I mean it's a super interesting topic, but
3:28
Speaker 3: clearly just an introduction to a much bigger topic of
3:33
Speaker 3: vaccines and where we are, and an even bigger topic
3:37
Speaker 3: of trust and science. And I know you're going to
3:40
Speaker 3: get into that and I'm really looking forward to discussing it.
3:44
Speaker 3: But let's start with measles. So, this is nothing about
3:47
Speaker 3: this is surprised. This is something that those of us
3:51
Speaker 3: that are vaccine advocates and understand this particular virus knew
3:55
Speaker 3: what's going to happen. So as immunization rates started to
4:00
Speaker 3: drop in the country and there was a significant drop
4:04
Speaker 3: post COVID and you know, we're not going to have
4:06
Speaker 3: time to get into the political politicalization of vaccines and
4:13
Speaker 3: the lack of trust and belief in vaccines that it
4:18
Speaker 3: was clearly decayed. So you know, we saw the numbers
4:24
Speaker 3: going down, and of all the childhood infectious diseases, the
4:29
Speaker 3: one we knew we would see first in significant outbreaks
4:32
Speaker 3: would be measles. And so the reason for that is
4:36
Speaker 3: it's one of the very most contagious viruses. So, for instance,
4:40
Speaker 3: when we started with COVID and said, you know, how
4:44
Speaker 3: scared should we be about this when we didn't know
4:47
Speaker 3: anything about COVID in twenty twenty and a lot of
4:50
Speaker 3: people said, well, let's hope.
4:52
Speaker 2: It's not measles.
4:54
Speaker 3: And the reason they said that was measles is so
4:58
Speaker 3: incredibly contagious. So it is a virus that spreads easily.
5:02
Speaker 3: It can be on a surface, it can be in
5:05
Speaker 3: the air, and it hangs out. So it's really tough
5:10
Speaker 3: when you think about it, that somebody that enters a
5:13
Speaker 3: space that an infected measles patient was in could be
5:18
Speaker 3: two hours after they left that space and it's still
5:21
Speaker 3: perfectly contagious. And so the other piece of it is
5:27
Speaker 3: we know that the herd immunity issue with measles that
5:32
Speaker 3: once it drops below a certain level, which we think
5:35
Speaker 3: is about ninety five percent of the population being immunized,
5:40
Speaker 3: then it the potential for outbreaks becomes significant and clearly
5:46
Speaker 3: around the country, particularly in certain areas of extreme vaccine hesitancy,
5:53
Speaker 3: that number has dropped way below ninety five percent, and
5:57
Speaker 3: so we knew that it would spread easily. It was
6:02
Speaker 3: just a matter of it being introduced to the area.
6:06
Speaker 3: You know, measles was eliminated from the United States in
6:09
Speaker 3: the year two thousand and why was it eliminated because
6:12
Speaker 3: of vaccines, And the vaccine take rate was so high
6:16
Speaker 3: at that point, or at least high enough that there
6:19
Speaker 3: was no measles in this country except for cases in
6:23
Speaker 3: it brought in from areas of the world where measles
6:26
Speaker 3: were still acted. So for years and years and years,
6:29
Speaker 3: the only cases I was seeing were imported cases from
6:33
Speaker 3: abroad in areas that had endemic measles. But in the
6:37
Speaker 3: United States that's how it came. It was you know,
6:41
Speaker 3: it was not happening here. This picture right now, which
6:45
Speaker 3: is really very significant, is very different because these are
6:50
Speaker 3: all endemic cases. So as of this week, which is
6:53
Speaker 3: the second week of April, we have over seven hundred
6:57
Speaker 3: cases in the United States, and those numbers are rising
7:03
Speaker 3: every single week and will continue to rise. This outbreak
7:06
Speaker 3: of measles, most people think, is going to go on
7:09
Speaker 3: for at least a year because and then that's getting
7:12
Speaker 3: back to your original question. Because it's spread so easily,
7:15
Speaker 3: there are large pockets of unimmunized people. All of those
7:19
Speaker 3: seven hundred people, essentially all of them were unimmunized of people.
7:25
Speaker 3: So it's almost unheard of for somebody who received certainly
7:29
Speaker 3: two doses of vaccine, but even one dose of vaccine,
7:32
Speaker 3: that they would get measles. But as you create pockets
7:36
Speaker 3: of susceptible people in an incredibly infectious virus, this is
7:41
Speaker 3: what happens, so we call it in id and infectious diseases.
7:46
Speaker 3: This is one of those scenarios. Brian of the Canarian
7:49
Speaker 3: the coal mine, right so this is the first indicator
7:54
Speaker 3: of low immunization levels. Measles was going to be the
7:58
Speaker 3: first thing we were going to see, but it's not
7:59
Speaker 3: going to be the last thing we see. Everybody's talking
8:02
Speaker 3: about measles. Really important for me to say immunization rates
8:07
Speaker 3: of ditheria, of pertussis, which is whooping cough, tetanus, hepatitis,
8:15
Speaker 3: and you know a number of other immune preventable diseases. Polio,
8:24
Speaker 3: which is something that essentially was gone. We think is
8:27
Speaker 3: something that we will be seeing more of and have
8:30
Speaker 3: seen some cases and that's a huge concern. But those
8:35
Speaker 3: are not quite as sensitive to immunization levels as you
8:39
Speaker 3: know as measles is. But the untold story right now
8:42
Speaker 3: is whooping cough. Nobody's talking about. Everybody's talking about measles.
8:45
Speaker 3: So with whooping cough, there were two thousand cases in
8:49
Speaker 3: the United States in twenty twenty one, So just four
8:53
Speaker 3: years ago, there were two thousand cases. In twenty twenty four,
8:58
Speaker 3: just three years later there were thirty thousand cases. So
9:03
Speaker 3: it's a fifteen hundred percent increase in whooping cough. Same
9:08
Speaker 3: reason as measles, the overall vaccine take rate because of
9:13
Speaker 3: the fact that people said, I don't now, I not
9:16
Speaker 3: only don't want or need COVID vaccine, but I want
9:19
Speaker 3: to make a personal decision on all vaccines and I'm
9:23
Speaker 3: not going to do those. So this was our biggest
9:27
Speaker 3: fear that not only would people not accept COVID vaccine,
9:30
Speaker 3: which I have to say was incredibly effective and incredibly
9:35
Speaker 3: safe despite all the misinformation, and the number of lives
9:39
Speaker 3: that it saved are hundreds of thousands, seriously, and so
9:43
Speaker 3: but nonetheless it became political and people said, vaccine for
9:48
Speaker 3: my children or for me is a personal choice. I'm
9:52
Speaker 3: sure we'll have a chance to talk about that whole issue,
9:55
Speaker 3: but nonetheless, measles is the first thing, but not the
9:58
Speaker 3: last thing, that we're going to say. The outbreaks of
10:01
Speaker 3: if immunization levels continue to drop.
10:04
Speaker 2: Really really helpful.
10:05
Speaker 1: And I think we can for most of these questions
10:07
Speaker 1: think about measles, the Canary and the coal mine line
10:10
Speaker 1: is excellent. Throw in any other infectious disease because we
10:13
Speaker 1: want to be you know, we want to be fit
10:15
Speaker 1: forward looking one measles specific well, two questions come out
10:19
Speaker 1: of sort of what you just laid out with measles one.
10:23
Speaker 1: So one is, what does measles look like for kids
10:27
Speaker 1: who end up with it sort of more mild cases,
10:29
Speaker 1: more severe cases, short term, long term, because I imagine,
10:33
Speaker 1: and you just sort of took us there with some
10:37
Speaker 1: folks understanding themselves to have a personal choice about whether
10:40
Speaker 1: or not to vaccinate at and we can get into that.
10:43
Speaker 1: But as someone weighs, right the costs and benefits, are
10:47
Speaker 1: they going to go in for this sort of thing
10:48
Speaker 1: for themselves and their family?
10:49
Speaker 2: Are they not?
10:50
Speaker 1: It's helpful if they have a picture. I mean, so,
10:53
Speaker 1: what does it look like for kids who gets really
10:55
Speaker 1: sick with measles?
10:57
Speaker 3: So well, let me start with how it looks like
11:00
Speaker 3: kids that don't get incredibly sick with measles. So, you know,
11:03
Speaker 3: this is really interesting because most pediatricians haven't seen measles.
11:07
Speaker 3: That's a wonderful thing. As I said in the year
11:09
Speaker 3: two thousand, there's no measles in the United States except
11:12
Speaker 3: these rare imported cases. So you had generations of medical students,
11:17
Speaker 3: residents in training, pediatricians in practice who never saw a
11:21
Speaker 3: case of measles, so they read about it. They may
11:24
Speaker 3: have learned it from me as teaching pediatric infectious diseases
11:28
Speaker 3: in our medical school, but they never saw that's different
11:31
Speaker 3: now so are people? What do most people see? The
11:34
Speaker 3: two biggest things is a fever and this classic rash
11:38
Speaker 3: that usually starts on the face and then moves down
11:41
Speaker 3: the body, so it looks like a lot of other
11:44
Speaker 3: rashes and can be confused with a number of other
11:47
Speaker 3: viruses that do similar rashes. Doesn't look that much different
11:51
Speaker 3: than say, German measles, or you know a number of
11:54
Speaker 3: other things that give you, you know, viral rashes. But
11:59
Speaker 3: those are the two biggest things, and then the other
12:01
Speaker 3: things is what we say are the three c's. This
12:05
Speaker 3: is what I teach the students. So cough something called caiza,
12:09
Speaker 3: which is a fancy name for just nasal stuffiness, and
12:13
Speaker 3: like having a cold, and conjunctivitis, which is red eyes.
12:17
Speaker 3: So that is the pattern. If you see somebody who's coughing,
12:21
Speaker 3: who has red eyes, who's got a ration fever, certainly
12:25
Speaker 3: these days you should be thinking measles. So that's the
12:29
Speaker 3: short term stuff. Now you can also have an ear
12:32
Speaker 3: infection with it. In the short term, they can also
12:35
Speaker 3: develop encephalitis. Now we're getting into the serious stuff. This
12:39
Speaker 3: is the stuff that lands kids in the hospital with
12:42
Speaker 3: a bad pneumonia, so they can get a brain infection
12:46
Speaker 3: that can lead to permanent disability, and they can get
12:50
Speaker 3: fearless severe pneumonia. So of these seven hundred plus cases,
12:55
Speaker 3: we know we already have three deaths from measles, so
12:57
Speaker 3: it can be fatal. We know that out of ten
13:01
Speaker 3: approximately in this outbreak land in the hospital because of
13:05
Speaker 3: some of those serious complications. So roughly eleven percent so
13:09
Speaker 3: far of people that have been diagnosed with it end
13:12
Speaker 3: up in the hospital. The smaller you are, the more
13:15
Speaker 3: you're a k. The highest percentage of those numbers are kids,
13:19
Speaker 3: and so you know those are the shorter term things.
13:22
Speaker 3: One of the things that we worry about is people
13:25
Speaker 3: that have encephalitis or even have pneumonia. We think there's
13:28
Speaker 3: some permanent issues in their immunity from measles, so that
13:33
Speaker 3: can be something that goes into the future. And by
13:36
Speaker 3: far the most feared complication, which was seen often when
13:42
Speaker 3: everybody got measles, so prior to vaccine, one hundred percent
13:47
Speaker 3: of the it's so contagious, right, as I said, one
13:49
Speaker 3: hundred percent of the population got measles. So if you
13:52
Speaker 3: were born before nineteen fifty seven like me, by a
13:55
Speaker 3: couple of years. You never ask anybody whether they had measles.
14:00
Speaker 3: Hundred percent of the population as measles, and they have
14:03
Speaker 3: antibodies that protect them. They don't need vaccine. It is unnecessary.
14:08
Speaker 3: They have antibodies. But then, you know, then immunizations, you know,
14:13
Speaker 3: came in in the you know, in the early sixties
14:16
Speaker 3: with the measles, mumps, rubella vaccine. So, but what happened
14:21
Speaker 3: in those days when everybody got it was this rare
14:24
Speaker 3: complication called s SPE or sub subacute sclerosing pan encephalitis,
14:31
Speaker 3: terrible disease, completely destructive to the brain. Somebody who gets
14:37
Speaker 3: that never never functions as a normal human again. They
14:42
Speaker 3: will be developmentally really hit hard. And you know, there
14:47
Speaker 3: are lots and lots of stories of people with s
14:50
Speaker 3: SPE who were not functional in terms of being able
14:55
Speaker 3: to do all the things that one wants to do
14:57
Speaker 3: in life, and often were in custodial care and that
15:01
Speaker 3: kind of thing. So there's no reason to think that,
15:05
Speaker 3: you know, it's fairly rare. It was much more common
15:08
Speaker 3: when everybody got it. But that's certainly a fear. Anybody
15:11
Speaker 3: who gets measles has the risk of this virus persisting
15:15
Speaker 3: and seven to ten years later caused this devastating brain disease.
15:19
Speaker 1: Wow, everyone does costs benefit analyses differently, but that seems
15:23
Speaker 1: that information seems to make a pretty persuasive case sort
15:26
Speaker 1: of to get no weeds, just very quickly with a
15:28
Speaker 1: short question, because you had mentioned effectiveness and rates of
15:32
Speaker 1: the vaccine for one versus two doses, and I think
15:35
Speaker 1: I had read the first dose is ninety three percent.
15:38
Speaker 1: If you've got both, it's ninety seven, say hypothetically for
15:41
Speaker 1: people who happen to have little kids whom I don't
15:43
Speaker 1: have one and not yet the second big difference there sort.
15:48
Speaker 3: Of different, so we're not seeing it in the outbreak.
15:51
Speaker 3: I mean, ninety three is pretty good. Ninety seven is better.
15:55
Speaker 3: If I were a pairent and worried about my kids,
15:56
Speaker 3: I'd rather have ninety seven than ninety three. But the
16:00
Speaker 3: fact is that in this outbreak of over seven hundred cases,
16:04
Speaker 3: it's people that didn't receive any vaccine. One dose or
16:08
Speaker 3: two doses is counted as having the vaccine. But you know,
16:13
Speaker 3: we do recommend that if people have had one, they
16:15
Speaker 3: should get a second.
16:16
Speaker 1: As a pediatrician, what do you think that folks owe
16:19
Speaker 1: other folks what do members of the human community owe
16:22
Speaker 1: to others relative to infectious diseases? So if I'm behaving
16:26
Speaker 1: in a certain kind of way, or i have a
16:28
Speaker 1: certain sort of life which doesn't impact others, I'm not
16:33
Speaker 1: concerned with those. I'm concerned about the inner relation between people.
16:36
Speaker 1: So infectious diseases. Do you think as a pediatrician, do
16:40
Speaker 1: you think folks so ought to get vaccinated? Should they
16:43
Speaker 1: if they're not, should they stay away from other people?
16:46
Speaker 2: Is that possible? Given out contagious measles? Is?
16:48
Speaker 1: Do we owe special things to children? I mean that's
16:51
Speaker 1: a lot, but sort of how do you think about
16:55
Speaker 1: the relationships and the relations between members of the human community?
16:59
Speaker 3: Great question, you know, certainly it's something we talk and
17:04
Speaker 3: think about a lot. And certainly as vaccine rate, you know,
17:07
Speaker 3: immunization rates decline, it becomes a real issue. So I
17:12
Speaker 3: think you break it down in two pieces. One, what
17:14
Speaker 3: do you owe your own children in terms of being
17:17
Speaker 3: a parent and being a good parent who wants to
17:19
Speaker 3: protect them? So saying that you know you're not and
17:25
Speaker 3: I really would give you know, people the benefit of
17:27
Speaker 3: the doubt. I mean, certainly are people who are vaccine hesitant,
17:31
Speaker 3: who think that they're actually really protecting their children by
17:34
Speaker 3: not giving them vaccines. And I'm happy to talk about
17:38
Speaker 3: the disinformation. MMR was out there and still there people
17:43
Speaker 3: talking about it that say that, you know, it causes autism,
17:48
Speaker 3: it caused all sorts of things that have been absolutely disproven.
17:53
Speaker 3: But now we're in a situation where, you know, one
17:57
Speaker 3: of the leaders of public health in this country has
18:01
Speaker 3: clearly made the statement that measles vaccine has killed more
18:05
Speaker 3: people than it's saved. A lie, totally unscientific, no truth
18:10
Speaker 3: to it whatsoever. But people that are out there and
18:15
Speaker 3: want the best for their kids say, how could I
18:17
Speaker 3: take a chance? You know, this is somebody in a
18:21
Speaker 3: leading position who's telling me that this vaccine is incredibly dangerous.
18:25
Speaker 3: I'm not sure I should give it to my kid
18:28
Speaker 3: while I'm telling you that it's not dangerous. The studies
18:31
Speaker 3: have been done. There's a lot of discussion right now
18:35
Speaker 3: that the studies need to be redone that they weren't correct.
18:38
Speaker 3: That is not correct. The studies are out there, have
18:43
Speaker 3: been looked at in every other possible way. And if
18:46
Speaker 3: I'm just going to throw it in there, we should
18:48
Speaker 3: be spending money, not on new studies for MMR and autism,
18:53
Speaker 3: but rather on autism research to find out what the
18:56
Speaker 3: real cause is. And then anything you do trying to
19:00
Speaker 3: redo these vaccine studies just takes away from the effort
19:03
Speaker 3: to find the real answer to the problem, which we
19:06
Speaker 3: desperately need. But nonetheless, I think parents, you know, need
19:11
Speaker 3: to have the conversations with their pediatrician. They need to
19:14
Speaker 3: have conversations with people they trust, and that happens often
19:19
Speaker 3: in an individual's office, with somebody that you think can
19:23
Speaker 3: interpret the information for you and help you make a decision.
19:28
Speaker 3: So I think, but in the end, you should be
19:31
Speaker 3: protecting your kids. And these vaccines which are safe, there's
19:36
Speaker 3: no question that they protect your kids. And it's so
19:39
Speaker 3: interesting to me because when you think about the history
19:42
Speaker 3: that most people didn't go through, and that's unfortunate that
19:46
Speaker 3: it's lost, is that polio was devastating. I mean, people
19:52
Speaker 3: tried to get out of the inner cities in you know,
19:56
Speaker 3: before polio vaccine, because we knew it happened in the
19:59
Speaker 3: summer when people were crowded into areas and the paralysis,
20:04
Speaker 3: the iron lung that they were on. Indefinitely, the things
20:08
Speaker 3: that happened, I mean Franklin Delan and Roosevelt had bad polio.
20:12
Speaker 3: I mean, it just was everywhere, and it was devastating,
20:16
Speaker 3: and it was so incredible. When Sabin and Salk came
20:19
Speaker 3: out with the vaccine, everybody knew that this was a
20:23
Speaker 3: massive scientific breakthrough. And there are these pictures that you know,
20:28
Speaker 3: are amazing of when the vaccine first came out, that
20:32
Speaker 3: there were people in line for five or six city
20:36
Speaker 3: blocks just waiting to get this magical thing that could
20:39
Speaker 3: protect their kids. So, whether it's measles, whether it's polio,
20:44
Speaker 3: these are things that people understood when the vaccine came out.
20:49
Speaker 3: We're saving lives and protecting their children. But I mean,
20:53
Speaker 3: I've given advocacy talks where people stood up and heckled
20:57
Speaker 3: me and said, you're trying to scare us about disease
21:00
Speaker 3: esses that don't exist anymore. And my simple answer is,
21:04
Speaker 3: please understand why they don't exist anymore, because vaccines have
21:09
Speaker 3: been so effective that you don't understand that anything could
21:15
Speaker 3: come back. And here's what we're seeing with musles. So
21:17
Speaker 3: what do you owe the population? I think everybody needs
21:22
Speaker 3: to do their part that if you drop the levels below,
21:26
Speaker 3: you may think you're protecting your own child. But in
21:28
Speaker 3: fact you're making other children vulnerable. There are a small
21:32
Speaker 3: percentage when the vaccine works in over ninety five or
21:37
Speaker 3: ninety seven percent, there's still a few percentage of people
21:40
Speaker 3: who got the vaccine that may not be protected. They
21:43
Speaker 3: are protected because everybody around them is protected. I mean,
21:47
Speaker 3: I think we owe it to our children to say
21:50
Speaker 3: school is a safe place. I mean, and that's why
21:52
Speaker 3: there've been vaccine mandates for entering school, which are now
21:56
Speaker 3: being rolled back in a number of states. To say
21:59
Speaker 3: it's a personal decision. But I do think that the
22:03
Speaker 3: reason people have gotten away with not getting vaccines is that,
22:07
Speaker 3: in fact, they've had a free ride. So they have
22:10
Speaker 3: been they've been in a position where their children were
22:14
Speaker 3: not vulnerable because everybody else was getting it. That doesn't
22:18
Speaker 3: seem philosophically right too.
22:20
Speaker 1: Yeah, I mean a great ethics point I want we
22:23
Speaker 1: talk about, you know, with the medical students.
22:25
Speaker 2: Somewhat regularly.
22:26
Speaker 1: It comes up in research ethics, it comes up in
22:28
Speaker 1: public health ethics. If there are certain folks who are
22:31
Speaker 1: bearing burdens, right and other folks who are benefiting, you
22:35
Speaker 1: want to think about that, and like you said, everyone
22:37
Speaker 1: needs to do their part. And this seems a fairly
22:39
Speaker 1: clear situation where folks are not doing it giving it safety,
22:44
Speaker 1: given the information out there. And I appreciate it though
22:46
Speaker 1: that you're attending to the considerations of trust and also
22:50
Speaker 1: the massive amount of misinformation and disinformation that's there, right,
22:53
Speaker 1: because at the end of the day, you think, you
22:57
Speaker 1: hope that most people are well meaning. In most people,
23:00
Speaker 1: or at least most parents, want to protect their kids.
23:02
Speaker 1: And human beings don't reason super well in situations of
23:06
Speaker 1: uncertainty or with probabilistic reasoning. Right, So if you tell me, right,
23:10
Speaker 1: I go to see you, I bring my kid and
23:11
Speaker 1: you tell me, oh, there's a one and x number
23:14
Speaker 1: of chants that something really bad is going to happen.
23:16
Speaker 1: Turns out it's false. But if there is, I become
23:19
Speaker 1: very hesitant. And that's the huge problem. I mean, how
23:23
Speaker 1: we ensure, as sort of interested parties in this whole
23:26
Speaker 1: conversation that people are able to access trusted persons to
23:30
Speaker 1: get the information is challenging in and of itself. And
23:33
Speaker 1: when you pull this back to a time when folks
23:35
Speaker 1: were lining up five city blocks to get a vaccine,
23:39
Speaker 1: I don't believe, at least as far as I've read
23:41
Speaker 1: that there was a great deal of mistrust in the
23:45
Speaker 1: scientific endeavor that seems to be more prevalent now and
23:49
Speaker 1: so let me push us there. So, given sort of
23:52
Speaker 1: the current context, considerations of trust, I think loom large.
23:57
Speaker 1: So recommendations. Do you see a way forward wherein enough
24:01
Speaker 1: folks could have enough trust whatever that would be in
24:05
Speaker 1: the medical scientific endeavor that vaccination rates aren't going to
24:09
Speaker 1: drop or put a standard whatever. The kind of best
24:12
Speaker 1: recommendations from the pediatricians are about keeping kids safe from diseases.
24:17
Speaker 2: So how do we address this idea? I mean, it
24:20
Speaker 2: is a huge question.
24:21
Speaker 3: A huge question, but it's a massive question, and it's
24:25
Speaker 3: one that people that are really concerned about doing the
24:29
Speaker 3: best for kids and for families are talking about, like
24:32
Speaker 3: how there's been so much in misinformation, and you know,
24:36
Speaker 3: I think people lived through COVID and it was a
24:38
Speaker 3: difficult time, and I think it's sometimes hard for people
24:41
Speaker 3: to understand that science evolves. Right, So you could talk
24:45
Speaker 3: about masks during COVID, Right, there wasn't great information. We
24:49
Speaker 3: were desperate, we didn't understand the virus, we didn't really
24:53
Speaker 3: understand how it spread, so people did mask mandates. Was
24:56
Speaker 3: it as necessary as we said at the time, the
25:00
Speaker 3: jury's still out on that, right, but we did what
25:03
Speaker 3: we could, but we didn't know everything. And then there
25:06
Speaker 3: was this blowback saying, well, oh, you said this about
25:09
Speaker 3: this and then you change. Well, that's what scientific evolution is, right,
25:14
Speaker 3: that we just didn't know. We were trying to be conservative,
25:18
Speaker 3: We were trying to make sure that people were protected,
25:21
Speaker 3: and maybe schools could have been opened a little bit
25:25
Speaker 3: earlier than they were they were in some states, but
25:29
Speaker 3: people didn't want to do that until they got a
25:32
Speaker 3: better feel. And I think it's that whole issue of well,
25:35
Speaker 3: if the doctors don't know what they're doing, then why
25:38
Speaker 3: would I trust them? And I think that that's part
25:41
Speaker 3: of the evolution, that we understand that we don't know everything,
25:45
Speaker 3: but we're going to do the best we can with
25:48
Speaker 3: the information we have and continue to do studies and
25:51
Speaker 3: get better information, and sometimes that means changing our mind
25:55
Speaker 3: from what we thought it was originally. But that changing
25:58
Speaker 3: of your mind is now been interpreted as you don't
26:02
Speaker 3: know what you're doing, and you know you said this
26:04
Speaker 3: with in a very forceful way, and in fact you
26:07
Speaker 3: were wrong. And so that we knew coming out of
26:10
Speaker 3: COVID that there, that this was going to be some
26:13
Speaker 3: innocent bystander h stuff, that there was going to be
26:17
Speaker 3: collateral damage on the other vaccines because of the whole
26:22
Speaker 3: politics of the vaccine that that happened, And and there's
26:26
Speaker 3: still people who are saying that, you know that the
26:30
Speaker 3: COVID vaccine was a disaster, and you know, we know
26:34
Speaker 3: now that in places that that people that refused COVID vaccine,
26:39
Speaker 3: that we could have saved probably two hundred thousand lives
26:42
Speaker 3: if people had accepted it. I mean, that's good data
26:45
Speaker 3: right now, but that's not what's out there. People are
26:47
Speaker 3: still saying it was ridiculous that anybody required COVID vaccines
26:52
Speaker 3: and that you know, you shouldn't have ever done that.
26:56
Speaker 3: But the fact was, sometimes you have to require it
26:58
Speaker 3: to get everybody to do it. And you want to
27:00
Speaker 3: have schools be a safe place. That's why there's mandates
27:03
Speaker 3: for entering school. That's what gets the immunization. It's not
27:06
Speaker 3: that people are necessarily resistant to vaccine. Sometimes they just
27:11
Speaker 3: have super busy lives and they're working two jobs and
27:15
Speaker 3: they've got all these kids and they just didn't get
27:18
Speaker 3: around to getting to that appointment. But now they know well,
27:22
Speaker 3: they can't get into school if they don't do it,
27:24
Speaker 3: so they do it. And so there's a whole group
27:26
Speaker 3: of that that allows you to get those vaccine rates
27:30
Speaker 3: up high and with no mal intent whatsoever, but that
27:35
Speaker 3: you know, this is how you do it, and this
27:37
Speaker 3: is how you protect the population. So I'm going to
27:41
Speaker 3: be speaking at our commencement of the Medical School exactly
27:45
Speaker 3: about this brand of you know, the medical students going
27:48
Speaker 3: out and having a real, really important task in front
27:53
Speaker 3: of themselves to get people to trust science again and
27:56
Speaker 3: to advocate for the science and be very very active
28:01
Speaker 3: in statements against misinformation and regaining the trust of the public.
28:06
Speaker 2: It's essential.
28:08
Speaker 3: How we do it is a big discussion, and it
28:11
Speaker 3: certainly doesn't help when people keep pushing the misinformation and
28:16
Speaker 3: people say, well, that's who I'm going to trust if
28:19
Speaker 3: there's a possibility not happening. So, you know, I think
28:24
Speaker 3: it's very hard, and I think people are truly worried that.
28:27
Speaker 3: You know, once you start to lose it, it's a
28:30
Speaker 3: lot harder to get it back.
28:32
Speaker 1: Yeah, I mean, and you've laid out a number of
28:35
Speaker 1: challenges relative to trust. The bigger problem than just sort
28:38
Speaker 1: of medical science and medical education I think can solved
28:42
Speaker 1: because what you pointed to early on about folks not
28:45
Speaker 1: understanding how science progresses. We've got a colleague of viralist
28:50
Speaker 1: in Jersey, Brian Nichols, who has done some work in
28:53
Speaker 1: the space right and makes exactly this point about masks.
28:56
Speaker 1: I believe with COVID and some which you double check
28:59
Speaker 1: this if you're you're listening, But I think the first
29:01
Speaker 1: study that came out about masks sets and we don't
29:03
Speaker 1: think they're super helpful. Very quickly as the end starts
29:06
Speaker 1: to get biggs, Oh, no, actually, masking is really helpful.
29:09
Speaker 1: And so folks did exactly what you said. But that's
29:12
Speaker 1: just to not understand how science progresses, and to think
29:16
Speaker 1: the folks, it's not even the changing of your mind,
29:18
Speaker 1: like that's just how it works. And so I mean
29:21
Speaker 1: that sounds like secondary education, primary education.
29:24
Speaker 2: Work around science.
29:25
Speaker 1: People understanding this. I mean that's a big challenge. So
29:28
Speaker 1: it's yeah, it's it's medical education. It's what you know,
29:30
Speaker 1: the excellent future physicians will have to do. And I
29:35
Speaker 1: think a lot of us, regardless of whether we're physicians,
29:38
Speaker 1: need to advocate in other spaces for better education around science.
29:42
Speaker 1: But I'll go to find my soapbox. Now, so let's
29:45
Speaker 1: let's shift more properly to medical education. So, as a
29:48
Speaker 1: leader in medical education, what do you think about what
29:52
Speaker 1: do you look toward relative to those other health institutions? Right,
29:57
Speaker 1: so you're talking at commencement, We're going to graduate a
30:01
Speaker 1: phenomenal a number of phenomenal medical students.
30:04
Speaker 2: We're all going to be doing this work, right, they're
30:06
Speaker 2: actively engaged.
30:08
Speaker 1: How do you think about the other pockets of society
30:10
Speaker 1: and combating infectious diseases? So HHS, CDC, local health departments,
30:17
Speaker 1: andih do you have any thoughts as a medical educator
30:19
Speaker 1: about the the sort of other pockets where work is
30:22
Speaker 1: done that helped you do your job?
30:25
Speaker 2: Well?
30:26
Speaker 3: Now it's essential and this is a big worry right
30:29
Speaker 3: now because there's a lot of uncertainty surrounding everything you
30:33
Speaker 3: just mentioned, whether it's the CDC, whether it's the NIH.
30:36
Speaker 3: I mean supporting that science, you know, it'd be an
30:39
Speaker 3: endless conversation with you about the amazing things that have
30:42
Speaker 3: come out in terms of cancer being fifty years ago,
30:46
Speaker 3: you know, leukemia virtually killing every kid that got it
30:51
Speaker 3: to now being better than a ninety percent cure rate. Yeah,
30:55
Speaker 3: that didn't just happen. That happened with new medications, happened
30:58
Speaker 3: with scientific studies, and you could go through anything, treatment
31:02
Speaker 3: of diabetes, treatment of you know, any chronic disease has
31:07
Speaker 3: progressed in a tremendous way, and it's all happened because
31:10
Speaker 3: of the support of science. So the NIH has been
31:13
Speaker 3: very active in funding scientists, supporting new generations of scientists,
31:19
Speaker 3: so you know, programs that you can get early stage
31:22
Speaker 3: grants for promising researchers, so that whole infrastructure is essential
31:28
Speaker 3: to keep moving, you know, the cure rates of disease
31:32
Speaker 3: and the prevention of disease. But that is not the
31:36
Speaker 3: message that's coming out. There are a lot of cuts
31:39
Speaker 3: in NIH funding right now that people are trying to
31:43
Speaker 3: sort through. You know, the public I thought we learned
31:46
Speaker 3: in a really important way during COVID that our public
31:49
Speaker 3: health surveillance systems, you know, were had really not been
31:54
Speaker 3: paid attention to in an adequate way, and that that
31:57
Speaker 3: was going to be a lesson learned from COVID. Well,
32:00
Speaker 3: I think there was some building back of that, but
32:03
Speaker 3: right now it's not being supported and so that's a
32:08
Speaker 3: real fear. And if you don't do the science. I mean,
32:11
Speaker 3: COVID is another good example. So it wasn't like we
32:14
Speaker 3: got this COVID vaccine in like nine months from when
32:19
Speaker 3: COVID started from scratch, this mRNA vaccine that turned out
32:25
Speaker 3: to be the key vaccine that present, you know that.
32:29
Speaker 3: I mean, I can't even begin to tell you how
32:32
Speaker 3: many lives were saved from this. I mean, it's just
32:35
Speaker 3: massive worldwide. That didn't just happen. There was an mRNA
32:39
Speaker 3: platform that was being used for other diseases that had
32:43
Speaker 3: already been built up, and it was known to be
32:46
Speaker 3: safe and had been tested in large numbers of people.
32:50
Speaker 3: So all this was was a modification of an existing
32:54
Speaker 3: thing that had just been developed, and you know that
32:57
Speaker 3: probably gave at least several years of head start to
33:02
Speaker 3: being able to push out that COVID vaccine. So here's
33:06
Speaker 3: COVID starting at the end of March in twenty twenty,
33:09
Speaker 3: and people are being immunized against COVID in the first
33:13
Speaker 3: week of December of twenty twenty. That's unbelievable. And the
33:17
Speaker 3: vaccine was already being tested in that summer, So four
33:21
Speaker 3: months or three or four months after this disease that
33:25
Speaker 3: we didn't even know anything about we're getting shots in
33:28
Speaker 3: people's arms to protect them. It's astounding, and yet people
33:33
Speaker 3: didn't appreciate it, I think to the degree that they
33:35
Speaker 3: should have. Without the science that was there, that had
33:39
Speaker 3: done that work, there would have been you know, many, many, many,
33:44
Speaker 3: you know, hundreds of thousands if not more deaths from
33:48
Speaker 3: cold worldwide. And so you know, you need that infrastructure.
33:53
Speaker 3: And again that's part of the thing. If you don't
33:55
Speaker 3: trust science and you don't want to fund it, there's
33:58
Speaker 3: going to be there's going to be issue and people
34:02
Speaker 3: who are going to be looking to have their really
34:04
Speaker 3: bad diseases on a number of fronts treated are not
34:08
Speaker 3: going to have those remedies, are not going to have
34:10
Speaker 3: those cures that they have come to be used to
34:13
Speaker 3: and you know, being able to get into a cancer
34:16
Speaker 3: trial with new drugs that have been based on new science.
34:21
Speaker 3: It's just not going to be there. And I'm really
34:23
Speaker 3: worried about the fact that those researchers aren't getting started now.
34:28
Speaker 3: So the funds that we're building that next generation that's
34:32
Speaker 3: going to be a lasting effect. If a PhD program
34:35
Speaker 3: of somebody with great promise and research isn't funded and
34:39
Speaker 3: that person has to go do something else in their life.
34:42
Speaker 3: You know that that's that's something that's going to have
34:45
Speaker 3: a long lasting effect. So I think, you know, and
34:49
Speaker 3: getting into you know, academic freedom and the number of
34:53
Speaker 3: other things, you know, even bigger topics of how you
34:57
Speaker 3: foster trust and how you know, really augment and nourish
35:06
Speaker 3: the you know, the whole scientific discovery process.
35:10
Speaker 1: Yeah, I mean, that's it's well put in that. There's
35:15
Speaker 1: always a host of other things we could talk about.
35:16
Speaker 1: We could talk about academic freedom for days, but it's
35:22
Speaker 1: it baffles me. I mean, this may be too autobiographical.
35:25
Speaker 1: I'm probably too naive, but it baffles me to think
35:28
Speaker 1: that folks are not interested in letting good scientists come
35:35
Speaker 1: up with cures. Right, I've got little kids. There are
35:38
Speaker 1: benefits that I have from scientific endeavors now that I mean,
35:42
Speaker 1: and this is a conversation in the same way that
35:44
Speaker 1: learn you walk around the neighborhood conversations during COVID or
35:49
Speaker 1: what are we going to do there when there's you know,
35:51
Speaker 1: school shootings, all conversations or what are we going to
35:53
Speaker 1: do about gun violence? Now? Just local chats neighbors, right,
35:58
Speaker 1: not podcasts on medical endeavors are Oh, jeez, what are
36:03
Speaker 1: we going to do with this these what are we
36:04
Speaker 1: going to do with twenty years?
36:05
Speaker 3: Like?
36:05
Speaker 1: Who has not been touched in some way positively by
36:09
Speaker 1: the great advances of science and sort of negatively by
36:13
Speaker 1: cancer some set of diseases. Like I think conversations with
36:17
Speaker 1: folks from different perspectives would be really helpful because these
36:20
Speaker 1: just seem like slammed, don't they seem obvious to me?
36:22
Speaker 1: But let me get you another question too, that's more
36:25
Speaker 1: sort of sure medical science folks. Then we'll go through
36:28
Speaker 1: so pedagogical question. As a teacher, what are you looking
36:34
Speaker 1: for sort of broadly speaking, and students who are interested
36:38
Speaker 1: in pediatric infectious disease or maybe interested in medicine in general.
36:42
Speaker 1: And I have sort of like the profession of medicine
36:45
Speaker 1: and this idea that folks graduate.
36:49
Speaker 2: From medical school are going to.
36:51
Speaker 1: Have to do a lot of the work that you've
36:52
Speaker 1: described in terms of rebuilding trust. So are there values
36:57
Speaker 1: that future physicians should have folks who want to go
37:01
Speaker 1: to medical school should have relative to being good physicians?
37:06
Speaker 1: And I mean this might put too fine a point
37:09
Speaker 1: on it, but are folks who are vaccine hesitant or
37:15
Speaker 1: anti vaxxers to use that phrase, are they good fit
37:19
Speaker 1: for physicians?
37:20
Speaker 2: Is that?
37:21
Speaker 1: I mean, because it seems like I don't know if
37:24
Speaker 1: that's controversially. Let me give you the philosophy example, right,
37:26
Speaker 1: because I'm a philosopher. If someone came and said, hey,
37:29
Speaker 1: I want to study philosophy, everybody's welcome. But if they said, look,
37:31
Speaker 1: I don't go in for arguments, so like, I'm just
37:33
Speaker 1: not going to do any logic. I don't care about
37:35
Speaker 1: premises and conclusions, like I don't care about how you reason.
37:39
Speaker 2: That just wouldn't be a fit. You can't do.
37:41
Speaker 1: Philosophy if you're not up for that. Any thoughts as
37:46
Speaker 1: a leader in medical education and as a teacher about
37:49
Speaker 1: you know, sort of what sensibilities or values medical schools
37:52
Speaker 1: need to inculcate in.
37:55
Speaker 2: You know, future physicians.
37:58
Speaker 3: No, absolutely, I mean, and you know, I think it's
38:01
Speaker 3: really important. And you know, you certainly know our students
38:04
Speaker 3: and you teach them well, and you know they are
38:08
Speaker 3: an extraordinary talented group. And you know, we look at
38:11
Speaker 3: how well they did on their medical college admission tests
38:14
Speaker 3: and their GPAs. That's not how they get into our school.
38:17
Speaker 3: They get into our school because they show us, care
38:19
Speaker 3: for other people, and empathy, and these are the traits
38:23
Speaker 3: of the physicians that we want to graduate. So going
38:27
Speaker 3: along with that is, you know, if we can teach
38:29
Speaker 3: you right, you're going to understand that if to truly
38:32
Speaker 3: care for your patients, you have to gain their trust.
38:34
Speaker 3: You have to listen to them, you have to give
38:36
Speaker 3: them your time. And I think if you can build
38:39
Speaker 3: that trust on an individual level within your own practice,
38:43
Speaker 3: you'll be able to serve those patients better. And so
38:46
Speaker 3: that's where we're trying to get them. And I mentioned
38:48
Speaker 3: before about commencement, that's going to be my charge to
38:51
Speaker 3: the class is that to serve your patients best, you
38:54
Speaker 3: have to listen to them. You have to give them
38:56
Speaker 3: the time they need. They have to come to trust
38:58
Speaker 3: you so that they they make the decision, but help
39:01
Speaker 3: them make what really is the right decision and based
39:05
Speaker 3: on the real information and the real science, not the misinformation.
39:10
Speaker 3: And so they need to be able to help distill
39:13
Speaker 3: that out for their patients and that will only happen
39:16
Speaker 3: if they come to trust them. Now getting to the
39:20
Speaker 3: second part, that's not a hypothetical question that you asked me.
39:23
Speaker 3: So I have had students apply to the school and
39:28
Speaker 3: even get to the point of being interviewed who say
39:33
Speaker 3: they don't believe in vaccines, and you know it's there
39:37
Speaker 3: are some people whose religion reflects that, and we look
39:42
Speaker 3: at that carefully and make sure that that's, you know,
39:45
Speaker 3: their true belief and not just being used. But we
39:50
Speaker 3: respect that. But I do have issues that you know,
39:55
Speaker 3: there are certain things you need to do to protect
39:57
Speaker 3: your patients. And if you think that vaccine are harmful
40:01
Speaker 3: to your patients and would never give a vaccine to
40:03
Speaker 3: one of your patients, I don't think you belong in
40:06
Speaker 3: our medical school. I don't think that you are. It
40:09
Speaker 3: comes down to a simple question, right, do you believe
40:12
Speaker 3: in science?
40:14
Speaker 2: Right?
40:14
Speaker 3: So, if you believe in science, we're going to present
40:17
Speaker 3: the real science to you to convince you, or not
40:21
Speaker 3: even to convince you, to have you understand why we've
40:26
Speaker 3: come to these conclusions of something that's really really important
40:31
Speaker 3: and saving lives. Right, Vaccines and antibiotics, without a question,
40:36
Speaker 3: have been the two single things in the twentieth century
40:40
Speaker 3: that led to an increased life expectancy that's known antibiotics
40:45
Speaker 3: and vaccines period, no dispute, Right, But you have to
40:49
Speaker 3: understand that if you come into medical school and say,
40:52
Speaker 3: I don't believe the science. I don't think that you're
40:57
Speaker 3: in an appropriate place to really practice good medicine that's
41:02
Speaker 3: based on that science. I think that's essential to being
41:06
Speaker 3: out there. And certainly there are people that over you know,
41:10
Speaker 3: many many years, have practiced pseudo medicine. Their patients have
41:15
Speaker 3: not been helped by their efforts, and in fact, often
41:18
Speaker 3: are hurt by their efforts. So we feel an obligation
41:22
Speaker 3: to graduate students who believe in science are willing to
41:26
Speaker 3: question the science. We think that's incredibly important, but have
41:30
Speaker 3: that discussion, look at the data, and yes, with a
41:35
Speaker 3: scientific guy, help reach a conclusion. We're comfortable with the
41:39
Speaker 3: science that we're presenting will stand up to that kind
41:42
Speaker 3: of scrutiny. But that's you know, we need students to
41:45
Speaker 3: be able to do that. If you come in and
41:46
Speaker 3: you can't listen, you're not going to do that debate. Hey,
41:49
Speaker 3: that's the same as the philosopher can't do it.
41:53
Speaker 1: Yeah, Yeah, that sounds exactly right and brings in considerations
41:57
Speaker 1: of conscious and respect for sort of differences different ways
42:00
Speaker 1: of knowing, different religious practices. But at the end of
42:04
Speaker 1: the day, if you're interested in medical science. You have
42:06
Speaker 1: to be interested in medical science. And it goes back
42:08
Speaker 1: to trust. And I mean, I'm not a doc. When
42:11
Speaker 1: I walk into the pediatrician's office with my kid, there's
42:14
Speaker 1: a great deal of trust that I have and I
42:16
Speaker 1: want them, you know, I think many many parents want
42:20
Speaker 1: folks who know the science. All right, I'll get you out.
42:22
Speaker 1: Last question from my phenomenal research assistant who heard that
42:25
Speaker 1: I would be chatting with you today and talks about
42:29
Speaker 1: pediatric infectious disease specialists as the kid's cold doctor. So
42:34
Speaker 1: she wanted to know two things and you can pick one. First,
42:37
Speaker 1: she wanted to know how do babies grow teeth? And
42:41
Speaker 1: the second question was how do other people get sick?
42:45
Speaker 1: And how do you not spread germs? So if you
42:47
Speaker 1: got asked those by a four year old, what do
42:50
Speaker 1: you say?
42:52
Speaker 3: So let me not take the obvious one for a
42:54
Speaker 3: pediacal infectious disease person, and that would obviously be you know,
42:58
Speaker 3: like I could give you another hour on how you
43:01
Speaker 3: know germs are spread and what we can do about
43:04
Speaker 3: it and the pathophysiology of how those germs get into
43:07
Speaker 3: your body and have certain targets and go on. That's
43:11
Speaker 3: probably not a good answer for your four year old,
43:14
Speaker 3: and even though she's an incredibly talented research assistant. But
43:20
Speaker 3: so I'll go a little more simple. So here's to
43:24
Speaker 3: a four year old. Think of the bones in your face.
43:28
Speaker 3: So think about your jaw and think about the upper
43:32
Speaker 3: part of your jaw, and think of it that as
43:36
Speaker 3: you're developing as a baby and starting to grow up,
43:40
Speaker 3: and even starting before you're even born, all those bones
43:44
Speaker 3: are forming. And think about teeth as being seeds that
43:50
Speaker 3: are planted in that bone. And that's literally what they are.
43:54
Speaker 3: So they're seats, they're called buds, and they are there
43:59
Speaker 3: as a part of you development. And you can't see
44:03
Speaker 3: them when a baby's born. There's just gums, but they're
44:07
Speaker 3: there and they start to sprout like just like seeds,
44:11
Speaker 3: and then they pop through and there you go. You
44:14
Speaker 3: got these things called teeth. It's incredible. I mean, when
44:18
Speaker 3: you understand the human body, the design of it is
44:21
Speaker 3: just always astounding to I think it's one of the
44:24
Speaker 3: greatest things of medical school. It's just how this whole
44:27
Speaker 3: thing works is just unbelievable. But here's one tiny area
44:32
Speaker 3: that knows that your jawbone is going to continue to grow.
44:35
Speaker 3: Your other bones are going to continue to grow. So
44:37
Speaker 3: those first teeth that are probably not going to be
44:39
Speaker 3: good enough for the rest of your life, and they
44:41
Speaker 3: just happen to pop out, and there's another butt underneath
44:44
Speaker 3: it that's starting to sprout, and there you go. So
44:48
Speaker 3: the tooth Fairy swoops in, takes those first teeth and
44:52
Speaker 3: then you get new ones that hopefully you'll have for
44:54
Speaker 3: a long time. But that's what it is. These are
44:57
Speaker 3: little seeds in your bone that pop in.
45:00
Speaker 2: To teeth that would be great. Like that Vera.
45:05
Speaker 1: That was fair because she likes the plans left too,
45:06
Speaker 1: And I'm glad you didn't mention any gifts that the
45:10
Speaker 1: tooth Fairy leaves. I hear the numbers are getting higher
45:13
Speaker 1: and higher. So yeah, thanks so much for the time today.
45:16
Speaker 1: I appreciate it for everyone listening. I'm seeing you with
45:19
Speaker 1: doctor Jeffrey Bosscamp on infectious diseases and Pediatrics. I'm Brian
45:24
Speaker 1: Pilkington and thank you all for listening. This podcast series
45:28
Speaker 1: is a production of the Health Ethics Lab, and I
45:31
Speaker 1: am grateful to colleagues in the Department of Medical Sciences,
45:34
Speaker 1: the IHS Library, and the Hackensack Ready in the School
45:36
Speaker 1: of Medicine for making this collaboration possible. To learn more
45:40
Speaker 1: about our work or to engage with the series content,
45:43
Speaker 1: reach out to me Brian Pilkington at Brian dot Pilkington
45:47
Speaker 1: at hmh N dot org.