Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep110: Vaccine skepticism, with Paul Offit, M.D.
Transcript
- 0:00 In many ways, public health is under siege, and I'm not sure what gets us out of this, but it's certainly the worst I've ever seen it in my lifetime. Welcome 0:21 to off the chart of business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the Assistant Editor of medical economics, and I'd like to thank you for joining us today. Today we're focusing on an issue that physicians are running into more often than they ever have before, and that's patients who are unsure about vaccines, are skeptical of the information that they're hearing. It's becoming a routine part of primary care and is reshaping a lot of everyday conversations. So for this episode, medical economics senior editor Richard Pearson spoke with Dr Paul Offit, director of the Vaccine Education Center, and a professor of pediatrics in the Division of infectious diseases at Children's Hospital in Philadelphia. They talk about what he's seeing right now, why confusion has grown, and how physicians can approach these discussions in a straightforward and practical way. Dr offit, thank you so much for joining us today. Let's get into the episode in 1:18 preparing for our conversation, I was kind of refreshing myself on a little bit about your background and refresh my memory frankly, that you've been writing for years about issues relating to, for example, autism research, the anti vaccine movement and alternative medicine. In your own words, how would you describe the current state of trust in medicine in the United States? And do you feel that science is under attack? 1:43 Grim is how I would describe it. I think science is under attack. I think science is losing its place as a source of truth. People are simply declaring their own truths, including people in prominent positions of leadership. So I think in many ways, public health is under siege, and I'm not sure what gets us out of this, but it's certainly the worst I've ever seen it in my lifetime. 2:06 One of the things, and like I said, we'll go back to even maybe before the before year 2025, and maybe even before the covid 19 pandemic, and certainly before Robert F Kennedy Jr was appointed to be the HHS Secretary, there had been some criticism about the CDC and other federal health agencies for handling of information and guidance, and especially during the covid 19 pandemic. What reforms would you like to see in federal evaluation and communication processes to increase that trust? Right? 2:38 I think, first of all, there's been distrust of vaccines ever since the first vaccine, which is the smallpox vaccine, that gave birth to something called the anti vaccination League. Because I think whenever you inject somebody with a biological agent, and especially when you have mandated vaccines like for school entry, there's going to be pushback. So that's always going to be true. I do think we have to today realize that vaccines don't sell themselves anymore. Quite the opposite. I think vaccines are a victim of their own success. I think right now, we ask parents, for example, to inoculate themselves, or inoculate their children to prevent 14 different diseases in the first few years of life, which can mean as many as 25 shots at that time. During that period of time, he committed as many as five shots at one time to prevent diseases people. Most people don't see using biological fluids. Most people don't understand. I mean, you didn't have to convince my parents to vaccinate me. I mean, they saw or experienced many of these diseases. You didn't have to convince me to vaccinate my children. I had measles, mumps, German measles, chicken, bucks, I had all those diseases, but my children didn't grow up with these diseases. And for them, it's it's more a matter of faith. And I think we have to understand that, we have to be sympathetic to that, that people are not so compelled to give vaccine or plus, I think, really largely, as a consequence of the covid pandemic, we have this sort of turbo fueling of this kind of medical freedom movement where people feel they just should make their own decisions for themselves and and, you know, can make their and can gather their own information for themselves, as they don't really need experts. And you'll hear Robert F Kennedy Jr say that he's, he'll say, you don't need experts. You can do this all on your own. So it's, it's a hard time. You know what? 4:22 This was something. I'm going to jump down my list a little bit here, because you mentioned some of that historical context. And I'm glad that you did, because I did want to. I remembered from our conversation researching our 100th anniversary issue, you would describe some of your boyhood experiences and memories, not least the joy that was felt when the polio vaccine was proven safe and effective. And do you think it would be helpful to educate more people about past public health crises such as polio and measles, to help counter the skepticism that people feel today, 4:54 I think they have to sense the disease is a risk for them. I'll give you a perfect example. Reese hilliman, who I think is the father of modern vaccines. He did the primary research or development on nine of the 14 vaccines that we currently give to infants and young children. I interviewed for him for a book I was writing in 2004 and so we had eliminated measles by the year 2000 but because of the Andrew Wakefield paper that was published claiming falsely that the measles, mumps, rubella vaccine caused autism, which clearly wasn't true and has been shown not to be true. Parents were choosing not to vaccinate their children, I think, in part because of that paper, and in part because when we eliminated measles in 2000 we largely eliminated the memory of measles, so people weren't as compelled by the virus anymore, but it was starting to come back in 2004 so I was interviewing him. He'd been diagnosed with disseminated pancreatic cancer. Was given six months to live and live six months, but during those last six months, he gave me his time to interview him. Now, He's the inventor of the current measles strain, the the measles vaccine that was introduced in this country in 1968 the so called Morton strain. He is the inventor of that strain. And so here's, here's a man who basically helped us to eliminate measles from his country, but it was starting to come back. So I said to him, what's it going to take? Can we educate people about the importance of this disease? Can we educate people about how well the vaccine works, or is the disease going to have to come back in order for people to realize how important it is to vaccinate? And he spent a long time answering that question. He's looking out his back window. It was a snowy day in suburban Philadelphia, and then he looked back at me and grimly said, No, I think the disease is going to have to come back for people to realize how important this is. And that was an enormous defeat for him. He was the inventor of this vaccine. He'd spent, you know, decades working on it. 6:37 I remember from our earlier conversation just learning about his experience and career, I think is just frankly incredible. I mean, that is extraordinary. You yourself have developed the childhood vaccine for the roto tech vaccine, if memory serves, with your experience with Dr Hilleman and then yourself. How does it feel to see the concept of immunization so politicized? 7:00 Oh, it's really hard. I mean, as the old saying goes, you know, when you miss science with politics, you get politics, and I think you're just seeing that now, to a degree, we've never seen it before. I really could have never imagined we'd be in this position. I feel like our country's been invaded by a foreign country. In that foreign country, the first thing they want to do is destroy the public health infrastructure. It's hard to watch. You have somebody like Robert F Kennedy Jr, who for 20 years has been an anti vaccine activist, science denialist, conspiracy theorist, shouting from the sidelines for 20 years about how awful vaccines are. Now he's in a policy making position, and that's what he's doing. He's going to make vaccines less available, less affordable and more fear. That's who he is. He believes it. He's a zealot. And it's hard to watch this because, you know, just from from my point of view, or Dr hillman's point of view, it's that, you know, why did we do what we did? We did what we did because we love children, and we see them as a vulnerable population. Want to be protected. That's why we did it. And it's hard to watch this infrastructure fraying the way it has, 8:05 when you touched on a moment ago, with Secretary Kennedy being in a policy making position, and one of the one of the items that has gotten a lot of public attention is regarding the Advisory Committee on Immunization Practices. A lot of advocates had said that the ACIP review process was a gold standard and world leader for Scientific Review. The United States has a thorough program evaluation. But no process is perfect. So what would you like to see improve on that? 8:33 Well, I mean, we don't have an advisory committee organization practices anymore, at least one where you would describe that committee as a group of external experts that advise then the CDC, that's not true anymore. They don't have an expertise. With the exception of our would be one of them there. They don't have an expertise. Rather, they are like the Secretary of Health and Human Services who has an anti vaccine, anti science bias. So I think when any of us watch those meetings now we just hold our breath waiting to hear what dangerous information they're about to give. It used to be that the CDC was the most important public health agency in this country. They would generate the kind of data that we needed to make good decisions, good policy decisions. They would present those data to the AC IP. The AC IP would then consider that, not only at those meetings, but in working group meetings that would be formed as many as 10 months before that meeting, and then you would get, I think, very good advice based on solid data. That's not true anymore. I mean, you have people like Tom fried or Rochelle walensky, who were formerly directors of the CDC, telling you they don't trust the CDC. I mean, it's that bad now. Fortunately, a lot of groups are standing up. Different states are standing up. I know our Commonwealth of Pennsylvania is standing up and putting out what they consider to be best medical practices, and then make sure that those best medical practices are insured or worse comes to worse, that you have a backup plan, like a vaccine for children's program, so uninsured or underinsured children. Can't get vaccinated. So I think that's that's happening, but it's happening in a fragmented way. 10:04 Just to follow up on that, I was curious, because the AC IP did have two public meetings this year. Did you follow along on their deliberations? 10:14 Painfully, yes, yeah, yeah. So you had the first one, where they met in June, where they had their first anti science vote, right? So you had a thimerosal or ethyl mercury containing influenza vaccine, I feel like I'm reliving the events of 25 years ago, when I was on the AC IP, between 1998 and 2003 when we went through all this. So there's nine studies showing that you are at no greater risk of any neurodevelopmental problems if you've gotten an ethyl mercury containing preservative in vaccines which are needed for multi dose files, as compared to the same vaccines that didn't contain thimerosal. Study after study after study. Nonetheless, they had an anti vaccine activist presenting those data to the AC IP, and then the ACP voted no on that vaccine. That was that was an anti science vote, and I think that was like the Velociraptor in Jurassic Park, where they keep looking for where that weakness is in defense. That was it. That was round one. That wasn't that big of a deal in it. Maybe the influenza that was thimerosal containing made up maybe four or 5% of the influenza vaccine that's out there. But nonetheless, then they meet again in September, and they're talking about now delaying the birth dose for hepatitis B vaccine, which would be tragic if that happened, but because they don't understand, they don't understand the genesis of the birth dose. I mean, you have, you have people even on that committee, or people like Rand Paul, or certainly people like President Trump saying, you know, why are we giving this vaccine to babies, when, in fact, the only way they're ever going to get this virus is by becoming a sex worker or getting intravenous drug use. And that's not true, although half the people say, in the early 90s, when this vaccine was recommended as a birth dose, would get it from passing through a birth canal where the mother was infected. The other half didn't, and 15,000 children less than 10 years of age. In 1991 got hepatitis B from coming in contact with relatively casual contact with people who had chronic hepatitis B, most of whom didn't know they had chronic hepatitis B infection. So they just don't understand any of that. And so they just put out these basically anti vaccine tropes and vote on them. It's it's hard to watch. 12:20 Doctor wanted to ask about this because, and obviously those studies exist now, there is a adverse, you know, adverse event reporting system that exists in our country too. And there are some people. It may not be very many, thankfully, but some people actually do have adverse effects from some shots. Is there a chance that debate about unproven harm is going to SAP time, money and resources from studying actual harm? 12:47 Yes, no, I think what's going to happen is, I think that Robert F Kennedy Jr has already shown the way he acts. He, for example, in that second committee hearing for his confirmation, the so called Health, Education labor Pension Committee, he was asked the question by both Senator Sanders and Senator Cassidy, you have to admit they said that we know now that vaccines don't cause autism, and he said that he wouldn't admit that until there was gold standard science showing that it did, and if you could show me those data, then I'll be convinced. Then towards the end of that hearing, he held up a paper by Mawson and colleagues, which was a terrible study. It was methodologically flawed. It was a Medicaid study where you couldn't tell who'd gotten vaccines and how or when, whether they got it from the vaccine for children's program. It was a terrible study. And so he held that up and he said, See, this is a gold standard study. And when he withdrew the billions of dollars of support that we have for the Global Alliance vaccine Initiative, a program that began in 2000 where we probably inoculated a billion children with vaccines and probably saved 20 million lives. And then he backed away in our commitment for that and held up a paper that said that the diphtheria, tetanus, Pertussis vaccine was killing young girls in Guinea Bissau, West Africa. Well, so the same authors that published that paper essentially later retracted it, saying that, no, we have new data that showed that was wrong. Many other people tried to reproduce that original study and couldn't. And for that, he withdrew then our commitment to the developing world, and called it again, gold standard science. So I think whenever you hear him say, gold standard study, beware you. Keith, 14:28 hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack, an employee engagement win, or a lesson learned the hard way, I want to feature it. Shoot me an email at kreynolds at mjh life science. Dot com with your topic, quick outline or even a smartphone clip, we'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 15:19 This wasn't a question I necessarily had on my my list here for our conversation. But frankly, I'm curious, because I think back to my research for the medic 100 and I got to speak with a it was I remember it, not least because it was the first time I'd ever interviewed someone from Africa, and he was a physician over there who had mentioned about when you're when you're over in foreign lands, not least the developing world, when people hear about Americans are getting this vaccine, it makes them want the vaccine, because Americans have a high standard of living, and they want to have what American people have. What do you think are do you think there could be a global effect, a repercussion that happens because of the current state of science in the United States. 16:04 No doubt about it, I had to give a talk virtually in Spain a couple weeks ago, and they were angry at me. They said, You know what is going on with you people? I mean, we're having more trouble now getting our citizens vaccinated because they read about what's going on in the United States. So does what happened here? Stay here? No, it travels across the ocean into both developed and developing world countries, and is doing harm. 16:26 You know, doctor, want to switch veins slightly, because this is a question with some real, practical effects. Our main audience, you know, has always been primary care physicians. A lot of internal medicine physicians and family docs, and many primary care physicians now find themselves on the front lines of medical misinformation. What communication strategies do you believe are most effective for clinicians encountering vaccine misinformation at the level of the exam room? Right? 16:54 Well, first of all, to sound one one positive note. Recent surveys have found that if you sort of put aside the covid vaccine. Most people support vaccines. Most people come into the doctor's office and ask, what vaccines Am I getting today? They do. 80% of people value vaccines. Value school entry requirements, and it's independent of your political affiliation, whether Democrats or Republicans all generally support vaccines. So people like Robert F Kennedy Jr or President Trump don't represent most people when they have their sort of anti vaccine bias. So I think know that and people do trust their doctors as a general rule, and people do trust scientists as a general rule. So I think what you should be compassionate and passionate and compelling in that you need to understand what it is that the person is worried about, and then to try and provide in as best a way you can in a compelling way that here are data showing that that isn't something you need to worry about and and we're always looking to make sure that there's not any new safety problems. I mean, you know, covid is a perfect example of that when, I mean, I was on the FDA vaccine advisory committee in December of 2020, when we reviewed those two big studies by Pfizer moderna. You know, those were 40,000 people, placebo controlled one to one or 30,000 for those two big studies. So basically, 35,000 adults got that vaccine, and we approved it knowing that another shoe was going to drop. You know that you're about to make a recommendation for hundreds of millions of people based on data from 35,000 people. So the good news is, we very quickly found out that myocarditis, this inflammation of the heart muscle, was a rare consequence of the mRNA vaccine. Unfortunately, it was short lived, self resolving and transient. But it certainly happened very quickly picked that up. And then, if you looked in February 2021 when we approved the adenovirus vectored vaccine by Johnson and Johnson again, that was based on 10s of 1000s of people, but then was given to 10s of millions of people, was found to be a very rare cause of clotting, including blood clotting of the brain, including fatal blood clotting of the brain, that ultimately drove that vaccine off the market by May of 2023, so you're always looking and that was really rare. There was like one per 250,000 people. You're not going to pick that up in a pre approval or pre licensure study. You can only pick that up afterwards, and it's very quickly picked up because we have systems in place to pick it up. 19:10 You know, in that again, that you got the wheels turning for me here because it I just want to continue on that train of thought only because, when a vaccine is researched, studied and then introduced, that study is not just a one time thing, there's going to be continuing monitoring in place, you know, down to the physician and patient level. 19:35 Yes, of course, of course. I think the language can be you asked me, what could be improved? I think we can be better at communicating. I think that the covid example is a perfect example of that. You know, Operation warp speed, not the best name for those who followed Star Trek. Worst, worst people something faster than the speed of light, but it creates this notion of things being done too quickly that you're ignoring key, key guidelines, especially if. Like safety guidelines, the term emergency use authorization. I really didn't like that term, and when I was on the committee, I said, Can we not use that term? Because the studies that we were looking at, the 40,000 person study for Pfizer or 30,000 for maternity, those are the size of any typical adult or pediatric vaccine trial. Why are we saying emergency use when these when we're still holding these companies to the same criteria in terms of manufacturing protocols, in terms of the building being being inspected, we're still doing the same things we were always doing. Why are we calling it that? And then six months later, when the vaccine was found to still protect Well, against severe disease, which was the goal? The goal of this vaccine was to keep you out of the hospital, keep you in, out of the intensive care unit, and keep you from dying. The covid vaccine, it's a short incubation period mucosal infection. You're not going to be protected against mild to moderate disease for long. And we should have made that very clear at the beginning, but didn't. And then, when people got a mild or moderate infection, we call those breakthrough infections, we would say things like, you know, this vaccine prevents transmission, and and although it lessens transmission, it certainly doesn't eliminate transmission, as would be true for any short incubation period mucosal infection like influenza or respiratory syncytial virus or rotavirus, and we never made that clear. And I think people got disillusioned by all that, and they thought we were lying to them. And I think we could have done a better job. Now, it's always easy. In retrospect, 1000s of people were dying a day. You know, we were doing everything we could to get that 30% of the population that refused to be vaccinated, vaccinated, and so I think we oversold 21:30 it a little bit. You know, doctor wanted to switch gears slightly, because there's, there's both sort of a cultural or social or political effect that is happening in our country right now, but also a financial one, because the federal government and Department of Health and Human Services has cut some research funding regarding either that political and social overtone or the financial ramifications for the next few generations of healthcare. Do you think the climate right now is going to affect willingness of young medical students and scientists to enter vaccine research? 22:03 Yes, I absolutely do. If you talk to people you know, like Drew Weissman, who was the won the Nobel Prize in medicine for his work on the mRNA vaccine. For Stanley Plotkin, who's the CO inventor of the rotavirus vaccine, is the inventor of the Rubella or German measles vaccine, did important work on the anthrax vaccine. These are major players, and they all say the same thing and answer your question, they just say one word, China that I think all the research and development on vaccines is not going to be in this country anymore. I think it's going to be China and then possibly India as well. But we're losing one of the strengths we had in this country, which was biomedical research, because we're so incredibly short sighted. I think you know people, there were three heroes of this pandemic. To me, one was drew Weissman and Kate Carrico for their work collaboration beginning in 1997 that enabled us to have an mRNA vaccine. They were able to figure out how to manipulate mRNA so that it was no longer able to induce an innate immune response. That's what you wanted. And they did that, and then you had operation warp speed, which was a major medical or scientific achievement. But I think people never realized who that second hero was, and that second hero was the National Institutes of Health. And the reason they were a hero is that when in 2002 and 2003 SARS one raised its head in Foshan, China and started to spread across the world, they started making an mRNA vaccine with SARS SARS one. And although the virus never really came into this country, it kind of burned out before it came to this country, we had a lot of information about how to make an mRNA vaccine against the coronavirus. So when SARS cov two raised its head in late 2019 we had all that information. So when Robert F Kennedy Jr removes $500 million from BARDA, you know, the biomedical Advanced Research Development Authority, where you're looking at things like, you know, say, bird flu, vaccines and stuff, you lose all that information. I don't think he has any idea, just the price that we're about to pay for this. And I think we are uniquely susceptible right now to to to things like bird flu or food borne illnesses, or a rogue nation or group that wanted to invest initiate a biochemical or biomedical attack? I think we're 24:07 in trouble right now. Doctor a couple of in sort of recent months, there have been some of the different medical societies have put out different you had mentioned, for example, action at the state level or guidelines at the state level, some of the medical organizations have also published their own guidelines. Do you think that's helping the situation, or is that just going to make people more confused? 24:29 I think it had to happen because we can't look to the CDC and the AC IP anymore for guidance. So I really applaud those states that have stood up for the children in their state and are basically putting out their own guidelines based on solid data, and there's a Western consortium that's formed, there's an Eastern consortium that's formed. I think it is going to mean a fragmentation of advice to some extent, and a fragmentation of funding. And I do worry about those states that are just sitting back and not doing anything. But so we'll see how this plays out. I think it's. Companies generally have been responsible here, because, frankly, it's just good business. You know, it's much cheaper to pay for a vaccine than a hospitalization. 25:08 You've talked about the element of communication and sort of, you know, the federal government, researchers, some of the doctors, communicating out to patients. But I think it was maybe one of the interviews you had with MSNBC that you talked about the the drying up of communication, so to speak, about reporting and notification requirements between and among maybe some of the doctors, public health agencies, state level agencies and the CDC. How important is that going to be coming up in months and years ahead? 25:40 I mean, if you look on the CDC website today under measles outbreaks, you will see lovely, roughly a little more than 1500 cases reported in 42 states and jurisdictions. If you talk to people on the ground about measles, they say there's at least 5000 cases. So what's happened? What's happened is that under the leadership, and I put that in quotes of Robert F Kennedy Jr, as Secretary of Health and Human Services, he has shredded their surveillance capacity. So it's not only that there's going to be more because there are more. We have the biggest measles outbreak in this country that we've had in 33 years. We had three people die from measles in this country. That equals the total number of measles deaths over the last 25 years, we've had two healthy little girls die in West Texas. That's the first child death for measles since 2003 we've had about 290 children die of flu this year. We haven't seen numbers like that since the last flu pandemic, and we've had many states that have reported pertussis deaths, whooping cough deaths that hadn't seen pertussis deaths a year. We've probably had 10s of 1000s of cases of pertussis this year, and over the last few years, it's gotten worse, because we had erosion and faith in vaccines, and more and more people are choosing not to vaccinate. And what worries me the most in all this is we're not going to know about it, is that, because it's sort of like the See No Evil approach, so we're not going to be able to do things like direct vaccination clinics to those areas at highest risk, meaning that have the lowest vaccine rates, because we're not going to know. And I think that is Robert F Kennedy Jr's legacy here, which is the See No Evil approach to what's going on and to ignore what's going on. What he should do, if he was actually a Secretary of Health and Human Services who was worth his weight in salt, is he would stand up and use his platform as as head of HHS and say, vaccinate your children. These deaths are unconscionable. This is preventable. There's so much in medicine we don't know. There's so much we can't do this. We know this. We can do vaccinate your children. But he is the last person to say that, 27:32 you know what? And I don't necessarily mean this to be an interview that is simply, you know, strictly, we're talking about vaccine vaccines in science, not necessarily about Secretary Kennedy, but one of the questions that I had down he has mentioned you by name for having an alleged financial conflict of interest in vaccine development while advising federal leaders on vaccine policy. How do you respond to that? 27:54 I know this is going to surprise you, and I'm glad to see you're sitting down. Robert F Kennedy, Jr, lies. Okay. I know it's hard to believe that, but so what he says that when I was on the advisory committee for Immunization Practices, I voted on licensure the or the agreeing to license the vaccine that me and my colleagues were working on. The thing that was a little wrong about that was I'd been off the committee for three years when that came up for a vote. He then says that. So he said I voted myself rich. Then he said that I sold out the patent on the vaccine for $182 million which I think I would have remembered. What he fails to notice is that that I, although a co patent holder with my two colleagues, I am the intellectual property of Children's Hospital of Philadelphia, they own that patent. They sell out the patent, not me. So when they take the money that they get, it largely just put into research. So he gets all that wrong. I mean, you know, he's been doing that for 20 years, and more recently, when he did it as Secretary of Health and Human Services, a couple of times on Fox, I did a little one minute video and just said, stop it. This is all wrong. Stop lying. Why don't you just do your job as head of HHS and not worry about sort of making this attack, this attacks, or making attacks on other people. He's he just gets it wrong. He, he is a deeply, deeply dishonest man. I think people don't quite understand that. 29:11 What did I not ask about that you would like to emphasize or explain? 29:17 I think we cover the earth fairly well. I do think this is a tragic time, and I think that what changes it? I don't think President Trump is going to change it. I think he buys into this anti vaccine stuff as much as RFK Jr does. He just the last day said we need to take aluminum out of vaccines, just like we took, you know, just like we need to take mercury out of vaccines. You can't take aluminum out of vaccines. They're at an adjuvant on seven of the vaccines we give to infants and young children. It's not possible. Not possible, so. And he has said we need to separate the MMR vaccine into its three component parts. He said we need to delay the birth dose of hepatitis B until people are 12 years old and fully formed. He said, So in any case, it's he's an anti vaccine activist, too. And so what changes things? I think. He's the key player. I mean, RFK Jr basically has an audience of one. He's constantly playing up to President Trump, and so it's not going to be the head of HHS, it's not going to be the president United States. The only way this can happen, I think, is that parents write letters to their congressmen, meet with their congressman and say, Look, I'm scared. I'm scared that these diseases are worsening. I'm scared for my children. I'm scared that they're not going to have vaccines. Do something. Because I do think congressmen are, for the most part, the wedded finger to the wind. They they are compelled, I think, by 1000s and 1000s of people in their district who stand up, but the time to stand up is now. And I think, you know, the old saying is that if everybody shows a little courage, no one needs to be a hero. And I think that's certainly true now I'm 30:41 Richard perch and reporting for medical economics. Dr Offutt, it's been a great time to catch up again. Thank you so much for your time. 30:48 Thank you. It's my pleasure. Once 31:01 again, that was a conversation between economics senior editor Richard pearton and Dr Paul Offit, director of the Vaccine Education Center and a professor of pediatrics in the infectious diseases Division at the Children's Hospital of Philadelphia. My name is Austin Latrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicianspractice.com off the chart, a business in medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the MGH Life Sciences family. Thank you. You