"the following is a conversation with michael minna his second time on the podcast he's a professor at harvard doing research on infectious disease and immunology in my view the most powerful doable an..."

"to support it please check out our sponsors in the description and now here's my conversation with michael minna we spoke a year ago about rapid at-home testing and i think you think it should have be..."

"last year and most of this year was about educating scientists educating public health leaders educating physicians to get them to understand that there is a different reason to test in a pandemic tha..."

"so on that front i think finally there is success people are actually understanding and you know i haven't stopped beating this drum for far too long and i like hate rapid tests now so maybe it's good..."

"then you read the result they are extraordinarily effective to answer one question am i infectious and that is the public health question that we need to answer and consistently ask during this pandem..."

"tool because it's fast because it's accessible we can use them in the home and there's some issues with using them a home we can talk a little bit about what those issues are like reporting and how do..."

"sensitive if the question is how likely is it to detect me if i'm a super spreader that's a really important one to be able to detect they're all about 100 sensitive so if you have extraordinarily hig..."

"you're infectious and for that question they're like 95 up to 100 sensitive when you're most infectious so you have a lot of iron particles in you so i mean that's what it means when you say viral loa..."

"well for that question i want to have the absolute best sensitivity test regardless of what it means for transmissibility because my patient isn't sitting in my office saying doc do you think i'm infe..."

"that's bad public health practice like if i haven't been infectious for three weeks i don't want to have somebody tell me that i need to go and isolate for 10 days just because i happen to use a pcr t..."

"infectious for 60 days and to be clear people are only infectious for i don't know somewhere between three and seven days but can be positive on a pcr test for 30 to 70 days so i mean it's it's potent..."

"for contagious people or for the infectious stage of an infection then it literally can't it is an impossibility for that test to achieve an 80 sensitivity at a population level against a medical devi..."

"why don't we still have hundreds of millions of at home tests the reason it's taking long i think is because every agency and government is generally deferential to the fda and in this context i would..."

"they say you know what i get back is this sounds really interesting michael uh it looks like it checks out but there's one problem we don't have the test there's no scale and that's kind of where it a..."

"the i think what the real reason is the fda has one job around these tests and it is to authorize them as medical devices they haven't been charged with doing anything else so in their eyes they're do..."

"they get applications and they evaluate them and the applications are for medical claims that's however because there's been a misunderstanding of these tests and the companies only know to apply for ..."

"the fda very clearly states that they do not authorize or review public health tools and not and they don't authorize or review public health tests for for covid so what i want the president of the un..."

"hook they're not trying to to cram a square peg through a round hole they can say look the antigen tests are not on us anymore at least if they're going to be used for public health like when you test..."

"manufactured is it possible to just go around all of this and just for somebody to manufacture at scale tests well you if you did that and you just called them you put a claim on them that called them..."

"kids so here you have a company that's testing in each pool five to 25 kids at a time millions of kids in a pretty distributed way across the country and all these different labs and the fda doesn't c..."

"it's a ridiculous reason and it's because the fda says that if a test and this is actually cms that says this and then the fda adopts it if a test alters your behavior if you get a single result and i..."

"and each classroom you might have 20 kids each swab their nose in a classroom and all those swabs go into a single tube and then you rinse that tube out with some saline and you run a pcr test on that..."

"you talk about the public health tools and cdc you look at masks so masks were decided to somehow be an effective tool to help with the pandemic like so i'm sure the evidence that was used there was p..."

"a weird role of the dice or is there a better explanation i think it's somewhat of a roll the dice but i also think it's that testing so doctors don't pretend to like really understand much about like..."

"line and people are flowing through without going through security that's not on the tsa agent that's not a big systematic problem of that of of the the system and we can't expect that tsa agent to ha..."

"at all and so what has happened is doctors got on board early and said oh hell no we've seen these antigen tests before they're not particularly sensitive compared to pcr and and early in the pandemic..."

"who is supposed to be so it's understandable that doctors kind of feel that way just like you said do no harm who's supposed to care about public health is it the fda is there some other organization ..."

"idea i think the cdc that it should start there override the fda well i don't even think it needs to override it and that's why i think these should just be designated as a different tool so that the ..."

"but there's a lot of really good tests out there we just are taking like 6 to 12 months to run trials they're failing because they can't keep up with pcr and if the president were to do this then the ..."

"really we're going to go through this whole pandemic and never figure this thing out that's just really sad you know if we get through this and don't figure out how to evaluate a damn rapid test so ho..."

"right after the first clinical trials and i'm sure we were talking about it when when i was last here i would imagine given the timing but those first clinical trials came out and everyone you know ju..."

"like we're okay with people getting ill and letting transmission go because we don't want to worry about it anymore we're not there yet so until we decide we're not going to stop transmission we need ..."

"that's the thing so you can you can get a sense of how prevalent the virus is in a particular community by testing the wastewater that's exactly right and so the viral load associated uh the viral loa..."

"we can do that and if you've now gone again you know a week or two with no cases uh identified stop the testing again that's the nice thing that everything changes when people have the tests in their ..."

"from everything you've seen how cheap can these things get from like in the past year in in terms of the developments you've seen with the various test manufacturers how cheap can it be to make a test..."

"profit and so so it's extremely cheap market competition can drive these tests uh way down in terms of cost i think one of the most important features of a rapid test program is what do you do with th..."

"bring the test into the home but that means we need the technology to enable it and so i was at a conference recently do you know mike milken milken institute he's a very wealthy billionaire but he's ..."

"that can be considered proof that you yourself use the test and you yourself got a negative so the tools are out here if we want to use them at scale and in fact the cdc uses emed now to enable people..."

"violate people's privacy or sense of freedom absolutely i i think so the way that um right now in the united states they're requesting that these tests get that the results get delivered to public hea..."

"by default they are participating in public health whether they know it or not because they're not going to go get their mom sick by mistake at least most people wouldn't and then also you can create ..."

"central to the vaccine hesitancy is a distrust of authority in the distrust of government so you're asking you're asking people to get tested and report their status to a centralized authority when th..."

"exist and it's a struggle because for those companies they don't want to fall out of favor with the cdc or with the fda and so this is a big problem in our marketplace in general by having by having p..."

"who frankly are just scared they don't know who to trust and we haven't given them a lot of reason to trust public health to be frank so i agree i mean now that you've opened the door i'll just say my..."

"going to be staying in stock on the on the shelves at cvs and walgreens and amazon or whatever so that's crisis number one it's like now the expectation is set for having rapid tests but they're not g..."

"speaking of politics one of the great things about testing maybe you can correct me but for my sense it's one of the only solutions to covid that has not yet been politicized so masks and vaccines whe..."

"just scaled up months ago people would have we could have delivered it to every household didn't even have to ask people to request to just deliver packages to every home in america by now easily if w..."

"worry am i infectious like i was out last night but i do want to go see my mom today you know like am i infectious i don't know and this has created massive anxiety and i can't tell i completely agree..."

"you know and yeah i like what you said the quarantine is an information problem that's absolutely right what is there something you can say to what people can do like listening to this individuals do ..."

"you know this doesn't have to be a six to twelve month endeavor this could be a two day endeavor we actually did it i judged the rapid test x prize and it went great we actually got incredible metrics..."

"constant state of uh fear-mongering for different reasons it's almost um it's almost like the virus got deeply integrated not into just our biology but in the game of politics and in the fear mongerin..."

"out is except the same way out as it was originally which is testing this information it's information yeah and and i think we can do that we can keep outbreaks suppressed with testing because it's in..."

"because they can allow people if you use them at a community level you can have enough people know that they're positive enough people are good people that they won't go out and affect others and the ..."

"days and you're sitting there thinking oh i feel fine i don't know why you know there's a lot of asymptomatic spread but if you see the two lines every day then you actually get to you're doing a litt..."

"with the title like dear potus yeah you know please designate these as public health tools or just start talking about in the media talk it talk about social media anywhere testing is a public health ..."

"only protective yeah you mentioned last time you spent time as a buddhist monk we like didn't spend much time talking about i just would love to talk to you about about it a little bit more maybe as u..."

"about detachment as a goal detachment from loved ones detachment from objects is kind of easy to reconcile like people understand that yeah i don't want to be too attached to my car or whatever but de..."

"loved it it was you know but it's a it's kind of a dangerous slope because you can kind of get caught up in it and like really start going from okay i'm trying to quiet my mind to almost being like ad..."

"positive and you know this is really it's really such a distinct thing in a relative to our normal lives here in america where we live for rises you know you want happiness and joy and then you also y..."

"exactly i mean that's i i do think that that's you know and they're two totally valid ways to live life um they are generally i think they're ingrained in us pretty early in society right and it's har..."

"find that to be not peaceful for me it's like i love the night to have the night the idea that if needed i could like pack up and move yeah and not worry about anything do i actually have that in real..."

"you're you're born free you live free i mean depends of course which country but in the united states even with all the possessions even with all the burdens of um sort of credit and owing money and a..."

"completely agree with that so in looking at our failure at scale to to engineer to manufacture to deploy tests how do you feel about our prospect as a human civilization are you optimistic so this pan..."

"we'll go in terms of civilization i think we're demonstrating a pretty significant inability to recognize the danger when whether that's the pandemic or whether that's climate change i think it's extr..."

"history um but the question is whether the negative stuff can sometimes peak to the level where everybody's just destroyed but as long as that doesn't happen i i tend to believe that there would be li..."

"and such so how they choose to wield that power you know is an interesting choice and i do hope that you're right in that over time fear will drive companies to produce a better product or whatever yo..."