Episode #9: Dr. Nahid Bhadelia (Transcript)


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Quinn:    Welcome to Important Not Important. My name is Quinn Emmett.

Brian:    I'm Brian Colbert Kennedy.

Quinn:    We think. This is episode nine with Dr. Nahid Bhadelia. Among other things, including maybe an exciting new iteration of a beloved action hero star, she is a world traveler, a photographer, a professor and the Director of Infection Control and Medical Response at the National Emerging Infectious Diseases Laboratory.

Brian:    Damn.

Quinn:    Which means exactly what you think it means and that means we're going to be talking about exactly what you think we're going to be talking about.

Brian:    That's right, zombies.

Quinn:    Kind of, yes.

Brian:    Zombies eating your brains.

Quinn:    Yep, almost. Our question today is what each of us can do to make sure America stays safe from infectious disease. That's on a micro level, a personal level and on a macro level, using your vote. This was a hell of a compelling conversation and I promise isn't just a bunch of nightmarish fear mongering.

Brian:    Yeah.

Quinn:    Again, medicine is amazing, these people are amazing. We've made huge strides in the past 100 years, the past 20 years, mostly thanks to people and heroes like Dr. Bhadelia and we are so thankful for them.

Brian:    Yeah, so don't give us any of your anti vax shit.

Quinn:    That's right. Here's a controversial question.

Brian:    Uh huh.

Quinn:    Brian told me that I was going to kill him by making him ride his motorcycle to our headquarters to record every week. Now everybody here knows I've been warning him for years, not in jest.

Brian:    No, truly.

Quinn:    That his motorcycle habits would end up snuffing him out. Is it on me for making him come all this way or is it on him for his choice of vehicle? I don't know. I don't know.

Brian:    I know.

Quinn:    Oh, you do?

Brian:    Yeah.

Quinn:    Really?

Brian:    I think the more you make me come up here, the higher the chances are that I'm going to be murdered and then the more that you'll feel bad about, "Well, maybe it was your fault a little bit."

Quinn:    Wait, is it? Because here's the thing, I'm not making you drive a motorcycle here. That's your choice of vehicle, right?

Brian:    Yes, that part is true, but knowing that that is my choice, the choice has been made, it's been three years, you still insist that I come up here all the way from the Valley day after day after day.

Quinn:    That's right, day after day. Jesus.

Brian:    It'll be fine. I'm not going to die and if I do it will be my fault, okay?

Quinn:    Well, I'm just saying you have plenty of other alternatives.

Brian:    I know.

Quinn:    You could even take the subway here. Ish.

Brian:    Ish.

Quinn:    Ish.

Brian:    Pretty soon, by the time the Olympics get here I will have a pretty good option.

Quinn:    To be clear, we're dead by then.

Brian:    Oh that's right, I forgot about that.

Quinn:    Two, I'm out of here when the Olympics happen. We're not recording that week. I'm out.

Brian:    I think we need to leave, yeah.

Quinn:    Not interested. Yeah, not interested, so that's up to you, listeners. What do you think? Who is responsible for Brian's imminent being swept under a truck by some idiot turning left on red in Los Angeles when they're looking at their phone?

Brian:    This is a shit question because you know what the answer is going to be and it's just going to make you feel good because you were right.

Quinn:    Do you think if you were running for election in Asgardia, that-

Brian:    Topic change, everyone.

Quinn:    No, it's included.

Brian:    Oh, oh.

Quinn:    Do you think that this would be a judge on your character, and also can you tell people what Asgardia is?

Brian:    Yeah. Asgardia's a space nation that I am a citizen of and you also can be. I would tell you what the web site is but it's not loading right now.

Quinn:    It's a high tech space civilization.

Brian:    It's in the very beginning stages of a nation and I think that they would, well I imagine up there I would have to have some sort of space motorcycle which would possibly be more safe.

Quinn:    Explain.

Brian:    I don't know. It's in the very beginning stages but I feel like there would be some sort of traffic system set up there that could be better than ours. Asgardia's learning from us and improving upon our habits and choices.

Quinn:    Mm-hmm (affirmative).

Brian:    Mm-hmm (affirmative), so actually right now, funny you bring it up, right now we're voting on the parliament.

Quinn:    Okay, who's running?

Brian:    Again, once the web site is working correctly I'll be able to get you that information.

Quinn:    Sure, sure. I should note, listeners, I just told Brian I didn't know that they were voting on parliament or that Asgardia existed, that it would have been beneficial to us if he had put his name in the running.

Brian:    Oh my God, absolutely and I am sorry. I do regret that, but I can still do something. They are currently holding contests so that I could be a part of the history of Asgardia. Two things.

Quinn:    What does that even mean?

Brian:    They're holding a currency design contest for creating the logo design for the solar and the lunar, the currency units on Asgardia, and the Asgardia Future and Finance of Economics contest.

Quinn:    That sounds right up your alley.

Brian:    Creating a framework for the, what the fuck does that mean? Okay, I could do this.

Quinn:    Creating a framework for what?

Brian:    For the financial and economic systems of the first space nation.

Quinn:    You know what you should do?

Brian:    What?

Quinn:    You should go and just start reading lyrics from the Hamilton musical because basically they're asking you to be the Alexander Hamilton of Asgardia.

Brian:    Yeah. I think I got, maybe I'll enter.

Quinn:    The logo design?

Brian:    Probably the logo one.

Quinn:    Or building monetary policy for a space faring civilization, got it.

Brian:    Yeah, I'm going to do the logo one.

Quinn:    Got it. Are they separatists? Are you a separatist? How are you related? Are you part of the UN or is that, no?

Brian:    Listen, I wasn't prepared to talk about this. I got a fucking email, I haven't even thought about Asgardia in a while. I just remember that I did apply to become a citizen and I was accepted and now I will do some more research so that we can talk about this.

Quinn:    I hope they play that exact clip and they're like, "I don't know, what are the pros and cons on Brian making the monetary policy?" "Listen, I got this fucking email and ... "

Brian:    It's going to be great.

Quinn:    Awesome. I want to hear more. We'll follow up on that, and as every week we'll follow up on whether Brian's alive or dead.

Brian:    Yeah.

Quinn:    Guys, tune in. This is a great one. It's an important one and I think it will help you have conversations with anti vaxxers, maybe.

Brian:    Ugh. I'm talking to you, Jenny McCarthy.

Quinn:    Don't. Just, I can't even.

Brian:    I know, I don't want to either, I'm sorry.

Quinn:    All right, let's do it.

Brian:    Bye.

Quinn:    Our guest today is Dr. Nahid Bhadelia and unfortunately she doesn't have much of a resume to talk about. No, Dr. Bhadelia is an infectious disease physician, assistant professor at Boston University and the Director of Infection Control and Medical Response at the National Emerging Infectious Diseases Laboratory. Her specialization is in infection control issues related to emerging pathogens and highly communicable infectious diseases. She's the director of the Medical Response Program for BU's Bio Safely Level Four Laboratories at the NEIDL, one of six such programs in the US. She's fought against Ebola on the front lines of Sierra Leone and seems to basically alternate mild mannered teaching with traveling the world to save people from infectious disease.

Brian:    Okay, so she's sort of like a smarter doctor version of Indiana Jones.

Quinn:    Yes.

Dr. Bhadelia:    Hey, that's what I was going for. I'm so glad I hit that.

Brian:    You nailed it.

Quinn:    Yeah. Anyways, so now I'm going to go wash my hands several times with scalding hot water and bleach. Just [inaudible 00:07:36]. Doctor, did we forget anything?

Dr. Bhadelia:    No, that was it. I think that kind of covers the kind of stuff that we're covering today.

Quinn:    Awesome. Listen, welcome. We usually don't have such a long bio to read for folks but we did think it was important to give people some context. Thank you so much for being with us today.

Dr. Bhadelia:    Thank you for having me.

Quinn:    Today we're going to get to the bottom of what do we need to do individually and as a populace to prevent a pandemic on American shores. No zombies. That's the goal, zero zombies.

Brian:    Please, no zombies.

Dr. Bhadelia:    That's a very good goal.

Quinn:    Is that realistic? Let's find out.

Brian:    Our listeners have heard this many times before but we're big believers in questions and questions that don't provoke action are basically just philosophy and that's fine.

Quinn:    We love philosophy.

Brian:    We love, it's the best, but we need answers. We need actually actionable answers on every level.

Quinn:    What we're going to try to do is get some context from you, the why of you, why you do what you do and why the immense change facing our listeners even if they're not really paying attention to it. Not their fault, that's why we're here. Then we'll progress to some actionable steps that our listeners can take, something that will inspire them to get to the work both again individually or even with their vote, whatever party they subscribe to. Does that sound good?

Dr. Bhadelia:    Sounds great.

Quinn:    All right. Doctor, we start with one important question to really get to the heart of why you're here today. Instead of saying, "Tell us your life story," we like to ask why are you vital to the survival of the species? I know, I get it, but again you're here for a reason, both literally on our podcast and sort of existentially. We encourage you to be bold and honest in your answer.

Dr. Bhadelia:    What I've always thought is my strength is that I'm able to take information from a few different fields, which is kind of what you need to do with a problem like pandemics, with epidemics, because infectious diseases are so fused in this canvas of the social, the economic, the scientific. You need to be able to understand a lot of those things and what I think my strength lies in is to be able to look at all those factors and hopefully be semi effective in teaching about it.

Brian:    Right.

Quinn:    Awesome. We don't actually normally spend too much time on backstory but yours is really interesting. If you could, I'd love if you could tell us just a minute or two on your youth and travels and the influence of your old man and maybe a little more about all 50 of your degrees.

Brian:    We counted.

Dr. Bhadelia:    That's what the rest of the show is about, is what you're saying.

Quinn:    Yeah, no, it's just I think it's important to talk about, like you said, the interconnectedness and that does dial down to even, like you said, the things you've studied and the things you teach and why they're all connected. I think it will give our listeners a little more understanding about how holistic and comprehensive your perspective is.

Dr. Bhadelia:    I'm American but I actually grew up in quite a few countries before the age of 11. I was born in India, moved around in the Middle East and then, believe it or not, straight from the Middle East to Sweden.

Brian:    Wow.

Dr. Bhadelia:    Yeah. Part of that was because my dad, who's a physician, was part of this brain drain generation in India that moved out and moved westward and it gave me this opportunity to be able to see how health and access to health and diseases are so different depending on the societies you live in and the challenges are slightly different depending on the societies you live in. At some point in college, I came across, I think I had always known I wanted to do infectious diseases and I came across this book by Laurie Garrett, The Coming Plague, and it sort of cinched it for me. I think you were joking about the Indiana Jones part of it.

Quinn:    Are we?

Dr. Bhadelia:    Not too far from the truth, but the idea that to really be able to get to the heart of where those diseases are causing issues and how we stop them before they become a global problem was something that really appealed to me. I did that, I got a master's in International Affairs while I was doing my medical degree, went on to get an Infectious Diseases sub specialty after getting my internal medicine residency and happened to fall into the exact same job that I thought would never exist which is perfect for my skills, that brought together my knowledge of international affairs, bio safety and infectious diseases and medicine, which is what I do right now. That's been about seven years now? Oh my God.

Quinn:    Yeah, but it makes so much sense. I'm going to do something ridiculous which is provide an analogy to myself from yours which has zero comparison. I went to college thinking I'd probably be a political science major or something like that. I went to Colgate up in the northeast and I ended up being a religious studies major. To be clear, I'm basically a pagan but my old man was a religious studies major and just always encouraged us, he was raised Irish Catholic back in the day and then walked away from it but always encouraged us to learn about them all. If we want to choose one, great, learn about them, don't do any harm, be good to people.

Quinn:    As much as I have not done anything to save the world like you have, from mine I did find that it was helpful because understanding how both a macro sense of religion in the world and which is defined so differently in the eastern and western hemispheres, and also on a micro level, why people, the fundamental reasons why so many people make the decisions they do, is really helpful. Because it influences political science, it influences medicine and all of those things and I didn't really understand that going in, but I'm glad that I have it going forward. Anyways, that's my one little thing and why I feel like I really appreciate your perspective on everything.

Dr. Bhadelia:    My family had a bit of a rebellious streak, I guess. My grandfather was put into a British jail because India, as you know, was colonized for a very long time. He was an Indian business owner who, you couldn't hold businesses as Indians and so he held a business and he went into jail for that. He's always had sort of this social justice background which I think tapered down a little bit in my dad and then whatever small fraction was remaining of it came to me.

Quinn:    We all appreciate it, that's for damn sure. All right, we want to establish a little context for the conversation today for our specific question. I'm going to provide what is basically a terribly brief and probably somewhat inaccurate history of infectious disease. Please just tell me to stop.

Brian:    Yeah, thankfully you're here.

Quinn:    Yeah, just say, "You're wrong." A quick disclaimer I feel like my lawyer would tell me to do after the fact which is this conversation is not intended to be a substitute for professional medical advice, diagnosis or treatment. I am not a doctor. Dr. Bhadelia is, but if you think you might be bitten by a zombie, call your doctor, go to the emergency room, call 911.

Quinn:    Just for our listeners, I feel like everybody hears Ebola hit the American shores and that's, not to denigrate Americans' education or knowledge of these things but we're always consumed by the newest news and nobody tries to provide context for anything, much less 24 hour cable news or anything like that. We're always trying to dig the gems out, to dig the important stuff and that's why we're here.

Quinn:    Just, I guess, a quick timeline of pandemics because we do tend to forget about these things very quickly and I think that's part of what's happened in the past, is you go back to the plagues in the 100s that possibly contributed to the fall of Rome, to the Justinian, the Black Death in the 1300s which was bubonic, I believe. Cholera a few times, 1860s, 1910, taking out almost a million folks in India. The Spanish Flu, which we can get into later, 20 to 50,000,000 people, and encephalitis lethargica, both hitting around World War I. Then you've got the Asian Flu in 1968 taking out about a million folks. Of course HIV AIDS peaking in the mid 2000s which probably killed about 30,000,000 people or so.

Quinn:    We've beaten certain other things along the way or at least beaten them back. I think what's interesting is the things that some folks have assumed are gone, that we don't need to deal with, which probably contributes a little bit to the anti vax stuff, but we still have tuberculosis, we still have measles and whooping cough. My daughter got it for instance.

Brian:    Ugh.

Dr. Bhadelia:    I'm sorry to hear that.

Quinn:    Yeah, no, super fun. We'll dig into that, but these things have always been around. Obviously medicine has advanced a lot but there is still stuff around and I know you work on a lot of this stuff daily. I would love to just talk about where we are now, what we've learned, how things are changing, what people can do on a personal level both from washing their hands to using their vote and also how they can contribute as a populace. Because things are changing and in the past 50 years with things like antibiotics and travel and climate change have made quite a difference. Is that right?

Dr. Bhadelia:    Yeah. Actually mostly for the better but there is a backward trend for things that we're going talk about today, which potentially is putting us at greater risk as a world population than we were maybe 50 years ago.

Quinn:    Do you want to talk about that a little bit and educate us on the recent, I guess, quarter century and those things and how they're affecting us for the better and the worse?

Dr. Bhadelia:    Sure. I should warn you, most of my students leave my one health class which is some of the stuff we're going to cover today and say, "That's the most depressing class I've ever heard."

Brian:    Yay!

Quinn:    Yeah, and we don't want to be-

Dr. Bhadelia:    Just want to warn you. [crosstalk 00:18:09].

Quinn:    No, no, no, but it's funny though. We don't ever want to be either-

Dr. Bhadelia:    There's so much to do.

Quinn:    There is so much to do but we never want to be fear mongers or just bring the bad news.

Dr. Bhadelia:    Exactly.

Quinn:    Even since we started this we try to also talk about like cool robotics stuff, but look, sometimes we need to have serious conversations which is, this is very real and I think the flu of the past eight months has taught that definitely and yet there's so much more perspective to it. If you could just educate us a little bit on that, that would be amazing.

Brian:    I'll just Google some math metrics.

Dr. Bhadelia:    Sure. I will just say, there is so much that can be done. I think it's just understanding the issues in the first place. Let me start with this. I think if you and your listeners, if you have been noticing that there's a new human disease like very year, year and a half on the main world scene, it's not your imagination. I think we're seeing more and more new human pathogens emerge and we're seeing those infectious diseases that we thought were under control coming back in a big way.

Dr. Bhadelia:    If I were to really bring it down to four reasons why that's happening, it's population growth, it's climate change, it's the fact that we are all tied into each other. We're very interdependent as a world, more so than I think most people realize. Lastly, I think that we're making some decisions as a population that are leaving us a bit more vulnerable.

Dr. Bhadelia:    Just to give you an idea, when I was born in the late 1970 something.

Quinn:    Anyways.

Dr. Bhadelia:    The world population was, I think, around 4,000,000,000 and the latest number's like 7.6 billion.

Brian:    Almost double in 37 years.

Dr. Bhadelia:    That's almost twice as many people in the same amount of land mass.

Quinn:    In 21 years.

Dr. Bhadelia:    21 years, yeah. Now you have all the same amount of resources because we haven't doubled those, so we're fighting and getting into areas of the world and using parts of the world that we weren't using before. What's happening with that is more people, you need more food. To make more food, you need more farmland and so now you go into areas that were in balance, the animals, the viruses, the bacteria, the nature was in balance with itself. When you introduce a new factor, namely us, all of a sudden you have this opportunity where pathogens can, quote unquote, spill over which is this idea that they can jump from animals that are wild animals into domestic animals or into humans, so we find new diseases in humans that we didn't see before.

Dr. Bhadelia:    By the way, if you have twice as many people in the same area, guess what? It's much easier for infectious diseases to get transmitted, right?

Brian:    Right.

Quinn:    Right.

Dr. Bhadelia:    You have huge populations. 2008 I think was the first year that humans, there are more of us living in cities than we are in rural areas. It's the first time the population of the world tipped.

Quinn:    Right, fascinating.

Brian:    Wow.

Dr. Bhadelia:    Yeah. Majority of us, the majority of that population growth is happening outside of cities, not just in cities but happening in cities in resource [inaudible 00:21:12] world and happening in peri urban areas where people are living where irrigation is not right, there's not enough access to sanitary systems. All of those things add up.

Quinn:    For you on the population growth, it's both the growth and volume, I guess threefold, volume, density and interconnectedness. Is that right?

Dr. Bhadelia:    Yeah, because the other part of it is not only are there so many of us but we are also much more mobile than we were before. There was a study in 2013 that said 3.1 billion people flew in that one year.

Brian:    3.1 billion, wow.

Dr. Bhadelia:    Isn't that crazy? When you look at, so SARS if you remember, the pandemic du jour from about 10 years ago.

Quinn:    Sure.

Dr. Bhadelia:    SARS made it from Asia to North America and back in less than 48 hours. That's something.

Quinn:    Wow, that's incredible. It's interesting because I was doing some reading on the Spanish Flu and EL, encephalitis lethargica, and it's interesting. We had so many fewer people in the world and we were much less globally mobile but one of the discussions was did Woodrow Wilson in deciding to help win World War I, which was important, make it worse because we were shipping tens of thousands, hundreds of thousands of young healthy men on these tightly packed ships and camps off to fight? It struck mostly young folks which is really, really interesting and how obviously those moves were necessary, but that almost sounds like a precursor to what we're facing now sort of on a microcosm level.

Dr. Bhadelia:    Yeah, and when I tell people that the, at the back of many people's minds is, "Well why can't we just make it harder to travel?" That's not where our world is going.

Brian:    No way.

Dr. Bhadelia:    I think we know for a fact that travel bans don't work.

Quinn:    Yeah, could you talk a little bit about that? I read that in one of your interviews and I would love to hear [crosstalk 00:23:30] because that is the first place people go and it's so frustrating.

Dr. Bhadelia:    Yeah, and I got to tell you, some of this is very personal to me too because as you mentioned at the very beginning I volunteered as a physician in Ebola treatment units. I was back and forth from Sierra Leone about four times in 2014 and a couple other times that I was down there when I was doing direct patient care, I was quarantined. The fear and just the amount of media response and even the person to person fear about this disease, which by the way, whatever you've read, Ebola is very hard to transmit. There's this concept in infectious diseases called R naught. It's how many new people one person with the disease can transmit. The R naught of Ebola is two. The R naught of measles is 20.

Quinn:    Jesus Christ.

Dr. Bhadelia:    Right. The crazy thing to me is that we were worried about Ebola and we're not really worried as much about measles.

Quinn:    Which again is still around. I mean look at what happened at Disneyland a couple of years ago.

Brian:    Right.

Dr. Bhadelia:    Oh God.

Quinn:    That number gives actual credence to it but it always felt like, "Boy, that doesn't seem to take much," and there you go. One to 20 is bonkers.

Dr. Bhadelia:    You might have also heard, Europe really has it bad. Between 2016 and '17 I think they went from like 5,000 measles cases to 21,000 measles cases, like a fourfold increase in measles. It's coming back in a big way, like I said earlier.

Quinn:    Is that seem to be sort of the anti vax issue that we're having here or what do you feel like that's from?

Dr. Bhadelia:    It's a combination. It's the result of people not being vaccinated and the reasons for why not, why they're not being vaccinated is sort of different in place to place. For example, I think two of the larger places that are having outbreaks are Romania and Italy and the Romania part of it is just that they have a large Gypsy population where it's sort of more related to cultural and religious beliefs in terms of what people would take their children to get, what kind of care people would take their children to get. Italy, it's a big harder to understand. Again, lower rates of vaccination there than we've seen in the past and I think that's what's tipping off a lot of these outbreaks.

Dr. Bhadelia:    Going back to your point about travel bans, the reason it doesn't work is, first of all, I think that that would mean you're screening every single traveler, right? Then you can say, "Well, all right, let's stop that. We don't want to screen every single traveler, let's just screen people from that country or that area that's more likely to have infectious diseases." Guess what? There's no one country where infectious diseases can come from.

Quinn:    Right, sure. Sure.

Dr. Bhadelia:    We have diseases within our borders that others don't see as much of. In fact we are seeing our own disease pop up a lot more. Did you know we still have plague in the US?

Quinn:    I do now.

Brian:    Wow.

Quinn:    Great, thanks.

Dr. Bhadelia:    It's growing in number because of climate change and other things, so you're seeing increasing number of cases of plague. Yersinia pestis is the bacteria that causes it.

Brian:    Wow.

Quinn:    Can you just again, because we want to make sure people are able to follow along, could you tell us, people hear plague and they literally think 28 Days Later, which is great.

Dr. Bhadelia:    Yes, you're right.

Quinn:    If you could just, we try to treat and this isn't again denigrating our listeners, literally ourselves.

Brian:    Especially me.

Quinn:    What is plague defined as and which ones throughout history were the actual plague? Because I think people apply it to basically everything and it's not.

Dr. Bhadelia:    Right. The word, there are two ways to interpret plague. The colloquial term of plague, using it to describe any infectious diseases. The plague that we a lot of times, pathogen specific one that we apply to something called Yersinia pestis. It's a bacteria that's transmitted by likely a rodent vector.

Quinn:    Oh yeah.

Dr. Bhadelia:    Basically a vector is an animal or an insect that carries the disease and can then infect the humans who then get sick from it. Yersinia pestis is a disease that, in the US the kind of diseases that we're seeing with it is people get exposed to it and particularly if they've been hiking, they're out in the woods.

Quinn:    Brian loves to hike. That's a problem.

Brian:    I may have Yersinia pestis.

Dr. Bhadelia:    Oh, you know, there are so many, if we're always worried about everything we would never be able to enjoy any part of the worst, so Brian, you go ahead and hike. Don't let this stop you.

Brian:    I've already started a not to do list and going outside is on it.

Dr. Bhadelia:    The chances that you'll run into a rodent with plague, with Yersinia pestis, is very low.

Brian:    Okay, good.

Dr. Bhadelia:    It can be, a lot of times it's a disease that we can, if we catch early it's actually pretty preventable but some people can get very sick from it. That's what I was referring to, is this particular bacteria.

Quinn:    Is the bubonic, is that that one? Is that that plague? I mean that's the name. I'm an idiot.

Dr. Bhadelia:    [inaudible 00:28:31]. There are so many, how do you even keep up with all of them, right?

Quinn:    Yeah.

Brian:    Yeah, right. Good times.

Dr. Bhadelia:    Bubonic also refers to, it refers to the same pathogen but the bubonic plague is the kind of manifestation of Yersinia pestis where you basically develop something called bubos. There's these skin lesions that people develop that drain and that's the kind of plague that they were seeing in Europe, the bubonic plague which they're not quite sure now what the vector is of that.

Brian:    Oh wow. Cool.

Dr. Bhadelia:    It's a kind of manifestation of the same bacteria.

Quinn:    Gotcha, okay.

Dr. Bhadelia:    It's the cause of the Black Death.

Quinn:    Gotcha.

Brian:    Right.

Quinn:    Perfect, perfect. That sums it up pretty great. Again, just trying to give some context because, again, it feels, and most people didn't go and study infectious disease but I guess if you studied European history or World War I or the Roman Empire you would think people would pick up on these but it just feels like whether on purpose or not, these things tend to be footnotes and they absolutely shouldn't be. Again, trying to give some, when we say plague, perspective. People go like, "Oh no, that was that bad one, got it."

Dr. Bhadelia:    No, no, it's the same bacteria, it's just manifested slightly differently. Again, it kind of depends on how you're exposed. Let me know, I'll get into this. Come to my office if you want more information on the plague. I can give you more.

Brian:    All right.

Quinn:    We'll do it in a hermetically sealed, so we've talked about population growth and we've talked about interdependency and certain diseases reemerging. We've talked about measles and plague. Is there anything else that people would be shocked to know has come back?

Dr. Bhadelia:    Yeah. I think that the other aspect of the reemerging pathogens is antimicrobial resistance. Bacteria that are just run of the mill bacteria that are causing infections like urinary tract infections or pneumonia, right, what happens over time is that these bacteria develop an ability to fight our antibiotics. The more exposure they get to it or more incomplete exposure they get to it, the more likely they are to sort of beat the antibiotics.

Brian:    It's one of the scariest things I can imagine.

Dr. Bhadelia:    Yeah, and what we're seeing is that we're actually, a lot of people will call this the post antibiotic age because, believe it or not, a lot of people are surprised when I say there are already patients that I will see, not often, thank goodness, but I'll see patients who come in with infections, particularly those because of their chronic illness who have had to have many, many courses of antibiotics, who have bacterial infections that I have no antibiotics left to give them.

Quinn:    Oh good.

Brian:    Wow.

Quinn:    I did read, and I'm going to mangle this, this was some woman who passed away last year or something like that, I mean again, this is going to be totally wrong, who they tried 26 different courses on and she seems to be that shining example of, has become immune to the best we've got. Again, I think we're going to not trash antibiotics going forward. I want to be clear, medicine is incredible and antibiotics changed the world and they're amazing, but could you talk to us a little bit, because I think this is a big one besides the anti vax stuff, the antibiotics. We have seem to have fallen into a place of either overprescription or feeling like we need it too often and asking for it, and then the other side of course is the antibiotics in our industrialized food. Could you take us through both of those a little bit?

Dr. Bhadelia:    Sure. Actually I think that most of the resistance probably doesn't come from, well I shouldn't even say that but I think a larger proportion of resistance probably comes from agricultural and animal use than anybody previously expected or would have thought. In fact I think the case that you're referring to is a gene that they discovered in bacteria a couple of years ago which was resistant to one of the last line antibiotics, something called colistin. It's a horrible antibiotic that we haven't used since like the 70s or 80s.

Brian:    Whoa.

Dr. Bhadelia:    We have to reach back to it because we're seeing bacteria that are getting so resistant. What we found was that there is now a bacteria, a gram negative bacteria that now carries the gene for resistance. The trouble is that if it pairs it up with other resistance genes then now you have a master organism that we have no treatment for. The trouble is, just taking backwards, that woman who had it, that gene in the US, they had found that same gene in Europe I think a few months before that in someone. Then if they traced it back, it was in China about eight or nine months before that.

Dr. Bhadelia:    In China, what they had noticed is that MCR-1, which is the gene I'm talking about which confers resistance, initially they saw it in animals. Animals were given a lot of antibiotics to make sure that they're healthier, that we get more animals because going back to the whole population growth thing, the more people there are, the more protein you need. To ensure that you're getting enough healthy animals to feed the rest of the world, I think you're seeing this massive increase in use of antibiotics in our animals, in our protein sources. What they noticed was that that gene went from animals into humans in that little area of China, jumped to Europe and then to the US, so we're all connected.

Brian:    Yeah, shocker.

Quinn:    Which is usually a real rainbow connection feeling, we're all connected.

Dr. Bhadelia:    It's not in this case.

Brian:    Except for when everyone's dying.

Quinn:    Not in this case. Right, and like you said, nobody sees the antibiotics being put into the animals. I mean I guess there's a few documentaries that show that. PS, if you watch those, you're not going to eat meat again. They're so well done and traumatic but necessary to call out what's happening. Regardless, there's a few of them, I can't remember the names of them but they're pretty shocking and illustrative of the fact.

Brian:    Oh yeah, they make you want to eat broccoli only.

Quinn:    Yeah, right. Please tell me broccoli's okay.

Brian:    I just want broccoli.

Dr. Bhadelia:    For now, broccoli's okay.

Quinn:    Is there anything being done? Because antibiotics in industrialized food which, I don't have the number, is such a high percentage of how most people get their meat and chicken. Healthier food is unaffordable, of course. Is there anything being done to curb that use? Because that falls into, again, our end point is what are actionable steps that our listeners can take either personally or with their vote? Is there anything being done on a larger macro level to curb that and if not or if so, how can we support it or endorse it to try to help that? If that is the cause of the majority of the overinfluence of antibiotics?

Dr. Bhadelia:    Sure. I think I can give you a bit more of, I deal more with humans than animals so I'll give you more of my knowledge of it from the human perspective.

Quinn:    Sure, sure, sure, of course.

Dr. Bhadelia:    There is a lot more, there was, an initiative was actually started under the Obama administration to address antimicrobial resistance. What that was trying to do is do multiple things. One was to make sure that we pick up antimicrobial resistance. Two was we need to invest in new antibiotics. It takes like 10 to 15 years to come up with a new antibiotic.

Brian:    Wow.

Dr. Bhadelia:    Guess what? It's actually not that profitable for the commercial sector and that's why it's so hard to come up with something, it takes that long. Someone needed to have invested in this five, 10, 15 years ago which didn't happen. That's one thing, is ensuring that we have enough investment for new antimicrobials but then the other part is linking exactly the kind of step that you were talking about, ensuring that we have responsible use of antibiotics in food and in the clinical setting as well. That's one part.

Dr. Bhadelia:    The other is there's a concept of something called One Health. It's also been Planetary Health which is slightly different, but One Health is this idea that our health and animal health and the planet's health are all connected and making these rainbow connections in such a way that-

Quinn:    I like those connections.

Dr. Bhadelia:    Yeah, to making those connections early before they become problem and ensuring that we follow the routes of a lot of these trends before they become public health issues. One Health, there's a bunch of One Health organizations that are working on that as well.

Quinn:    Gotcha. I'm just also noticing, and I want to make sure we touch on this because it actually ties into a conversation we had with a wonderful woman, Dr. Ayana Elizabeth Johnson, this amazing marine biologist. You noted in some notes you sent us the interdependency on trade and you said you'd be surprised at how much of your food is globalized. Dr. Johnson had mentioned that to us as well, how even, I can't remember what the statistic she gave was on US fish consumption and how much is caught in the US, sent to Asia to be processed and sent back, which I don't even understand. Do you have any thoughts on that?

Dr. Bhadelia:    Yeah. I show this graph a lot of times in class and I'll tell you what it looks like. It's this silhouetted world map and it's showing where meats are being transported from and our beef comes from Australia. By the way, we send pork to China and Brazil sends pork to China and it goes back and forth. India sends stuff to the Middle East. The connections are so insane and so global that it's hard to tease out. It's not something where one day you can just say, "No, we are going to only provide locally," because I think that you can't given how many of us there are.

Brian:    Right, and how much money's being made.

Dr. Bhadelia:    We just need to do it in a more sustainable way.

Quinn:    Sure. Could you provide us with that slide? We'd love to put it in the show notes if you don't mind sharing it.

Dr. Bhadelia:    Yeah, I'll send you that link. The other thing that we haven't talked about, by the way, is climate change.

Quinn:    Yeah, I was going to get to that.

Brian:    We love talking about that. That'd be perfect.

Quinn:    It's our favorite. Tell us, why, because I imagine some folks are like, "Why would climate change affect us getting sick?" If you could illustrate that, that would be great.

Brian:    Help us connect.

Dr. Bhadelia:    I think after population growth, climate change is probably the biggest thing that's making our ability to predict where infectious disease is coming from and the risk of new infectious diseases higher than what it's been in the past. One thing that I didn't realize until maybe, I don't know, 10 years ago or something or five years ago, was that the CO2 that we emit in the air, it takes decades for that to convert into an increase in temperature. The stuff that we're seeing now, this is from decades ago and we've done a lot of damage in the decades since.

Dr. Bhadelia:    What you're seeing with climate change is areas get unpredictable weather patterns, so there's the direct stuff like you saw with the hurricanes. You had Puerto Rico and a lot of the Caribbean islands just getting devastated and in the aftermath of that, a lot of bacteria and diseases like listeria and diarrheal diseases that wouldn't have been around came up again. Then a bit more complicated than that is this idea that when you have climate change and you're getting areas that are warmer than before or colder than before, you're changing the kind of animals that can live there. For example, mosquitoes can now live in a greater part of the world. Mosquitoes by the way, number one killer of mankind for infectious diseases. Did you know that?

Brian:    [crosstalk 00:40:16].

Quinn:    It's like Bill Gates versus the mosquitoes right now.

Brian:    They already suck, just being little fuckers flying around stabbing you, now this?

Dr. Bhadelia:    They're so annoying. I can't even begin, but what's happening is with rising temperature you're seeing a shift and an increase in density in mosquitoes. They're saying by like 2030 you're going to get, I don't know, like almost 200,000,000 more malaria cases and almost like 2,000,000,000 cases more of dengue and that's in areas that already have mosquitoes.

Dr. Bhadelia:    Now it's also making new areas that didn't have a lot of those same pathogens develop those diseases. We in the US for the first time, I think this was early 2010, 2011, 2011 I should say, for the first time we saw chikungunya, it's this viral disease that's seen in Latin America a lot and it's transmitted by mosquitoes, we saw it here in Florida. We got our own chikungunya now within our borders.

Brian:    Whoa, really?

Dr. Bhadelia:    We had never had that before.

Quinn:    How did that go over at the office that day?

Dr. Bhadelia:    Yeah, not good.

Brian:    Wow.

Dr. Bhadelia:    There was this caption I think I saw on Twitter or it was an Onion article but for a second I was like, I really thought it was a real thing which basically said a climate scientist got up and said, "Hey, you know what? There's nothing we can do so I am just going to leave for the day and go enjoy [inaudible 00:41:41]."

Quinn:    The Onion does that sometimes.

Dr. Bhadelia:    It was an Onion article but I was like, "Oh my God!" That's how I felt that day.

Quinn:    Ah, Jesus.

Brian:    Jeez.

Dr. Bhadelia:    Things are better than what they seem.

Quinn:    I thought about the other day, and again Brian and I were talking about this a little bit before we called, about how we try to paint these conversations as much as we can. Again, it's less an interview, we try to make it more of a conversation where Brian and I represent not just ourselves but our listeners a little bit, which is like progressive actionable folks who are, again, progressive, probably more activated than they've been in the past year, moderate to fairly educated and invested in this sort of thing.

Quinn:    At the same time, both our day to day life and our experience couldn't be more different than yours in the sense of the perspective that you have on things in your day to day. For instance, your office emergencies versus mine. My robot vacuum hasn't worked in three days and it's driving me insane.

Brian:    It's very annoying. There's shit everywhere.

Quinn:    Yours is just ...

Dr. Bhadelia:    Wait, aren't you on the west coast? You guys have a lot of stuff going on out there.

Brian:    We are on the west coast.

Quinn:    We do, yeah.

Dr. Bhadelia:    Your emergencies are pretty bad. The drought and the fires. I don't know, give yourself some credit.

Quinn:    It's not great, it's not great. I just mean more on a personal level. One of my best friends is an EXO on a nuclear sub and he'll let me call and bitch about my day and then he'll be like, "Oh, we had a fire today underwater and somebody died." I'm like, "Well, why did you let me go on about my email server problems? I don't understand."

Brian:    Because he's a good friend.

Quinn:    Yeah. Anyways, hopefully what we're able to show is you have a greater understanding of this than the rest of us.

Brian:    We realize that you're necessary for the safety of mankind and thank you.

Quinn:    All right, so you know what? Actually it's funny, I spend part of the year in Virginia with my family. There's always been Lyme disease there but I wonder if you could talk a little bit as we're sort of moving into more steps folks can take and what we can do and then things that are coming down the line in the future. If you could talk a little bit about, since we were just talking about climate change, what Lyme disease is, why it's so nasty and why it's actually getting much more prevalent?

Dr. Bhadelia:    I think it's building off the point that I just made, is that when you see changes in weather you all of a sudden see whatever the vector is, mosquito, tick, animal, that carry the disease can now be in a greater geographical area. Combine that with the fact that there are many more of us going into the woods, many more of us living near woods, you're seeing an increase in diseases associated with a lot of these vectors.

Dr. Bhadelia:    Lyme is a bacterial disease that's transmitted through a tick. Generally it's, initially when it was discovered or classified, it was in Lyme, Connecticut, right? This is the horrendous thing about infectious diseases. Certain places get, the disease becomes the name of the place, so unfortunately this is Lyme, Connecticut. Lyme, Connecticut, is now sort of the namesake for this disease.

Dr. Bhadelia:    Lyme disease, the reason why it's troublesome is that it's transmitted by these ticks and a lot of people won't notice that they have this tick. In some people it's asymptomatic and they won't notice at the very beginning, it can go on to be a very serious disease. It can cause a lot of chronic muscular, skeletal issues and things like that. Once treated with antibiotics, actually a majority of the people get total remission from the disease.

Dr. Bhadelia:    We're seeing not just Lyme but we're actually seeing an increase in tick bourne diseases all across the northeast and just the eastern sea border. Add that to the fact that we are actually picking up on things much more than we were before because we're looking for them, so I think it might be a twofold thing. One, I think there's a lot more of us, but the other is that we are picking up a lot more because we are much more aware of it, there's a lot more education about it.

Quinn:    Right.

Dr. Bhadelia:    What can you do?

Quinn:    Yeah, and that's a great segue way, by the way. You gave a quote in an interview where you said, "Epidemics are disastrous but they don't have to be disastrous. They're only disastrous because of the vulnerabilities in the health care systems." We've talked about some of these diseases that in the past were not too long ago, though the public has either not been educated on them or have forgotten about them. Some of them were either fairly mismanaged or we just didn't have the know how or medicine to deal with them yet. Talk to us a little bit about the weaknesses in our armor today, both in the US and I guess North America because we're all connected and globally and then from the weaknesses, I guess, what are the US's strengths? Why, besides it being sort of a one to two number, why did something like Ebola not hit us as hard?

Dr. Bhadelia:    People would be surprised at how many diseases are quickly picked up and addressed without anybody hearing about it in the US. The reason why is because we have a very strong public health system, a public health system which, by the way, is seeing cuts in public funding so let me make a plug on that.

Quinn:    Right. Oh, we're aware.

Dr. Bhadelia:    We're seeing a decrease in our vector control programs and, God, everything across the board. Here's what happens. If you're sick, if I, Quinn, let's say you.

Quinn:    Oh great.

Brian:    Aw, I was just going to volunteer.

Quinn:    Thanks Doctor, I didn't want to sleep tonight. Let's get to it.

Dr. Bhadelia:    Let's say you went to some part of the world, you come back and you feel sick. What's the next thing you're going to do? You feel really, really crappy, you're going to go to the emergency room or you're going to go to the doctor's office.

Quinn:    Sure.

Brian:    You probably look for us too. [crosstalk 00:47:37].

Dr. Bhadelia:    The way it works in the US is that when your doctor asks you, "Hey, how do you feel and where have you been," the moment they suspect that you have some sort of infectious disease they have to let the public health body in that area know. Whether it's the state public health department or the city public health department depending on where you are. Just in case the doctor forgets, if the doctor sent any blood work, the laboratory that's taking care of you or checking your blood is going to send that information to the public health folks.

Dr. Bhadelia:    The minute the public health folks get this, they send out the force that's going to help detect anyone else who was potentially exposed to you and combine that with the fact that we have very good health care systems where you can be isolated pretty quickly and taken care of without other people getting sick. That works. I mean 99.9% of the time, that works great.

Quinn:    It's funny you used me as a very convenient example by the way, but I actually went through all of that when my two year old daughter got whooping cough.

Brian:    Oh really?

Quinn:    She got whooping cough, they think they narrowed it down to a class that she had been going to which is here in Los Angeles where we, it's gotten a little better because of a new law but we had a serious anti vax issue for a number of years. A lot of folks who were wealthy and thought they were smarter than the doctors.

Brian:    I think Jenny McCarthy spearheaded that.

Quinn:    I can't even. Anyway, my two year daughter got it which was bad enough because she was two. The other problem was I had a one week old baby at home.

Dr. Bhadelia:    Oh no.

Quinn:    Not only did we have to do complete isolation, fearing for both of them, but yeah, we had the calls from the CDC for weeks and months after. Our checkups and everything like you said got forwarded along immediately and I was both impressed by that, with how quickly and efficiently and seriously they took their jobs, and also a little taken aback by it because it is a little overwhelming to think like, "Whoa, okay, it's not, this doesn't seem crazy."

Brian:    Yeah, that's got to be pretty fucking scary.

Dr. Bhadelia:    It's serious, yeah.

Quinn:    As much as they're worried about her and I can't be more clear that they did an excellent job, they were much more worried, knowing the situation in this town, about it going further. Both from her and where else it started because her immunity was in a very bad place here. Correct me if I'm wrong, I think typically you're looking for, and maybe you can explain a little bit about herd immunity, but I think it's about you're usually looking for 90% or so and some of them are higher and I thinks some of these schools, it was like 40, 50% of the kids were unvaccinated. Even if she was, it didn't really matter at that point.

Brian:    Right.

Quinn:    Anyways, I have been through all that and I am both impressed by it but also can see why it's in place.

Dr. Bhadelia:    It works well here, right? For the most part it does unless it's a disease that we've never seen before and we don't know how to recognize. Now you could sort of put yourself in the same scenario again and that's where it becomes a bit harder, but still your doc will see it and say, "Hey, this looks not right, let me at least put this person in isolation until we figure out what's going on." That's kind of what I do. I run a special pathogens unit that helps take care of patients with highly communicable diseases with health care workers that are particularly trained to do exactly that.

Dr. Bhadelia:    Now take an area of the world where you have the same scenario. Now you are Quinn living in west Africa.

Quinn:    Great.

Dr. Bhadelia:    Quinn can get sick there or your daughter can get sick and a lot of people don't have access to care. If the same thing happened and someone had measles in an area of the world where they don't have access to care, all of a sudden that becomes a cluster and an outbreak pretty quickly.

Quinn:    Or I imagine, I mean it's probably less so in 2018 because so much more of the population is at least semi educated but I imagine in some places it's still not even diagnosed correctly.

Dr. Bhadelia:    That's correct, because a lot of infectious diseases all look the same. It's fevers, it's muscle aches, in some cases it's nausea, vomiting, diarrhea depending on the disease you're talking about and a lot of things look the same. One could be treated for something that's not the right thing.

Dr. Bhadelia:    What this creates is that at the end of, we create all these international surveillance systems. When people talk about why we need to invest in the rest of the world aside from our own shores to keep us safe, how can we keep North American safe by investing in the rest of the world? The reason why we need to do that is because for all the reasons we talked about earlier, a disease anywhere, a disease outbreak anywhere is a disease outbreak everywhere.

Brian:    Here, yeah, anywhere.

Quinn:    Right, right.

Dr. Bhadelia:    It can be transmitted very, very quickly and it's not through individual fault, it's just how we are as a world now. What happens is first you have that and the fact that then you might have public health systems that are not as good as reporting it.

Quinn:    I was going to use that as a small segue way to start to move towards the actionable steps. This is because you mentioned and has been reported in the news and we've certainly tried to cover as much as we can, there have been serious cuts and even more serious proposed cuts in the exact systems you're talking about. Can you tell us a little bit about that?

Dr. Bhadelia:    Yeah. After Ebola, every time there's an outbreak, every time there's SARS or a novel influenza or Ebola, the whole world goes, "Well, how could we have done this better? Why did this happen? Why couldn't we have stopped it?" After Ebola, there was this program that was launched by the Obama administration but also actually supported by almost 50 countries at this point called the Global Health Security Agenda. What it means to do is to do exactly what we talked about, is to go into all the different areas of the world and assess their ability to pick up patients quickly, take care of them and respond to an outbreak. That's called the Global Health Security Agenda.

Dr. Bhadelia:    The trouble is the Global Health Security Agenda is on the chopping block. We're about to see about an 80% cut in the proposed-

Quinn:    80%? That's an eight zero?

Brian:    Eight zero.

Dr. Bhadelia:    Eight zero. Again, these are not made yet but that's the recommended cut right now to Global Health Security. It's going to have an impact because we've learned all these lessons from Ebola so that we don't have to face it again. One thing that I would say that's very obvious to do is to advocate for policies and vote for politicians that help create a safer world and a scientifically responsible community.

Quinn:    Oh, that's a nightmare.

Brian:    80%.

Quinn:    Advocate for that. 80%, so to infuriate our listeners just a little bit, can you tell us some specific markers and gains that a program like that if not that specific program have made to show us what an 80% cut will do?

Dr. Bhadelia:    Yeah. I should start by saying it's not the CDC that's seeing the 80% cut, it's this particular program.

Quinn:    Right, sure.

Dr. Bhadelia:    CDC had existing programs in, I think it was like less than 15 countries and they're going back to, maybe it was 11, going back to, they were going to expand the work to a greater number of countries and they have expanded the work through a greater number of countries since the end of the Ebola outbreak. What they were doing in collaboration with the USAID and a ton of other countries that have also put up money for this was to help set up ways to quickly diagnose infectious diseases outbreaks.

Dr. Bhadelia:    When you look at some of the numbers that they have provided for the success of Global Health Security the first year, I think in some of the countries where they went in they were able to pick up and stop outbreaks from becoming bigger problems. I can give you the web site if you want more specific information.

Quinn:    Sure.

Dr. Bhadelia:    You can see even within a couple of years what they've been able to do. It's pretty striking. It's www dot G-H-S-A-G-E-N-D-A dot org, so GHSAgenda.org.

Quinn:    That's illustrative, I think. Again, that's starting to move into what people can do because it's a little bit like when the recession happened after 2008 and Obama got stuck with this horrific crash. There was all this talk over the next few years about how many jobs his administration and their moves saved. It was easy, it was cherry picking for these talking points to be made saying, "Well how do we know he saved those many jobs," because you didn't actually see them get saved. You didn't see people lose their jobs because he, quote unquote, saved them.

Quinn:    To me, that compares a little bit to this which is this is a program that is set up to go to these places where they cannot help themselves as well to quickly diagnose and extinguish these infectious disease, but because they didn't actually happen-

Dr. Bhadelia:    You can't really prove it.

Brian:    Oh my God, it's like Minority Report.

Quinn:    Yeah, I guess so, Brian.

Brian:    [crosstalk 00:56:46].

Quinn:    I guess so.

Brian:    You guys should watch it again.

Dr. Bhadelia:    See it as another sci fi [inaudible 00:56:50].

Brian:    It's just like that.

Quinn:    It's so good, it's so good. No, I, yeah, believe me, I love it, but that's what that feels like to me. I'm sure it compares to, as well, all these diseases like we talked about.

Dr. Bhadelia:    It's exactly the [crosstalk 00:57:01].

Quinn:    That we thought, that everyone says, "Oh, we beat, why do we need," and this was some of the arguments you'd hear in Los Angeles when we had the anti vax stuff a few years ago. It was like, "Oh, we already beat that, why did we get vaccinated again?" It's like, Jesus Christ.

Dr. Bhadelia:    Yeah. You asked me about herd immunity. The reason we want to maintain herd immunity is that we want to make sure that we, herd immunity is this concept that when you have enough people vaccinated against a disease, even if the disease makes it into the community it's not going to go beyond the one or two people because you have enough people that have received it and have immunity. One person or two people might get it, that's where it will stop.

Dr. Bhadelia:    Now if you drop that vaccination rate, as you said, below 90%, all of a sudden you have the potential that that disease is going to affect people like your daughter or those who are adults and may not have the best immune system for whatever chronic other diseases. It's a responsibility not just for your own personal protection to get vaccinated but also because I think you're protecting those that are vulnerable in our own community.

Quinn:    Sure, sure. All right, so our people are going to advocate for programs like this, both proactively and defensively, that are on the cutting block. Do you have any idea how much money 80% is?

Dr. Bhadelia:    I think it was 1.4 billion, is what was allocated to the whole program. Now I don't remember what the cuts were to CDC and specific but the entire amount was about 1.4 billion I believe. Here's the thing, I don't even know how much of that was left because if you remember after Ebola we had Zika and instead of putting new money up, Congress said to CDC just take the money we gave you for Ebola and Global Health Security and apply it to Zika.

Quinn:    I just want to put that in perspective, that number and that's why I think that number's important. It's easy to sound like, "1.4 billion, doesn't that, what an aircraft carrier costs? Why should we spend that?" This is one report I saw this weekend. This is talking about the current flu which has been devastating, at one point killing 4,000 people a week in the US which is mind boggling. There's an estimate that said the flu cost the nation last year about $10,500,000,000 in direct medical costs last year. God knows on top of employee work hours lost and economic productivity.

Brian:    Economic [crosstalk 00:59:22].

Quinn:    Right, sure. That's what we lost from the flu, and yes, they're different, but at the same time when you're just looking at the numbers, 1.5 billion, I don't know. It feels like for something that could possibly be worse, as much as the flu has been terrible, it doesn't feel like a lot.

Dr. Bhadelia:    Wouldn't be great if you could catch the next flu before it gets on the plane?

Brian:    Before we have to spend $10,000,000,000?

Dr. Bhadelia:    I mean rather than just saying, "Let's ban everybody everywhere," why don't we catch the diseases where they occur whether they be within our own borders or between our own communities or across borders in other countries? If we can catch these things early rather than just stopping our entire way of living, the prevention is so much more of a better investment overall.

Quinn:    Right.

Brian:    Clearly.

Quinn:    I mean the only thing I can think of besides-

Brian:    Is Minority Report?

Quinn:    Yes, is Minority Report. Is as much as it's a policy to cut spending as much as it's an invisibility or a stick your head in the sand because we are snuffing these things out and you guys have been successful, or we've forgotten about it because it was not too long ago. It just seems to be an argument against basic science in some ways which is just infuriating and just so dangerous.

Brian:    Which there's a lot of these days.

Quinn:    It's one thing not to fund NASA that much, which I'm also against.

Brian:    Let's be clear.

Dr. Bhadelia:    I was going to say at some point we'll need to leave the earth, by the way, because we'll destroy it enough.

Quinn:    You fit in pretty well here, Doc.

Brian:    Yeah.

Quinn:    You're fitting in pretty well. All right, so that's one of the main things. We're getting into these steps here.

Dr. Bhadelia:    Oh, by the way, it was 1,000,000,000. I take it back. Even a better deal than what I said earlier. Not 1.4.

Quinn:    Not that much money. For the effect it could have.

Brian:    I don't think much of it is left. I've read articles about how that money's going to be gone next year. Next year.

Dr. Bhadelia:    Yeah.

Brian:    Great.

Quinn:    All right, let's start,  we talked about that. Let's start with the fundamentals here. What can a human do, an American human do in their life, in their home to keep themselves healthy and, let's just say because this is the way it's going to be going forward, in a year like this, in a winter like this, it's the end of March or beginning of March, we've just had a horrendous flu season. It's peaked but it's certainly not over yet and just going forward, what are they doing to take care of themselves and their loved ones?

Dr. Bhadelia:    There are simple things that you can do first within your own home and life. One is get vaccinated. Get your kids vaccinated, get yourself vaccinated. I know a lot of people say, "Oh, I don't want the flu vaccine, it makes me sick," and yeah, every year to year it tends to be a bit more or less, a bit less effective but overall all the antibodies you get from any of the flu vaccines help you to beat any big one that comes down the road. Not only that, but by you getting vaccinated, even if you're not getting sick with the flu, you might be transmitting. If you get a little bit of the illness you might be transmitting it to people, like I said, who are vulnerable around you. That's one. It has a huge impact. Vaccines work. It's how we've eradicated so many of these diseases. We've almost to the point where polio's going to be eradicated.

Brian:    Wow.

Quinn:    That's incredible. This is [crosstalk 01:02:44].

Dr. Bhadelia:    Smallpox we eradicated more or less. It's gone. We as humans have been able to do incredible things when we've put the might and the community behind it.

Dr. Bhadelia:    Two, finish your antibiotic course. I think you made the point of when do we need antibiotic course and I think that's a physician education component.

Quinn:    Sure.

Dr. Bhadelia:    Also, educating parents about when their kids actually need antibiotics or not or even they themselves. If you are given an antibiotic, of course, if you don't finish it that gives the bugs a lot more of a chance to develop resistance. Even if you start feeling better after a couple of days, finish the whole course

Quinn:    Yeah, because even with my kids when they have an ear infection, it seems like it's like, "All right, take this for two weeks," and they feel better after four days and it's easy to be like, "Everything's fine."

Brian:    Right.

Quinn:    There's a reason it's prescribed for two weeks.

Brian:    Yeah, was not random.

Quinn:    Yeah. Just pull that number out.

Dr. Bhadelia:    That's the other part, is that that's our way of being responsible. Of course the other part related to that is that if you do get sick, make sure that you do good hand hygiene, that you stay home from work if you're sick. There's something called respiratory etiquette which is basically if you sneeze, don't sneeze onto surfaces or your hands or sneeze into a napkin or, if you can't find anything, your sleeve.

Quinn:    Yeah, what did Obama say, into your elbow, right?

Dr. Bhadelia:    Into your elbow, yeah. The thing is the hand hygiene part, people are like, "Oh, whatever, it's hand hygiene." It is the biggest, Semmelweis is the guy who came up with this idea that hand hygiene has an impact on human mortality. This dude noticed all these pregnant women dying of just infections and it's because physicians hands are transmitting all these bacteria. One of the single biggest thing you can do every day is to maintain good hand hygiene.

Quinn:    I remember there was some story, and I'm going to mangle this and I have done in the past talking to folks, but here in LA we have two incredible health systems with Cedar Sinai and UCLA. There was some story about, again, the physicians' hands and either the nurses or someone took samples of the physicians' hands and ran the pathology and then made it the screensaver on the computers or something so the physicians could see.

Brian:    Whoa.

Dr. Bhadelia:    That's awesome.

Quinn:    All of a sudden, the hand washing went through the roof.

Brian:    Right. Wow.

Dr. Bhadelia:    Yeah.

Quinn:    Because again, it was visualized. I'm sure that's totally wrong but it's such a great idea.

Dr. Bhadelia:    It sounds effective.

Quinn:    Yeah, right? It worked.

Dr. Bhadelia:    The crazy thing is, of course I think physicians definitely need to work on this. All health care workers need to work on this.

Quinn:    [crosstalk 01:05:22].

Dr. Bhadelia:    Each of us in our homes, yeah, exactly. I'm seeing even in the last five years, haven't you noticed there's so many more antimicrobial alcohol hand sanitizers around town, like [inaudible 01:05:34]?

Quinn:    Oh yeah.

Dr. Bhadelia:    Interestingly enough, when I was in the middle of the Ebola outbreak, that's one of the ways that Sierra Leone, Liberia and New Guinea stopped their outbreak, was they had hand hygiene outside all their buildings and at checkpoints everywhere. It is so part of the basic thing. That's three.

Dr. Bhadelia:    The other is if you're traveling and I would say stay informed. Go to the CDC travel page, find out a bit more about the risks of the areas you're traveling to. To Brian's point about hiking earlier, I don't think we should ever stop travel unless it's sort of something that CDC tells us. We shouldn't change our lives. We should be more responsible and be more aware. I think that that's what I would recommend to those that are traveling.

Brian:    All right, I still get to hike.

Quinn:    Jesus.

Dr. Bhadelia:    Go on hiking. Hiking's one of my favorite activities too.

Brian:    It really is wonderful.

Dr. Bhadelia:    The other is learning about the issues.

Quinn:    Sure.

Dr. Bhadelia:    I think that there are a couple of books that I personally always recommend for people to read. If you really are interested in his idea of how diseases jump from animals into humans or how climate changes are impacting this disease spread, I would read David Quammen's Spillover. The book's [inaudible 01:06:42] Spillover. If you're a bit more interested about just climate change in itself and I'm sure your prior guests have had some recommendations that are great, but Elizabeth Kolbert, who's a New York Times science writer, wrote The Sixth Extinction which is the scariest book I've read.

Quinn:    Oh my God, Jesus. I did not click on that on my Amazon wish list for so long.

Brian:    Purposely.

Quinn:    Because I was like, "This can't be good. This can't be good," and it is stunning.

Dr. Bhadelia:    It is. It really opens your eyes and I would say Spillover and Sixth Extinction, but I think anything to learn about the diseases. What I'm trying to do personally aside from all the things that I mentioned, I'm really trying to live a life with a lower carbon footprint. It's not a direct impact. I know I'm not a climate change scientist but I can tell you as an infectious diseases doctor I see the impact that climate change is having on my job, on our risk. I'm trying to do my part by living sort of a life with lower carbon footprint.

Quinn:    Thank you.

Dr. Bhadelia:    That's what you can do in your home in your life at least.

Quinn:    Talking about the personal stuff, how can people, and this was such a big issue here in town a few years ago and it still is in a lot of places, let's say I follow all these steps. Again, I'm not a fear mongerer and I'm not a clean freak, but I'm living a clean life and trying to teach my kids to do the same thing. How do we have those proactive, productive, constructive conversations with folks around us without seeming preachy and or fear based? What are the pointers we give people or send people to, I don't know, just do the right thing?

Dr. Bhadelia:    It's such a tough thing. Going back to the anti vax thing, it's so hard for physicians because you're trying to, when you look at the studies a lot of the public, if you give someone who is scared of vaccines, who doesn't believe in vaccines the information, the data about the safety of vaccines, it doesn't work. If you do public service announcements, it doesn't work.

Brian:    Right.

Quinn:    We've seen that so much this year.

Dr. Bhadelia:    Yeah. If you do one to one, apparently if you keep doing one to one repeated education, it almost makes them sort of dig into their position a bit more and so how do you do that as a physician to maintain a therapeutic relationship with someone who doesn't believe in vaccines? It's a hard thing. You said give you answers and not questions? Well, here's a question. I think that one of the toughest problems we're seeing not just in medicine but in politics and everything is how do you share data without antagonizing? How do you share ideas across the border, I should say, across the ideological border?

Quinn:    It's a good one.

Dr. Bhadelia:    You got to give me that answer. I don't know the answer to that.

Quinn:    Well, what are you doing here? What are you talking about?

Dr. Bhadelia:    I told you about the plague. I thought my job was done after that.

Quinn:    No, great, great. Good work. No, it's true and again, whether from anti vax or clean energy or arguing with, hell, I'm in two unions and I'm not going to be, well everybody's going to be, I'm not going to be the first affected by automation and artificial intelligence, but truck drivers are and I believe in unions. Organized labor has been incredible for 70 years and brought us things like weekends. It's going to be an issue and that's a really hard conversation to have because it's so nuanced and so complex and you can say to people, "Well, road safety and efficiency and costs," and things like that and someone's like, "Yeah, but that's my job," and it's the number one job among white males in America.

Quinn:    It's complicated. It's really hard. You would think infectious disease would be a little bit easier but the thing we discovered in LA a few years ago is some people just feel like, either their head's in the sand about it or they just honestly felt like they were smarter than the doctors and I'm not sure how you argue with that. It's so hard.

Dr. Bhadelia:    Your point about not fear mongering, so here's where it gets really difficult because one of the other strategies you can do is really show them that, "Look how bad measles is, it's terrible, look at what it does to kids." You play this sort of narrow line of, you don't want to fear monger but you can say, "Hey, look at what's going to happen if you take this decision," or if you go down these road.

Quinn:    Right, and you and I talked a little in an earlier conversation about how important, again, facts aren't cutting it, this straight up science isn't cutting it. Scientists have forever needed to be better storytellers but of course their argument, rightfully so, has been like, "We shouldn't politicize this, we shouldn't turn it into an epic." At the same time, when my daughter got diagnosed and I was worried about two kids, I wrote a scathing Facebook post, which is ridiculous, everybody does that. I felt the need to personalize it and turn it into a story because if you don't understand, if you think it's okay if 40% of the kids in this school aren't vaccinated, what happens when a kid you know or your kid gets it?

Quinn:    It's so frustrating because you just, I felt desperate in that moment of, "Well, you know what? Let me show you what the hell it looks like. Maybe that will change your mind." You hate for it to get to that point. It's terrible.

Dr. Bhadelia:    Yeah, and maybe I'm slightly different than your other guests on this but I actually think it's hard for scientists not to be political. If you have the data, if you have the science, if the data's out there that this is the most likely accurate answer, science has always been political. Like hey, when we told everybody the earth was round and not flat, that didn't go over well.

Quinn:    It didn't go over well, a lot of people died.

Dr. Bhadelia:    Yeah. I think the same thing with climate change. I think the data is in, we already have that information. Some of the vaccine stuff, we have that information. It's hard not to go out there and make a strong support for something when you know it's the right thing and I don't think scientists and doctors should shy away from that.

Quinn:    We're happy you came on to help us kickstart that conversation certainly. All right, so advocating, again, proactively or defensively for programs like the ones that are under threat like the GHSA and then taking all those personal steps and trying to have meaningful educated conversations and personalizing the storytelling as necessary. Is there anything else that people can actually do that is actionable, that they can start doing today?

Dr. Bhadelia:    I felt like I covered that. What else? Let me think.

Quinn:    No, I just want to make sure we're exhausting it. This is one of the most important ones.

Dr. Bhadelia:    Yeah, I definitely think preaching to other people and having those one to one conversations even if we haven't seen as much success of it, it's probably the only way we can move forward. It's the strongest way to move forward. When someone trusts you but they disagree with you, they may be more likely to listen to you than to listen to someone who's a stranger outside.

Quinn:    Sure. I feel like the same thing we say for all of these things and we did with the climate change is like we try to be, quote unquote, correct on this but don't be a dick about it because that doesn't help. They won't trust you anymore because then you're just being an asshole and like you said, people really tend to dig in in those moments and that's not great.

Quinn:    Well, that has all been incredibly helpful. We are getting towards the end here. We can't thank you enough. We do have a few last questions we ask everybody, sort of a lightning round.

Dr. Bhadelia:    Sure.

Quinn:    If you're ready for that. First one, when was the first time in your life you realized you had the power of change or the power to do something meaningful? It sounds like about four years old for you which is not fair.

Brian:    You're 21 now so that's just 17 years ago. We got that.

Dr. Bhadelia:    Probably college. I think a lot of us discover that during college when you can advocate for a position, one position or another. The most recent one is the one you spoke about which is the Ebola outbreak. I think sometimes being a doctor in a resource rich world, you know you have an impact but the system sometimes can get you down so much. Volunteering during the Ebola outbreak made me realize every little thing that I'm doing is helping, it's having an impact. It was very, it made me realize I'm glad I went into this field.

Quinn:    Sure. This is a side note and I'm not necessarily saying, I'm pretty split on this. I'm not saying I would love for you to run for office because it's obviously super important what you're doing but we've seen so many incredible folks and really a lot of female scientists, and I know you and I talked about that a lot, that have said essentially, "Well fuck it, I'll do it myself," and have decided to run this year. Any thoughts on that? Not you personally, necessarily, but advocating for that or anything?

Dr. Bhadelia:    I think I mentioned one person in particular, one of the prior CDC, the head of CDC HIV global programs is Shannon Hader.

Quinn:    Yeah, Shannon, she's coming on.

Dr. Bhadelia:    Oh, that's really great. She's an example of a scientist that has that background, has the creds and is taking that to public office. I think it's so important and, again, another reason why I feel like scientists and doctors shouldn't shy away from data supported politics, let me just sort of put it that way. I think looking at where the local, I've made a habit of starting to follow a lot of the kind of candidates that we've been taking about on Twitter or social media and really learning about them, whether they're in your backyard or somewhere else and supporting their candidacy. I've been donating where I can. I think that's the right way to go. We can't all run. That would be great.

Quinn:    Sure. No, we desperately need you to do your job. Again, I'm pretty split on this.

Dr. Bhadelia:    I feel like that's another way to do this, is to learn about those folks and support them and support their campaigns.

Quinn:    It just seems so, we talked to another woman, Jess Phoenix who's a volcanologist and is out here just north of LA running against Steve Knight who's a nightmare.

Brian:    Steve Nightmare, they should call him.

Quinn:    Nice, Brian.

Brian:    Bam!

Quinn:    Nice. Just the same thing, not infectious disease but boy, it would sure be great to have someone who really knows geology in there when we're having these climate change and clean energy talks. It just seems like the right thing to do. All right Brian, you got the next question.

Brian:    Question number two.

Quinn:    This is kind of a favorite one. We're making a list of these.

Brian:    Yeah, yeah. You've mentioned three books already so maybe one of those would be the answer but if you could Amazon Prime one book to Donald Trump, what book would it be?

Dr. Bhadelia:    I mean he's very scared of diseases so maybe it would be Spillover. I remember he sent that Tweet out, it was actually two weeks before I took off the first time around for Sierra Leone and his Tweet was, "They're not coming back," the people, the physicians or clinicians who are being brought back. I think anything that shows the importance-

Quinn:    You wrote that to me?

Dr. Bhadelia:    Yeah. No, I literally said that. I was like, "No, what does this mean? If I go they won't let me back in?"

Brian:    Oh my God.

Dr. Bhadelia:    I think the Spillover book would be a good one because I think it shows a lot of the connection to our everyday activities and the scary part that is emerging diseases.

Quinn:    That's a pretty damn good recommendation.

Brian:    Yeah. Wowza. Question number three, what do you do for fun? What are your hobbies?

Dr. Bhadelia:    Oh, I love taking photographs.

Brian:    Oh, awesome.

Dr. Bhadelia:    I actually carry a camera with me all the time.

Quinn:    Wait.

Brian:    Your iPhone 10?

Quinn:    Some of our listeners are young. You mean like a real camera?

Dr. Bhadelia:    Yeah, a DSLR. I finally upgraded to a full frame and I'm going to pat myself on the back, one of my photos won me a trip to Paris a few years ago.

Quinn:    What?

Dr. Bhadelia:    Very [inaudible 01:18:51].

Quinn:    Holy cow.

Dr. Bhadelia:    I'm trying to keep, I think you need to, whatever else we do, some of the most interesting people that I know after retirement took on a second career or another serious hobby so I feel like I want to be one of those 90 year olds that does something else on the side.

Brian:    Wow. Are you a Nikon or a Cannon woman?

Dr. Bhadelia:    Cannon. I was Nikon, I don't know, seven years ago. Just shifted. They're both the same.

Quinn:    This is a whole thing. Brian, do you have some photography background I don't know about?

Brian:    You should have seen the look you just gave me. What a look of shock. No, I just know that there's a lot of people that are really pro Cannon and a lot of other people are really pro Nikon

Quinn:    Fascinating. Look at that.

Brian:    Also, where's the, can we see the photo that won you a trip to Paris? Is it somewhere on the internet?

Dr. Bhadelia:    Yeah. Let me see how you could, I have a Nat Geo page actually.

Quinn:    Oh cool.

Dr. Bhadelia:    You can probably look that, if you do Your, sorry. There's a Nat Geo Your Shot and all the photographers are able to upload theirs. The one that's published for obvious reasons is the one that I'm talking about. It's a picture that I took, interestingly enough, the only stable glacier in the world is, one of the only stable stable glaciers in the world which is Perito Moreno Glacier in Argentina. Everything else in the northern, as you know, the northern hemisphere is melting.

Brian:    Right.

Dr. Bhadelia:    It was an interesting moment of reflection for me too.

Brian:    Wow, that is really very cool.

Quinn:    That's awesome.

Brian:    Yeah.

Quinn:    That's cool. I need more hobbies. Listen, Doctor, this has been so fantastic and everything I hoped for. We really appreciate it. I appreciate your enthusiasm. I was so delighted when I woke up in the middle of the night, you'd send me a list of 30 more people to talk to. It's fantastic but it's just so necessary. Just the conversations and also the enthusiasm to say like, no, these are the people making a difference that need to, we, to talk to them about what they're doing and why it's important but also who they are because those should be the people being talked about these days.

Brian:    Yeah.

Dr. Bhadelia:    Thank you for having me on and I'm looking forward to hearing the other podcasts.

Quinn:    Yeah, please tune in.

Brian:    Yeah, [crosstalk 01:20:54].

Quinn:    We've got some awesome folks recorded, we've got some awesome ones coming up. We feel lucky and we feel like it's hopefully, it's fun but making a difference in what is probably the most important year of our lives. No big deal. Where can our listeners find you online? Can they find you online?

Dr. Bhadelia:    Yeah, I'm on Twitter. My handle is @BhadeliaMD. B-H-A-D-E-L-I-A-M-D.

Quinn:    Awesome.

Brian:    Got it.

Quinn:    Rock and roll. We'll find that photo and we'll put that on there and we'll find all these books which sound-

Dr. Bhadelia:    I'll send you that slide about the meat getting transported left and right.

Quinn:    Yeah, I would love that and any other ones that you've got that you think would be instructive.

Brian:    Yeah, we're happy to share anything.

Quinn:    Nobody wants to see, maybe not everything, Brian.

Brian:    Within reason.

Quinn:    Nobody wants to see me hand draw some of these things.

Brian:    I want to see you hand draw.

Quinn:    I think all it would do is lead people astray. Not pretty.

Brian:    Got it.

Quinn:    Listen, this is awesome.

Brian:    Thank you.

Quinn:    Thank you so much.

Brian:    So very much.

Quinn:    So much for your time today, Doctor, and for all that you do. Again, I'm not saying run for office, I'm just saying I really appreciate you on a daily basis.

Dr. Bhadelia:    Aw, thank you. Thank you for what you do. I think I said this to you before, I think your program probably has a larger everyday impact in getting through to people and helping them be connected, so thank you for that.

Brian:    We hope so.

Quinn:    We're trying, we're trying.

Brian:    Thank you for letting me know that I can still go hiking and travel and make babies and shake people's hands.

Dr. Bhadelia:    Yeah, please do. We can't stop that.

Brian:    I appreciate it.

Quinn:    All right, awesome. Thanks for everything and we'll talk to you again real soon.

Dr. Bhadelia:    [inaudible 01:22:33] too soon. Bye you guys.

Quinn:    [crosstalk 01:22:34].

Brian:    All right, thank you Doctor. Ciao.

Quinn:    Thanks to our incredible guest today and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dish washing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species.

Brian:    You can follow us all over the internet. You can find us on Twitter at @importantnotimp. Just so weird. Also on Facebook and Instagram at Important Not Important, Pinterest and Tumblr, the same thing, so check us out, follow us, share us, like us, you know the deal. Please subscribe to our show wherever you listen to things like this. If you're really fucking awesome, rate us on Apple Podcast. Keep the lights on, thanks.

Quinn:    Please.

Brian:    You can find the show notes from today right in your little podcast player and at our web site, importantnotimportant.com.

Quinn:    Thanks to the very awesome Tim Blane for our jamming music, to all of you for listening and finally, most importantly, to our moms for making us. Have a great day.

Brian:    Thanks guys.