EP. 107: TO CREATE A VACCINE

WITH PAUL OFFIT

Apr 9

WITH PAUL OFFIT, MD

One of the world’s leading experts on vaccines shares how he created the rotavirus vaccine, which now saves hundreds of lives each day, and how we can rebuild trust in public health by acknowledging the limits and promises of science.

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Episode Summary

Rotavirus, a highly contagious virus that causes severe diarrhea and vomiting, used to kill more than half a million children annually. But the introduction of the rotavirus vaccine has slashed that number dramatically, saving hundreds of thousands of lives each year.

Joining us in this episode is Paul Offit, MD, a co-inventor of one of the two most widely used rotavirus vaccines worldwide. Dr. Offit is a professor of pediatrics and vaccinology at the University of Pennsylvania and director of the Vaccine Education Center at the Children's Hospital of Philadelphia. A leading world expert on vaccines, he served on the FDA Vaccine Advisory Committee during the COVID-19 pandemic. He is the author of more than 15 books, most recently Tell Me When It's Over: An Insider's Guide to Deciphering Covid Myths and Navigating our Post-Pandemic World (2024).

Over the course of our conversation, Dr. Offit shares what drew him to pediatrics, how he developed a vaccine that now saves hundreds of kids every day, the stringent process by which new medications are approved, the origins of vaccine hesitancy. Why public health communication failed during the COVID-19 pandemic, what we can do to restore public trust in medicine, and more.

Paul Offit, MD is a prominent American pediatrician specializing in infectious diseases and an expert in vaccines, immunology, and virology. He has made significant contributions to the field of vaccinology, most notably as one of the co-inventors of the rotavirus vaccine, RotaTeq, which has been credited with saving hundreds of lives every day by preventing severe rotavirus-induced diarrhea in infants and children worldwide. Dr. Offit is the Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, and the Director of the Vaccine Education Center at the Children's Hospital of Philadelphia.
A prolific author, Dr. Offit has written extensively for both scientific journals and the general public, debunking myths about vaccines and advocating for evidence-based medicine. His dedication to public health is evident through his participation in various advisory committees, including the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices. Dr. Offit's work has not only contributed to advances in pediatric healthcare but has also been a beacon for science communication, emphasizing the importance of vaccines in preventing disease.
In this episode, you will hear about:
• 2:24 - The harrowing experience Dr. Offit endured as a young child that inspired him to a seek a career in pediatrics
• 6:40 - How Dr. Offit’s research led to a successful rotavirus vaccine in 2006
• 10:46 - A brief history of vaccines
• 16:40 - Why Dr. Offit chose to become a public advocate for vaccines
• 20:14 - Why vaccines have garnered such intense backlash from large proportions of the public
• 26:44 - Factors that have led to an erosion of trust in public health over the past four years
• 33:01 - What Dr. Offit means when he talks about “following the science”
• 40:35 - How public health officials can speak about scientific knowledge in a way that acknowledges uncertainty
• 47:37 - The future of vaccines mandates in our society
• 54:16 - Dr. Offit’s advice for building trust with skeptical parents
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine, we will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:01] Rotavirus, a highly contagious virus that causes severe diarrhea and vomiting, used to kill more than half a million children annually. But the introduction of the rotavirus vaccine has slashed that number dramatically, saving hundreds of thousands of lives each year. Joining us in this episode is Doctor Paul Offit, a co-inventor of one of the two most widely used rotavirus vaccines worldwide. Doctor. Offit is a professor of pediatrics and vaccinology at the University of Pennsylvania, and director of the Vaccine Education Center at the Children's Hospital of Philadelphia. He is one of the world's leading experts on vaccines, having served on the FDA Vaccine Advisory Committee during the Covid pandemic. He is the author of more than 15 books, most recently 2024 Tell Me When It's Over An Insider's Guide to Deciphering Covid Myths and Navigating our Post-pandemic World. Over the course of our conversation, Doctor Offit shares what drew him to pediatrics, how he developed a vaccine that now saves hundreds of kids every day, the stringent process by which new medications are approved, the origins of vaccine hesitancy. Why public health communication failed during the Covid pandemic, what we can do to restore public trust in medicine, and more.
Henry Bair: [00:02:24] Paul, welcome to the show and thanks for being here. We're going to delve deeply into your work with vaccines and during the heights of the Covid pandemic. But first, tell us about your origins. What first drew you to a career in pediatrics and then to vaccine development?
Dr. Paul Offit: [00:02:42] Sure. I'll give you an honest answer. As a child, I was born with club feet. My right foot was operated on when I was five years of age, which was unfortunate because there really was no operation at that time until about really 40 years later. And so it was a botched operation. And so that that landed me in a, um, chronic care facility for about six weeks, which in the mid 1950s was a polio ward. So I was in Kernan's Hospital for Crippled Children back in the days when you could use words like 'crippled' and 'feeble minded' in the names of children's hospitals, and I was there for six weeks. It was, um, because it was a polio ward and because it was the mid 1950s, you know, there was one visiting hour a week. My father was a traveling salesman. He was unable to visit me, and my mother was sort of bedridden with a complication from pregnancy with my brother. And so she couldn't visit me. So I remember my my bed was right next to a window that looked out onto the front of the hospital, and I just laid there, stared out at that window, waiting for somebody to come save me.
Dr. Paul Offit: [00:03:44] I mean, this is the day. This is. It's not like they had therapy animals or iPads or even TVs in that room. You just laid there and stared out the window, and it was a polio ward. So I remember children in iron lungs. I remember the Sister Kenny hot pack treatments, you know, where they would take these excruciatingly hot packs and put them on withered arms and legs as a way to try and get any kind of residual function they could. So it was literally hell. I mean, it was it was Dickensian. It was awful. And I think that that the real answer is that the the scars of our childhood invariably become the passions of our adulthood. And I think that seeing that seeing those children as I saw them, which is vulnerable, helpless, alone, I think that drove me into a career of medicine. I think it drove me into a career in infectious diseases. I think the first book that I wrote was about the polio vaccine. I think that that was all that, to be perfectly honest with you. I think it's I guess we're always kind of treating ourselves as children.
Tyler Johnson: [00:04:39] And what has it been like then for you? It's interesting to hear you frame it. As, you know, your career as a physician is partly to, uh, dress the wounds that you had as a child. Do you feel like it's been effective in doing that?
Dr. Paul Offit: [00:04:53] No, I think it's an unfillable hole. I think I think, um, I'm very quick to see children as being mistreated. I think all my books are in many ways about child advocacy, whether it's regarding vaccines or the law. And no, I think it's an unfillable hole when I see people like, for example, Robert F Kennedy Jr, Del Bigtree or Barbara Fisher or any of this sort of anti-vaccine activists that are out there, I see them as hurting children. For me, it's like a crusade, and it's very emotional and it never lessens. No, it's never resolved.
Tyler Johnson: [00:05:26] Can you then trace us through? So you go to medical school and then you go to residency in pediatrics, and then sort of where has your professional life taken you since then? What's been the arc of your career?
Dr. Paul Offit: [00:05:37] Right. So so I did a medical school at the University of Maryland, my state school. Then I did residency at Children's Hospital in Pittsburgh, a pediatric residency. Then I did a fellowship in pediatric infectious disease at the Children's Hospital of Philadelphia under the mentorship of Stanley Plotkin. And I just was really lucky to have him as a mentor. I mean, here's a man who, aside from being a brilliant clinician and scientist, was the inventor of the 27 three strain of rubella vaccine, which we currently use today. He was a key contributor to the human diploid cell rabies vaccines, which are what we use today. He contributed to the anthrax vaccine. I just was lucky, lucky to be under his tutelage. I think any success I've had in my life, I can trace directly back to him. So I did my fellowship there and then I spent a few years at Stanford doing learning some techniques that I needed to learn, and then I came back to Children's Hospital of Philadelphia, and I've been there ever since 87, so I've been there for a long time.
Tyler Johnson: [00:06:35] It's never too late to come back to Stanford. I'm just saying.
Henry Bair: [00:06:40] So it's one thing to study and administer these vaccines. It's another to actually create one. You are, of course, famous for having invented the rotavirus vaccine. How did that process actually unfold?
Dr. Paul Offit: [00:06:54] Well, I can safely say you never think you're creating a vaccine. What you think you're doing is learning about the virus. And so when you you write your papers or when you submit your grants, although the first paragraph of your grants always says, you know, they're rotavirus kills 2,000 children a day in the world, there's a lot of public and private interest in trying to create a vaccine. We need to learn this and this and this before we can have a vaccine. You never think you're making a vaccine. You're just trying to stay funded basically by continuing to get your grants. So my work for that, you know, for the 26 years or so that it took to finally have a vaccine really centered on trying to understand, you know, what were the critical proteins of the virus in inducing an immune response? What were the critical proteins that were responsible for virulence, and then creating sort of these reassortment or recombination viruses that had the attenuated virulence characteristics of, in our case, an animal strain, a bovine strain, and yet included the genes that coded for the human proteins that we thought were critical for inducing protective immunity. And so that's so we did that work in experimental animals. We really were one of the first to create a small animal model, mice to study this virus. Because the veterinarians were way ahead of us, the veterinarians had figured out rotaviruses were a cause of animal disease decades before we figured that out in humans.
Dr. Paul Offit: [00:08:10] And so it was a commercial issue. So there was a lot of really good pathogenesis studies, you know, in pigs and lambs and sheeps and horses, etc. but, you know, those were never going to be inbred. So you can't do the kind of genetic studies that you can do with an inbred animal, especially when you talk about cytotoxic T cells. So so that was my work. So, so for ten years we, um, did the kind of studies that enabled us to answer the question about the genetics of virulence, the genetics of neutralization phenotype and create strains we thought could be a vaccine. And then we went to several different pharmaceutical companies and said, look, here's our idea for how this could be a vaccine. But, you know, at that point you'd just done work in experimental animals. And as David Weiner, who's a vaccine researcher at The Wistar Institute, famously said, mice lie and monkeys exaggerate. You never know until you go into people. And so so that was it. Ultimately, we Merck became interested in our program and did the series of studies that the phase one, phase two, phase three studies that ultimately led to that being a vaccine, you know, thus taking so so the research part was ten years, the research development part, which is the hard part. Now you have to have the right buffering agent, the right stabilizing agent, the right Val, you have to figure out the right dose. You have to dose ranging studies.
Dr. Paul Offit: [00:09:21] You have to do proof of concept studies that you need all the strains in there you think you need. And then you do phase one studies and sort of 50 or 100 people, then phase two and hundreds and then phase three and tens of thousands. And then, you know, it's a vaccine, although even there, you know, you've done our study was it's the Merck study. The phase three study was a prospective, placebo controlled, 70,000 person, four year, 11 country, probably $350 million from. But even then, you know, you you've studied tens of thousands of people for a vaccine that's going to be in hundreds of millions of people. Do you know enough? Because you never know everything. Do you know enough? And it's just this constant sort of struggle of waiting between sort of boredom and anxiety for for this. And even when it, when it was licensed, you know, in February of 2006, you know, Fred Clark and I so Stan Clark, Stan Clark and Fred Clark and Fred Clark and I, Stan had left at that point, Fred Clark and I just poured through gene databases. I mean, what are we missing? Or or any of the rotavirus proteins mimicking proteins in synovial cells? Could we be causing arthritis or pancreatic islet cells could be causing diabetes? I mean, because you, you know, the other shoe is going to drop, you know, that because that's invariably true in medical innovation. But fortunately it really didn't for rotavirus.
Henry Bair: [00:10:34] And then at this point, since its development, I mean, depending on where you find your numbers, like it's been estimated to have saved hundreds of thousands of lives, essentially, which is I mean, it's incredible to think about.
Tyler Johnson: [00:10:46] To provide a little bit of historical context, because I think a lot of even people who are pretty involved in medicine don't really have a sense of this. Can you trace like, how did we get the idea for vaccines? Right. It's a little bit of a especially before we had a detailed understanding. Not that I mean, you know how detailed it is now we can have a discussion, but especially before we understood the immunology behind it. It's a little bit of a weird idea, right. Like, oh, I know, let's take a part of or a not quite as virulent strain of or whatever, some version of a bad thing and give it in smaller doses to make it so that people then don't get sick with that thing. Right? Like 100, 200 years ago. It's a little bit of a strange thought. So, and it is also a place where in many ways, at least, the original examples outstripped any real scientific understanding of what they were even doing. Right. So can you just trace for us a little bit, like where did the idea originate and sort of how did it evolve over time to bring us to where we are now?
Dr. Paul Offit: [00:11:41] Right. No, that's exactly right. So the first vaccine was the smallpox vaccine, Edward Jenner smallpox vaccine. So he was a physician working in southern England who noticed that every 2 to 3 years, smallpox would sweep across the southern English countryside, leaving many people dead or permanently disabled, primarily blind. And he noticed that that that, as others had before him that quote unquote, milkmaids have fair skin meaning, because if you get smallpox and you survive it, you invariably have these pock marks on your face, but not true of milkmaids. So why why were they protected? And he reasoned, as actually had a man named Benjamin Jesty a couple of decades before him, that when the when these milkmaids would milk cows and the cows would have these vesicular lesions, these blisters on their udders, and then they would get blisters on their hand that somehow that protected them. Now, this is before the word virus meant what we mean it to be today. Then it was just a general word meaning poison. And we obviously didn't know what viruses looked like until we invented electron micrographs, which was until the early 1930s. So this was this was just phenomenology. So what he did was he then took the purulent fluid from the wrist of a milkmaid who was in his employ named Sarah Nelmes. He then injected it into his son, and then he did something that had been available since the early 1700s, which was variolation.
Dr. Paul Offit: [00:12:59] The variolation was, you took again vesicular fluid from someone with smallpox who had a mild smallpox infection. Then you would inoculate him essentially with what you were hoping was an attenuated form of smallpox, essentially a human smallpox to protect against human smallpox. That was variolation. And when you got variolated, you had a very intense reaction. So what he did was he inoculated them with what we now know to be cowpox. I mean, that wasn't true. They didn't know that. Then. Variola vaccinae was the term he used. Then he challenged his son with by variolation, and he had a very minimal sort of reaction. So he argued that those two that he was protecting his son. And that's where the word vaccine comes from, from the Latin vacca, which because there's no Harvey in Latin. So waka is cow Wakannai vaccine is of the cow sort of genitive form of the cow. So, so technically our vaccine, which was essentially taking a cow virus and then inserting into a genes that coded for human proteins, we took advantage of the attenuated virulence characteristics of the cow virus, which is essentially what he did. I mean, the cow pox was similar enough to human smallpox, so that immunization with one could protect you against the other.
Dr. Paul Offit: [00:14:06] And then from there, you know, we went to the fast forward 100 years. We have the rabies vaccine in the late 1800s where Louis Pasteur, you know, took rabies virus and essentially inactivated it with drying. So essentially it was a whole kill viral vaccine, which is essentially what it is today. And then then you had, you know, you moved into the first live attenuated viral vaccine, which was the yellow fever vaccine of Max Theiler. And, you know, so human pathogen and he passed it in non-human cells, you know, like mouse embryos and was able to weaken it by just serially adapting it to growth in non-human cells. And that's how we got the measles vaccine and the mumps vaccine and the rubella vaccine and the varicella vaccine and the other rotavirus vaccine was all made that way. And then you took viruses and completely inactivated them, like the hepatitis A vaccine or the the polio vaccine, or you took just a part of the virus, like the hepatitis B vaccine or the human papillomavirus vaccine or the and then you move to Covid, which is a completely novel concept, which is the part that was the most amazing to me thing to me about this whole pandemic, actually, was, was this contrast between two things. You have this virus, SARS-CoV-2 virus, which was isolated and sequenced in January of 2020, and then this unusual virus, which had unusual clinical and physical characteristics, biological characteristics that you're then going to try and defeat with the technology you'd never used before, because we'd always given some part of the virus, whether it was a whole virus or killed virus or protein from the virus. Now you're not doing any of that. You're just giving the gene that codes for a virus protein, no experience, never had any experience with that technology before. And it worked remarkably well. And. Then we figured out how to mass produce this, which was not easy. Those lipid nanoparticles, by the way, are not easy to mass produce because they're sticky. So we mass produce it, we mass distribute it. We mass administered into a country that doesn't didn't have an infrastructure for vaccinating adults. And we vaccinated a million people, 2 million people a day, 3 million people a day. Then we hit a wall in May, June of 2021, hit a wall. 30% of this country refused to be vaccinated because they were overwhelmed by the misinformation and disinformation and sort of libertarian notion of don't tell me what to do. And 300,000 people died because they just refused to get the vaccine. So so you have, on the one hand, this amazingly technologically rich country, which did an amazing Operation Warp Speed, I think was one of the most amazing scientific and medical feats in my lifetime. And then we see hundreds of thousands of people die because they simply deny the technology.
Henry Bair: [00:16:40] Over the past ten years or so, you've become increasingly known as the face of vaccine advocacy. With reflection, it might seem odd that we'd need advocates for something that's been around for decades, and that demonstrably saves lives. You don't hear about advocates of statins to prevent heart disease, or of steroid inhalers to prevent asthma exacerbations. And somehow there's significant resistance in the general population out there about vaccines. How did this part of your career, this public facing side that counters the disinformation and politicization around vaccines come to be?
Dr. Paul Offit: [00:17:19] Right. So in 1998, I was asked to join the Advisory Committee for Immunization Practices because I had an expertise in rotavirus, not because because I published a lot of papers on rotavirus. I mean, our vaccine wasn't a vaccine until 2006. So this was well before our vaccine was a vaccine. So I was brought on to the committee as a rotavirus expert. So three things happened between like 1998 and like 2001. There were like the one, two, three punch against vaccines. One was a shield, which was a vaccine that was developed by Wyeth in collaboration with researchers at NIH, was on the market for ten months before it was taken off because of an adverse reaction called intussusception. Right when the small intestine sort of telescopes into itself gets stuck and it could be a medical emergency. That was one. And then you had this notion that thimerosal, this ethylmercury containing preservative in vaccines, was causing harm. And so the Public Health Service essentially put a gun to its own head and said, okay, we're going to take thimerosal out of vaccines, even though there was no evidence that it was harmful. In fact, all the evidence since then has shown that it wasn't. But nonetheless, as they said in the public Health Service, we're going to take thimerosal out of vaccines, although all the evidence is that it's not unsafe. We're going to take it out just to make it safer. Well, if it's not unsafe, then taking it out didn't make it safer. But in any case, that created anti-vaccine activists, I mean, Moms Against Mercury, Generation Rescue, that episode created anti-vaccine groups. And then there was Andrew Wakefield's publication of the MMR vaccine caused autism.
Dr. Paul Offit: [00:18:50] And so here we were as an advisory committee, voting on whether or not we should separate that vaccine into its three component parts, because the CDC is funded by the the Appropriations Committee. And somebody in the Appropriations Committee wanted us to vote on something as ridiculous as that. And so the reason I got into it was that I thought that pediatricians were great. They were out there with vaccines are good, vaccine preventable diseases are bad. We're vaccinated. But what I didn't see is I didn't see scientists getting out there and saying, look, here's why it doesn't make sense that MMR would cause autism. Here's why it doesn't make sense that mercury ethylmercury at the level contained in vaccines would ever cause this kind of harm. Given that, you know, you live on this planet, you're exposed to Mercury all the time. And so that's with that, Moser and I created something called the Vaccine Education Center to provide that information, the scientific information. And that's when I got got into it. We created a tear sheet, we got funding, and we got out there and ultimately into the media. And naively, I thought, okay, I'm just going to sort of, you know, get good science out there. But the minute you do that, the minute you sort of especially if you mention anybody's name, like Andrew Wakefield or Barbara Fisher, who was sort of an advocate for the pertussis or whooping cough vaccine was dangerous. Now it's not science anymore. It's politics. You've crossed the line from science to politics, and politics is mean and personal and ugly and not anything for which you're trained.
Tyler Johnson: [00:20:14] You know it... It is kind of a strange thing that. On the one hand, vaccines are a very specific kind of preventative medicine that have a, you know, now, previously, hundreds of years ago, we were, as you mentioned, working phenomenologically, but now we have this really sophisticated, beautiful immunological understanding of what a vaccine is doing and how it's stimulating the immune system and how that primes the body against whatever the invading infection is going to be in the whole nine yards. And so on the one hand, that would seem like about as dry and almost no offense, but bordering on boring of a scientific thing as you can imagine, right? Like as I mean, we've all been medical students, right? I think that with the exception of people who just really find their calling in immunology, most medical students have sat through many, many immunology lectures with little spiky looking circle things and lots of, you know, diagrams and whatever about who's, you know, the MHC and this and that and whatever, which most even medical students maybe have a little bit of a hard time getting into all of the details. And then they produce these things and then, you know, through all of this sophisticated understanding. And then, as you mentioned, in the development of the rotavirus vaccine, these enormously expensive and extensive and well designed clinical trials, you bring that sort of dry scientific knowledge into a product that then, like any medical product that's going to be administered, is trialed, rigorously found to have more benefit than harm, and then is deployed out into the public.
Tyler Johnson: [00:21:58] But all of that stuff is almost never where we have the focus, really, when we're talking about vaccines, right? And instead, at least in the public sphere, when we're talking about vaccines, almost immediately it becomes this hyper tribal partizan passionate personal thing. Right? And I think anybody who has ever uttered the word vaccine on any form of social media knows that you, almost, in spite of yourself, are going to rile up all kinds of passionate opinions almost the moment that it appears on your Facebook, Twitter, TikTok, whatever page. Why do you think that is? Like why this of all of the medical innovations, not that other things don't have, you know, their doubters and whatever, but there are not like passionate advocacy groups out there talking about antibiotics, right? Or even I'm a cancer doctor. I don't even see passionate advocacy groups, for the most part out there campaigning against chemotherapy, which in many cases is literally poison, right? Like we literally use the active chemical in mustard gas to combat some cancers. And yet that doesn't seem to give rise to the same kind of passionate intensity that discussion about vaccines does. So why do you think that is?
Dr. Paul Offit: [00:23:20] Well, I think the difference when you say antibiotics and chemotherapy versus vaccines is you're treating a disease versus trying to prevent a disease. And if you think about what we do with vaccines, we have vaccines to prevent 14 different diseases in the first few years of life, which can mean as many as 25 inoculation in those first few years. That can mean as many as five shots at one time to prevent diseases most people don't see using biological fluids most people don't understand. I think it's not hard to believe that people would push back from that. And vaccines, like any medical product, do have side effects. And some of those side effects can be serious. So the anti-vaccine leagues, if you will, have been born ever since the smallpox vaccines, there's nothing new. I think they took off in the early 1980s with the false notion that the whole cell pertussis, or whooping cough vaccine could cause permanent brain damage, which wasn't true. But nonetheless, it got a lot of play and ultimately led to the creation of the National Childhood Vaccine Injury Act, which contained the Vaccine Injury Compensation Program and the Vaccine Adverse Event Reporting System.
Dr. Paul Offit: [00:24:22] And it's a much more cynical, litigious time. I mean, I, I wrote a book years ago called The Cutter Incident, right, about a polio vaccine made badly. Okay, so here's Jonas Salk takes polio virus, grows it up in cell culture, purifies it, kills it with formaldehyde. Whole killed viral vaccine. So five companies stepped forward to make that vaccine. I mean, he was a hero. He had ticker tape parades, you know, Fred Clark and Stan Plotkin and I, when we developed our rotavirus vaccine, never had a ticker tape parade. I know it may surprise you, but we never did. I'm just happy when I don't get hate mail, when a day goes by, when I don't get hate mail. And so you have five companies step forward to make it. One of them especially made it badly. Cutter Laboratories of Berkeley, California, failed to inactivate that virus. So you had 120,000 children, primarily in the West and Southwest, that were inoculated with live, fully virulent polio virus. 40,000 people got polio, mostly aborted. 164 were permanently paralyzed, ten were killed. I think it was the worst biological disaster in this country's history and didn't really in any way spark an anti-vaccine movement. People generally trusted pharmaceutical companies. They generally trusted public health agencies. They trusted the CDC. They trusted the FDA. I know it's hard to believe there ever was a time like that, but this was in the mid 1950s. And the jurors who were who were associated with the early trials.
Dr. Paul Offit: [00:25:44] So here's a vaccine that clearly caused paralysis. And the original case was a woman named Anne Gottsacker, who was paralyzed by that vaccine. And there was no debate about whether she was paralyzed. She was paralyzed by that vaccine. But what the jurors saw, jurors saw was that all the companies had a problem inactivating the virus. It really should have been called a scale up incident. Wyeth also made a vaccine that paralyzed and killed children. The other three companies had a lot of trouble in activating that vaccine. The jurors saw that for what it was, they wanted to find cutter not liable for that vaccine because they thought process of evolution. You learn as you go. We didn't know enough. You know, we needed better safety testing. We needed better sort of separation of cell debris from virus. And they got that. And they didn't want to find cutter guilty. But it was a directed verdict. And so meaning if you found that the vaccine caused this, you have to find them liable, period. Even if you don't think they were at fault. And it was the birth of liability without fault for biological products. Which I would argue has probably done us more harm than good.
Henry Bair: [00:26:44] Earlier, you jokingly mentioned back in the good old days when people trusted in public health. When I think about it, though, it seems to me not so much that people used to trust public health before Covid, it was more so that people just didn't think much about public health. And now that public health was on TV on a daily basis during Covid, a large proportion of the public were finding themselves skeptical of it. What do you think are the main drivers and factors that have shaped the skepticism about public health?
Dr. Paul Offit: [00:27:15] Well, I mean, certainly if you look at vaccines, vaccines will save their lives. I mean, we live 30 years longer now than we did 100 years ago, in large part because of vaccines. I mean, you know, we you know, we routinely, you know, 30,000 people would be paralyzed by polio every year. Diphtheria would kill 8 to 10,000 pertussis, whooping cough would kill 8000 people a year. I mean, it's, uh, pneumococcus Hib meningococcus. I mean, those those were killers. And we live longer because of that. So. So you would think that they would sell themselves. But I think what's happened is. I think there was an erosion, an enormous erosion in faith in the FDA and the CDC, like to a level we'd never seen before this pandemic, really. And there were polls to show that a dramatic drop in what you think of the CDC, what you think of public health groups or people like Tony Fauci or whomever and the FDA.
Dr. Paul Offit: [00:28:04] And I think part of it is just a general anti-institutional backlash from the right, because this really was for the first time in US history. A disease where you were far more likely to be hospitalized and die if you were a Republican than if you were a Democrat. I mean, if you lived in a heavily Red County versus a heavily blue county, you were much more likely to be hospitalized. People called it red Covid, and I think it was because of that sort of libertarian notion of government off my back. I think with the mandates where people were fired from their jobs and, you know, you couldn't go to the bar you wanted to go to, you couldn't go to the restaurant, you wanted to go to. You couldn't go to the place of worship. You wanted to go to. You couldn't go to sporting events. I mean, we it was public health Uber, Alice in 2020, we didn't have anything. We didn't have antivirals till October of 2020. We didn't have monoclonals till November of 2020. We didn't have vaccines till December of 2020. We had nothing for a virus that was contagious, as contagious as flu anyway. You know, that was spread asymptomatically. So everybody was at risk no matter who you came in contact with. If they had no symptoms, they could potentially infect you and kill you. So we just tried to limit human contact shuttered schools, closed businesses, restricted travel, quarantine, isolated. Tested, tested, tested. So it was public health Uber alles. And I think you saw Francis Collins recently had a quote in the Wall Street Journal where he regretted that we didn't sort of take a little bit of a step back and answer the question, did we really need to close schools as long as we did? Should we have worked with the teachers unions to get kids back to school sooner? Did we really need to close businesses to the degree that we did? Because we really hammered the economy, and there were regrets in retrospect about all that.
Dr. Paul Offit: [00:29:42] But, you know, as someone who's in medicine and worked in a hospital, we were overwhelmed in our hospitals. We had three floors of kids with Covid, and I worked in a pediatric hospital. I mean, we're sort of in a far less likely to die than adults were. So I get it. I just think it was we leaned into a libertarian left hook, and as a consequence, there have been hundreds and hundreds of pieces of legislation pushing back now on all kinds of Band-Aids and meaning masking and vaccinating, etc.. And you see, 35% of American parents now think that there shouldn't be school mandates, period, for all vaccines and kindergarten immunization rates, which have started to drop. And we're seeing measles outbreaks, which are all part of one thing. And so I think that's what happened here. I mean, and I talk about this at some length in the book, but I think for me, I was on the FDA and I'm still on the FDA vaccine advisory committee, it was hard to watch some of the things that happened in 2020. It really was. I mean, let me just bring you back to this time of how awful this was, and this is why I wrote the book.
Dr. Paul Offit: [00:30:44] It was a catharsis for what has been a very tough, emotional four years for me and for all of us. But in 2020, lest we forget, in April of 2020, the FDA authorized authorized the use of hydroxychloroquine, an anti-malarial drug to treat or prevent Covid without any data. And when data poured in and there were many, many studies, excellent big prospective controlled studies, it didn't work and it didn't to treat or prevent the disease. And it was it has side effect profile which could be dangerous. And so they then took back that emergency use authorization three months later, authorized it in April, took it back in June. And it was because of the heavy hand of the Trump administration, who had bought 29 million doses of hydroxychloroquine because Donald Trump wanted a magic medicine to make this all end. And to him, that was the magic medicine, whether it was that or ivermectin or whatever, that was what he wanted. And so that scared people. I mean, I wrote an op ed with Zeke Emanuel at Penn called are We Going to Have an October Surprise? Because everybody knew that the vaccines that were in development had to have a two month follow up after the last dose? Because that's routine for all vaccines, because when there's a serious event typically occurs in a few weeks, but two months gives you that safety net, well, that two month follow up would have ended in December, not before November, which is what Donald Trump wanted.
Dr. Paul Offit: [00:32:01] He wanted this to happen before the election in November of 2020. And so he brought Stephen Hahn, who was commissioner of the FDA, into his office and screamed at him and said, I want this out before November. What ended up happening then? Ten states, 12 states formed their own vaccine advisory committees. They didn't trust us. They didn't trust the FDA vaccine advisory committee to give them good advice because they thought we'd be under the thumb of the administration. I'd like to say on behalf of the FDA vaccine Advisory Committee, you can't be on that committee unless you are independent of the pharmaceutical industry and independent of the government. So we give the best advice we can. Um, not necessarily always right, but we certainly try and give the best advice we can. And so that was the mood around that time. And I understood how people came to maybe distrust the FDA. And, you know, and it's a pandemic. You know, you learn as you go. And there were certainly decisions that were made by the CDC and the FDA that weren't necessarily the right ones, the confused people. And so that's where the trust got lost.
Tyler Johnson: [00:33:01] Let me ask you a question, though. So you now have written this, as you mentioned, this entire book about sort of the experience of being kind of on the inside as the pandemic is unfolding and all the rest of it. Right. But then in the I think it's an epilog for the book. You have the lessons learned or not learned from the pandemic, right? So or sort of advice for us to take as a society and whatever going forward. And number nine on that list is follow the science and in part of the text for that point, you say, it's not hard to fix this. Public health officials need to quickly update recommendations based on new data, no matter how painful or contradictory to what was previously believed to be true. That this is after, I should say, the first part of under that point is talking about mistakes that the Trump administration made, then mistakes that the Biden administration made, and then you and then you write what I'm reading right now, educate about reasoning behind the change, and then trust the American public to understand that some recommendations might change when dealing with viruses or vaccines with which we've had little previous experience. So I want to ask you two questions relating to that. The first one is that. So I try to pretty regularly read editorial pages of The New York Times and The Wall Street Journal, because it often seems like they're operating in separate countries or something. And I feel like it's important to kind of play them off of each other to get an idea of, you know, sort of the spectrum of what's going on and what people think about it.
Tyler Johnson: [00:34:27] And as you can imagine, because the The Wall Street Journal is generally more conservative, they were much less, let's say, boosterish about a lot of the things that happened during the pandemic, everything from vaccine mandates to school closures to, you know, shop closures. And they talked much earlier on a lot more candidly about effects on educational attainment rates and the economy and other things in terms of all of that. But one point that they have made that I think is a fair question to ask or a fair point to make, is that the science that term, the science, got co-opted in all sorts of places for all sorts of reasons during the pandemic. Right? So that if you said, well, no, actually, I think this elementary school should be open because kids need to learn their math and reading and writing just as much during the pandemic as not during the pandemic, people would say, including in op eds in the New York Times or whatever. They would say, well, you're not following the science. You need to follow the science, right? Like the science became like this talisman that you would just sort of wave around whenever you wanted to make any point related to the pandemic. So my first question, I guess, is, okay, sure, follow the science. But who gets to determine what is the science like? I mean, is there because it feels like a term or even an idea that has become so widely co-opted as almost to have become meaningless because everybody uses it for everything.
Dr. Paul Offit: [00:35:57] Right? So I'll give you what I think, for, at least for me, is the cleanest example. In December 2021, the Omicron entered the United States so-called Ba1 strain. It was the first immune evasive strain, meaning even if you've been vaccinated or naturally infected or both, even recently, you could get a mild illness with this virus. And so the thinking was, do we still really need to give the Wuhan one strain, meaning the ancestral strain, the original strain? Why not put this virus or the mRNA that codes for the spike protein of that virus into the vaccine? And so thus was born the notion of a bivalent vaccine. Right. So we're going to give a half a dose of the ancestral strain and a half of dose of what became one of the Omicron variants, BA four, BA five. So those data were presented to us, the FDA vaccine Advisory committee, in June of 2022, the immunological data. And they were not impressive. They weren't. I mean, it's probably because of imprinting, so-called original antigenic sin. You didn't look like you had a better immune response to the novel epitopes on the Omicron strain as compared to just what the shared epitopes on the Wuhan one strain. You didn't make a better immune response to Omicron by giving these two half doses. Okay, so I voted no. And I wasn't the only no vote on that. Okay. So then what happens is the next day, the government purchased 105 million doses of this bivalent vaccine.
Dr. Paul Offit: [00:37:25] In September of 2022, it goes up to the CDC. In the meantime, they purchased another 66 million doses of Pfizer's vaccine and spent about $3 billion on the bivalent vaccine. Now, it was pretty clear that the immunological data didn't show that it was any better. And then there were three studies showing that clinically it wasn't any better. So so it wasn't more likely to protect you against the circulating Omicron strains if you'd gotten just the Wuhan strain, meaning the monovalent vaccine or the bivalent vaccine. So that was a learning moment, right? We were wrong. Okay. To be wrong. You don't get it right the first time. None the less, you had person after person in public health standing up and saying, need to get this vaccine. It's better they weren't following the science. That wasn't the science. I understood. They bought that vaccine. It was no worse. So it's okay to say that. Look, this is this is we thought this was going to be dramatically better. It wasn't. But it is no worse. And if you're in a high risk group, you should get this vaccine. But that's not what they said. So I wrote a piece in the New England Journal of Medicine, a perspective piece, basically saying that. And so now I'm on CNN, okay. And there's Pamela Brown on CNN, and they have Ashish Jha.
Dr. Paul Offit: [00:38:34] They have a clip from Ashish Jha, who was, you know, the it was a great guy and a really smart, good guy, very good at translating science. And he so they show a clip of him saying, need to get this bivalent vaccine. It's much better than what we had. It has the Omicron strain in there and the Omicron strain is circulating. So you need to get any scientist who is looking at this knew this wasn't right, that this was no better. And so then the clip is over and Pamela Brown looks at me and says, is he right? So it doesn't matter what he says any more than it matters what I say. And the only thing that matters is what the data show. And the data didn't support that. And so that's what I said. I said, there's two state studies just came out in the New England Journal of Medicine that showed it's no better, no worse boosters boosts. And so the minute I did that, I was a bad guy to to a number of people in the public health community, people who were prominent bloggers sort of blamed me for low vaccine uptake rates. Then, as if I have any. I don't even have that kind of influence on my own children, even the one who just called me. But and so here's what that taught me in the world of rotavirus, when I would do scientific studies on rotavirus and you would go to national and international meetings and present your data, you wanted to be criticized.
Dr. Paul Offit: [00:39:39] I mean, you had a conclusion. I think this protein is critical in inducing protective immunity. Did you do the right studies? Did you have the right controls? Was it robust? Was it internally consistent? Et cetera. Et cetera. You want that because that makes your science better. Does not work well in a public health venue. You're on the bus or you're off the bus. And the minute you say something that in any way contradicts the science on which a public health recommendation is based, even if it's a fair criticism, you're a bad guy. I mean, I got love letters from anti-vaccine activists telling me that they'd been praying for me and my family for years, and now, finally, their prayers have been answered. I was asked to be on Newsmax. Tyler, this is when you know that you know your message isn't getting out there. And actually, I went on, I actually chose to go on just because I'll never be invited again, given that I wasn't the guy they thought I was. But it's too bad because you should be able to do it because you lose trust, not only with the public. I think you lose some trust with scientists when they see it being more political than it needs to be.
Tyler Johnson: [00:40:35] That brings me to the second question, which is one of the other things that you talk about in these, you know, lessons that we should have learned even if we didn't learn them. It's lesson number five, getting the public to understand the scientific process. So, you know, I know that most of our folks who listen are medical people. But just for framing, right. The whole like her idea of the scientific process is that you have an idea, you test it. If your evidence backs up your hypothesis, then great, it moves forward. And if not, then you either have to modify it or discard it and move on to a different hypothesis. Right? So the idea is that it it allows over time. It is an inherently iterative process where we are trying to evolve our understanding of the world to better match the concrete reality of the world, and over time, because it keeps questioning itself and keeps discarding things that are wrong. You hope that you keep getting closer to what's right. Right? And if you conceptualize it of it that way, then it's pretty clear that the idea that there was quote unquote, a mistake or that we quote unquote got something wrong, not only should that not be feared, that's the whole point, right? Like especially if you have a pandemic based on a novel virus, of course you're going to get stuff wrong, because how? I mean, we're not omniscient. You can't possibly not get stuff wrong. That, in fact, recognizing what you got wrong should, in and of itself, be seen as a marker of progress.
Tyler Johnson: [00:42:05] Right? We are learning what is not so that we can learn what is, and that's how science works. But then there is the problem. I mean, you know, I'm just one guy, but I followed the public health discourse and Anthony Fauci and, you know, the whole thing in that era very closely because, you know, we were basically on house arrest in Northern California. So there wasn't all that much else to do late at night. And my observation was that public health officials in particular, were virtually, it seemed to me, anyway, that a lay person would conclude that they were allergic to even mentioning, oh, yes, we got this wrong, or now we understand this better. And it often seemed like there was this almost instinctive inclination to just kind of glide over that stuff and pretend that somehow our recommendations always were what they are and always be will be what they are. Right? And that's understandable in the sense that, as you say, if you mention is our initial declaration that masking was not important is wrong, and now we need to change then. You can get pilloried on social media or get threats or get, you know, whatever. I mean, it's understandable the inclination. But how do you inculcate or no pun intended, inject a dose of sort of public humility into the public health discourse that allows public health officials to talk about that iterative process in a way that is realistic to how science actually works? Well, I.
Dr. Paul Offit: [00:43:35] Think that's a really perfect point. I mean, if you look at the bivalent vaccine example, what did we learn? We learned that you really can't still tether this vaccine, the current circulating strains to the old vaccine, because what's happening is because you've been primed and boosted with this old vaccine, you're still going to recognize shared epitopes and not novel epitopes. So therefore, you need to give a full dose of the new one to get your best chance. And that's what we learned. And so we don't do that anymore. We don't do the bivalent vaccine anymore. So we do one full dose of whatever is sort of prominent circulating strain that. So so we learned something good and we didn't really it was a pretty small price to pay because it still boosted you. And the fact of the matter is, without getting into too much details, T cells are also important here, especially cytotoxic T cells. And those are recognized largely shared epitopes, primarily on proteins other than the fusion protein like the Nucleoprotein. So any any natural infection is generally also providing sort of broad protection in any case. So what do you do, you would argue, in a world dominated by logic and reason, which is a world in which we don't live, you would say, okay, we learned here, this is what we learned, and we're going to make it better next time. But see, people, I think the instinct among public health officials is that the fluidity of science is disconcerting to people. They want to believe that you know, everything, even though I think if you ask people, do you think we're going to know more about science and medicine 50 years from now than we know now? I think everybody would say yes.
Dr. Paul Offit: [00:44:57] But when it comes to your disease or in this case, our pandemic, they want to believe, you know, everything you need to know, especially when you're making recommendations that are somewhat draconian, like, you can't go to work unless you've got a vaccine. And to me, I think the biggest communications blunder was early on. So here you have the the these two vaccines that were presented, by the way, in terms when you were talking about sort of things being boring, I would like to say I was on the edge of my seat when I got those, those sort of 200 page things from FDA and from the companies for both the Moderna vaccine and Pfizer vaccine. I read every sentence. I mean, I was scared to death about, you know what? We didn't know the question for me and for all of us on the FDA committee, did you know enough to authorize this? Did you know enough knowing that you didn't know everything? So it was it was actually pretty frightening, the whole thing. So in any case, um, in July of 2021. So now you're about seven months into the availability of vaccine, there was an outbreak in Provincetown, Massachusetts. Thousands men get together, celebrate July 4th holiday. 80% are vaccinated. Nonetheless, there's an outbreak 346 men get who were vaccinated at this point, got two doses of vaccine, got Covid, four were hospitalized. Right. That's a hospitalization rate of 1.2%.
Dr. Paul Offit: [00:46:12] That's a win. That's a vaccine that's doing great. There are other 342 had mild or asymptomatic infection, which the CDC in their publication about this outbreak in Morbidity and Mortality Weekly Report labeled as breakthrough infections bad word breakthrough implies failure. This wasn't a failure. This was just what you wanted. We had basically taken a virus which could cause you to be hospitalized or worse, and made it a milder, asymptomatic infection. I mean, I don't know if you remember this at the time, but I was on CNN, so I remember the segment before mine. Brett Kavanaugh had an asymptomatic infection. He was just picked up as routine screen walking into the Supreme Court chamber. If you watch the way that infection was carried on on CNN, you would have thought the man was fighting for his life. I mean, breakthrough infection. Brett Kavanaugh has a breakthrough infection. I mean, the CDC with the current flu vaccine has said it exactly right. What's the what's the flu? Flu. Current flu campaign. Wild to mild. Right. You're taking a virus which can kill you or cause you to suffer. Seriously. And making it a mild infection because this is a short incubation period of mucosal infection, you're not going to be protected against mild disease for long. Even if you've been vaccinated and naturally infected, that's going to wane because circulating antibodies wane over 4 to 6 months. And so what happened was here, people were thinking, I got this vaccine, I was made to get this vaccine, and I still got infected. Cdc lied to me.
Henry Bair: [00:47:37] So you know, you who I think it's safe to say that you probably know more about vaccines than just about anyone in the world. From your vantage point, from having studied the benefits, the mechanisms, the harms of vaccines. In your view, what is the role of vaccines in our society? And what I mean by that is you mentioned earlier now the rising trend of parents who are against mandated vaccines for kindergarten children, which have been in place for years, decades, unchallenged, unquestioned, in your view, like how should we proceed as a society? What are the role of mandates, if any?
Dr. Paul Offit: [00:48:15] Oh. There is a critical role for school mandates. School mandates have been in place for decades and decades and decades. I mean, it wasn't until, um, really 1980, 81 that we had all 50 states had school vaccine mandates. And with that and with the the having a measles, mumps, rubella vaccine combination and with the second dose of measles vaccine in the early 1990s, we eliminated the most contagious of the vaccine preventable diseases and arguably the most contagious of the infectious diseases, measles. That's an amazing accomplishment, but that's because of enforcing school mandates. If parents get some parents get their way and we continue to erode school vaccine mandates, you'll see more and more measles. And I'm in Philadelphia, so we just had a measles outbreak. And I also was in Philadelphia in 1991 when we had in a three month period between 91 and 92, in the winter, we had 1400 cases of measles and nine deaths from measles. People were scared to come into the city. I mean, our hospital was overwhelmed. Saint Christopher's Hospital was overwhelmed with measles. You couldn't get admitted unless you had severe pneumonia or dehydration. Otherwise, regular measles, you were not admitted. That was a scarring moment.
Dr. Paul Offit: [00:49:23] That measles epidemic is actually the first time in American history ever before since that you had compulsory vaccination. So you have mandatory vaccines. You can get a vaccine or pay some sort of societal price. You know, you don't get to work, go to work, you don't get to go to school. This was compulsory vaccination, which is the there were two groups, two, um, fundamentalist groups that didn't vaccinate or frankly, seek medical care that were this epicenter of this outbreak. And they accounted for 600 of the 1400 cases because the virus spilled, obviously out into the community. And we got to the point where we had a law on the books. We were able to get a legislation passed to forcibly vaccinate those children against their parents will. That's never happened before. And the ACLU, which is perfectly willing to represent incredibly unpopular causes, didn't take that case. And they said while they recognize the the free exercise of religion clause and it is your right to express your religion, it is quote, this was Karen Levy in she was the Pennsylvania chapter of the ACLU said, it is not your right to martyr your children. And they didn't take that case.
Tyler Johnson: [00:50:30] So I want to ask though, back to something you were saying a moment ago. So you mentioned earlier on in the show that vaccines, like any medical intervention, can cause adverse events and that some of the adverse events are serious. And we know, for example, that some vaccines have been linked to Guillain-Barré syndrome, which if you are, you know, a medical professional who has seen that, you know that that is a big deal, just as one example. But here's my issue, an observation which leads to a question. A lot of the sort of rhetoric around vaccines during the pandemic in particular, my observation was that it felt like the intent of the communication was to say, vaccines are foolproof, they're perfectly safe. And if you think anything other than that, you are back to the point for me earlier, you don't understand the science, or you are not following the science or you are, you know, just a fool, in effect. Which strikes me as doubly problematic. First of all, it's condescending and offensive, and secondly, it's not accurate. And third, it is counterproductive. Right? Because then when people find out about, yes, actual adverse events, then, as you mentioned earlier, people feel like they're lied to. And I think the same thing is true. When people refused to acknowledge the changes that the science dictated as the understanding of the pandemic evolved, I think it got to the same point. And so I guess my question is whether we're talking about adverse events from vaccines or whether we're talking about the fact that science iterates over time or whatever, what is the best way to better instill a sense of humility or a recognition of reality, or something along those lines into the way that public officials talk about science and medicine to the public.
Dr. Paul Offit: [00:52:24] So I think we need to define what we mean by the word safe. I mean, it is fair to say that vaccines are safe and effective, but they're not absolutely safe, which may be more of a legal definition of safe, that something is absolutely safe. But anything that has a positive effect can have a negative effect. If it doesn't have a negative effect, it probably never had a positive effect. So, so so the definition of safe is that the benefits of receiving a vaccine have to clearly and definitively outweigh the risks. But there are risks. And sometimes with a novel vaccine like Jay and Jay's vaccine, the virus vectored vaccine, I think nobody expected that that was going to activate platelet factor four and cause clotting, including clotting in the brain, including what could be fatal clotting in the brain that ultimately drove that vaccine off the market in May of last year. But our eyes are open and and there are in place systems like the Vaccine Safety Datalink, where you very quickly pick up rare adverse events. I mean, myocarditis was associated broadly in roughly 1 in 50,000 with the sort of blood clotting, especially sort of severe blood clotting, 1 in 200,000.
Dr. Paul Offit: [00:53:22] You're not going to pick that up in a pre-approval or pre-licensure program, but you are going to pick it up afterwards because you're looking. And I think you need to make it clear that there are no risk free choices. They're just choices to take different risks. And your job as a parent is to choose the lesser risk. So now you know that roughly, um, depending on the age. But let's say overall about 1 in 50,000 risk of myocarditis, which was after the second dose, it was within 4 or 5 days of the second dose. It was generally transient and self-resolving. Um, you make an immune response to your heart that is transient. Well, that happens with the virus too. When we were overwhelmed with this virus in 2020, the so-called multisystem inflammatory disease of children, 50 to 75% of those kids had myocarditis, and a lot of them ended up in the ICU. It was much more severe. So there are no risk free choices. But but it's hard to do this. I mean, how do you get people to understand risk?
Henry Bair: [00:54:16] Paul, you've taken us through your personal journey from your early career all the way to the big picture societal implications of public health, communication and disinformation. But I want to bring us back down to the granular level for a minute, and it helps that you are also a clinician. So let's say that a clinician is seeing a child in clinic, and the parent expresses hesitancy about a vaccine, preferring, say, naturopathic concoctions or healing crystals to prevent disease for their child. What would you recommend a clinician do or say to empathetically convince them otherwise?
Dr. Paul Offit: [00:54:54] Well. So? So I looked to my wife, who's a general practicing pediatrician. She deals with this far greater than I do. I mean, I work on an inpatient consulting service regarding infectious diseases, so I don't see that quite as much. But what she does is she, um, basically makes this argument. Let me love your trowel. Don't put me in a position where you're asking me to send this child out of this office today, when I know there are diseases out there, like pneumococcus or varicella or meningococcus or Covid, they could hurt your child. Please don't put me in that position. Please. And so what she does with that is she establishes an even ground with the parent. In other words, she's not just sort of coming off as a, you know, this is the science. You have to trust the science. It's basically, let's both love your child. That seems to work for her. Initially, she didn't do it that way. Um, she just said, you know, sort of to try to make the scientific argument. But I think by framing the scientific argument in an emotional way, that helped.
Henry Bair: [00:55:52] Well, well, with that, you know, we want to thank you again, Paul, for coming on the show, for sharing your insights, your personal stories, your struggles, your challenges, how you've overcome them. It's truly a privilege to to hear your story. And we thank you for the work, the amazing work, important work that you've done over the years and that you still continue to do to this day.
Dr. Paul Offit: [00:56:14] Thank you very much. It was my pleasure.
Tyler Johnson: [00:56:15] Thanks so much. Great to have you on.
Henry Bair: [00:56:21] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.TheDoctorsArt.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:56:40] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:56:53] I'm Henry Bair.
Tyler Johnson: [00:56:54] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.