Sanjeev Sabhlok's blog

22nd November 2022

Transcript of the John Ioannidis movie

This is taken from youtube: I’ve used bits of it to shortlist portions of the video to clip. And one day I’ll try to fix this transcript. But at the moment it is mainly a dump.

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I think that science is like swimming in an ocean, it’s swimming in an ocean at night. So it is dangerous but in the same time it is extremely enjoyable

for someone who has been swimming in Greece at night and this is probably one of the best experiences what you can have.

The least thing that you can imagine is that you might drown one day or there might be sharks around,

but it is what it is and we have to learn being able to swim in that ocean.

I am still searching to find out who John Ioannidis is. I think that when I find out who that person is it would be so final

that it has no value any longer, so it is the iteration, it is the process, it is the travel, it is the trip that matters the most,

and that person changes, it changes all the time. So when I know exactly who it is, probably it wouldn’t matter.

In which world do you want to live? In a world that I can shape, that I can help shape and

that other people are also free to help shape. In a world that is respectful of all of us

and that humans have value. I think that I worry about a world where humans have less and less value,

that other things have value. It could be money or artificial intelligence, or whatever.

Or maybe we wouldn’t even know what has value, maybe nothing has value any longer – and maybe that’s a problem.

I would like to feel that humans and humanity has value. And that’s something that is not to be secured

unless you’re willing to help that happen.

It doesn’t happen automatically. There’s lots of stakeholders out there who don’t really care that much

about humans and humanity. Death is a beautiful woman that you can be in love with

but you don’t want to meet. But it is that love affair that probably drives our entire life, in a sense.

And it puts it into some perspective. It gives it some perspective about why are we living and why are we doing whatever we are doing.

I can be happy with very minor things, just a sunny day, just looking at the sea, swimming, being with family,

the mere act of breathing can make me happy. So, I am more happy when I am also occupied with things.

So, when I have a lot of things to think about and ponder and try to work on,I am a little bit of a workaholic in that regard, so.

But I can be happy with very different combinations of what might occupy me I think that I always liked a lot of things. Even as a little kid I liked very different things.

I was seen as a child prodigy because I was writing novels when I was 4 or 5,

and poetry, and I could do mathematical calculations when I was 4 and worked with equations when I was 8.

And I also had experience in a medical environment because both my parents are physicians.

So, I didn’t know what to do with my life in a sense. I enjoyed doing lots of things, I was trying my hands in different venues

of writing and science and medicine and health.

And I decided to go down the path of medicine mostly, because I thought

that that was the best way to help people, to save lives, to be there in a positive way.

I thought, How can you be more helpful to humanity? And mathematics was really great but it was too abstract.

It could be used in anyway, it can be used to harm humanity, for example. And writing was also fantastic and I never thought of giving up writing,

but again it was very self-centerd, in a way, and I am afraid that I am very often self-centred.

So, I thought well can you help that a little bit? Medicine would be the best way to go.

And then within medicine again I had a very hard time to choose what path exactly I wanted to take for specialisation.

I went to internal medicine and then infectious diseases and epidemiology. Epidemiology is the discipline that is closest to mathematics in a sense.

It has a lot of quantitative methods and it’s like the quantitative machinery

of biomedical research. So, things did fall into place. I tried to work in my early career

in bench work in completely abstract mathematical work, in clinical work, in epidemiological work.

I think all of these experiences were helpful and shaping my skill set

and also my sense of understanding that, goodness, I know next to nothing.

Sciences is too broad and too difficult to harness. So, I still tried to have that perspective of, I know next to nothing;

there’s lots smart people out there, let me try to find some of them to teach me something.

I am trying to learn every day from young colleagues, young of all sorts of ages and try to be stimulated.

And that’s what I enjoy the most, learning from other people.

The biggest mistakes, I am sure, are mine. So, I think that science is about mistakes, it’s about making mistakes,

but trying to realise them and compare them with what might be better evidence and hopefully correct them as quickly as possible,

And I think my biggest mistake – and I think that others probably can think about their mistakes –

is that I underestimated how much power politics and media,

and powers outside of science, could have on science. I think that I had no clue and no preparation for this invasion of science.

I think that the war on science, science surrendered immediately

and the whole country of science was torn apart among people with very different ideologies and partisan beliefs

with strong opinions, with power struggles, with the thirst for power and dominance

and conflicts and that’s something that I have not witnessed before, and I was not prepared for that and I think that I did my best but I was

close to rediculously poorl prepared for that. I think my preparation had been for debates with other scientists,

with a few scientists who might be knowledgeable in the field or are interested and sometimes very interested and are fighting

for the truth, which is of course evasive for all of us, but I was not prepared to have to fight with all of these powers

that had nothing to do with science. That’s something that I feel a complete idiot about.

There is a lot of frightening developments in the world, but I want to take a step back and think positive, think about the good things about our world.

Think about the good things, about what we can achieve, about the younger generations, about our future, about our dreams,

about our creativity, about how much we can do, how much we can change our world for the better.

There are threads all over the place. Of course, we have climate change, we have war, we have pandemics, we have disease, we have inequalities,

we have hunger, we have poverty, we have all sorts of things to worry about.

But the worst thing would be to just keep threatening people, and putting that ghost of disaster that is coming to us.

Because if we do that, disaster will come to us sooner or later. And we will just create it with our own hands.

We just need to stay calm, stay focused, stay peaceful and stay committed

to each other and don’t think of the world as a hostile place,

as a place where we need to compete and to destroy others, we need to have some war against entities, be that a virus or other countries or

other people or other communities. We need to get back to some sense of belonging and believing and

mutual understanding and I think the pandemic just took us very far from that. It instilled tremendous fear, as I said initially,

with the virus, then with the vaccines, then wherever and then that was passed over to the war.

We just need to regain that ground that we have lost and try to be positive

about what we can achieve as human beings.

These have been two and a half or close to 3 years now that have been really tough for the whole world.

I don’t think that any of us could predict what would have happened, I don’t think that we can predict what will happen even in the future

after we have gone through all of this. But we know in the big picture that this is a crisis that we were unprepared,

this is a crisis that I think many of us, we did the best that we could,

but I think we made lots of errors, we made lots of miscalculations, we made a lot of mispredictions, we took lots of measures that probably

we should not have taken This is not to blame anyone, but I think that it’s a learning experience for all of us.

The number of measures that we threw against the virus and against the crises, and against the circumstances that were generated from the crisis and the pandemic,

were really thousands of different measures, it was not one thing that we did. Every politician, every public health official, every county, every state, every country,

every scientist, committee, everyone was responsible or irresponsible,

was taking measures or suggesting measures or implementing measures and changing measures, sometimes on a daily basis if not an hourly basis.

So we threw in that kitchen sink of probably ten’s of thousands of measures

against the virus, and to be honest, I doubt whether more than a handful of them were really effective.

We did lot of things and probably did very little to help and probably caused substantial damage, because anything that we do can have some

collateral damages down the road.

I think that for children and for young people they suffered pretty much

the collateral damages with very little benefit from everything what we did. The reason for that is that this particular virus –

of course each virus is different – and when it broke first time and

we just didn’t know how it would behave. But this one, we were fortunate that kids and young people were

relatively protected – and not that they couldn’t have been infected, they were massively infected. So, after a couple of years,

practically almost the entire population has been infected, including children and young adults

But the severity of the disease and the impact of the disease – let alone the death risk, once you go to the young ages

and children and adolescence, is extremely low, it’s not zero. So, it is an infection that we always need to consider seriously like

any other disease, but we have very strong documentation that the risk of death, for example, increases about 3-fold for every ten years

and it’s also associated with frailty and with the other diseases, or called

morbid conditions, that someone may have. So, for children the risks of suffering

something serious were enormously minimal and at the same time

everything that we did, or almost everything, was really creating problems for children:

It was creating problems to their education. It was creating problems to their socialising. It was creating problems to their mental health,

to their psychology, to their ability to grow in a world that made sense.

I think that the world very often does not make sense to adults, and we see that, and I think that a lot of people

got even more depressed and very anxious during the pandemic. But for children it was really the apocalypse, in a sense, because they had far less

experience and suddenly they saw a world that was completely unnormal and completely weird in their eyes. So, I think that it’s very difficult

to measure some of these consequences and some of these repercussions,

but I am really sorry that much of what we did – closing down schools, keeping children

without being able to socialise, without being able to function – really created major problems that we will see the repercussions

of down stream, unfortunately.

When will this pandemic end? It depends on how you define the pandemic phase.

So, we have a new virus and it is spreading around the world, using the term pandemic is probably a good choice, even though if you

go to dictionaries of epidemiology you will see that there is ambiguity about the use of that term, and people have revisited the

definition now and then. But I think it is a good use of the term – it was a crisis; it was a pandemic crisis. If you want to have the majority

the population to have some immunity to that virus, not perfect immunity, but some immunity, either because they were infected or because

they were vaccinated; I think in most places around the world by the end of 2021 we had reached that point. I would argue in New York probably we

reached that in 2020, because a very large segment of the population got infected very quickly.

In a place like Germany, I think it was late 2021, in some places probably early 2022.

In most places I think the pandemic phase ended at that point, probably at about the time that you had the first wave of Omicron, even in places that had not been

widely infected before with Omicron, I think we had very widespread infection Then we had other variants before, B5 – who knows what will be

in the fall and winter and spring. There’s always unpredictability about it. but I believe that that should

be seen as the endemic phase. So, I believe that this virus will not go away. I would be the most happy person to see

it disappear but it doesn’t seem to be the sort of virus that disappears. And how many people will be affected?

I guess to make that probably we had close to 10 billion infections already, including almost everyone in the world, other then maybe some places in China,

who got infected; in most places I think 70, 80, 90 percent or more of the population are already infected. A large share have been infected twice,

some have been infected three times, so this will continue. And unless as a society we destroy ourselves with climate change or

with nuclear war, perhaps we should wish that perhaps we should wish that this virus kills tens of billions of people

because we survive as a human species and if we survive for millions of years,

this virus probably will be with us, much like influenza has been with us. Influenza has killed one to two billion people already from the start of the human species

and unless we make ourselves disappear, it will continue killing billions of people

down stream if there is still human history.

I think that I will start with lockdown. Lockdown is a series of multiple measures,

it’s not one measure, it’s thousands of measures that are implemented. And I don’t want to say that none of them worked. I think that some of them probably did

have some benefit in slowing down the dispersion of the virus in the community.

But the vast majority of measures that we followed probably did not. And to be honest, almost none of them – probably none of them –

had any serious evidence base when we took them. Back in very early 2020 – I have to apologise – that I was in favourite for lockdown.

Many people asked me and I said that we have no clue what this virus is and what its fatality is, and what its risk profile and how people

would be affected and how easily its spreading and how even its spreading in what ways, so I said it makes sense until we get some sense about

these very basic features of the virus, to go with a very stringent approach and try to avoid having people infected. So lockdown was on the table.

I said that’s okay for a couple of weeks, for a few weeks, to see where we are; very quickly we knew where we were. We knew what kind of virus

we were dealing with, we knew that it had a very sharp, steep age gradient in it’s risk. We knew that

it had much higher risk for specific types of vulnerable people. We also knew that is was very easily spread.

It was also spreading among unsymptomathic people. So, it was not something that it would be easy to just go with

a zero covid policy It would be almost equivalent to saying that I am going to pinch molecules of air in place and keep them there

and not allow them to move. That was completely crazy. It didn’t make sense because lockdown, with all these thousands of measures,

was so disruptive in many aspects of physical health, mental health, social health, the economy, understanding of who we are and

what we do and how we live. I believe that the stringent lockdown approach is, based on what we know now,

where we will see that they didn’t really save lives and at the same time they created all that series of problems, and that was not a good idea –

not to blame anyone because I said I was one of them who said in the beginning we should try, but be very, very careful, because we need to pay close attention

to all the negative consequences that may emerge. Masks were one among many measures in the series of efforts to try to contain

the spread of the virus in the community. And compared to others, like shutting down schools or shutting down the economy or letting people go unhelped

with all their problems in the middle of crises, I didn’t see them as being so disruptive, it was something that probably could be done,

most people could do it without a problem. Did it help a lot?

Probably it helped a little bit based on what we know. We have two randomised trials: One suggested that a mask didn’t have any

benefit for people who were wearing it – and that was the Danish study; and a study in Bangladesh, that suggested that it decreased

the risk of transmission by about 10 percent. So, 10 percent on a relative scale – which means that if 1 percent was infected

in the control group, then 0,9 percent was infected in that group that got the masks.

So it’s a very small benefit, you have to balance that against the inconvenience

or the sense of irregularity that they create. So, in a very acute epidemic wave, especially when you have unprotected populations,

you have highly vulnerable populations, you have unvaccinated populations, you have crowding and big events with thousands of people mixing,

I think it makes sense, it’s something easy and I think it can be done. If we see masks as something that is to be carried forward and can infect

our daily life and have little kids that have close to zero risks wearing masks

all the time and in the educational environment, I think that’s crazy – that makes absolutely no sense. I think that it creates more disruption,

it kind of perpetuates a feeling of pandemic crises even in settings

that we should not be feeling that there is a pandemic crisis any longer,

Probably many measures caused more harm than benefit and I think that we need to look very carefully at what we did, and what kind

of an impact each one of the measures had. It’s difficult to be precise because other than a few things like masks, for example,

where we only have a couple of randomised trials, in most of the other measures we just adopted them without any randomised trials.

It was just a few experts or a few politicians or a few policy people or a few completely ignorant people who were actually very powerful in social media, who said, „We need to do this!“ And there was a domino effect and people did this. And now we are just scratching our heads to say, „Who said that?“ Because really that was not in our text books, that was not in our studies that had been done or were being done, that was not what science was telling us.

It was what panic and fear, and the best will you know – good intentions to save the world, in a sense – were dictating at a time that there was really little room for evidence based approaches and for common sense, let alone for science. It was all, if you don’t do that then you are a bad person, you want to kill people and you are horrible. And I think we did a lot damage that will be very difficult, even to appraise its depth. I think we see the consequences now, we see the consequences

on a major impact on health in any survey that has been done. We see the consequences at the level of societal melt down.

We see the consequences at the level of disadvantaged,

minorities, marginalised populations, poor populations, poor countries having an extra burden, although no countries were spared.

We see an estimate of 950 million people who are in hunger in 2022. The numbers were in the range of 600 million from 2015 to 2020.

They escalated almost by 50 percent within a couple of years. And we see also the consequences now in children on a wide scale.

The problem is not so much to try to find who did this and point the finger

and create even more crisis and ask for retribution and retaliation, because think this is leading nowhere, I think that we need to recognise

our mistakes but not try to create a further blame-culture, because this is just propagating further the pandemic fear

and the sense of war, in a sense, within society. What matters is to deal with these negative repercussions

that we have created. I feel very worried, because I mentioned hunger and that almost

one billion people are under that category of hunger around the world,

and I heard, for example, that the G7 Leaders Summit pledged 4.5 billion dollars

for hunger around the world for these 950 million people.

Just the US alone gave 5 trillion for pandemic stimulus for Covid-19.

So we completely blew up our economies and our societies for something that

I am not saying it was not important, it was important, but it was one of multiple

problems and we just invested all our efforts, all our resources, all our money, all our attention, all our panic, all our politicians,

all our social media, all our media, to that theme and left everything else go astray. That’s what I really worry about.

I think that coming out would mean that we try to get back to some

sort of normality and one option is to try forget about it,

to be honest at this point I am even wondering should I be talking about Covid19,

because I just give more ammunition to people to talk about that same topic again.

Or should we try to just get rid of it, just forget it and just move on with our lives?

There’s lot of things that are not helping us to do that, because we still have that incasement within this super-diagnostic framework

with extensive testing and contact tracing, and still many measures being around –

many of them implemented again with no evidence-base, and putting a lot of people under a lot of pressure, there’s still mandates or semi-mandates

or indirect nudging and pressuring people to do specific things. So it’s very difficult to just forget about it,

and of course these other problems that humanity is facing – we have, as I said, hunger and starvation and mental health and war unfortunately

and a lot of instability. So this new wave of fear that’s replacing Corona virus – but to me

it’s the same primal fear that is being transformed. You know we had Corona virus that was the big fear,

and then vaccines became the big fear. We had conspiracies that, in the first place,

it was Corona virus killing people and then vaccines killing people and now its war killing people, and it does kill people unfortunately.

And I think that we have to find some peace, we have to find some sense

of social responsibility, social cohesiveness, respect for others,

respect within ourselves, to start with, and then within our families and within our communities across countries.

I think what I worry about a lot is that Corona virus and the response to it

were so extreme that now people think that everything is allowed,

that everything is possible. We shut down everything, we destroyed the economy, we destroyed our kids, we destroyed ourselves.

We can destroy ourselves in other ways as well, we can do it with war, we can do it with nuclear war, with climate change, it’s so simple,

we did it with Corona virus. Why not do it again? We can do it on a large scale. Somehow, that moral switch has been

activated and this is what I worry about. And I’m trying very desperately to turn that switch down again.

I think that there was a problem in scientific communication during the pandemic. Lots of scientists has jumped to

the forefront to try to help and I think for the vast majority of them they had good intentions, they wanted to help,

they saw there was a major crisis. They said: I have some skills, I have some knowledge, I want to put them forward to help

my community, this is a time for me to offer my best. But unfortunately most of them did not have skills or training or education

or had never done research in fields that would be relevant to the crisis.

So that we had a lot of people who – very well intentioned – started screaming a lot in the media, in social media, putting also their scientific tag at the

bottom as a sense of credibility. We had politicians who gave them credibility by adopting them

as experts, as advisors. Even though for someone who knew the field, they would know, „Well that person knows nothing about this.“

But now he is the number 1 expert in the country and he is running the show. He has more power than any dictator could have had

in the history of human kind. And for serious scientists there was that debate,

„Do we really try to join that party of madness?“

Do we try to continue doing our job, which takes time, takes effort, we make a lot of errors in the process, we make a lot of mistakes,

we try to correct them, it’s an iterative process, we cannot give you an answer right now – in 5 minutes – for, „I want an answer.

Should I shut down the schools and should I close down everything?“ It was a real challenge and I think that people who were less trained

in the scientific method and more confident in themselves, in the wrong way,

probably had the upper hand and they spread a narrative that was

not completely false, but very largely false, and created a lot of problems for scientists who were using the more traditional

scientific approach to counter this. At the same time you had tremendous pressure from media, and social media,

which we knew from the pre-pandemic years that journalists are not trained in science.

It is something that we knew very well, we knew that even science journalists are clueless about science most of the time. However, they write about science,

and they write about science in ways that most of the time has nothing to do with the scientific process.

They tried to find messages that are very strong and exaggerated and extreme

and the end-of-the-world type of story, and this is not what science is about.

Science is about healthy scepticism, it’s about risks and benefits, it’s about nothing is black and white, it’s not a matter of signature collection

or getting more votes or getting more people to agree on this and then it is correct.

The scientific method just completely fell out of the reader screen,

and we had people in media, in social media, politics, some circles of science, really taking up the whole show and creating a complete mess.

I don’t want to exclude myself from this, I am not saying that I was correct and they were wrong. I was part of this.

I was one scientist among many fighting in that complete chaos, and we were

not trained to fight in this chaos. We were trained to do other things, rather than fight with powers in politics, social media or media,

that use very different types of weaponry.

I think all scientists are biased. I am biased, I am tremendously biased.

The one thing that we try to do in science, is to continuously fight against our bias.

I try to understand why we believe some evidence and why we don’t believe,

and where do we base that. What kind of data do we have, can we get better data, get more transparent data, can we get

closer to a more accurate estimate? And this is not an easy process, it’s a process that takes time,

it’s a process that takes a lot of effort, and I think that you have to try to take a step back and be as objective as possible. It’s not an easy process.

On top of this you have biases which are due to conflicts of interest. You have people who may be conflicted because they may be paid by some entity,

they may have a financial interest or some other interest to support one type of process or another.

We knew for example that big pharma – the industry – had very strong conflicts

n trying to guide results in bio-medical literature. Of course big pharma is producing some very effective medications and some

very effective and useful vaccines, so it’s not that they are useless and they are just conflicted and they are just trying to promote their

products to make money. It’s not like in the tobacco industry which – you know – again makes 1 trillion dollars

a year, but they are just also killing 8 million people every year with their products.

So, they make money und they kill people. Big pharma makes money but they also hopefully save lives.

But in the pre-pandemic years the approach was that we have to be

very careful about big pharma because their incentives are such that they would try to bias the literature and we have to be very careful –

we need to scrutinise our data. We need to put pressure on them to be more transparent, to be more open, to share, to check what they do.

Very often, what they did was perfectly fine, some other times we need to correct it. During the pandemic all of this was completely inverted.

Big pharma suddenly became the saviours of the world. For whatever they were producing, that was an amazing discovery and

amazing product. Everyone had to use it. Everyone had to be mandated to use it.

And in some cases maybe they had wonderful products being produced, but the whole mentality, that even asking a question or asking for a

risk benefit calculation, for example, immediately was classified as an outlyer,

as an conspirator, as someone very weird. That was something very unique. The moral odds were inverted.

People who had no conflicts were claimed to have conflicts. People who had conflicts were seen as the heroes and the saviours of human kind,

and it’s a situation that still persists, to a large extent, and it’s going take

some time to be able to reverse it, or maybe it would not be reversible. Maybe we will end up in a situation where people who are more methodologically

savy and more careful, are seen as outliers. And people who just want to maximise profits for the industry are seen as the way to go,

as the wave of the future of morality, of ethics, which is something very dangerous,

I believe, because it completely reverses what we know about science and about the

interface between industry and science. So during the pandemic, within two years, or a little bit over two years,

we published close half a million papers and about one million different scientists

published these papers. They came from all ways of life; science is divided into 174 fields and all 174 fields of science published something

on Corona virus and Covid-19 and the pandemic. Most of these papers were of very low quality, however they dominated science.

We have run some analysis that shows that in the early pandemic years,

98 of the top 100 most cited papers in the scientific literature were on Covid-19.

Now, for a topic that is very important, you expect maybe one or two, maybe three, papers out of the top of 100, across all science, to be related to that topic.

98 out of 100 means that science was entirely absorbed by Corona virus.

Much of that science was of low quality and much of that science was not transparent, and I think that that showed we had a number of very high profile retractions

for example, we had a paper published in The Lancet that claimed that it had collected data from hundreds of hospitals around the world.

No hospital had any clue that that study had happen and the paper was completely fake.

We had other situations where very high profile questions where raw data –

you know access to data transparency – would have made all the difference. One classical example is the leak theory of the virus leaking from a laboratory.

That was a very simple situation where the Wuhan lab should have released

the data for all the experiments that they were running. They should release that to the scientific community, the scientific community

should see that, they can judge if what was done could have led to the possibility of a lab leak. It hasn’t happen, at least until now,

up to our having this discussion. I hope it does by the time this interview comes out but I am not really very optimistic. I want to believe that the virus was

just a natural evolution event, but if that most crucial question

we cannot have transparency, we cannot have data sharing then one wonders: Is really science open?

Is it transparent? Is it believable? How much can we believe? Another example, I am one of the strongest supporters of vaccines.

I believe vaccines were one of the big successes in this pandemic. However, I do want to see the raw data from the clinical trials,

and again until this point it’s practically impossible to get the full raw data from these trials. I don’t see that that should be a big issue.

The claims that there might be conspiracy theorists who take this data and run wild, of course that can happen with anything.

But if you have raw data for something then you can put more trust in that. here’s many, many examples were some of the chronic problems of science,

which are: Lack of transparency, lack of healthy scepticism, lack of a risk benefit ration considerations,

lack of communalism – which means that you share with th wider community – they became very sharply

enhanced during the pandemic. And many people started losing their trust of science because of this.

They felt that science was encroaching on their rights, on their freedoms, on their life, on their every day expectations.

At the same time it was happening in a very esoteric mode that only

a few people had control of the data and somehow then decisions were imposed

by them while the data were not available for others to see. Sometimes there was no data at all, which was even worse.

Or data evidently was of low quality. it was a challange it was like a crash test for science,

to see whether we can survive in an environment where everybody is looking at us; not just a fellow scientist,

not just a few people who are in the field, in the specific sub-sub-subfield,

but the whole community is looking at us. And what do we say, well we have no data, or we have poor data,

or we have data but we are not sharing it with you. So none of these three situations is very nice. Conversely we say, „Oh but we have half

a million papers, most of them are of very poor quality; and we have about a half million decisions that encroach into your life.“

That’s not the best light for science to gain a name in the community, as being the best that can happen to humans.

My belief is that science is the best thing that can happen to humans, but it should be transparent, it should be shareable, it should be

able to be validated and proven with arguments; that it is so and that it’s not

different from what is being presented.

I think the future of medicine is very unpredictable; it can be a bright future or it can be a very dark future.

I think that we have more tools, we have more data, we have more ability to collect information and analyse information,

we have more fancy ways of going after and asking questions, and addressing them

and getting answers. We have great advances in biotechnology, in bioengineering, in artificial intelligence

Our capacity is clearly at a much higher level compared to what it was even 10 years ago.

So there is good hope on one side. On the other side, I think that there are

still very strong conflicts of interest, there is still a lot of uncertainty about many of these tools, whether they can really come up with deliverables

for the promises that have been launched. And I think that there is also a dark side of medicine

in that medicine can also serve itself rather than serve the patient or the citizen,

when it comes to public health. Too much medicine is not a good thing. Too much public health is not a good thing.

I am not saying we should invest more in the war industry,

in comparison to medicine, please don’t get me wrong. Or to tobacco, which again made more money during the pandemic –

it increased it’s sales by two percent every year. But medicine is good when it is in proportion to the problem

It is bad when it creates problems that do not exist or it exaggerates problems that do not exist. So, if you invest in a given field of medical research

or of medical practice or public health practice, and you say I am giving you more money,

I am giving you more resources, and then the problem goes away or the problem becomes much smaller, or maybe the problem was not

so big as you thought – and these resources continue to be spent. Then you have a problem, you have a mismatch,

you have people who might directly or indirectly have a conflict of interest to propagate that problem

or to create an even bigger problem, so that they can justify their existence. And this is something that I worry about, also with Corona virus,

even if the virus were to go away, for example, which it will not, but at least become endemic and not be such a big problem.

All of that investment will continue to have a legacy upon how much we believe

that it is a problem and how much we should talk about it, and how much we should invest in it, and how much research should just focus on this and not on many

other aspects of health which might be far more important. We give close to nothing to study things like starvation or hunger or poverty or war

or, you know, major problems that make our health systems dysfunctional

in most countries around the world. But even in wealthy countries, I think that there are still a lot of dysfunctional aspects.

And conversely I see all these minute details about Corona virus even now.

I still get emails that a single case has been detected in some building, and a whole

series of measures that have been taken to do something about it, and to feel

that w4e have invested enough resources to this. So, it’s creating a new bubble of means and resources,

and the means and resources of science and of society, and of our communities, are not endless, they are limited.

So we have to be very wise. If we invest everything in one basket, we have far less to invest, or nothing to invest,

in other areas that are more important.

But this is happening now. It is happening and it is very sad. And I think that we need some sort of a reset to be able to reappraise

what we are doing and where we are heading. And what do we expect, and what do we expect of medicine,

what do we expect of health care, what do we expect of public health? What are the anticipations? What are are goals?

What are our priorities? Is our goal to go back to zero covid? That, I think, will never happen. Is our goal to diminish one burden

of disease to a given level? What is good enough, what is not good enough? What about other diseases? What about other conditions?

What about other social welfare? What about education? What about the future of our societies at large?

I think we are completely unbalanced at the moment. We are in the middle of a series of crises, and one crisis propagates the other.

We just don’t know what would hit us next. Many people feel very uneasy about it. Many people feel very anxious. Many people get extremely angry or

maybe sometimes elated, in the wrong way, about that crisis

and they want to scream and shout and complain. I think all of that is really creating a lot of problems and a meltdown of our societies.

Even of societies that are democratic – which, hopefully, should have resources and some resistance to meltdown.

But if you are not in the mainstream opinions, you get problems. So what are your experiences?

I cannot complain. I think that in my experience I published

so many papers on Covid-19, I polluted the literature probably heavily

with some sixty peer-reviewed papers. But I believe for people who were probably

less known and less visible it was very difficult to take positions that would be seen,

at a given moment, as being not within the main frame, within the main narrative.

I think that sometimes – even for myself and for other colleagues who are very senior and established and well known – it was not very easy, and one would have to

kind of question, „Is it worthwhile to get all that push-back?“

And we had lots of experiences of push-backs. I received death threats.

There was a hoax on social media that almost killed my mother. They said that she had died of Covid-19 and started getting a mass of phone calls

at her home asking about her funeral. She had a hypertensive crisis and she almost died. So, there are some points you say,

„Is it worth it to do research if my life – and even more the life of my family members –

is put at risk?“ Is it worth while to just be exact and give

the exact estimate and the exact uncertainty, if I have to deal with all the social media people

who are anonymous, or they carry a name but they don’t really care about it, because they have nothing to lose. They are just there to smear and to attack.

Or to fight against journalists who are likely to distort the message just because they

had been given some order or they have been convinced that this how it should be.

How should a scientist behave in this situation? I witnessed that on a large scale, both for myself and for many other colleagues.

I think it’s hard to think of some scientist – who was really a good scientist –

who didn’t get stressed during this pandemic. think that probably a few who didn’t care that much

and maybe they were very willing to go with the flow, and maybe they did well, maybe those, though, were attacked.

But anyone who wanted do do a serious job and be honest and be accurate, that was not an easy time. And there are surveys now that show

that a large share of scientists had these same experiences. So, I respect tremendously and I feel very sorry for those people who had

these experiences and who had the opposite views to mine. For those who had the same as mine, I mean that’s fine, we try to say

what we want to say, but those who had opposite views and were attacked, I feel very very sorry, because I think this is not what a scientist should have to worry about.

What’s happening with politicians and social media, and who is going to attack me next,

it has nothing to do with science – and it should have nothing to do with science. I think that science should be separate from politics and I feel very sad

when politics interfere in science, when they somehow shape science,

and when they dictate what science should be. And I think that this happen during the pandemic,

maybe in a defensive way, because of politicians wanting to defend their decisions and because of some eager scientists were willing to take positions to please politicians.

I think that they should be very separate. It’s extremely important for science to be independent, completely independent, not to be hostage to politics.

Media, I think, also have a very prominent role and I am afraid that media were very detrimental in many ways during the pandemic,

because they took sides, they took sides without knowing the science, without having any understanding of the science,

just in a very partisan way and it was equally bad when it was a partisan way for the right or for the left or for the alt-right.

I think they all became extreme in a sense, and they all harm science and they all harm society at the end of the day.

I think that science should be able to give nuance, to give some second thoughts, some sort of moderation,

and some sort of mutual respect in society. And I am very much worried that what happened fuelled extremism in different forms,

in different forms in different countries, depending on what their political mix might have been.

But extreme voices were strengthened during the pandemic and conspiracies

and conspiracy theorists often became very prominent and very famous and infamous.

People who tried to fight with them, they sometimes used the same means that conspiracy theorists use and they became conspiracy theorists themselves.

So that’s really bad. You have misinformation and disinformation,

thought with more disinformation and more disinformation, that’s not the way to deal with a problem.

I think we should make sure that our children are back to living normal lives.

I think that there is absolutely no indication, at least now that we’re talking, that there should be any restrictions

on what they do, on how they are educated, on how they go about living their lives, enjoying their lives, learning,

experiencing, socializing, doing whatever matters, and whatever they can do.

Most of what we do really posed a heavy burden on them. It posed an even heavier burden on children who were not wealthy, who were disadvantaged.

I think wealthy children did probably substantially better during this crisis

because they had the means to overcome the restrictions, both in terms of how they would get educated and also how they would even socialise.

So, I think that I cannot justify any measure at this point that would put any limitations on children, and we need to find ways

to give back what we have taken away from them. I think that they have lost 2 or 3 years, almost,

from their lives and we need find ways to repent, in a way,

for that major loss. I don’t want to be pessimistic; I think that children can adapt,

I think that they can learn I think that they can gain back more easily but we need to go back to respecting them.

It’s very bad that many of our decisions, in a way, were putting our children as a shield to protect us.

For many months, probably a year or more, the whole debate about children was

not really for children but really for protecting adults from the dangerous children

and creating a sense for children that they are dangerous – that they are dangerous to each other and they are dangerous to adults.

Which is completely horrible. It’s like the worst thing that one can do for human beings in general –

even elderly people and adults – but for children even more so. So, I think we should just let them live, and let them enjoy.

I would say that we should let people live also in general but that applies even more in the case of children.

Would you vaccinate a child of 6 months or…? I am happy that we have vaccines. As I said, from the beginning I was

the happiest person when I saw that vaccines could be developed so quickly. I think that should be a decision of the parents. We should just give them the data.

We should just tell them, „This is the risk, this is the benefit. This is how much we know, this is what we do not know.“

We should be very honest about how much we do not know. If someone asks me what might happen 10 years down the road,

I have no clue because this is 10 years down the road. Do I believe that it would be a complete disaster or that these vaccines

would just cause massive cancer and people would be dying like flies? I don’t think so, I don’t believe so. Why?

Based on what we call ‚priors’. My prior experience has not been such that I have seen this to be the case for other things that we have developed.

But we need to be honest about what the benefits are and what the risks are, and let people decide. No mandates, no pressure,

no indirect pressure – like you cannot travel unless you get vaccinated, you cannot work unless you do this and you cannot do that

I think this is just destroying trust in public health. But it’s horrible to just put pressure, and make people feel that they are in

jail and they are not going to come out unless, you know, they do this, because I know exactly what needs to be done.

I don’t know exactly what needs to be done. I think that I have some data, I’m going to present them to you. I think it’s a good idea to do this.

But it’s up to that person – in the case of kids, up to parents – o decide whether they want to do this, because otherwise we end up

in an endless problem, because this virus is not going away. So, are we are going to go with a series of these types of indirect, strong

recommendations and mandates that will go on forever, and then a fourth dose, a fifth dose, a tenth dose, one millionth dose?

It makes absolutely no sense. At the same time, we need to get better data.

So, instead of putting pressure on the community and on parents and on people to do this, because otherwise they cannot live their lives,

we should get the right type of studies. We should get randomised control trials that give us, in larger populations, in more diverse populations, with longer follow up, with more detailed data collection. What happens when we take one route versus when we take another route? It’s very unfortunate that we don’t do that. We just do a few randomised trials that have a relatively small sample size.

They look okay. I want to believe that they are okay. I am not saying that they are not okay. I do not agree with people who say that vaccines are killing people massively. I think that is completely wrong. I have looked at these data, I didn’t see that. But I am very much in favour of getting rigorous data, now that we are out of the pandemic waves and out of the crisis, and we’re in the endemic phase – and we probably have to live with the virus – we need very precise knowledge about what is the benefit of each intervention. How much can we gain? How much we lose?

And at what cost, at what cost of resources, at what cost of investment, at what cost for other aspects of requirements that may be necessary to adopt an intervention?

Do you think that the side effects were underreported?

Side effects are always underreported. This is not a new thing.

We know from the pre-pandemic years that our culture in medicine is tilted towards benefits. So, if you look at randomised trials – I am not talking about Covid-19 – only a minority of them were reporting harms in a rigorous way and in a complete way.

And the vast majority also did not have information of harms in the long term. Recently, we looked across the entire Cochrane data base of systematic reviews.

We took a very large sample, a random sample of thousands of reviews on topics of inventions for medicine, and we tried to see how often they have very strong evidence for benefits and how often they cover harms.

We saw that it’s only a small minority that have strong evidence for benefits and in the majority of cases harms are not even dealt with. So, people just leave them aside, they don’t say anything or they say very little. We have very poor documentation, very poor evidence, about whether there might be harms.

Do I believe that when this is the case, the medication or the vaccine, or whatever, would be harmful and it would be killing people? No. But at the same time, we have a gap, we have a knowledge gap that we need to fill in. And our systems of capturing harms is through, for example, passive surveillance – which is what mostly has been done for vaccines and for biologics and for drugs. We know that it’s up to people and physicians and practitioners to report the events.

So, many events happened but they don’t report them. Many events of course are missed because they don’t even realise them.

If you have, for example, myocarditis but you don’t have some symptoms, even though you may have a problem with your heart muscle then you don’t really report it because you never felt it. And could that person die at some point?

Yes. One in, who knows, a million or 100,000. Maybe that will happen and then that would be the first event that someone would just drop dead on the floor. So the rest will not be captured. And even those events that happen are not really reported most of the time, because just this is the way that it has been. In the case of Covid-19, we saw also a countercurrent.

We saw a lot of people who were so scared of vaccines, and so much influenced by all that pressure – that these vaccines are killing people, and they’re horrible, and this a conspiracy to kill the entire population – that they started over-reporting.

So, we had a mix. We had a component of the population that were very, very diligent to report everything, probably even to a detail that was not needed. And we had another portion in the population that was not reporting, along the practitioners and the physicians who are taking care of them.

In some cases we even saw some wonderful scientists who said, “I was thinking whether I should report this, because I would be giving ammunition to anti-vaxxers.”

Which I thought, my goodness, have we reached that point, to be afraid of anti-vaxxers. That would be like the best ammunition we can offer to anti-vaxxers, that we say we don’t report because we are afraid of anti-vaxxers.

So reporting has problems – surveillance and passive surveillance.

All these vaccine recording systems are there, they do what they can do.

They can tell us about some major problems, some things that happen far more commonly, compared to normally, but for serious things that happen only a little bit more commonly, but they may be common and therefore a little bit might be substantial – they cannot tell us much. So, if it’s a common problem like heart attacks, if you have a 10 percent increase, would we capture that with our systems? Not really. That’s not what they are designed for.

Now science has its own language, it has its own rules, it has its own perspective. You cannot violate these rules. Writing also has its own perspective and its own rules. Maybe you can violate them a bit more, which is fun if you know how to do it and if you do it in a way that the final outcome is not completely meaningless.

But I like the complementariness, I like that back and forth, and the ability to communicate in these two worlds.

I think it offers an ability to realise how much or how little – actually how little – one knows and how more difficult it is to have meaning eventually; meaning either in terms of science or in terms of meaning in life.

It’s a struggle, it’s a struggle not to have very high expectations but you must still continue with the goal of achieving something – maybe a little better, a bit more clear, a little more transparent.

So, we were talking about transparency in science, there is also transparency in literature and also transparency in thinking and in emotions, in conveying these emotions, in making an art of this. Art was completely ignored, I believe, during the pandemic.

I was very sad because I know artists from very different walks of life and art was practically suppressed. It was the most effective way to suppress art. I cannot think of any other regime in the past that has managed to suppress art so efficiently. Now of course people could continue to write at home, but, for example, performances were banned for a long period of time. Things that I enjoy: I like, for example, writing libretti for operas. Operas could not be staged. I had an opera that I was waiting for its premiere at the Greek National Opera. And eventually the premiere happened without an audience – it was just on video.

People who are in outcomes research, I don’t think that they have ever measured how much we lose in our life when we lose art or we lose multiple dimensions of art. When you cannot communicate art, you cannot hope to have an environment where art has meaning, has the potential to be expressed. Time will tell whether these years were sterile in creativity, probably they were not, I think people still continued to be creative. But just being creative in a closed room without being able to communicate, I am not sure if that’s really what an artist wants to be.

I cannot translate that to quality of life, but it is essential for life.

Art needs freedom, it needs perfect freedom. I can understand that in the scientific method you have limitations and some boundaries in terms of how you use your methods. In art the first method is freedom. And if you don’t have the ability to think freely and to express yourself freely, then you cannot really do any art. Now … this doesn’t mean that if you express yourself freely, that that would be high art. It would possibly be complete nonsense. But it’s a ….prerequisite. I think that in an environment where suppression and subversion and restriction becomes the norm, when security becomes the dominant theme in human life, art is not in an environment where it can thrive.

Art wants to dismantle security, it wants to make you insecure in a way. So that you can question again things that you have accepted and maybe they were not as correct or as solid at one thought. So, it was something that probably created some of my bias, my personal bias as a scientist, because I had this other perspective, that I felt, so my goodness, this is so incongruent with the other side of myself, this is completely killing my other side.

So maybe I was biased because of that reason. But I think that many people were also effected in the same way they felt that much that we valued was under threat. If you remove art then you are left with, you know, media and social media to fill in the gap. And I don’t think that they can do that.

In a way it’s preposterous to think that media and social media or other entities can replace art – and they have done that to a large extent. I don’t want to give them 100 percent of the art territory.

I think it’s good to have some free territory for art that is independent of them, regardless of how society was.