Pandemic: Coronavirus Edition

How does documented reinfections change the game plan, and taking a deep reflection on the why of anti-maskers

August 24, 2020 Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger Season 1 Episode 40
Pandemic: Coronavirus Edition
How does documented reinfections change the game plan, and taking a deep reflection on the why of anti-maskers
Pandemic: Coronavirus Edition
How does documented reinfections change the game plan, and taking a deep reflection on the why of anti-maskers
Aug 24, 2020 Season 1 Episode 40
Dr. Stephen Kissler, Dr. Mark Kissler and Matt Boettger

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[00:00:00] Matt Boettger: [00:00:00] You're listening to the pandemic podcast. We equip you to live the most real life possible in the face of these crises. My name is Matt and with my good friends, dr. Steven Kessler epidemiologist the Harvard school of public health. And dr. Mark Kissler, doctor university of Colorado at the hospital. This is an absolute miracle.

[00:00:15] I think this is the third time together. We have been together. I feel like we're, we're like, we're like called blood brothers. I mean, you clearly, you are 

[00:00:23] Mark Kissler: [00:00:23] actually

[00:00:28] Matt Boettger: [00:00:28] so, I feel it, I feel in my heart. So how's it going guys? 

[00:00:32] Mark Kissler: [00:00:32] Good. We're doing great. Yes. It's good to see you guys. 

[00:00:37] Matt Boettger: [00:00:37] It's great to see you guys. And I am absolutely utterly, mentally exhausted. 

[00:00:42] Mark Kissler: [00:00:42] Yeah. Dealing Gleevec. 

[00:00:44] Matt Boettger: [00:00:44] Dealing with this stuff. Like, I it's just been so hard. I was talking to one of my coworkers and he just sat on this chair yet.

[00:00:51] So we had a big event. it was out so outside, everywhere, mass, it was a huge success for that. We're really excited to say every ticket seriously, but before it [00:01:00] just thinking the anticipation of how many people are going to show up. And just, just like, he looked at me and he's like, I'm just mentally absent, exhausted.

[00:01:07] Like I just, I just he's he's up at night. Cause he, he wants to do the, make the best decisions and, and play it safe yet do our job. And it's just complicated. So we're just, it just makes everything so tiring. 

[00:01:17]Mark Kissler: [00:01:17] Right. And still provide the kind of, I had a really good conversation with a good friend of mine, over the weekend about just the types of needs that people have right now, the social needs, you know, and that are like, it's super empowering to be able to, to connect right now.

[00:01:33]so if you're one of the people who's supporting. You know that or who is trying to create environments in which people can do that safely. It's super tough. Super tough. 

[00:01:43] Matt Boettger: [00:01:43] Yeah. And you could see that there was a longing, I mean, we had, it was really for us a huge success because we didn't have nearly as big of a group as we normally do, which we expected.

[00:01:51] However, just the amount of people wanting to connect with people, you could see there was, there was like this deep desire, like we're excited. [00:02:00] We're here. And they were exchanging their, Snapchat, usernames, whatever. I don't know. I'm not on Snapchat. Right? What are you on Snapchat, Mark? 

[00:02:09] Mark Kissler: [00:02:09] No, I'm not 

[00:02:10] Matt Boettger: [00:02:10] Steven.

[00:02:10] I got a Snapchat,

[00:02:14] Stephen Kissler: [00:02:14] Snapchat, 

[00:02:16] Mark Kissler: [00:02:16] whatever, whatever it is. So, 

[00:02:18] Matt Boettger: [00:02:18] but anyway, just this idea of it just be an exhausting and it's really hard. I don't even know. Honestly, I have no idea how our numbers are dropping in the U S so I do know. In a, in a largely, because everybody take it so seriously. However, just reopening us. And you know, our, our first event and last week was already an exposure and like our very first event, that was the bad news.

[00:02:39] The good news is all our student leaders immediately went from, Hey, we can do this. This is fun. No big deal to, Oh my gosh, this is a serious reality. So we hit it. We hit the ground running. All of our leaders take it very seriously. And we have had our first exposure last Sunday, and then the consequences of exposure.

[00:02:55] We just found out a couple days with another one. So where does a small little drop [00:03:00] in the book? No, it could just be of circumstances, but it just like, this is mind boggling, how we've even made it this far with this article. I know it feels like I'm jumping. I love this entitled articles, the science behind campus, coronavirus outbreaks.

[00:03:13] Do we need science for this? We do I really sorry. I get it. Maybe to see the joy, let me come some Friday night on the Hill in Boulder, the Hill. This is a place where everybody hangs out parties and hear the amazingly loud music and screaming until four in the morning. Every having the time of their life, like.

[00:03:33] It's just different than a regular community. So people are like, sure. The science is great, but it's whatever. 

[00:03:42] Mark Kissler: [00:03:42] Okay. There are times when anecdote can, can get just part of the world. Yeah. 

[00:03:48] Matt Boettger: [00:03:48] Anyway, so that's my tangent. It's mine. That's my riff. That's my exhaustion. But I'm excited to be here on a Monday. It is a Monday.

[00:03:54] It's not Wednesday. We're right now, switching to Monday and big news. This is episode 40. [00:04:00] Did you guys know your, the last, this 

[00:04:02] Mark Kissler: [00:04:02] long? It's kind of like a fullness we've we've gone through it. Yeah, 

[00:04:07] Matt Boettger: [00:04:07] we are. We are all together. All three of us are eating cooperating and midlife crisis right now. Oh, 

[00:04:15] Stephen Kissler: [00:04:15] 40. 

[00:04:16] Matt Boettger: [00:04:16] We are 40.

[00:04:16] So we're struggling. So anyway. We're at episode 40. Thank you guys for listening. It's been awesome to hang with you since March. We hope to continue this for a long time and I have reviews. Keep them coming. Another one from Erica  mr. Last, last week, but didn't, wasn't able to, to mention what she said.

[00:04:35] Thanks so much for this podcast. She says it helps me keep perspective. The actual status of Kobe I'm pregnant with twins. So we are still trying to isolate as much as we can without going crazy with our other two small active extroverted boys, man. God bless you. The COBIT fatigue that you mentioned on the last podcast at home, we are struggling with telling friends we are not comfortable doing certain things and just cannot wait for this all to be over.

[00:04:58] Thanks for keeping it [00:05:00] real, man. I know that the temptation to want to take up a mask, like hard to say, keep away from the fence from the backyard. You just feel like this bad person, but it's hard. It's tough times, but thank you for that review. Keep them coming. We could 

[00:05:12] Mark Kissler: [00:05:12] always use all the best with the twins.

[00:05:15] Matt Boettger: [00:05:15] Oh my gosh. Yeah. 

[00:05:16] Mark Kissler: [00:05:16] Twins. The twins. That's exciting with two 

[00:05:18] Matt Boettger: [00:05:18] other ones. Didn't she say? Boys. Awesome. Right. That's fundamentally crazy. 

[00:05:24] Mark Kissler: [00:05:24] So I can imagine that would be very busy. 

[00:05:29] Matt Boettger: [00:05:29] Yeah. Yeah. I wish you the best, always need support financial support. podcast. Here's what we're trying to do.

[00:05:37] I have, but we need about 600 more dollars flat to get everything covered. I want to push this one time. 60 people, $10. That's wiped away. We are done. And then we can rely on just our regular Patrion, benefactors to keep it going. The subscriptions last $600 push. If you, if you have it $10 60 people.

[00:05:54] That'd be awesome. Thank you so much for audience Dota. Oh yeah. The one person who cannot donate anymore as page you're [00:06:00] discluded. Thank you so much for all. You've given you were excluded from this entire request, so you are out, so thank you so much. Okay. So a maintenance checklist, I gave it a couple of weeks ago on my LTR podcast, living the real man.

[00:06:14] If you're in this, in this moment of constantly going crazy and chaos and order, I know for us. We have our, we get our house together and then three days later it looks like we did nothing. Like it just absolutely is destroyed. And I have a little good cheat sheet of how to really get at, get from this crazy loop of chaos and order and just stay in that maintenance mode.

[00:06:32] And right now I think we need that. Anything when we have so much energy being spent. On other things right now, like how do I educate my kids at home online, all this kind of stuff. It's complicated. So check it out. I live in the real deal, calm slash maintenance checklist, download that, at the sweet little cheat sheet and how you can get your life into a better rhythm.

[00:06:51] So let's get going in the news. We have lots of talk about first thing I just saw before we started Hong Kong researchers report first known [00:07:00] COVID-19 reinfection. So I guess there's always been kind of this idea that the, but this is the first really, I guess. True one back in March, this was infected, went to Europe was reinfected.

[00:07:11] So what does this mean? Start with you, Steven. Is anything new? What, what, is there anything to conclude about this? 

[00:07:18] Stephen Kissler: [00:07:18] Yeah, so it's, it's an important finding for sure. because it. Definitely shows. I mean, as, as convincingly, as I, I I'm, I'm convinced based on what I've seen from, from the data that, that they've really done their homework and verified that these were two separate infections.

[00:07:34]and so it says that there's, there's at least a possibility that some people can get reinfected with COVID as, as quickly as four months apart. now that doesn't. Necessarily me and, and I, and I think that it probably doesn't mean that, that the duration of immunity for COVID is four months. the, the immune responses, of course, this incredibly complex thing and people Mt.

[00:07:53] Different levels of response and the duration of immunity varies from person to person, depending on how effective that response is and that sort of thing. So, [00:08:00] it doesn't necessarily mean that that everybody's immunity is going to decline that quickly. it could, but I, I don't. I think that that's probably the case, at least not based on, on the evidence that we've seen yet.

[00:08:10] So, so I think it's another useful piece of information. it's not entirely unexpected. We know that coronavirus immunity probably wanes over time. Anyway. Yeah. It was just a question of for how long. So I think this is probably the first of many sort of examples, this kind of finding that we're going to come across, but again, it's just.

[00:08:26] Just one case so far. and so now we gotta do the hard work of figuring out just sort of what that whole distribution is and, and how long in unity actually lasts. 

[00:08:34] Matt Boettger: [00:08:34] Okay. Sounds good. Mark. Anything to add to that? 

[00:08:36]Mark Kissler: [00:08:36] No, that sounds great. 

[00:08:38] Matt Boettger: [00:08:38] So this was a great day there. ha Headline. Trump says FDA is expanding access to COVID treatment with plasma.

[00:08:44] So just a week or two ago, we talked about how we saw Russia. It was two weeks ago. We looked at Russia in the, in the, in the expediting of the vaccine scene and all the implications and maybe some of what, what they're trying to say and how we're talking in comparison to the U S and how we're trying [00:09:00] to keep our I's dotted.

[00:09:01] Our T's crossed. Now I'm concerned here is, are we starting to reach that precipice or is this something a little bit different when it comes to plasma? 

[00:09:09]Mark Kissler: [00:09:09] Yeah, I think this is definitely different. So, we have been using convalescent plasma, so plasma from individuals who have contracted and then recovered from COVID, really from.

[00:09:20] Pretty early on. And the idea again is that, it's sort of a way of inducing an immunity. but it's not an immune response from your own body. It's somebody else's antibodies that you give directly to the person. it's generally super well tolerated. The major risks of this are just the same risks that you get with getting blood anyway, which now nowadays are very low risk.

[00:09:40]and we've been using it in clinical trial settings. And there was, and so we've been using it just, quite a bit in the hospital. What I suspect this is, and I'll have to look a little bit. more deeply is what it looks like on this FDA press releases that they were doing an analysis of some of these preliminary studies.

[00:09:57] So they were looking and seeing mortality [00:10:00] differences, and in patients who get the convalescent plasma and patients who don't, and it was so favorable, that even though we haven't kind of completely gone through the arc, they think that this is beneficial and should be in. Wider circulation. So this seems to me to be kind of the appropriate March of, you know, trying something, keeping really close tabs on the influence, and then monitoring, or modifying our interventions based on that data, downstream.

[00:10:27]Matt Boettger: [00:10:27] Good. Okay. So anything else, Steven, on that? We're good. Okay. Next thing, this is great. Is it to be expected? I kind of, in my mind thought would happen. COVID-19 data will, once it can be collected by CDC, in a policy reversal from a what? For, what was it at the health services? 

[00:10:48] Mark Kissler: [00:10:48] What was it? 

[00:10:49] Stephen Kissler: [00:10:49] Yeah. The four letter acronym that starts with an H I'm sorry.

[00:10:52] I should 

[00:10:52] Matt Boettger: [00:10:52] never, this 

[00:10:54] Stephen Kissler: [00:10:54] is an epidemiologist, but they're not the people who normally collect the data. So that's why, 

[00:11:00] [00:11:00] Matt Boettger: [00:11:00] so yeah. So the big reversal, going back to the CDC to be expected in the end, as complicated as talking with you guys and joking, and I'm like, Oh yeah, here, you know what? I got the newest Excel sheet on Microsoft.

[00:11:10] It's awesome. It just like Rez. I have these sweet pivot tables, 70 information I'll crunch the data. And send it your way. Right? So it's a little more complicated than I think we just realized that, so the CDC it's back in their hands and they're working on the new technology to expedite their own fights, which is great.

[00:11:24] I hope that I hope it's a huge success for them. one other thing I totally forgot about this. Guy's back in may or April. Well, I was excited cause I'm a tech geek and so Apple and Google came together, which is kind of like a week phenomenon for those two to come. They have fundamentally different approaches to privacy and that kind of stuff.

[00:11:40] So they came together for the sake of COVID to do contact Tracy and I was super excited and then I forgot about it. And then I'm like, Hey, wait a minute. This must be some contact tracing stuff going on. So I'm a listen to this. I'm a tech geek and I had to look all over searching. Where is this? After an hour of searching, I found it in my settings and obscure place in iOS.

[00:12:00] [00:12:00] Try to activate it. And then I couldn't activate because you need another app. Then I do research on what do you mean by another app? And then I realized, Oh, States and federal governments have to make their own app to connect to this, this process, and then realize only three States at this point in time, have the app to even be used.

[00:12:17] So then I came like, what is going on this to me, this was like a low hanging fruit. This could be helpful. Is this like a lack of technology or Steven ender, you're talking about like, why is it just at the forefront of our minds, especially if you were saying he hasn't even been even talking about it that much lately, is it.

[00:12:32] Why, why is this? 

[00:12:33] Stephen Kissler: [00:12:33] Yeah, so, I mean, it's a good point. I I'd forgotten about it to some extent, too. and I, I think, I think part of what it comes down to is that, in my understanding the, the contact tracing technology builds upon the testing technology, to do effective contact tracing. You have to know roughly when you got infected, roughly when you were infectious sorts of things.

[00:12:53]and right now our, our, our testing capacities really aren't at the point where we can reliably tell. When a person first turned infectious. [00:13:00] so I think that that really limits the utility of these kinds of things. And so why different States haven't really invested in them much because they're other places.

[00:13:06] Yeah. They really need to invest in much more basic sort of infection control strategies first. but that's, that's just my first, first pass gloss over it. but. Yeah, it's a super interesting, 

[00:13:18] Mark Kissler: [00:13:18] yeah, it'd be, I'm curious. Cause I remember we've talked a little bit about this, but not too in depth about privacy concerns related to contact tracing, particularly if there's some kind of in an app on your phone, that's monitoring, who you're with and where you're at at all times.

[00:13:33] And then sending that to a third party. I think there's some legitimate, you know, there's there's room for legitimate critique of. Fat and the way that it could be used for this for other things. and so I think, I, I don't know though, I haven't heard that conversation very much. and maybe I'm just not tuning.

[00:13:48] And Steven, do you guys talk about that or what's the story there? 

[00:13:51] Stephen Kissler: [00:13:51] Yeah, absolutely very much. And that's been sort of at the center center and forefront of these questions anyway, because, in, in many ways an app that like actually sort of kept a [00:14:00] central repository of. Oh, who you're in contact with at a given time.

[00:14:04]I think you would actually be illegal. and so, but there are there really creative ways for, using these sort of like packets of signals where, you can decentralize that process so that no one actually has. That information, no one phone nor any central repository. They're super interesting that computer scientists have been working on exactly this for years for different applications, in ways that you can actually really maintain the privacy of individuals and their contacts.

[00:14:30] And really the only information it's basically trying to minimize the amount of information that's stored such that you get the, the minimum amount of information that you need to identify, whether you've been exposed to someone. Yeah. Who's bitten, who's gotten COVID. and you can do that. And. Such a way that you can't actually track individuals or who they've been in contact with, on any sort of like individual basis.

[00:14:50] Super interesting. but I do think that probably the suspicion around these things might be contributing to. Why they haven't been, implemented as well? I, because it, it, it certainly [00:15:00] sounds really suspect. but I, I would have to go back and review in detail, but, but I've listened to a number of, of people who are working on these algorithms and have been, been convinced that, that, that privacy would be pretty safe with the strategies that they're proposing.

[00:15:13] Matt Boettger: [00:15:13] I was, I had been reading a few things about this morning and, you know, I see the example, all other countries who try to build a platform, which actually kind of housed the data, which then was suspect, but it seems to be that Apple and, Google has become the gold standard, but like they don't, and that's even part of their criticism that they don't use location-based tracking.

[00:15:33] So it's not as, quite as precise. They really rely on Bluetooth, which is, so then it's on the device, you know, it's falling, Apple's kind of, you know, paradigm of like, look, it stays in device. We don't put it in the cloud. it random keys. It seems as though, again, I'm not the expert. This is just an awesome resource that keeps privacy and also allow another level.

[00:15:51] But. I'm just, I was mind blown, but it kind of makes sense if you were saying Steven, that if, if our it's kind of like getting a brand new PlayStation when he can't even get it food [00:16:00] on the table. Right. So it's got to get the two, get to get on the food food on the table at first. And then, then we can get the luxury a PlayStation.

[00:16:06] So let's get our, our testing up a little bit more. I don't play video games. I don't even realize it. So don't just PSA guys. Don't be like, dude, you say you're so busy, man. You just said that word PlayStation to me. You guys are just totally random. I can't play those games anymore. They have too many buttons, man.

[00:16:22] I was I'm from the I'm from the eighties, Nintendo a be up down right left. And you just like, you just, you just master that. So this is what this is not about. Okay. Let's continue. so. another one I just wanted to, to bring about, Oh, no, coronavirus will not be eradicated with vaccination, like smallpox.

[00:16:41] This is me. I know we've talked about this before. I w but the difference, I just, for my own wellbeing, how, what is it? It's between something like a vaccine for smallpox and then coveted, because in my mind, I'm thinking I've been drilled by you guys overnight. This is different than the flu, the flu mutates coronaviruses much more stable.

[00:16:58] So in my mind, I'm like, Hey, stability [00:17:00] means better vaccine, maybe like smallpox. So yeah. What is the difference that I can compare these two to understand why smallpox vaccine works and coronavirus may not have that efficacy for that length? 

[00:17:10] Stephen Kissler: [00:17:10] so I think, probably two things, I mean, one goes back to the duration of immunity.

[00:17:14] So, it's not always the case, but I think oftentimes the, the length of immunity from a vaccine follows to some extent, the length of immunity that you get from natural infection. And we know that coronavirus is usually don't give you permanent immunity. So, which is not. Case, I believe for smallpox, generally speaking.

[00:17:30]so you've got a smallpox vaccine and you you're immune to that for life. So you can basically immunize kids. Basically. It's just part of their routine vaccinations when they're very young and then that protects them for the rest of their life. It goes a really long way towards, Eliminating an illness.

[00:17:44]another thing with the smallpox, I believe that it's, it's generally only contagious after you've started showing a rash. So it's like very clear when you've been infected. And so there are also a lot of public health strategies that you can use to enhance the vaccination strategy to reduce the transmission of the illness.

[00:17:58]which also is not so [00:18:00] much the case for COVID, since it seems like you can spread disease before you actually know you're infected. So both of those things are not working in our favor for COVID. and is Y yeah, Y I'm I'm doubtful that. Vaccination alone will lead to an eradication. 

[00:18:12] Matt Boettger: [00:18:12] Great. next one, I love this one.

[00:18:14] U S will have third act of credit virus and it will likely be more pervasive. So you guys, so we started with lovely the curve. It was a curve, right? A geometry. Then we went to a wave. So we went to the ocean. And now, now we're at act. You guys, I love this one. There's a couple of reasons why number one, I just thought, you know why I love this one.

[00:18:32] When you say a wave, I feel like an ocean, a wave never ends it comes and it comes in and beats the heck out of you and act feels like a play. It ends at some point in time. So I'm like, okay, we're at, we're at we're approaching the third act. I feel like I'm ready for 

[00:18:46] Mark Kissler: [00:18:46] right. 

[00:18:47] Matt Boettger: [00:18:47] This is a, to me, this is intermission, honestly.

[00:18:50] Like w I'm looking at articles, I'm like, what are we gonna talk about? Because it's a little bit of a dead time we had that. We had our second act, you know, about a month ago, but we're seeing the, the, the, [00:19:00] the, the infections that drop, hopefully I've read the news and maybe you can, you can talk backseat.

[00:19:04] This is inaccurate. There's an expectation that the death rate's going to drop here soon, probably dramatically for, for, for immediate next week or so. but. There's an expectation that there's going to be another, you know, another rise, but I have to say we keep changing our terms, but I really I'm voting that.

[00:19:20] We all stay with this one, right? 

[00:19:21] Mark Kissler: [00:19:21] This is the one that theater metaphors 

[00:19:24] Matt Boettger: [00:19:24] I do. I do. And it also makes me feel like it's fake. 

[00:19:30] Mark Kissler: [00:19:30] This is a lot of benefits. Let a secondary 

[00:19:32] Matt Boettger: [00:19:32] gain that makes me feel a little more lighthearted. Okay. Okay. So a D six, 14 G stupid, crazy coronavirus mutation, a new, less deadly strain.

[00:19:44] I just want to know we talk about it all the time and maybe, maybe not, but this is, does this have any factor there with the complexity as you, as an epidemiologist looking at, Hey, why, why Sweden reacts this way? And Peru is reacting this way. I know there's a lots of different reasons why different [00:20:00] countries suffer differently or don't suffer at all.

[00:20:03] Is the mutation part of this equation or is that just kind of at least for coronavirus? A very small piece. 

[00:20:08] Stephen Kissler: [00:20:08] Yeah. So I think that, Mutations could potentially be playing a small role here somehow. And the we're still trying to gather evidence on exactly this, there are a lot of, genetic epidemiologists who are, are looking at exactly this mutation and ones like it.

[00:20:23] And there seems to be some, some evidence that maybe this. Mutation allows the virus to be a little bit more transmissible maybe, but it's but so far the patterns that I've seen are also, consistent with other factors, driving, driving the differences in prevalence that we see between these two and one may be out competing the other.

[00:20:42]so it's possible. I'm definitely not saying that the mutations are, are like completely inconsequential. but, It's it could be playing a role. I think, I think that what part of the resistance you're hearing in my voice is just that yeah. Similar to what we were talking about last time about the, that we [00:21:00] have this, this real psychological desire to link what we.

[00:21:02] Eat with how we get infected with things basically that like we're linking like swine flu with, with the consumption of pork. And now, you know, these same sorts of things that that's like a very, that's a very sort of mentally sticky idea. And I think that mutation sort of offers something similar. Right?

[00:21:16] You think of every pandemic movie you've ever seen and the, the change happens when the virus mutates, right? Like that, that is like the climax of the story. Right. And so, 

[00:21:26] Mark Kissler: [00:21:26] so absolutely these things are in the third act. 

[00:21:28] Matt Boettger: [00:21:28] Exactly. See this fits so perfectly. 

[00:21:33] Mark Kissler: [00:21:33] Yep. Yeah, 

[00:21:34] Stephen Kissler: [00:21:34] yeah, no, exactly. And so, so it's true that, that, that viruses mutate to make them more or less transmissible, usually more transmissible, but they also mutate to make them more or less.

[00:21:44]severe clinically, that happens. Absolutely. But usually the consequence of those changes within a given virus that's already spreading are, are usually pretty small relative to the basic public health sort of interventions that we, that we do. So, so that's why I think that it's, [00:22:00] it could be real for sure, but I don't think that it's necessarily as consequential as, as many of the other things that will be coming down the pipeline.

[00:22:06] So. 

[00:22:07] Matt Boettger: [00:22:07] Yep. That sounds great. Good. Well, one last thing before we head to our deep dive, when talk about a few things that we've been experiencing lately, again, I love this concept. I don't really love this concept. I'm intrigued by this concept of the long haul there's in the COVID and I'm gonna follow this little more closely in the coming weeks.

[00:22:22] I won't say much. I just, another article I'll put in the show notes about so many people suffering from mild symptoms, just really mild symptoms, but then having extreme fatigue, heart racing, and forgetfulness, these kinds of things for long for months on end up to 21, 23 weeks after the infection. So more of a, just a PSA that if you may suffering from this, just to get checked out, I know that I also read the article that oftentimes these people will get antibody tests and report negative.

[00:22:44] So it makes it even more complicated. The reason why I kind of hit home for me. Is it, my dad, it was just on a FaceTime with him and my family. And he was talking about, trying to mow the lawn and just be in a really fatigue way more than usual can barely even mow the lawn. And all of a sudden this article [00:23:00] struck me.

[00:23:00] I'm like dad, you know, just, I have no idea whether it's even possible. You could have got COVID and a mile away, and that you're suffering some longterm effects. You don't have no idea, but it's hard. It's, everything's complicated by dad. They live in Southern Missouri. It's 95, 98 degrees with 98% humidity and in mowing and crappy lawn.

[00:23:16] And there. Right. So it could be just the circumstances of the environment, so many different things, but just wanted to PSA. If you feel in that to get checked out, who knows what it could be, and I'm sure down the road we'll have more answers as we kind of explore that it's kind of new terrain. 

[00:23:30] Mark Kissler: [00:23:30] Yeah.

[00:23:30] And probably a good idea. Just putting my doctor hat on. You know, for a second there's often in a time like this, we do, what's called, we have, what's called an availability bias. So like we think about covert all the time. We're talking about COVID all the time. And so then we attribute a lot of our symptoms or, you know, think that it may be related to COVID because of that.

[00:23:49] But of course there's other things going on. We've seen, especially in certain places, Reduce number of contacts with healthcare, because people are worried about COVID. but there may be something else [00:24:00] going on that's totally unrelated, but that also merits getting checked out. and so, you know, we want to make sure people feel safe coming in when they feel like they need to.

[00:24:09]they're coming into the hospital, coming into the clinic. It is a safe thing to do. and it's important to not forget that, you know, sometimes you just need to get checked out. So. 

[00:24:18] Matt Boettger: [00:24:18] Absolutely. Yup. Yup. I'm gonna get my physical soon and thanks for just Roy reading. My excuse for everything I've been blaming COBIT for everything, my bad temper, my overweightness and everything was just been covered.

[00:24:29] But now you've just messed everything up. Hey, Mark, can you report, I know one thing, we had a question from Deborah about vitamin D. So the question was, you know, does this help the immune response? Is this something we should be doing as a preventive measure? What is it? 

[00:24:42] Mark Kissler: [00:24:42] Yeah, so I was interested in this, so there's been some conversation from early in the pandemic.

[00:24:47]and there's actually been some, Limited amount of data from long ago that perhaps vitamin D is related to acute respiratory infections. And there's some connection there. So when I think about vitamin D vitamin D is one of our [00:25:00] macronutrients, that's really important, that, we, I tend to think that mostly in.

[00:25:04] In terms of bone health and our calcium metabolism. and, so vitamin D is something that you can get, from dietary sources, a lot of milk and orange juice is supplemented these days. you can get it from oily fish. So like salmon in particular is one of the big sources. You can get a little bit from eggs, and.

[00:25:22]but most, most of our vitamin D actually comes from sun exposure and the conversion of cholesterol in our skin, into vitamin D. and then, down the chain and to forms that are usable to help your intestines. Hold onto the calcium that you eat. And so the main mechanism, you know, the main kind of Hathaway we think about it as in this calcium metabolism, but there has been a little bit of data and a little bit of signal in terms of acute respiratory infections.

[00:25:49] And of course, given the global pandemic, people have been turning to that and saying, well, is there. Any relationship to COVID-19? there's this question can be sliced a lot of different ways. I think that's really one of the [00:26:00] things about it. That's interesting to me, is, and so there's a good, I can send it to you.

[00:26:05] There's a good one. comment in the Lancet, that was published on August 3rd, for their September issue. It's it's the Lancet endocrinology. journal, where the authors kind of do a very brief commentary on what's been done so far in terms of vitamin D and COVID research. and it does, there's at least hypothesis that the vitamin D may have an effect on the immune system, both in the early vie remix stages.

[00:26:31] So the early stages, when you have a lot of virus floating around and that's in your bloodstream, as well as the later hyper inflammatory stages. we've talked about those two stages and kind of the one, two punch, you know, before where you have a buy remix stage that causes a lot of the typical symptoms of an acute viral infection.

[00:26:48] Then you have this hyper inflammatory stage later. That's why we're now standard practice using dexamethazone and the sicker patients who have that hyperinflate inflammation we're using. Elevated anticoagulation [00:27:00] protocols because people tend to get blood clots in the hypercoagulable phase. So there's definitely this kind of bi-modal or to, you know, at least two kind of physiologic responses to a COVID infection.

[00:27:09] And some of the hypothesis seem to say that vitamin D may have a beneficial effect in each of those. Now we, anytime we're talking about, nutritional stuff, often at the school signal is going to be a little bit lower. So the signal of vitamin what vitamin D does in this hyper inflammatory phase is often going to be out overshadowed by something like dexamethadone, there's one that has a much higher, you know, kind of effect size.

[00:27:32] And so when we're talking about the good that vitamin D can do and the importance of vitamin D. we're thinking a lot on sort of a populational epidemiologic level. there's some people who think may be a, can confer, some resistance to severe infection. and that, that information is coming from a couple places.

[00:27:48] So there have been some studies, they did a meta analysis. Isn't been peer reviewed yet. So in Akash, it's in pre-print right now, I'm at analysis of a bunch of studies over, I think, over a decade. Yeah, [00:28:00] 2007 to 2020.  took a bunch of randomized controlled trials, looking at vitamin D and acute respiratory infections.

[00:28:07]and they found, some protective yeah. Of effects of vitamin D with. Acute respiratory infections, but it was what they called modest size and substantial heterogeneity, which essentially means all this. A lot of the studies said different things had conflicting information. Some said yes, some said no.

[00:28:25] And the regardless the effect size when you lumped all that data together was not super big.  There's also been some, so another way to slice the data is to look at epidemiologically what's going on. So one of the things that some researchers have done is looked in Europe at countries that are known to have higher rates of vitamin D in the population and some that are having lower.

[00:28:46] And then. Overlaid the COVID mortality data. And there has been a little bit of a signal there too. So the hypothesis is in a country with lower baseline rates of vitamin D population. Maybe we'll have higher mortality and that's seems to be there. [00:29:00] There does seem to be some signal there. So that's a different way of slicing.

[00:29:03] You know, slicing data's looking at it. And then the other way, I mean, there's lots more ways, but one thing that these researchers propose that I think is a really interesting idea, would be doing a large scale supplementation, with a control group and doing a prospective randomized control trial and saying, okay, we're going to get.

[00:29:19] You know, huge number of patients, and give half of randomized them and half of them vitamin D supplementation and half of them not. And then see over time, what percentage of each of those groups gets COVID and gets severe complications from that the big take home point where people are going to want to know is okay, that's all good and fine, but should I be getting more vitamin D and should I be taking vitamin D.

[00:29:43]Everything that I've been able to see has recommended nothing more than the typical recommended daily allowance of vitamin D. So if you're getting your typical recommended daily dose, that's it. And it's not one of these things where we think that, and sometimes we can get into trouble, especially with nutritional interventions where we think, well, if a little [00:30:00] bit's good, then a lot must be great.

[00:30:02] But vitamin D is a fat soluble vitamin. so your body doesn't get rid of it in the same way that it gets rid of water soluble, and you can get. Hyper vitamin OSIS D you can get overdosed. And so you don't want to be going out to the pharmacy and getting vitamin D supplements and just taking a ton of those cause you could get sick.

[00:30:19]and so the recommended daily allowance in the United States is about 600 to 800 international units a day. we get most of that, especially in the summer months. We get that mostly just from routine sun exposure, you know, experts do not recommend. Tanning beds, you know, or things like that to get more vitamin D and like hyper supplementation could be dangerous, but I think there's lots of compelling health reasons to have a diet that's rich in, you know, like these oily fish and Omega three is for other reasons.

[00:30:48] I think that's a good idea. and generally the thought is that you can, most people can get, enough vitamin D just kind of in your daily life and your, your sunlight. And we don't. Unless you have [00:31:00] other risk factors, for vitamin D deficiency. It's not something that's generally recommended to check like your primary care doctor.

[00:31:07] Doesn't usually check vitamin D levels unless you're in a population. Like if you're homebound, or if you're older than 70, or if you have some other risk factors to low vitamin D, then it might be worth checking slowly. but otherwise it's yeah, mostly just a matter of making sure that you get a healthy amount, which is what's.

[00:31:25] Been recommended, you know, up until this point, 

[00:31:27] Matt Boettger: [00:31:27] hugely helpful. No, not to go down this rabbit hole just for a second. I'm gonna throw a question back your way now. We're kind of in the vitamin domain. So we're in like natural path and this kind of stuff. And, so, so my mother-in-law eighties, if I were to say, Hey let's and I could have asked this question back in March when it was actually, we were still first starting out she's in her eighties.

[00:31:46] What should she be taking or what could, now this is a good segue to talking about masks, because we're going to talk about the idea of probability and possibility in some sense, like we're looking at like what, what's a good probable thing or a series of things that maybe my mother-in-law [00:32:00] could take just to, to help, you know, to help fight the edge if she were to get it.

[00:32:05] Is there anything, I mean, vitamin D Claire, you said that seventies, maybe eighties taking a vitamin D supplement might be. Ben might have, might have some beneficial or at least the benefit would 

[00:32:13] Mark Kissler: [00:32:13] outweigh, and that's for us. So that's for the other reasons that those individuals would take vitamin D to begin with.

[00:32:19] So this there's, none of the data has high enough resolution at this point to say these, this is kind of the cocktail of things that you should be taking to prevent a severe case of COVID. If we, you know, we don't. We just don't have that type of data right now. And so there wouldn't be anything that I would recommend from that standpoint.

[00:32:35] What I would recommend would be routine healthcare maintenance, which in, you know, an 80 year old woman would include, You know, osteoporosis prevention and consideration and things like that among lots of other things. and so, yeah, I mean, it's good. It's a good moment. I think anytime we're talking about this stuff, it's a good moment to just plug some of the basic population level health and stuff.

[00:32:55]and so, so, you know, obesity is actually a risk factor for low vitamin D. [00:33:00] and, and I think that. You know, we're again, just as we don't want to not go to the doctor because of COVID we don't want to forget that there's other important, you know, routine age, appropriate cancer screening, you know, routine vaccinations, things like that, that are going to be just generally helpful and generally accepted.

[00:33:15] And just because we're in an extraordinary time, doesn't mean that all of those things need to go away necessarily. 

[00:33:21] Matt Boettger: [00:33:21] And again, you may disagree. We'll move on to the next thing too. When we're talking about mass here a little bit, and just talk about the bigger complexity of the Saul, but you know, in my mind, I'm like, now's a great time.

[00:33:30] To get some screen done, because I feel like we're in between these two realities, the second act, the third act, if you already kind of worried. In general, there's no better time than right now to, if you need some screening, I'm booking my physical because I'm 42. I just want to go. And I feel like it's a great time to do it before the winter 

[00:33:47] Mark Kissler: [00:33:47] hits.

[00:33:47] So I think that's feasible for sure. 

[00:33:49] Matt Boettger: [00:33:49] Yeah. Yeah. So let's go, let's get into this. So let's talk about face mask. We've talked about it before. It's been a crazy complicated reality in my world. It's one thing to talk about in this cerebral fashion [00:34:00] down here in my dungeon of a basement with you guys, but then they actually go to work and just deal with people who are all over with hesitancy and then feeling this kind of like almost Scarlet letter written over on my face of like, somehow I have, I have an issue or fear.

[00:34:14]This has just been hard. And just understanding what on earth is going on with this strong hesitancy. For may for face mass. What have you guys been experiencing? What what's on your guys' thoughts and minds? 

[00:34:25] Mark Kissler: [00:34:25] Yeah, I think, I mean, I'm really interested to hear kind of what you guys have been seeing. I think that this is likely, and one of the things that interests me about this in terms of having the conversation is I think this is likely a microcosm of a lot of what we see in terms of how do we have conversations around issues related to COVID and then broadly, how has COVID kind of exposed these.

[00:34:49] Can these differences in how do I obtain data that I trust? How do I obtain opinions that I trust in our culture? And so there's, you know, this is like a tiny microcosm of like, but it's like [00:35:00] a thread that you pull on and you get to a bigger societal issues. And, and largely, I think there's, especially in some places, what I've heard is that this, this feeling of sort of a despair at finding.

[00:35:14] Being able to discern the truth. so one of the things, you know, there was, there's, there's been conversations about, or there's a news article about a sheriff, I think in Florida who had outlawed face masks in his jurisdiction, and citing concerns about. Safety in it or something like that and not, not wanting people to have their identities obscured when they come into the Sheriff's department.

[00:35:36] And, and what I found was that there was most interesting about that was the rationale, which was that, well, you can find, he said in this article, he was quoted as saying, you can find doctors. Of Goodwill on both sides who say that masks are good and that masks are harmful, or the master effective and masks are ineffective.

[00:35:52] And in a setting, in a scenario in which people are saying both things, then how does one discern what's real. and [00:36:00] you know, I think that now, so that to me, Is the question underneath that's right. Really worth talking about, because we can talk all day about, you know, and we can go back and forth about the data on masks and this and that, and the way that it's part of, kind of a broader paradigm about prevention.

[00:36:17]and when is it appropriate? When is it not necessary and things like that? That being said, I think there's, there's this underlying question of like, is it even possible to come to a sort of, sort of understanding in a mutual agreement about that? And so, so I think that one of the things that I've seen is a feeling sort of, of, of despair, of the ability to find.

[00:36:37] A common truth. Sometimes it's around face masks, most often surround all sorts of things, you know, COVID in general. And I think there's a lot of fatigue out there just from the number of voices, you know, being conscious that we were also of those, you know, but the number of voices that are out there, and sort of the extreme flattening where like anybody can put up a video [00:37:00] on YouTube, anybody can.

[00:37:01] You know, fire up, fire up a podcast. Anybody can write an article. Not that that's a bad thing, but that flattening does just have this effect of creating a huge sea of voices and a difficulty in kind of cutting through that. so those are kind of my that's the that's the prolegomena to our face. Face mask, tuck that I just want to do, you know, 

[00:37:21] Matt Boettger: [00:37:21] we'll put that, we'll put that word in the dictionary and Def adept find it in our show notes for you.

[00:37:27] Mark Kissler: [00:37:27] Stupid. I can talk a little bit more, cause I think, well, I'm curious to talk about it too, as a social phenomenon, but Stephen, is there anything before we dive into it that you've been talking about? 

[00:37:36] Stephen Kissler: [00:37:36] I mean, I think, I think that's about it. It's just, There's a, I think he made an important sort of distinction.

[00:37:43] You brought up both, risk and benefit, and then also effectiveness and ineffectiveness, which I think are like slightly different things. And then I think in some, some cases might be. I don't know if they're necessarily conflated, but I think that oftentimes when people are talking about masks, who disagree on them, one is speaking in terms of risks and [00:38:00] benefits.

[00:38:00] And one is speaking in terms of effectiveness and ineffectiveness, and that can make it really hard to find common ground and less those, those sorts of things. and unless those are very explicitly sort of accounted for, Yeah. So, it's I think it's, I think it's a real challenge. and so 

[00:38:14] Mark Kissler: [00:38:14] I think it's one of these things that's, it's also revealing, because I think it's often difficult for individuals on, to understand the motivations or the hierarchy of goods that's at play, with somebody who, who doesn't have their.

[00:38:28] Necessarily the same opinion about masks, right? So for someone, there may be just like a very strong internal sense that, the, the, the interruption of interpersonal communication, the interruption of like, you know, visual feedback and communication of the feeling of closeness, of a constant reminder of an altered reality, that that's a really big, important.

[00:38:51] Thing. and others, those are real, tangible felt harms. and for other people it seems that that seems less important [00:39:00] or less, you know, less significant. And you say, well, I'm, I'm ordering my goods in this different way. And really, I'm more worried about creating, you know, kind of super spreader scenarios or whatever.

[00:39:10] And, and that I can tell, take these. Harms, you know, which are, which are real harms, you know, not being able to see the face of the person you're talking to and not having the nuance of conversation and things like that. but I'm ordering it in a different way, you know, that has this kind of seductive sense that like, Oh, well we can just come to a, we can come to.

[00:39:32] We just have to debate this rationally. You know, we just have to have a conversation and somebody is going to be right and somebody who's going to be wrong, you know? but what we're often seeing, I think is people just get really there's, you know, there's having fights about it or, you know, there's there, there's all these conflicts.

[00:39:48] And then there's shaming about if you're not wearing other like your way, bring it in places where it's not really effective. And that of course. Also is it doesn't help, you know, that doesn't, that, that just creates more and [00:40:00] more on this side of, of the confusion as well. And so I think that's a tricky.

[00:40:05]Tricky thing is, you know, you think you're entering into a conversation where we're like, okay, great. Well, let's talk about, let's talk about the reasons let's talk about the evidence let's talk about and we very quickly end up, you know, really we're talking about these other things, you know, these, these felt certainties, you know, that we're arguing from, and, I don't, I've been talking a lot, so I want to let you get a sec though.

[00:40:27] The thought that I had is I've been reading, I've been revisited a book, that was from my narrative medicine days called on dialogue by David Boehme. Who's a scientist and he talks about, he, he turns sort of his attention in this. Analysis. It's like a hundred page, but it's pretty dense. It's a good, good look.

[00:40:46] And he looks at dialogue as a funnel between people and one of his fundamental premises is the dialogue itself is kind of a creative mode. Of relationship, in which solutions we often approach these, [00:41:00] we often approach problems with like a very linear kind of, hyper rational approach. and there's this way that dialogue.

[00:41:07] Opens up a ground for creative solutions that may not be there when we're approaching things as like these abstract problems. it's one of the things that I kind of like about the podcast medium, to be honest with you is because we, you know, we, we talk about evidence. We talk about data. but I, I really do feel like it's in the diet log that we have around those things.

[00:41:27] That's something else. Can happen. and similarly, you know, that's one of the big harms of this time. One of the big, sacrifices that we have made that's very felt is that we've all been siloed even more, you know, from a very siloed preexist condition, a hyper siloed and kind of, you know, Atomized existence, where we're all living, looking at each other over zoom, you know, and even as we've started to get back together and see people again, it's hard to renew those rich dialogue.

[00:41:59] And remember that [00:42:00] that's actually a creative place, in a place of like really important understanding and the ability to kind of move away from my fundamental. Assumptions and have a little bit of wiggle there as I am in dialogue with somebody and, and start in beef. one of the words, this is a softening of my basic assumptions to allow for the other person just to be, you know, and I think that that's a pretty beautiful, image of what, what can go on.

[00:42:26] And, and I don't think that that means that abandoned a search for reality, you know, or some, some kind of. Common ground by any means. It's not, it's not kind of abandoning, abandoning at all to like, what's your opinion. In my opinion, then that's all we have. What it is is it's a, it's a mode of discourse.

[00:42:44] It's a different way of approaching, approaching that. That's a little bit less 

[00:42:49] Matt Boettger: [00:42:49] in battle. I love like this is also part of my personality, like personality tests, like the disc profile, the Colby index Meyers-Briggs strengths finder, [00:43:00] because what you just said is that truth is there. Well, we don't obtain truth just by this abstraction of pursuing the truth that comes from.

[00:43:07] Maybe in other words, perspective, we have our own perspective by which we, we, we pursue the truth. I, I was just listening to a class yesterday, by idea of, if you put your finger up in the air and look at it from above and twirl in, in the air, you can see it going clockwise, but then if you actually bring it down below you and keep doing it, it's now counter-clockwise, it's like this idea of looking at these two different perspectives.

[00:43:27] One is clockwise. One is counter-clockwise. And what am I getting to this as I, it, I had a particular perspective of how I approach my life. And I've started to see this more and more through. I took this thing called the Colby index, which helped me understand how I approach things. Right. And, and I just had a discussion with a good friend of mine who thinks very deep, differently about me, about mask.

[00:43:48] And we initially had a very difficult conversation on Thursday, but then Friday, we came together and ended up being a wonderful conversation. And if it all started with the big aha moment that he saw, when I chew, when I explained my [00:44:00] perspective, when I, when I I'm a guy who loves systems and my disc profile, I'm a high seat, which means I'm a high compliance.

[00:44:07] Like I really do love systems. I like, I like obeying the law. I like, and I see this with my eldest son Kieran. He just, yesterday he got it, he got a Lego set out and it had instructions and he loves he'll just sit there and read the instructions and go step by step. That's his favorite thing. I love manuals.

[00:44:24] I love reading them at night. I love instructions. I love these things. It gives me a sense of order and peace. In the other, the other part of this perspective is it because of that, it offers for me a lower sense of risk. I don't like risk. Like I'm a risk adverse versus so my greatest talent and strength to organizations to myself, to my family is seeing what the risks are and how we can lower the risk.

[00:44:44] I'm not going to be maybe a high D on the district, which actually is a high risk taker.  that's the Steve jobs, right? Those people who really cut through. We'll take a log of risk so you can see where I'm going through my perspective. I see in my mind, my perspective risks before I even look at the science as a [00:45:00] possibility to reduce the risk.

[00:45:01] So I'm on board. Now, now if there's science behind this, that's awesome. Right. And so when I shared this with this person who was he, he was like, Oh, like, that's why you think this way. Right? So this was like a big moment to seeing the perspective and seeing his perspective, which was really fundamentally different.

[00:45:17] It was like yours, where you were talking about Mark, not yours, but you were talking about how his perspective was. One of them was. He doesn't like the idea that he has to be in front of, tons of people not see their faces and it really hurts him. And I realized for him, he is so he's a priest. this one, this one person I was meeting with.

[00:45:33] And, and for any parish, any priests they're there, they're kind of family. Is there congregation that's her family? My family is my wife and my kids could I imagine if I came home every single night to my masked wife and my mass kids. How, like that would just like really frustrated me in a tremendous way.

[00:45:50] I don't have to do that. Right. But, but he has to, so there's a whole other perspective. And from that, he comes from that perspective. So this idea you're you actually hit the nail on the [00:46:00] head. It's opened my eyes. 

[00:46:01]Mark Kissler: [00:46:01] And I think, you know, there's this funny, funny way in which, you know, that we think out of our.

[00:46:08]we kinda think out out of these original assumptions and we think out, but our thoughts, the thoughts that we have are actually they act in the world, you know, in a, in a pretty meaningful way. So like the way that you met, you know, from your. Kind of your disc profile of whatever, you know, whatever it is that you're thinking that your thoughts are manifested in the way of that you have relationships at work and in the way that you think about, you know, ordering your day and ordering your life right, as soon as you're able to offer up to your own attention.

[00:46:40] Those underlying assumptions, and kind of, and have that moment of, Oh, I, I'm not, I'm not just seeing the thoughts themselves as being like, well, thoughts are just thoughts that are, you know, that arise from the true me, but it's actually like, Oh, that's actually my highly risk averse. Part of me that's speaking really loudly right now.

[00:46:59] And I can for that up to [00:47:00] my attention, then I think it's softened. Is that a little bit enough for us to be able to receive somebody who's speaking from a different. Part of them. and, you know, if you're, again, we've talked about this. You know, I don't know if we could talk about it enough where we talked about it a lot, but that if there could be some good out of this, you know, the, the epidemiologists are not happy that this has happened.

[00:47:23] You know, nobody's happy that that we're seeing the, and there are real measurable economic harms, interpersonal arms, in addition to COVID that had been going on. but if there's anything good that could come out, I think there's a sense of like a restoration in our. Commitment to, and like being better at, having good dialogue within our society.

[00:47:44]and you know, I don't think that's going to come from the top. I think that's got to come from. 

[00:47:48] Matt Boettger: [00:47:48] Yeah, I know we're running a little long here, but one thing I wanted to end on, and this is the second aha moment, and I give this other elders who are listeners. That even though we have perspectives, there is truth out there.

[00:47:58] And we, and where to look for [00:48:00] is really difficult when you're cause you know, he sent me a video. I sent him a video to explain our different in the it's like you just, you, you gave me one media outlet. I gave you another media outlet, pick your flavor. Right. And so he had this idea of just it's complicated.

[00:48:14] Nobody there's too many cognitive biases. everybody has an agenda. So pick your flavor. So, and this is a deeply, deeply thoughtful individual. Who's saying this deeply thoughtful. And so my biggest thing to him was, and this is, this is how I work. This is me and my system. I T systemizing, like I feel uncomfortable when I can't apply a principle to everything in my life.

[00:48:34] I just can't do it. I said, well, I feel really uncomfortable. I get uneasy. If I, if I, if I, if I feel like I'm wrestling between two different principals. So my thing was just like, I don't care whether you were, if we're, if we're going to wear a mask or not. I mean, I do care, but in the end that's not the biggest issue.

[00:48:47] My biggest problem is that. We have a bunch of people who look towards us as being leaders. And so as long as we do that, we need to make sure that we're integrity with how we think about one thing. We applied to this, to the other camps. So, and the [00:49:00] one context, maybe I look at one area of my life in a very detailed fashion.

[00:49:04] I scrutinize it and I really hold people to account of that same kind of scrutiny, but this other part of my life, Pick your flavor. It's too complicated. Those things don't work together. And when you, when you're a leader, it's going to, it's going to chip away at our, at our credibility. So just calling us individually, whatever it is that you are able to follow a principle and a series of thoughtful reflections.

[00:49:25] That are integrity that have integrity between the lives we straddle. And that was a big aha moment to him to be like, Oh yeah, like I might be thinking one way here. And the other way I hold people to a whole other, your level of academic and intellectual X, you know? Excellent. So maybe not quietly as, as on the other way.

[00:49:42] And I think for all, that's my biggest encouragement, whatever we land on, just allow it to be integrated with your entire life, that this idea of siloing is not beneficial to anyone. And we see it already with the stream silos of our, of our country. So it starts with ourselves be integrated. And then from that close, good, a [00:50:00] conversation of integrity.

[00:50:02] I really think so. And it comes from the mode. The means the vehicle is knowing your perspective. And honestly, for me, this is who I am. I'm a high seat. I like it. So I'm going to take tests to know about myself, cause I'm a high C and like, Hey, show me. Right. I don't need it. Right. 

[00:50:16] Mark Kissler: [00:50:16] Even, even your, even your.

[00:50:18] Kind of epistemological method that you apply to yourself is a result of who you learn. Right. And so your, your way of self knowledge is it's in part. And just like, you know, you know, you don't have to get like super wrapped up in that, but it's helpful to recognize that like, that you, that even the fact that you take it to the survey and the personality types and the Myers-Brigg or whatever, whereas like for, you know, for me who, that those things are helpful, but they're not kind of the core.

[00:50:46] In terms of self-understanding and there's a lot more about like metaphor and things like that. They're like helpful in that, that those sorts of things are, we think of them as neutral, but they're actually being shaped sorta just by, by who we are. And that's good. That's [00:51:00] okay. but if we can be attentive to that, then maybe we have a fighting chance at like listening to somebody else.

[00:51:05] Matt Boettger: [00:51:05] Absolutely. Great in that awesome guys. I love the conversation about an hour in good work. It's Monday happy Monday to you. Have a great week. You who are listening. Thank you so much for listening. We'll be back on Mondays now every week. I'm assuming Mark. Won't be with us next Monday. but if he is, it'll be a miracle and that'd be great.

[00:51:23] So if you want to get into contact with Steven S T E P H E N K I S S L E R on Twitter. If you want to talk to us, just reach out and Matt at living the real comma for the message. How's it going, how you're engaged with your friends and your family? How has it, how has it waning on you? We want to hear back.

[00:51:39]also you can support a 600 more dollars. We can be done with this 60 people, $10. We'll be done. Thank you so much for all those you who have contributed, especially page, that that who have been helped this podcast running. Right. We will see you next week. Take care. Bye bye.