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New guidelines from the CDC have people wondering: Just who should get a second COVID booster? In the Bubble favorite Dr. Eric Topol returns to break down who should get boosted, who should get a second booster, and who can wait a bit. They also discuss Eric’s thoughts on where we are in the fight against COVID and what the next frontier of vaccines will look like. Plus, Andy and Eric reflect on Dr. Ashish Jha’s time as the head of the COVID White House task force and look back at what he was able to accomplish.

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Transcript

SPEAKERS

Andy Slavitt, Stephanie Wittels Wachs, Eric Topol

Andy Slavitt  00:03

This is IN THE BUBBLE with Andy Slavitt. Email me at andy@lemonadamedia@com. Anytime I love reading your emails, we’re welcoming Eric Topol back to the show today, love having Eric on, we usually have Eric on if something is happening in the world of COVID. Land. Something major, generally speaking, Eric is going to be the one to come on the show, we’re gonna have a great episode and a great conversation about this. As you know, many of you started listening to this show during COVID times. And so when something material happens, it’s on us to bring it to you. And something material has happened. A couple things as a matter of fact, one of them is that we now have new guidance on whether or not people should be boosted with the COVID vaccine, the multi-vaillant vaccine more than once a year. And we’re going to unpack that some people should tell people shouldn’t according to the FDA and CDC, we’re going to understand why that is and who that is and how that works. And then secondly, something that Eric himself was, I think, largely responsible for, which is pushing to get the US to fund the next generation of vaccines, and should COVID return in a major way with a new variant, we’re going to need to do something about it, we’re going to need to do something quickly. And due to his pushing, the White House has announced that a major new initiative called next gen for the next generation of vaccines has been put forward. That’s very exciting. And we’re going to talk about that. And we’re going to talk about what’s the likelihood that we’re going to need that Eric has a very specific interest about the likelihood that we’re going to see some kind of unfortunate new variant. So while it’s a knot on most people’s minds, while it shouldn’t be on many people’s minds for most of the time, it’s not something that should be forgotten. It’s something we need to be continued to be focused on. We will always bring you that information. As you may know, we are now if you didn’t hear the trailer that was out on Monday, we are now in a new format. We’re coming to weekly on Wednesdays, you can listen to it any day of the week you want. That’s my gift to you, you don’t have to listen on Wednesdays, or you can listen on Wednesdays and another day of the week. But we’re gonna bring you I think much more powerful topics, much more significant interviews, and we hope you’re gonna love this new format. I think we’re gonna get to meet do a great job of it. But let us know you have my email address. I’m on the East Coast right now in New York, and Atlanta, visiting both of our sons, one who lives in New York when it goes to college in Philadelphia, that sack we were down to Philadelphia yesterday ran into Ashish Jha in the 30th street train station. And he’s got a week or two left in his role, funny running in him in the train station, but fun to get the family back together and saw from what she had to say, will bleed into the episode here that a lot of what we’re going to talk to Eric about, which is some of the goings on, that have resulted in the big news items of the week that we have for you. I can’t wait for you to hear it. Here comes Eric.

Andy Slavitt  04:56

Hey, Eric.

Eric Topol  04:57

Hi, Andy.

Andy Slavitt  04:59

Hey, sorry to be late. If you want to hear my excuse, I got a call from my mom. And I was like, Mom, I’m recording a show. I’ve got Eric Topol on, and she’s like, oh, that’s great. That’s so I love it. And then she’s like, Oh, and one more thing. I’m like, no, he’s actually literally waiting. And she’s like, that’s fine. But can I tell you one more thing, honey? Yes, mom. What do you want to tell me?

Eric Topol  05:25

That’s great.

Andy Slavitt  05:28

I love it. So sorry about that. I was like, I probably should just add you in it. Like, you know, Bob, let’s just sign up. Eric gets we don’t keep it waiting. And the three of us can talk. I want to talk to you about a couple of things that I think people need some help with. And the first one is a question that the FDA just it’s just been considering, which is whether people should be getting a second booster. And who should?

Eric Topol  05:56

Right. Well, it’s tricky because there’s limited data about the second bi-vaillant booster. And all we have, of course, the timelines between the previous boosters, and how we seen some attrition of protection after four to six months for severe COVID among people, particularly aged 65 and older and immunocompromised. But I think the FDA’s decision, which was backed up by CDC last week, is that it’s a good idea for people 65 and older and immunocompromised to have access to a second booster.

Andy Slavitt  06:39

Okay, so let’s just make sure I understand how it works. So what did the FDA and CDC say that if you are over 65, or immunocompromised, you can get if you would like a second booster, i.e. two boosters a year? Six months or so after the first one is that? Is that pretty much what it says?

Eric Topol  07:01

Even if you’re over four months, since your first bi-vaillant booster, you can go now which as of Saturday, local pharmacies here in San Diego, we’re giving out by valence, second by valence to people 65 and older. So yeah, if you’re past four months, you can get that now.

Andy Slavitt  07:22

Okay. But if you get one after four months, let’s talk about what makes the most sense. Since if you assume that those folks are going to be people who will want to get it again. When next fall? It doesn’t make sense to do it roughly six months apart. So you because you’re going to do two of them?

Eric Topol  07:38

Yes. I mean, I think most people who did get the Vibiana got it in the September October timeframe. Okay. So yeah, in fact, we’re already overdue for those folks, because getting down to seven or even eight months, so yeah, spacing it out to two. But that, of course, will get us to the other topic is we can’t just be having boosters every six months, and people have increased risk, we’ve got to come up with better solutions than that.

Andy Slavitt  08:05

Yeah. So at the present time, you don’t need to have a prescription from a doctor, you could waltz into a cartwheel into a CVS or a Walmart or Walgreens, and say, Hey, I’ve got my booster car, just like before, it’s been more than four months. I’m either over 65, or I’m gonna test it. I’m immunocompromised. And, therefore, you can have a booster. And I want to make just taking a couple of things here that you also said. One was, if you’re 64, and you’re not immunocompromised, you will not be able to do that efficiently. Unless, is there an unless or it’s it just won’t be able to do it?

Eric Topol  08:47

Yeah, I mean, right now, you can’t, you know, unless you come up with some type of immunocompromised reason, but no, you can’t. It’s only available for 65 and older. The immunocompromised lists, of course, you could be on various medications that put you in a compromised status. But if you’re not and you’re perfectly healthy, certain you’re not going to be able to get an appointment schedule.

Andy Slavitt  09:12

What would you say to those folks? Would you say, you know, it’s basically Okay, your chances of getting COVID in the next six months after your booster after your last shot is worn out are indeed higher. But if you get it, it’s very, very unlikely to be of concern, and you’ll still have some remnant forms of immunity. Or would you say that there’s reason for people to be concerned that I put my eldest use myself as an example. I’m 57 I got the booster last fall sometime. It’s probably about six months. How should I think about that?

Eric Topol  09:53

Well, first question is did you ever have COVID?

Andy Slavitt  09:55

Well, that’s a little bit personal, Eric. Yes, I did have COVID.

Eric Topol  09:59

Because if you had COVID, that gives you an edge, because your immune system has seen the virus plus you have the amplified spike response. So you have hybrid immunity, okay, and you’re a lot better off than the people who are totally COVID naive, Covid, if you will.

Andy Slavitt  10:19

That will be my wife. Okay, who’s the listener to the podcast. So I’m sure she’ll be asking the question. She’s never had COVID. She’s some kind of superhuman. Because she, you know, we spend a lot of time together. gladed when I had COVID. And she, she’s recently was she was here, people with COVID. And she’s never gotten it, doesn’t mean she can’t get it. So what would you say? And she’s roughly the same age and although obviously looks 10 years younger.

Eric Topol  10:44

Well, I don’t think she needs to be concerned. You know, I just say that by having had COVID, you get an extra boost. But if you’re younger than 65, you’ve relied on vaccines and boosters for your immunity, you’re going to do well, because if you get COVID, there’s packs of it, which is still highly effective. Taking that early, with just very low risk really have rebound. So if it happens, you’ve got basically a way to stop the replication of the virus quickly. So I don’t think there’s a reason to be concerned. And also, I just would comment that I haven’t had COVID. Neither has my wife, neither of many other people I know. And this exaggeration, and everyone’s had it, everyone’s had it at least once. It’s not really backed up. Yeah, there’s at least 10% of people that have not had the Novid, if you will, okay. And if they have had at least the by Vela booster, they’re pretty good shape, because as it turns out unexpectedly that bi-vaillant booster took on the like, for example, the current variants like XBB15, XBB16, it did better than was expected is supposed to be just against BA5, but it actually did pretty well. So if you’ve had a bi-vaillant, I don’t think there’s too much to be concerned about with that in that age group.

Andy Slavitt  12:10

And do you think that the FDA, upon review of more data, would, at some point move the age group down to a lower number, based on you mentioned, they’re looking at some data in Israel? Or are there other factors which would cause you to say, You know what, even though we know there’s some heightened risk in the second half of the year, typically, people are having a hard time with this, they asked me this question is, I know, this is supposed to last four to six months. And so four to six months go by and I’m not permitted to get another one. What am I missing?

Eric Topol  12:44

Yeah, well, that’s been, I think, a source of contention, that the FDA wants to stretch it out to once a year, when the data has never shown, at least in people who are, who have remained free of COVID never been exposed to the virus per se. There’s really not good data to go along with that policy. It’s more convenient. It’s practical, once a year, like a flu shot. But on the other hand, we just don’t have any data to show that after you get five shots, that it lasts longer than it did after four shots or three shots. So that’s our problem really right now.

Andy Slavitt  13:19

But even with a doctor’s prescription, it’s still not possible for them to get that second vaccine, is it true?

Eric Topol  13:26

That’s what my understanding is, unless, as you as you alluded to Andy, it could get changed in the weeks ahead.

Andy Slavitt  13:32

Got it. Let’s take a quick break. And then we’re going to come back and talk about how we’re going to solve all this with the next generation of vaccines that are going to change the way we think about this virus and maybe other viruses. You said something very, very important, which is people are used to getting vaccinated as soon as and as frequently as they had been because we were in the throes of the pandemic, there were lots of cases, we still had relatively high death tolls. We have new variants coming on the scene at all time. That world at least for now, is that the world we face? You know, the world we face now is one where test positivity rates are, you know, 5%. And in many, many places a lot lower hospitalizations are I wouldn’t say they’re non-existent. But there’s about as many people in the hospital with COVID, as there are hospitals in the country right now, something like that, which doesn’t mean that it’s one per hospital. But it does mean that there’s not that many people. And you know, you’ve got you still have a five minute private the numbers, right, you still have 150 175 people a day, dying from COVID, which is really in some ways, a bright microscope on kind of what happens with all diseases and as people age, in our society in this country. So there is I wouldn’t say we’re back, we’re at a normal level, this is still a top five disease. But you know, it’s a different world out there than it has been, you know, it has been for some period of time now.

Eric Topol  17:54

You’re right. With a couple of qualifiers, I think you’re making a critical observation that if you look at these metrics, we’re at the best point we’ve been in the pandemic. You know, since the beginning, when data were being collected in March 2020. This is the lowest number of recorded confirmed hospitalizations, from COVID and deaths. On the other hand, there is some movement to this excess mortality. So some of the COVID deaths are probably not getting confirmed. That may also, you know, spill over to the hospitalization issue as well. But for the overall along with the wastewater, which are the only things we have to follow, things are very favorable now, well, that stay the course over time, you know, is a 20% chance if you go through all the projections that we will see a new family beyond Omicron, whether that’s want to call it pi or sigma, whatever you want to call it, a new Greek letter family. That’s the real risk. Now things are, you know, in a relatively good state is still too many deaths concerns, as you well know, so many of those could be prevented. Many of those hospitalizations could be prevented, because they’re largely and people who didn’t get a booster who are of an advanced age. Some of them also never even got vaccinated. So the problem was, while things are pretty good right now, they could deteriorate quickly, if we saw a whole new family of variants. We might not ever see it. But this virus isn’t going away. So 20% chance over the next two years is what the consensus is and increase more over time. If you go beyond two years.

Andy Slavitt  19:36

Let’s talk about how we arrive at that 20% Because I think that’s of interest to people kind of what’s the sort of scientific basis What’s the common sense test, or what’s the reason why there’s a consensus and how broadly is that consensus felt?

Eric Topol  19:51

Yeah, so this was data that was compiled by your team, former team at the White House COVID Response Team They went to at least 10 to 12 experts who’ve been tracking COVID, you know, really closely, and some with advanced mathematics like Trevor Bradford at UW. So he came up with the highest 32% chance of an Omicron like event, the lowest was 5%. Most of the projections from the experts were between 10 and 20. But if you add them all up, or no matter how you look at it, no one thought that the chances are lower than 5%, the Max was 32%. And almost all the others were right in between. So I think based on how Omicron came along, which, as you know, raised a lot of havoc. And it was, it was by far the worst wave around the world with over 60 new mutations across the whole virus, not just in the spike protein, we could see that again. I mean, there’s so many immunocompromised people, that just one of them would have a very accelerated evolution of the virus. And if it was somehow able for that to spread to others, and then just catch major transmission chain. So it could happen, we’ve got the animal spillover potential, we’ve got all these recombinant, you know, this x BB that we got right now with X BB once dot one, six, and there’s so many recombinant with mutations added on top of them. So we’re kind of if we never see, another Greek letter family will be damn lucky. But that chance, if all the people studying this every day, think that the chances are one in five in the next two years and up from that point.

Andy Slavitt  21:41

So what one in five is that was what my next question is, it’s over what period so one in five over the next two years, and possibly higher above that. So I want to maybe it’s a good, it’s a good reason to flip the conversation to talk about the future and some of the future proofing. And the things you’ve talked about are two principal things. One is a nasal vaccine. And the other is what you call it universal vaccine. For those who don’t know, Could you just explain what those two things are and why they’re important. And then I think we’re going to talk about the good news that those things are we’re making an effort?

Eric Topol  22:19

Yes. Well, the nasal vaccine, you know, we already have seen some examples that it works exceptionally well. This was first approved from randomized trial in India. The biotech came from the Washington University, St. Louis. So it was intellectual property from Michael diamond here in the US that was licensed out to India. The idea is as a booster, on top of shots, you achieve what’s called mucosal immunity by this new vaccine whereby your upper airway is now protected. So the virus you can’t even get an infection or the chance of infection is markedly reduced. And there are so many candidates out there, there’s over 100 Nasal or oral vaccines, there’s at least a few that are going to be reporting out soon, that are in late stage trials beyond the Barrett biotech. And these on top of shots, or compared with shots provide far better immunity because they basically are where the virus gets in, they block at the earliest possible entry point rather than, you know, at a at a subsequent time when the immune system reacts or responds. So we’ve got to have nice vaccines. And interestingly, they all have appeared to be variant proof because they’re basically just setting up this barrier of sterilizing mucosal immunity, the data across the board from all the experimental studies is really quite extraordinary. So I’m confident we will have a needle vaccine, if we go after it in this country. And there are, you know, beyond the Washington University, there’s the one from Mount Sinai that’s getting in late testing in Mexico. And that’s kind of a theme here. We the academic labs in the US have come up with really great nasal vaccines, like Akiko or Saki and Yale and others, but they don’t get developed in this country because we haven’t had funding until recently to accelerate this.

Andy Slavitt  24:27

Can we talk about what the data say about how well they work?

Eric Topol  24:31

Yeah, the only from patients or from people. The only data we have is the India trial, where they haven’t released the regular efficacy they only have released as a preprint the immunologic response, but the people who got shot third shot versus who got the nasal vaccine had superior antibody neutralizing antibody, T cell response, particularly the immunoglobulin A which is the one that is the local antibody capable of achieving the so called mucosal immunity. So, we have that data. But moreover, we’ve got data from so many labs, particularly in the US, the University of Virginia, Yale, probably ten others now, that show in every experimental model, mouse, Hamster, multiple models, the shot is not as good as the nasal vaccine, in protecting against infections. And whatever variant you throw at a nasal vaccine, it doesn’t seem to make a difference. You know,

Andy Slavitt  25:39

the idea of being able to take a nasal vaccine and prevent yourself from even getting the virus to begin with would be a game changer because all of a sudden, vaccines do what people colloquially think they do, which is prevented from getting sick, as opposed to what the vaccines do today, which is prevent people largely from getting very sick. I’ve heard people say, and they may tell me if I get this right, that we have a hard time producing vaccines in areas where the body is not able to mount the immune response on its own. And that one of the reasons why creating a nasal vaccine would be harder, is because the body is not able to do it on its own. So why should we be able to expect a vaccine to be able to do that? That’s at least one of the scientific views that I’ve heard. Is that wrong?

Eric Topol  26:33

I think so. Yes. A lot of the reason that there’s not been the enthusiasm for nasal vaccines is that we only have one commercially available and it’s flu mist. And it’s not that powerful. But remember, neither are our flu shots. In terms of efficacy. The difference, I think, is the virus. So if you look at the SARS-CoV-2 profile, we have triumphed over this virus compared to flu, like for example, Paxlovid versus Tamiflu. They’re incomparable with respect to the efficacy, or the vaccines, the COVID vaccines up through when we had were hit by Omicron. far more effective than what we’ve ever seen with influenza shots. So the point is, this virus is one that we have triumphed over, and I don’t think our ability to do that to prevail with a virus with nasal vaccine is an exception to that I, I’m confident since we’ve already seen one, and we seen across so many different experimental models, that we will get this done. And up until recently, the US had not made it a priority and had no resources to get behind it.

Andy Slavitt  27:53

Right. And we’re going to talk about why that changed. But first, maybe you could just cover what the universal vaccine is and why it is important.

Eric Topol  28:00

Yeah, so this is another separate, important path. Because if the virus gets in, let’s say you had a nasal vaccine, you can take it every three or four months, or what have you still get COVID. And now, it’s a COVID, from a variant that we it’s this new family, it’s this new pie, or sigma, whatever you want to call it, well, it will look so different that it will cause a lot of challenge with respect to that the vaccines and prior infections don’t hold up that well. So that’s why we need a vaccine, a shot that is geared to take on any variation of this virus. So for example, what else could happen in the spike protein? What else in the nucleo capsid? Or the membrane envelope portion to the virus? What about portions of the virus that are conserved for every variant that you that are part and parcel of this virus that we’ve never seen change? What about T cells, all these different things that we can do with a vaccine that would basically whatever it did to us, we would have immune protection, so that it didn’t matter, whatever variant this virus could come up with in its future. And so there are now over 50 different programs that have come up with the so called broad neutralizing antibodies. Most of these identified in nature, from these treasure chest people who when they get COVID, they just make these incredible broad neutralizing antibodies. And then you use as a template for a vaccine. So there’s no shortage of candidates. But there’s a shortage of interest by the companies who make vaccines. Because if they had a choice of a universal vaccine versus an updated bi-vaillant, guess which one they would pick.

Andy Slavitt  29:58

Okay, let me take one final break. And we’re going to come back and let’s talk about some really good news surrounding all this. Okay, so now let’s talk about the very good news. Our friend, Ashish Jha, as we know is the White House are at least until you know, for the next, you know, weeks or month or so. And he heard your call for these two very specific and important things. And in his waning days there, he only had the ability with no more money from Congress to pick a couple of priorities and make a couple of decisions of things to push. We’ll just break the news for those who haven’t heard it. And what happened.

Eric Topol  31:57

Yeah, well, I think he deserves hero status for having taken on Congress. Republicans, and specifically, and just kept going after this. And finally, I think discussions with the President and the team and HHS, he was able to get $5 billion for this project, next gen, which is directed towards nasal vaccines, universal vaccines, and getting monoclonal antibodies that work again, which is kind of tied into the universal vaccine. So he did it. It’s an extraordinary accomplishment. I know that there has already been a reaction from Republican members of Congress to try to get that clawed back and not deploy those funds. But hopefully, that’s not going to happen. But he was up against a brick wall, because he even though he tried and met with so many Republicans in the Senate and Congress, he could never get support for what was needed. And ironically end, a couple of senators even wrote to President Biden saying Why aren’t there a nasal vaccine and universal vaccine programs? So we have, I think, to be indebted to Ashish Jha for his efforts here that really been extraordinary. And, of course, the whole administration for supporting this, because it’s, it’s what we need to make sure that the pandemic doesn’t come back to bite us again.

Andy Slavitt  33:26

100%, you’ve been beating this drum on these two priorities in the way that I find very effective. Because, you know, there’s a lot of good ideas out there. And I think what I really appreciated about what you did here, because you said, Let’s do these things, let’s focus on universal vaccines. Let’s focus on monoclonals, let’s focus on nasal vaccines. And you made that the priority, which is let’s this is what we should do with the next hour to spend. And Ashish was very wise, as all good people in his role due he listened to smart people around him, not just yourself, but he listened to lots of people, but including yourself. And what that allowed him to do was get the very best opinions, which is what we owe our policymakers. And I think he came to the point of view that you did, which is this is the most important thing we could do to future proof against this pandemic. And so you’re gonna be applauded for that as well. Although I know you don’t take credit for this sort of thing. I happen to know it. And I’m very appreciative.

Eric Topol  34:28

That’s really kind of you. I mean, I think what we both are centered around as Ashish and so many others, is that not only do we have the immunocompromised folks out there who we don’t have protection for them, and there’s at least 7 million Americans that fall into that category. Then we have people of older age groups that are, you know, also going to remain vulnerable even with more of these Vaillant boosters. Dr. Alan multifilament, whatever. We got to have better but most importantly, besides being ready for another We’re kind of like family of new variant. If we can do this, it puts us in good stead for the next pandemic. And as you mentioned, Andy, for non-infectious disease efforts, it’s exciting because now you know, with 5 billion, a lot can be accomplished pretty quickly. I mean, we can get these nasal vaccines into high gear, there’s several companies in the US, who just didn’t have the resources to make at scale the vaccines, even though they had good data, so just even production, no less helping to get the trials finished, the universal vaccine will take a little bit more time, but we’re gonna see some real benefits of this next gen program.

Andy Slavitt  35:44

And fascinating, you know, these are real advances that come out of this. There was one other priority that I had mentioned, that was one of the ones that has been very much on my list. And he’s also I think, gonna get done, which is making sure that as the National Health Emergency goes away, people who are uninsured, or for whatever other reason can’t get vaccines, or particular therapies paid for, we have an easy method to do that. You know, and to me, it’s Eric, if you know, somewhat of my history, like it brings together two threads that I’ve worked on separately into the same place. One was the ACA and making sure we get people access to health care, so they could take care of their families and live healthy lives. And then, and then, of course, you know, we all got thrown into this world of public health in the public health response. So I asked him to make this a priority he has already I think he would have made it a priority anyway. And he assured me, and I think we’re starting to hear reports of this, that before he leaves, this will be ironed out. And indeed, regardless of insurance status, people will have access to free vaccines and insurance.

Eric Topol  36:55

I think it’s terrific. And it’s something that you’ve worked on for years, when, you know, this is just a critical, the people who might not get a vaccine who needed so badly just because, or packs COVID, or whatever treatment comes forward, just because they couldn’t afford it because of the serious problem of health inequities in this country and access. And so it’s great that this is yet another dimension of the plane going forward. There’s a lot of dismay among people about the lack of the emergency continued status. But you know, at some point they had to go, I understand that, but at least this is one seminal protective feature that will be ongoing and so glad they got confirmed.

Andy Slavitt  37:44

Just to close, a lot of people got to know you, over the course of the pandemic, and less people think you were you know, just me, you created out of whole cloth three years ago, you’ve been working on some cool things for quite some time, some amazing things, some really cool innovations. And maybe a great way to close is it would be a way of helping people understand you a little bit better is maybe to talk about one or two of the very coolest, exciting things that either you’re working on aware of, or excited about the outside of COVID that give people that sense to the kind of the full breadth of the kind of stuff that you do in your group does.

Eric Topol  38:28

Well, thanks, Danny. I mean, the thing that is most exciting to me is understanding our uniqueness. Each of us are truly unique at multiple levels, biology, physiology, anatomy, I mean, you name it. So the fact that we can define each person’s uniqueness now with various layers of data, and AI. So when I wrote the book, deep medicine, back that was published four years ago, now, we didn’t have the way to take all that data and give it to a person to be their coach, their feedback mechanism, we have that now with these GPT4 and large language models, which is what we work on. So our group is really interested in individualized medicine. And in now, using these new models to actualize that opportunity. We, we could collect all the data before with sensors and electronic records and a genome but we couldn’t put it all together and keep a person healthy. Or if they had a condition. Manage it better.

Andy Slavitt  39:36

Give us an exciting use case for what you’re talking about. So people can really get it.

Eric Topol  39:40

Yeah, well today, let’s say you have high blood pressure or you have diabetes, there are ways to get your data continually go back to you, whether it’s your glucose or your blood pressure readings that you got and give you coaching so that you have optimal blood pressure or glucose management. But what we’re talking about is all your data, all the medical knowledge and literature so that you can prevent an illness. So let’s say, Andy, you were at high risk for asthma, by your genetics, family history and whatnot, we would have the data. So you would never wheeze in your life, never have an asthma attack, as an example, or, you know, you name a condition, whether it’s type two diabetes, an autoimmune disease, you know, heart disease, whatever, we have the capacity in the years ahead. To prevent that illness, which is a dream, it’s a fantasy, we’ve never been able to prevent anything, we always come in with secondary prevention. So it’s about having all the persons data and the medical knowledge, and the ability to help a person who’s willing to have that assist that coach effort, and we’ll get there eventually, you know, I think, to me, the generative AI is the most exciting thing I’ve seen in the healthcare space ever, ever. And we’re, obviously our group works a lot in that, and we’ve been kind of assembling the parts for the last 15 plus years, to the point we are now and it’s exciting. Obviously, there’s lots of downsides, as you well know, with the hallucinations and the bias, and, you know, lots of things that are not the holes that are not filled in, but over time, we’ll get there. And I think that the opportunities here to change medicine, the immediate one, of course, is when you go to a doctor, and you don’t even talk to the doctor, because they’re pecking on a keyboard, which is the source of profound disenchantment across all clinicians, we’ll get rid of keyboard liberation will happen in the in the foreseeable future now, and that is just the chapter one of this kind of ongoing effort. So that’s what I’m most excited about. COVID, for me was a detour. Just because I’m kind of a data centric, not in love, you know, new information, that kind of stuff.

Andy Slavitt  42:08

A real credible voice.

Eric Topol  42:11

Thank you, you know, obviously COVID is never going to really go away, we’re going to have issues of law and COVID and 10s of millions of people. It’s a horrible legacy that we haven’t come up with a no effective treatment. We’ll work on that too. But what really excites me in the future is the ability to harvest people’s data to them to prevent an illness or better manage a condition that they have. And that will be the most transformative thing we’ll see in the decades ahead for medicine.

Andy Slavitt  42:47

Well, let’s agree that as you make progress, the exciting things to talk about. You come here and we’ll do a show love to help the world see what’s been created as we particularly with generative AI, and that was standing the butts and the ifs and the wherefores, the power, the positive potential that holds for us and healthcare and our bodies in our lives. Eric Topol, you’re a gentleman, you’re a friend. Thank you for being in the bubble.

Eric Topol  43:16

It’s great to be with you Andy always a joy. Thank you.

Andy Slavitt  43:33

Alright, let me tell you what’s coming up as we move forward. With our Wednesday shows. Ben Smith, who was the former editor in chief of BuzzFeed News is going to be on. You may have seen that BuzzFeed, which was kind of a phenomenon for how people got news shutdown at the newsroom. And we’re going to talk about that phenomenon of kind of news as a viral commodity, as opposed to news is something which educates us and informs us with Ben, he’s had a lot to say on that topic. Likewise, we also have coming up on an episode, Noah Barton, who is the founder of post, if you haven’t heard a post, that’s part of the issue. Post is really set up to be the new Twitter, the kinder, gentler nun, Elon Musk version of Twitter, that his post, if we’re going to talk about that with Noah, as he tries to figure out whether or not there is a social media platform without all of the kind of negativity that can sometimes emerge on these platforms. That’s no as goal. It will be worthwhile talking to him. Thank you for tuning in. I look forward to talking to you next week.

CREDITS 44:51

Thanks for listening to IN THE BUBBLE. We’re a production of Lemonada Media. Kathryn Barnes, Jackie Harris and Kyle Shiely produced our show, and they’re great. Our mix is by Noah Smith and James Barber, and they’re great, too. Steve Nelson is the vice president of the weekly content, and he’s okay, too. And of course, the ultimate bosses, Jessica Cordova Kramer and Stephanie Wittels Wachs, they executive produced the show, we love them dearly. Our theme was composed by Dan Molad and Oliver Hill, with additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia where you’ll also get the transcript of the show. And you can find me at @ASlavitt on Twitter. If you like what you heard today, why don’t you tell your friends to listen as well, and get them to write a review. Thanks so much, talk to you next time.