Michael Mina: Rapid Testing, Viruses, and the Engineering Mindset

Lex Fridman (01:24.380)

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Michael Mina (01:26.780)

to get a discount and to support this podcast.

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As a side note, let me say that

Michael Mina (01:31.620)

I've always been solution oriented, not problem oriented.

Lex Fridman (01:35.660)

It saddens me to see that public discourse

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disproportionately focuses on the mistakes

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of those who dare to build solutions

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rather than applaud their attempt to do so.

Lex Fridman (01:46.380)

Teddy Roosevelt said it well

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in his The Man in the Arena speech over 100 years ago.

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I should say that both the critic

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and the creator are important,

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but in my humble estimation,

Michael Mina (01:59.140)

there are too many now of the former

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and not enough of the latter.

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So while we spread the derisive words

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of the critic on social media, making it viral,

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let's not forget that this world is built

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on the blood, sweat, and tears of those who dare to create.

Michael Mina (02:18.020)

If you enjoy this thing, subscribe on YouTube,

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review it with five stars on Apple Podcast,

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follow on Spotify, support on Patreon,

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or connect with me on Twitter at Lex Friedman.

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And now, here's my conversation with Michael Minna.

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What is the most beautiful, mysterious,

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or surprising idea in the biology of humans or viruses

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that you've ever come across in your work?

Michael Mina (02:41.720)

Sorry for the overly philosophical question.

Lex Fridman (02:45.260)

Wow, well that's a great question.

Michael Mina (02:47.720)

You know, I love the pathogenesis of viruses,

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and one of the things that I've worked on a lot

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is trying to understand how viruses interact with each other.

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And so pre all this COVID stuff,

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I was really, really dedicated to understanding

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how viruses impact other pathogens,

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so how if somebody gets an infection with one thing

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or a vaccine, does it either benefit or harm you

Michael Mina (03:21.660)

from other things that appear to be unrelated to most people.

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And so one system which is highly detrimental to humans,

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but what I think is just immensely fascinating, is measles.

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And measles gets into a kid's body.

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The immune system picks it up,

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and essentially grabs the virus,

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and does exactly what it's supposed to do,

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which is to take this virus

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and bring it into the immune system

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so that the immune system can learn from it,

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can develop an immune response to it.

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But instead, measles plays a trick.

Michael Mina (04:00.740)

It gets into the immune system,

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serves almost as a Trojan horse,

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and instead of getting eaten by these cells,

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it just takes them over,

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and it ends up proliferating in the very cells

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that were supposed to kill it.

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And it just distributes throughout the entire body,

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gets into the bone marrow,

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kills off children's immune memories.

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And so it essentially, what I've found

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and what my research has found is that this one virus

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was responsible for as much as half

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of all of the infectious disease deaths in kids

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before we started vaccinating against it,

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because it was just wiping out children's immune memories

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to all different pathogens,

Michael Mina (04:41.560)

which is, I think, just astounding.

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It's just amazing to watch it spread throughout bodies.

Michael Mina (04:49.000)

We've done the studies in monkeys,

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and you can watch it just destroy

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and obliterate people's immune memories

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in the same way that some parasite

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might destroy somebody's brain.

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Is that evolutionary just coincidence,

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or is there some kind of advantage

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to this kind of interactivity between pathogens?

Michael Mina (05:08.560)

Oh, I think in that sense, it's just coincidence.

Lex Fridman (05:11.740)

It probably is a, it's a good way for measles to,

Michael Mina (05:17.600)

it's a good way for measles to essentially

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be able to survive long enough to replicate in the body.

Michael Mina (05:23.180)

It just replicates in the cells

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that are meant to destroy it.

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So it's utilizing our immune cells for its own replication,

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but in so doing, it's destroying the memories

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of all the other immunological memories.

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But there are other viruses,

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so a different system is influenza,

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and flu predisposes to severe bacterial infections.

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And that, I think, is another coincidence,

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but I also think that there are some evolutionary benefits

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that bacteria may hijack

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and sort of piggyback on viral infections.

Michael Mina (05:59.460)

Viruses can, they just grow so much quicker than bacteria.

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They replicate faster,

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and so there's this system with viruses,

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with flu and bacteria,

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where the influenza has these proteins

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that cleave certain receptors,

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and the bacteria want to cleave those same receptors.

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They want to cleave the same molecules

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that gave entrance to those receptors.

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So instead, the bacteria found out, like,

Michael Mina (06:25.140)

hey, we could just piggyback on these viruses.

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They'll do it 100 or 1,000 times faster than we can.

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And so then they just piggyback on,

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and they let flu cleave all these sialic acids,

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and then the bacteria just glom on in the wake of it.

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So there's all different interactions between pathogens

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that are just remarkable.

Lex Fridman (06:45.280)

So does this whole system of viruses

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that interact with each other

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and so damn good at getting inside our bodies,

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does that fascinate you or terrify you?

Lex Fridman (06:54.880)

I'm very much a scientist,

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and so it fascinates me much more than it terrifies me.

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But knowing enough, I know just how well,

Michael Mina (07:03.540)

you know, we get the wrong virus in our population,

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whether it's through some random mutation

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or whether it's this same COVID 19 virus,

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and it, you know, these things are tricky.

Michael Mina (07:14.580)

They're able to mutate quickly.

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They're able to find new hosts

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and rearrange in the case of influenza.

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So what terrifies me is just how easily

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this particular pandemic could have been so much worse.

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This could have been a virus

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that is much worse than it is.

Lex Fridman (07:33.980)

You know, same thing with H1N1 back in 2009.

Michael Mina (07:37.340)

That terrifies me.

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If a virus like that was much more detrimental,

Michael Mina (07:43.060)

you know, that would be,

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it could be much more devastating.

Michael Mina (07:46.720)

Although it's hard to say, you know,

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the human species were, well,

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I hesitate to say that we're good at responding to things

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because there are some aspects that were,

Michael Mina (07:58.660)

this particular virus, SARS COVID 2 and COVID 19

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has found a sweet spot where it's not quite serious enough

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on an individual level that humans just don't,

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we haven't seen much of a useful response by many humans.

Michael Mina (08:14.060)

A lot of people even think it's a hoax.

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And so it's led us down this path of,

Michael Mina (08:19.420)

it's not quite serious enough

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to get everyone to respond immediately

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and with the most urgency, but it's enough,

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it's bad enough that, you know,

Michael Mina (08:27.540)

it's caused our economies to shut down and collapse.

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And so I think I know enough about virus biology

Michael Mina (08:34.180)

to be terrified for humans that, you know,

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it can, it just takes one virus,

Michael Mina (08:39.220)

just takes the wrong one to just obliterate us

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or not obliterate us,

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but really do much more damage than we've seen.

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It's fascinating to think that COVID 19

Michael Mina (08:47.540)

is a result of a virus evolving together with like Twitter,

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like figuring out how we can sneak past the defenses

Michael Mina (08:55.580)

of the humans.

Lex Fridman (08:56.820)

So it's not bad enough.

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And then the misinformation,

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all that kind of stuff together is operating

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in such a way that the virus can spread effectively.

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I wonder, I mean, obviously a virus is not intelligent,

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but there's a rhyme and a rhythm

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to the way this whole evolutionary process works

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and creates these fascinating things

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that spread throughout the entire civilization.

Michael Mina (09:23.060)

Absolutely, it's, yeah,

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I'm completely fascinated by this idea

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of social media in particular,

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how it replicates, how it grows.

Michael Mina (09:36.460)

You know, I've been, how it actually starts interacting

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with the biology of the virus, masks,

Michael Mina (09:42.860)

who's gonna get vaccinated, politics,

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like these seem so external to virus biology,

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but it's become so intertwined.

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And it's interesting.

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And I actually think we could find out

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that the virus actually becomes,

Michael Mina (10:00.580)

obviously not intentionally,

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but we could find that people choosing not to wear masks,

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choosing not to counter this virus

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in a regimented and sort of organized way,

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effectively gives the virus more opportunity to escape.

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We can look at vaccines.

Michael Mina (10:20.740)

We're about to have

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one of the most aggressive vaccination programs

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the world has ever seen.

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But we are unfortunately doing it

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right at the peak of viral transmission

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when millions and millions of people

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are still getting infected.

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And when we do that,

Michael Mina (10:37.340)

that just gives this virus so many more opportunities.

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I mean, orders of magnitude more opportunity

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to mutate around our immune system.

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Now, if we were to vaccinate everyone

Michael Mina (10:48.220)

when there's not a lot of virus,

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then there's just not a lot of virus.

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And so there's not going to be as many,

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I don't even know how many zeros are at the end

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of however many viral particles

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there are in the world right now,

Michael Mina (10:59.540)

more than quadrillions.

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And so if you assume that at any given time,

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somebody might have trillions of virus in them

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and any given individual,

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so then multiply trillions by millions

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and you get a lot of viruses out there.

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And if you start applying pressure, ecological pressure,

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to this virus, that when it's not abundant,

Michael Mina (11:21.260)

God, the opportunity for a virus to sneak around immunity,

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especially when all the vaccines are identical,

Michael Mina (11:27.860)

essentially, it's...

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All it takes is one to mutate and then jumps.

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Takes one.

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Takes one in the whole world.

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And we have to not forget

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that this particular virus was one.

Michael Mina (11:39.780)

It was one opportunity and it has spread across the globe

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and there's no reason that can't happen tomorrow anew.

Michael Mina (11:46.140)

It's scary.

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I have a million other questions in this direction,

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but I'd love to talk about one of the most exciting aspects

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of your work, which is testing or rapid testing.

Michael Mina (12:00.700)

You wrote a great article in Time on November 17th.

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This is like a month ago about rapid testing titled,

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How We Can Stop the Spread of COVID 19 by Christmas.

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Let's jot down the fact that this is a month ago.

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So maybe your timeline would be different,

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but let's say in a month.

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So you've talked about this powerful idea

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for quite a while throughout the COVID 19 pandemic.

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How do we stop the spread of COVID 19 in a month?

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Well, we use tests like these.

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So the only reason the virus continues spreading

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is because people spread it to each other.

Michael Mina (12:39.380)

This isn't magic.

Lex Fridman (12:41.060)

Yes.

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And so there's a few ways to stop the virus

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from spreading to each other.

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And that is you either can vaccinate everyone

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and vaccinating everyone is a way to immunologically

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prevent the virus from growing inside of somebody

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and therefore spreading.

Michael Mina (12:58.760)

We don't know yet actually if this vaccine,

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if any of these vaccines are going to

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prevent onward transmission.

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So that may or may not serve to be one opportunity.

Michael Mina (13:10.060)

Certainly I think it will decrease transmission.

Lex Fridman (13:12.680)

But the other idea that we have at our disposal now,

Michael Mina (13:16.220)

we had it in May, we had it in June,

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July, August, September, October, November,

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and now it's December.

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We still have it.

Michael Mina (13:23.720)

We still choose not to use it in this country

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and in much of the world.

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And that's rapid testing.

Lex Fridman (13:29.300)

That is giving, it's empowering people to know

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that they are infected and giving them the opportunity

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to not spread it to their loved ones

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and their friends and neighbors and whoever else.

Lex Fridman (13:41.860)

We could have done this.

Michael Mina (13:43.640)

We still can.

Lex Fridman (13:44.740)

Today we could start.

Michael Mina (13:46.380)

We have millions of these tests.

Lex Fridman (13:48.540)

These tests are simple paper strip tests.

Michael Mina (13:51.820)

They are, inside of this thing

Lex Fridman (13:54.660)

is just a little piece of paper.

Michael Mina (13:58.000)

Now I can actually open it up here.

Lex Fridman (14:00.340)

There we go.

Lex Fridman (14:01.540)

So this, this is how we do it right here.

Lex Fridman (14:05.260)

We have this little paper strip test.

Michael Mina (14:08.140)

This is enough to let you know if you're infectious.

Lex Fridman (14:11.160)

With somewhere around the order of 99% sensitivity,

Michael Mina (14:14.700)

99% specificity, you can know

Lex Fridman (14:18.100)

if you have infectious virus in you.

Michael Mina (14:20.820)

If we can get these out to everyone's homes,

Lex Fridman (14:23.220)

build these, make 10 million, 20 million,

Michael Mina (14:25.220)

30 million of them a day.

Lex Fridman (14:26.820)

You know, we make more bottles of Dasani water every day.

Michael Mina (14:30.500)

We can make these little paper strip tests.

Lex Fridman (14:33.500)

And if we do that and we get these into people's homes

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so that they can use them twice a week,

Lex Fridman (14:39.060)

then we can know if we're infectious.

Lex Fridman (14:41.980)

You know, is it perfect?

Lex Fridman (14:43.140)

Absolutely not.

Lex Fridman (14:44.060)

But is it near perfect?

Lex Fridman (14:45.140)

Absolutely.

Michael Mina (14:46.340)

You know, and so if we can say,

Lex Fridman (14:48.540)

hey, the transmission of this is, you know,

Michael Mina (14:51.380)

for every hundred people that get infected right now,

Lex Fridman (14:54.720)

they go on to infect maybe 130 additional people.

Lex Fridman (14:57.980)

And that's exponential growth.

Lex Fridman (14:59.180)

So a hundred becomes 130.

Michael Mina (15:01.340)

A couple of days later that 130 becomes

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another 165 people have now been infected.

Lex Fridman (15:08.660)

And you know, go over three weeks

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and a hundred people become 500 people infected.

Michael Mina (15:13.940)

Now it doesn't take much to have those hundred people

Lex Fridman (15:17.080)

not infect 130, but infect 90.

Michael Mina (15:20.760)

All we have to do is remove say 30, 40% of new infections

Lex Fridman (15:24.540)

from continuing their spread.

Lex Fridman (15:26.300)

And then instead of exponential growth,

Lex Fridman (15:28.060)

you have exponential decay.

Lex Fridman (15:30.060)

So this doesn't need to be perfect.

Lex Fridman (15:32.020)

We don't have to go from a hundred to zero.

Michael Mina (15:34.180)

We just have to go and have those hundred people infect 90

Lex Fridman (15:37.300)

and those 90 people infect, you know, 82,

Michael Mina (15:40.660)

whatever it might be.

Lex Fridman (15:41.820)

And you do that for a few weeks and boom,

Michael Mina (15:43.760)

you have now gone instead of a hundred to 500,

Lex Fridman (15:45.780)

you've gone from a hundred to 20.

Michael Mina (15:48.060)

It's not very hard.

Lex Fridman (15:49.740)

And so the way to do that is to let people know

Michael Mina (15:54.300)

that they're infectious.

Lex Fridman (15:55.300)

I mean, we're a perfect example right now.

Michael Mina (15:58.780)

This morning I used these tests to make sure

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that I wasn't infectious.

Lex Fridman (16:03.700)

Is it perfect?

Lex Fridman (16:04.540)

No, but it reduced my odds 99%.

Michael Mina (16:06.900)

I already was at extremely low odds

Lex Fridman (16:08.660)

because I spend my life quarantining these days.

Michael Mina (16:11.520)

Well, the interesting thing with this test,

Lex Fridman (16:13.780)

with the testing in general,

Michael Mina (16:15.040)

which is why I love what you've been espousing,

Lex Fridman (16:17.380)

is it's really confusing to me that this has not been

Michael Mina (16:20.220)

taken on as it's one actual solution

Lex Fridman (16:24.700)

that was available for a long time.

Michael Mina (16:28.740)

There doesn't seem to have been solutions proposed

Lex Fridman (16:33.780)

at a large scale and a solution that it seems

Michael Mina (16:36.860)

like a lot of people would be able to get behind.

Lex Fridman (16:38.840)

There's some politicization or fear of other solutions

Michael Mina (16:44.240)

that people have proposed, which is like lockdown.

Lex Fridman (16:47.100)

And there's a worry, you know,

Michael Mina (16:48.260)

especially in the American spirit of freedom,

Lex Fridman (16:50.740)

like you can't tell me what to do.

Michael Mina (16:52.640)

The thing about tests is it like empowers you

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with information essentially.

Lex Fridman (16:59.100)

So like it gives you more information about your,

Lex Fridman (17:06.180)

like your role in this pandemic,

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and then you can do whatever the hell you want.

Lex Fridman (17:10.420)

Like it's all up to your ethics and so on.

Lex Fridman (17:13.020)

So like, and it's obvious that with that information,

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people would be able to protect their loved ones

Lex Fridman (17:19.500)

and also do their sort of quote unquote duty

Lex Fridman (17:23.580)

for their country, right?

Michael Mina (17:25.000)

Is protect the rest of the country.

Lex Fridman (17:26.820)

That's exactly right.

Michael Mina (17:27.820)

I mean, it's just, it's empowerment,

Lex Fridman (17:30.300)

but you know, this is a problem.

Michael Mina (17:32.220)

We have not put these into action in large part

Lex Fridman (17:35.280)

because we have a medical industry

Michael Mina (17:37.860)

that doesn't want to see them be used.

Lex Fridman (17:40.200)

We have a political and a regulatory industry

Michael Mina (17:44.140)

that doesn't want to see them be used.

Lex Fridman (17:45.620)

That sounds crazy.

Lex Fridman (17:46.500)

Why wouldn't they want them to be used?

Lex Fridman (17:48.820)

We have a very paternalistic approach

Michael Mina (17:51.180)

to everything in this country.

Lex Fridman (17:52.620)

You know, despite this country kind of being founded

Michael Mina (17:55.500)

on this individualistic ideal,

Lex Fridman (17:58.340)

pull yourself up from your bootstraps, all that stuff.

Michael Mina (18:01.420)

When it comes to public health,

Lex Fridman (18:03.240)

we have a bunch of ivory tower academics who want data.

Michael Mina (18:09.300)

They, you know, they want to see perfection.

Lex Fridman (18:12.340)

And we have this issue of letting perfection

Michael Mina (18:15.900)

get in the way of actually doing something at all,

Lex Fridman (18:19.500)

you know, doing something effective.

Lex Fridman (18:21.500)

And so we keep comparing these tests, for example,

Lex Fridman (18:25.080)

to the laboratory based PCR test.

Lex Fridman (18:27.980)

And sure, this isn't a PCR test,

Lex Fridman (18:30.780)

but this doesn't cost a hundred dollars

Lex Fridman (18:32.440)

and it doesn't take five days to get back,

Lex Fridman (18:34.740)

which means in every single scenario,

Michael Mina (18:36.780)

this is the more effective test.

Lex Fridman (18:38.860)

And we have, unfortunately, a system

Michael Mina (18:41.700)

that's not about public health.

Lex Fridman (18:42.940)

We have entirely eroded any ideals of public health

Michael Mina (18:48.180)

in our country for the biomedical complex,

Lex Fridman (18:51.340)

you know, this medical industrial complex,

Michael Mina (18:53.220)

which overrides everything.

Lex Fridman (18:55.260)

And that's why, you know, I'm just,

Lex Fridman (18:58.620)

can I swear on this pot?

Lex Fridman (18:59.700)

Yes.

Michael Mina (19:00.540)

I'm just so fucking pissed that these tests don't exist.

Lex Fridman (19:06.160)

Meanwhile, and everyone says, you know,

Michael Mina (19:08.460)

oh, we couldn't make these, you know,

Lex Fridman (19:10.100)

that we could never do it.

Michael Mina (19:11.180)

That would be such a hard, a difficult problem.

Lex Fridman (19:14.380)

Meanwhile, the vaccine gets,

Michael Mina (19:16.260)

we have at the same time that we could have gotten

Lex Fridman (19:18.740)

these stupid little paper strip tests out to every household,

Michael Mina (19:22.020)

we have developed a brand new vaccine.

Lex Fridman (19:25.300)

We've gone through phase one, phase two, phase three trials.

Michael Mina (19:27.980)

We've scaled up its production.

Lex Fridman (19:29.980)

And now we have UPS and FedEx

Lex Fridman (19:31.860)

and all the logistics in the world,

Lex Fridman (19:33.800)

getting freezers out to where they need to be.

Michael Mina (19:35.860)

We have this immense, we see when it comes to sort of

Lex Fridman (19:39.260)

medicine, you know, something you're injecting into somebody,

Michael Mina (19:42.380)

then all of a sudden people say, oh, yes we can.

Lex Fridman (19:45.520)

But you say, oh no, that's too simple a solution,

Michael Mina (19:48.640)

too cheap a solution.

Lex Fridman (19:49.740)

No way could we possibly do that.

Michael Mina (19:52.140)

It's this faulty thinking in our country,

Lex Fridman (19:54.020)

which, you know, frankly is driven by big money, big,

Michael Mina (19:58.340)

you know, the only time when we actually think

Lex Fridman (1:00:01.580)

Even more.

Michael Mina (1:00:02.940)

The vaccine rollout isn't gonna be as peachy

Lex Fridman (1:00:05.620)

as everyone is hoping.

Lex Fridman (1:00:07.940)

And I hate to be the Debbie Downer here,

Lex Fridman (1:00:09.420)

but there's a lot of unknowns with this vaccine.

Michael Mina (1:00:13.540)

You've already mentioned one,

Lex Fridman (1:00:14.620)

which is there's a lot of people

Michael Mina (1:00:16.100)

who just don't want to get the vaccine.

Lex Fridman (1:00:19.220)

I hope that that might change as things move forward

Lex Fridman (1:00:21.420)

and people see their neighbors getting it

Lex Fridman (1:00:23.060)

and their family getting it and it's safe and all.

Michael Mina (1:00:25.580)

We don't know how effective the vaccine is gonna be

Lex Fridman (1:00:27.580)

after two or three months.

Michael Mina (1:00:28.620)

We've only measured it in the first two or three months,

Lex Fridman (1:00:30.900)

which is a massive problem,

Michael Mina (1:00:33.180)

which we can go into biologically,

Lex Fridman (1:00:35.100)

because there's very good reasons to believe

Michael Mina (1:00:38.180)

that the efficacy could fall way down

Lex Fridman (1:00:40.100)

after two or three months.

Michael Mina (1:00:42.420)

We don't know if it's gonna stop transmission.

Lex Fridman (1:00:44.540)

And if it doesn't stop transmission,

Michael Mina (1:00:46.940)

then there's, you know,

Lex Fridman (1:00:48.340)

herd immunity is much, much more difficult to get

Michael Mina (1:00:50.820)

because that's all based on transmission blockade.

Lex Fridman (1:00:54.580)

And frankly, we don't know how easily

Michael Mina (1:00:57.580)

we're going to be able to roll it out.

Lex Fridman (1:00:58.860)

Some of the vaccines need really significant cold chains,

Michael Mina (1:01:01.580)

have very short half lives outside of that cold chain.

Lex Fridman (1:01:05.700)

We need to organize massive numbers of people

Michael Mina (1:01:10.300)

to be able to distribute these.

Lex Fridman (1:01:11.420)

Most hospitals today are saying that they're not equipped

Michael Mina (1:01:14.740)

to hire the right people

Lex Fridman (1:01:16.060)

to be even administering enough of these vaccines.

Lex Fridman (1:01:19.140)

And then a lot of the hospitals

Lex Fridman (1:01:20.220)

are frustrated because they're getting much lower,

Michael Mina (1:01:22.140)

smaller allocations than they were expecting.

Lex Fridman (1:01:24.860)

So I think right now, like you say,

Michael Mina (1:01:28.860)

right now is the best time,

Lex Fridman (1:01:31.540)

you know, besides three or four or five or six months ago,

Michael Mina (1:01:34.460)

right now is the best time to get these rapid tests out.

Lex Fridman (1:01:38.020)

And we need to, I mean,

Michael Mina (1:01:39.860)

the country has the capacity to build them.

Lex Fridman (1:01:42.380)

We have, we're shipping them overseas right now.

Michael Mina (1:01:45.340)

We just need to flip a switch,

Lex Fridman (1:01:47.020)

get the FDA to recognize

Michael Mina (1:01:48.460)

that there's more important things than diagnostic medicine,

Lex Fridman (1:01:51.460)

which is the effectiveness of the public health program

Michael Mina (1:01:54.860)

when we're dealing with a pandemic.

Lex Fridman (1:01:57.300)

They need to authorize these as public health tools,

Michael Mina (1:02:00.540)

or, you know, frankly, the president could,

Lex Fridman (1:02:05.700)

you know, there's a lot of other ways to get these tests

Michael Mina (1:02:08.540)

to not have to go through

Lex Fridman (1:02:09.660)

the normal FDA authorization program,

Lex Fridman (1:02:11.740)

but maybe have the NIH and the CDC give a stamp of approval.

Lex Fridman (1:02:15.940)

And if we could, we could get these out tomorrow.

Lex Fridman (1:02:19.100)

And that's where that article came from,

Lex Fridman (1:02:20.700)

you know, how we can stop the spread of this virus

Michael Mina (1:02:23.500)

by Christmas, we could, you know, now it's getting late.

Lex Fridman (1:02:26.900)

And so we have to keep updating that timeframe,

Michael Mina (1:02:30.180)

maybe putting Christmas in the title wasn't,

Lex Fridman (1:02:32.060)

I should have said how we can stop

Michael Mina (1:02:33.580)

the spread of this virus in a month.

Lex Fridman (1:02:35.540)

It would be a little bit more timeless,

Lex Fridman (1:02:37.220)

but we could do it, you know, we really could do it.

Lex Fridman (1:02:40.620)

And that's the most frustrating part here is that

Michael Mina (1:02:43.700)

we're just choosing not to as a country.

Lex Fridman (1:02:46.460)

We're choosing to bankrupt our society

Michael Mina (1:02:48.820)

because some people at the FDA and other places

Lex Fridman (1:02:52.980)

just can't seem to get their head around the fact

Michael Mina (1:02:54.980)

that this is a public health problem,

Lex Fridman (1:02:56.460)

not a bunch of medical problems.

Lex Fridman (1:02:58.140)

Is there a way to change that policy wise?

Lex Fridman (1:03:00.500)

So this is a much bigger thing that you're speaking to,

Michael Mina (1:03:03.260)

which I love in terms of the MIT engineering approach

Lex Fridman (1:03:09.780)

to public health.

Lex Fridman (1:03:11.500)

Is there a way to push this?

Lex Fridman (1:03:13.260)

Is this a political thing?

Michael Mina (1:03:14.980)

Like where some Andrew Yang type characters

Lex Fridman (1:03:17.580)

need to like start screaming about it?

Michael Mina (1:03:20.420)

Is it more of an Elon Musk thing

Lex Fridman (1:03:24.380)

where people just need to build it

Lex Fridman (1:03:26.100)

and then on Twitter start talking crap

Lex Fridman (1:03:28.780)

to politicians for not doing it?

Lex Fridman (1:03:31.320)

What are the ideas here?

Lex Fridman (1:03:34.820)

I think it's a little of both.

Michael Mina (1:03:37.140)

I think it's political on the one hand,

Lex Fridman (1:03:38.860)

and I've certainly been talking to Congress a lot,

Michael Mina (1:03:41.100)

talking to senators.

Lex Fridman (1:03:42.420)

Are they receptive?

Michael Mina (1:03:43.380)

Oh, yeah.

Lex Fridman (1:03:44.220)

I mean, that's the crazy thing.

Michael Mina (1:03:45.360)

Everyone but the FDA is receptive.

Lex Fridman (1:03:47.900)

I mean, it's astounding.

Michael Mina (1:03:49.240)

I mean, I advise, informally I advise the president

Lex Fridman (1:03:53.380)

and the president elects teams.

Michael Mina (1:03:55.740)

I talk to Congress, I talk to senators, governors,

Lex Fridman (1:04:01.140)

and then all the way down to mayors of towns and things.

Lex Fridman (1:04:05.020)

And I mean, months ago I held a round table discussion

Lex Fridman (1:04:08.900)

with Mayor Garcetti, who's the mayor of LA,

Lex Fridman (1:04:12.100)

and I brought all the companies who make these things.

Lex Fridman (1:04:15.340)

This was in like July or August or something.

Michael Mina (1:04:17.140)

I brought all the companies to the table

Lex Fridman (1:04:18.540)

and said, okay, how can we get these out?

Lex Fridman (1:04:21.180)

And unfortunately, it went nowhere

Lex Fridman (1:04:23.500)

because the FDA won't authorize them

Michael Mina (1:04:25.860)

as public health tools.

Lex Fridman (1:04:28.980)

The nice thing is that this is one of the nice

Lex Fridman (1:04:31.100)

and frustrating things.

Lex Fridman (1:04:32.040)

This is one of the few bipartisan things that I know of.

Lex Fridman (1:04:35.180)

And like you said, it's a real solution.

Lex Fridman (1:04:38.340)

Lockdowns aren't a solution.

Michael Mina (1:04:40.220)

They're an emergency bandaid to a catastrophe

Lex Fridman (1:04:45.820)

that's currently happening.

Michael Mina (1:04:46.960)

They're not a solution.

Lex Fridman (1:04:48.140)

And they're definitely not a public health solution

Michael Mina (1:04:51.060)

if we're taking a more holistic view of public health,

Lex Fridman (1:04:53.240)

which includes people's wellbeing,

Michael Mina (1:04:55.700)

includes their psychological wellbeing,

Lex Fridman (1:04:57.460)

their financial wellbeing.

Michael Mina (1:04:59.620)

Just stopping a virus if it means

Lex Fridman (1:05:01.400)

that all those other things get thrown under the bus

Michael Mina (1:05:03.840)

is not a public health solution.

Lex Fridman (1:05:05.680)

It's a myopic or very tunnel visioned approach

Michael Mina (1:05:11.380)

to a virus that's spreading.

Lex Fridman (1:05:14.460)

This is a simple solution with essentially no downfall.

Michael Mina (1:05:20.340)

There is nothing bad about this.

Lex Fridman (1:05:22.060)

It's just giving people a result.

Lex Fridman (1:05:25.500)

And it's bipartisan.

Lex Fridman (1:05:27.580)

The most conservative and the most liberal people,

Michael Mina (1:05:30.540)

everyone just wants to know their status.

Lex Fridman (1:05:32.500)

Nobody wants to have to wait in line for four hours

Michael Mina (1:05:35.700)

to find out their status on Monday,

Lex Fridman (1:05:39.380)

a week later, on Saturday.

Michael Mina (1:05:40.860)

It just doesn't make any sense.

Lex Fridman (1:05:41.980)

It's a useless test at that point.

Lex Fridman (1:05:43.700)

And everyone recognizes that.

Lex Fridman (1:05:45.460)

So why do you think, like the mayor of LA,

Lex Fridman (1:05:49.380)

why do you think politicians are going for these,

Lex Fridman (1:05:54.540)

from my perspective, like kind of half ass lockdowns,

Michael Mina (1:05:58.060)

which is not, so I have seen good evidence

Lex Fridman (1:06:01.440)

that like a complete lockdown can work,

Lex Fridman (1:06:04.700)

but that's in theory, it's just like communism in theory

Lex Fridman (1:06:07.740)

can work.

Michael Mina (1:06:09.540)

Like theoretically speaking, but it just doesn't,

Lex Fridman (1:06:12.100)

at least in this country, we don't,

Michael Mina (1:06:14.740)

I think it's just impossible to have complete lockdown.

Lex Fridman (1:06:17.180)

And still politicians are going for these kind of lockdowns

Michael Mina (1:06:21.900)

that everybody hates,

Lex Fridman (1:06:24.020)

that's really hurting small businesses.

Lex Fridman (1:06:28.420)

Like why are they going for that?

Lex Fridman (1:06:29.260)

And big businesses, and yeah, all businesses,

Lex Fridman (1:06:32.700)

but like basically not just hurting,

Lex Fridman (1:06:35.660)

they're destroying small businesses, right?

Michael Mina (1:06:38.660)

Which is going to have potentially, I mean,

Lex Fridman (1:06:43.380)

yeah, I've been reading as I don't shut up

Michael Mina (1:06:47.300)

about the rise and fall of the Third Reich,

Lex Fridman (1:06:49.780)

and there's economic effects that take a decade to,

Michael Mina (1:06:57.420)

there's going to be long lasting effects

Lex Fridman (1:06:58.940)

that may be destructive to the very fabric of this nation.

Lex Fridman (1:07:02.460)

So why are they doing it,

Lex Fridman (1:07:04.500)

and why are they not using the solution?

Lex Fridman (1:07:06.260)

Is there any intuition?

Lex Fridman (1:07:07.700)

I mean, you've said that FDA has a stranglehold, I guess,

Michael Mina (1:07:11.680)

on this whole public health problem.

Lex Fridman (1:07:14.820)

Is that all it is?

Michael Mina (1:07:16.260)

That's honestly, it's pretty much all it is.

Lex Fridman (1:07:20.100)

The companies, so somebody like Mayor Garcetti

Michael Mina (1:07:23.700)

or Governor Baker, Cuomo, Newsom,

Lex Fridman (1:07:27.780)

any of these, DeWine, I've talked to a lot of governors

Michael Mina (1:07:31.860)

in this country at this point,

Lex Fridman (1:07:34.740)

and of course the federal government,

Michael Mina (1:07:36.740)

including the president's own teams,

Lex Fridman (1:07:40.300)

and the heads of the NIH, the heads of the CDC about this.

Michael Mina (1:07:45.820)

The problem is the tests don't exist in this country

Lex Fridman (1:07:50.040)

at the level that we need them to right now

Michael Mina (1:07:53.360)

to make that kind of policy, to make that kind of program.

Lex Fridman (1:07:57.140)

They could, but they don't.

Lex Fridman (1:07:59.140)

And so what that means is that when Mayor Garcetti says,

Lex Fridman (1:08:03.040)

okay, what are my actual options today,

Michael Mina (1:08:06.780)

despite these sounding like a great idea,

Lex Fridman (1:08:08.620)

he looks around and he says, well, they're not authorized.

Michael Mina (1:08:11.700)

They don't exist right now for at home use.

Lex Fridman (1:08:15.300)

And from his perspective,

Michael Mina (1:08:16.420)

he's not about to pick that fight with the FDA,

Lex Fridman (1:08:19.040)

and it turns out nobody is.

Lex Fridman (1:08:20.980)

Why are people afraid of,

Lex Fridman (1:08:22.580)

it seems like an easy struggle to fight.

Michael Mina (1:08:25.140)

It's like a...

Lex Fridman (1:08:25.980)

So they don't see it as a fight.

Michael Mina (1:08:28.260)

They think that the FDA is the end all be all.

Lex Fridman (1:08:31.660)

Everyone thinks the FDA is the end all be all.

Lex Fridman (1:08:34.680)

And so they just defer, everyone is deferential,

Lex Fridman (1:08:37.760)

including the heads of all the other government agencies

Michael Mina (1:08:40.820)

because that is their role.

Lex Fridman (1:08:42.380)

But what everyone is failing to see

Michael Mina (1:08:44.980)

is that the FDA doesn't even have a mandate or a remit

Lex Fridman (1:08:48.640)

to evaluate these tests as public health tools.

Lex Fridman (1:08:50.820)

So they're just falling in this weird gray zone

Lex Fridman (1:08:53.860)

where the FDA is saying, look,

Michael Mina (1:08:56.300)

we evaluate medical products.

Lex Fridman (1:08:57.980)

That's the only thing that I meant,

Michael Mina (1:08:59.500)

like Tim Stenzel, head of in vitro diagnostics at the FDA,

Lex Fridman (1:09:02.740)

he's doing what his job is,

Michael Mina (1:09:04.900)

which is to evaluate medical tools.

Lex Fridman (1:09:09.220)

Unfortunately, this is where I think the CDC

Michael Mina (1:09:12.340)

has really blundered.

Lex Fridman (1:09:13.820)

They haven't made the right distinction to say, look,

Michael Mina (1:09:17.060)

okay, the FDA is evaluating these for doctors to use

Lex Fridman (1:09:20.380)

and all that, but we're the CDC

Lex Fridman (1:09:23.260)

and we're the public health agency of this country

Lex Fridman (1:09:25.380)

and we recognize that these tools

Michael Mina (1:09:27.940)

require a different authorization pathway

Lex Fridman (1:09:30.080)

and a different use, not prescription.

Michael Mina (1:09:30.920)

There's a difference between medical devices

Lex Fridman (1:09:33.700)

and public health.

Lex Fridman (1:09:35.340)

And I guess FDA is not designed for this public health,

Lex Fridman (1:09:38.500)

especially in emergency situations.

Lex Fridman (1:09:40.660)

And they actually explicitly say that.

Lex Fridman (1:09:43.780)

I mean, when I go and talk to Tim,

Lex Fridman (1:09:46.340)

and he's a very reasonable guy,

Lex Fridman (1:09:48.540)

but when I talk to him, he says,

Michael Mina (1:09:50.660)

look, we don't, we just do not evaluate

Lex Fridman (1:09:55.220)

a public health tool.

Michael Mina (1:09:56.060)

If you're telling me this is a public health tool,

Lex Fridman (1:09:57.500)

great, go and use it.

Lex Fridman (1:09:59.240)

And so I say, okay, great, we'll go and use it.

Lex Fridman (1:10:03.760)

And then the comment is,

Lex Fridman (1:10:05.420)

but does it give a result back to somebody?

Lex Fridman (1:10:08.780)

I say, well, yes, of course it gives a result

Michael Mina (1:10:11.060)

back to somebody, it's being done in their home.

Lex Fridman (1:10:13.300)

So then it's defined as a medical tool, can't use it.

Lex Fridman (1:10:16.400)

So it's stuck in this gray zone where unfortunately,

Lex Fridman (1:10:19.620)

there's this weird definition that any tool,

Michael Mina (1:10:21.780)

any test that gives a result back to an individual

Lex Fridman (1:10:25.260)

is defined by CMS, Centers for Medicaid Services,

Michael Mina (1:10:29.660)

as a medical device requiring medical authorization.

Lex Fridman (1:10:34.900)

But then you go and ask, it gets crazier,

Michael Mina (1:10:36.900)

because then you go and ask Seema Verma,

Lex Fridman (1:10:38.900)

the head of CMS, you know, okay,

Michael Mina (1:10:43.020)

can these be authorized as public health tools

Lex Fridman (1:10:47.340)

and not fall under your definition of a medical device?

Lex Fridman (1:10:50.100)

So then the FDA doesn't have to be the ones

Lex Fridman (1:10:52.200)

authorizing it as a public health tool.

Lex Fridman (1:10:54.700)

And Seema Verma says, oh, we don't have any jurisdiction

Lex Fridman (1:10:59.060)

over point of care and sort of rapid devices like this.

Michael Mina (1:11:04.620)

We only have jurisdiction over lab devices.

Lex Fridman (1:11:07.420)

So it's like nobody has ownership over it,

Michael Mina (1:11:10.340)

which means that they just keep,

Lex Fridman (1:11:11.660)

they stay in this purgatory of not being approved.

Lex Fridman (1:11:15.260)

And so this is where I think, frankly, it needs a president.

Lex Fridman (1:11:18.480)

It needs a presidential order to just unlock them,

Michael Mina (1:11:21.040)

to say this is more important than having a prescription.

Lex Fridman (1:11:25.900)

And in fact, I mean, really what's happening now,

Michael Mina (1:11:28.240)

because there is this sense that tests

Lex Fridman (1:11:31.280)

are public health tools,

Michael Mina (1:11:32.760)

even if they're not being defined as such,

Lex Fridman (1:11:35.140)

the FDA now is pretty much,

Michael Mina (1:11:37.100)

not only are they not authorizing these

Lex Fridman (1:11:39.100)

as public health tools,

Lex Fridman (1:11:41.140)

what they're doing by authorizing

Lex Fridman (1:11:43.700)

what are effectively public health tools as medical devices,

Michael Mina (1:11:47.500)

they're just diluting down the practice of medicine.

Lex Fridman (1:11:50.620)

I mean, his answer right now, unfortunately is,

Michael Mina (1:11:54.240)

well, I don't know why you want these to be

Lex Fridman (1:11:56.940)

sort of available to everyone without a prescription.

Michael Mina (1:11:58.940)

We've already said that a doctor can write

Lex Fridman (1:12:01.240)

a whole prescription for a whole college campus.

Michael Mina (1:12:04.780)

It's like, well, if you're going in that direction then,

Lex Fridman (1:12:06.580)

and that's no longer medicine,

Michael Mina (1:12:08.660)

having a doctor write a prescription for a college campus,

Lex Fridman (1:12:11.580)

for everyone on the campus to have repeat testing,

Michael Mina (1:12:14.360)

now we're just in the territory of eroding medicine

Lex Fridman (1:12:18.780)

and eroding all of the legal rules

Lex Fridman (1:12:20.860)

and reasons that we have prescriptions in the first place.

Lex Fridman (1:12:23.820)

So it's just everything about it is just destructive

Michael Mina (1:12:27.140)

instead of just making a simple solution,

Lex Fridman (1:12:29.900)

which is these are okay as public health tools

Michael Mina (1:12:32.980)

as long as they meet X and Y metrics,

Lex Fridman (1:12:35.500)

go and CDC can put their stamp of approval on them.

Lex Fridman (1:12:38.140)

What do you think, sorry if I'm stuck on this,

Lex Fridman (1:12:41.660)

your mention of MIT and public health engineering, right?

Michael Mina (1:12:47.260)

I mean, it has a sense of,

Lex Fridman (1:12:49.100)

I talked to computational biology folks.

Michael Mina (1:12:51.380)

It's always exciting to see computer scientists

Lex Fridman (1:12:54.140)

start entering the space of biology.

Lex Fridman (1:12:56.140)

And there's actually a lot of exciting things

Lex Fridman (1:12:58.100)

that happen because of that,

Michael Mina (1:12:59.780)

trying to understand the fundamentals of biology.

Lex Fridman (1:13:03.060)

So from the engineering approach to public health,

Lex Fridman (1:13:07.400)

what kind of problems do you think can be tackled?

Lex Fridman (1:13:09.660)

What kind of disciplines are involved?

Lex Fridman (1:13:11.580)

Like, do you have ideas in this space?

Lex Fridman (1:13:14.200)

Oh yeah.

Michael Mina (1:13:15.040)

I mean, I can speak to one of the major activities

Lex Fridman (1:13:19.600)

that I wanna do.

Lex Fridman (1:13:20.440)

So what I normally do in my research lab

Lex Fridman (1:13:22.180)

is develop technologies that can take a drop

Michael Mina (1:13:26.260)

of somebody's blood or some saliva

Lex Fridman (1:13:27.940)

and profile for hundreds of thousands

Michael Mina (1:13:30.560)

of different antibodies against every single pathogen

Lex Fridman (1:13:33.300)

that somebody could be possibly exposed to.

Michael Mina (1:13:35.540)

That's awesome.

Lex Fridman (1:13:36.380)

So this is all new technology

Michael Mina (1:13:38.300)

that we've been developing more

Lex Fridman (1:13:39.440)

from a bioengineering perspective.

Lex Fridman (1:13:43.100)

But then I use a lot of the mathematics tools

Lex Fridman (1:13:47.700)

to A, interpret that.

Lex Fridman (1:13:49.380)

But what I really wanna do, for example,

Lex Fridman (1:13:51.020)

to kind of kick off this new field

Michael Mina (1:13:52.680)

of what I consider public health engineering

Lex Fridman (1:13:55.260)

is to create, maybe it's a little ambitious,

Lex Fridman (1:13:57.640)

but create a weather system for viruses.

Lex Fridman (1:14:02.260)

I want us to be able to open up our iPhones,

Michael Mina (1:14:06.100)

plug in our zip code and get a better sense,

Lex Fridman (1:14:08.820)

get a probability of why my kid has a runny nose today.

Lex Fridman (1:14:11.700)

Is it COVID?

Lex Fridman (1:14:13.060)

Is it a rhinovirus, an adenovirus, or is it flu?

Lex Fridman (1:14:16.500)

And we can do that.

Lex Fridman (1:14:17.980)

We can start building the rules of virus spread

Michael Mina (1:14:21.100)

across the globe, both for pandemic preparedness,

Lex Fridman (1:14:24.300)

but also for just everyday use in the same way

Michael Mina (1:14:28.900)

that people used to think that predicting the weather

Lex Fridman (1:14:31.180)

was gonna be impossible.

Michael Mina (1:14:33.220)

Of course, we know that's not impossible now.

Lex Fridman (1:14:34.860)

Is it always perfect?

Michael Mina (1:14:35.740)

No, but does it offer, does it completely change the way

Lex Fridman (1:14:39.780)

that we go about our days?

Michael Mina (1:14:42.260)

Absolutely.

Lex Fridman (1:14:44.380)

I envision, for example, right now,

Michael Mina (1:14:46.860)

we open up our iPhone, we plug in a zip code,

Lex Fridman (1:14:50.100)

and if it tells us it's gonna rain today,

Michael Mina (1:14:51.860)

we bring an umbrella.

Lex Fridman (1:14:53.380)

So in the future, it tells us,

Michael Mina (1:14:56.100)

hey, there's a lot of SARS CoV2 in your community.

Lex Fridman (1:14:59.660)

Instead of grabbing your umbrella, you grab your mask.

Michael Mina (1:15:02.500)

We don't have to have masks all the time.

Lex Fridman (1:15:05.260)

But if we know the rules of the game

Michael Mina (1:15:07.380)

that these viruses play by,

Lex Fridman (1:15:09.340)

we can start preparing for those.

Lex Fridman (1:15:10.820)

And every year, we go into every flu season blindfolded

Lex Fridman (1:15:15.900)

with our hands tied behind our back, just saying,

Michael Mina (1:15:18.700)

I hope this isn't a bad flu season this year.

Lex Fridman (1:15:21.660)

I don't, I mean, this is, we're in the 21st century.

Michael Mina (1:15:28.980)

We have the tools at our disposal now

Lex Fridman (1:15:31.140)

to not have that attitude.

Michael Mina (1:15:32.740)

This isn't like 1920s.

Lex Fridman (1:15:35.420)

You know, we can just say,

Michael Mina (1:15:37.380)

hey, this is gonna be a bad flu season this year.

Lex Fridman (1:15:40.500)

Let's act accordingly and with a targeted approach.

Michael Mina (1:15:44.780)

You know, we don't, for example,

Lex Fridman (1:15:47.060)

we don't just use our umbrellas all day long,

Michael Mina (1:15:50.300)

every single day, in case it might rain.

Lex Fridman (1:15:53.620)

We don't board up our homes every single day

Michael Mina (1:15:55.580)

in case there's a hurricane.

Lex Fridman (1:15:56.700)

We wait, and if we know that there's one coming,

Michael Mina (1:15:58.940)

then we act for a small period of time accordingly.

Lex Fridman (1:16:03.420)

And then we go back, and we've prepared ourselves

Michael Mina (1:16:05.780)

in like these little bursts to not have it ruin our days.

Lex Fridman (1:16:09.220)

I can't tell you how exciting

Michael Mina (1:16:10.740)

that vision of the future is.

Lex Fridman (1:16:13.140)

I think that's incredible.

Lex Fridman (1:16:14.580)

And it seems like it should be within our reach,

Lex Fridman (1:16:17.380)

the, just these like weather maps of viruses

Michael Mina (1:16:22.380)

floating about the Earth, and it seems obvious.

Lex Fridman (1:16:26.060)

It's one of those things where right now,

Michael Mina (1:16:28.780)

it seems like maybe impossible.

Lex Fridman (1:16:31.980)

And then looking back like 20 years from now,

Michael Mina (1:16:34.820)

we'll wonder like why the hell

Lex Fridman (1:16:37.620)

this hasn't been done way earlier.

Michael Mina (1:16:39.340)

Though one difference between weather,

Lex Fridman (1:16:42.260)

I don't know if you have interesting ideas in this space.

Michael Mina (1:16:45.380)

The difference between weather and viruses

Lex Fridman (1:16:47.940)

is it includes, the collection of the data

Michael Mina (1:16:51.140)

includes the human body, potentially.

Lex Fridman (1:16:54.460)

And that means that there is some, as with the contact

Michael Mina (1:16:59.420)

tracing question, there's some concern about privacy.

Lex Fridman (1:17:03.460)

There seems to be this dance that's really complicated.

Michael Mina (1:17:07.700)

With Facebook getting a lot of flack

Lex Fridman (1:17:11.180)

for basically misusing people's data,

Michael Mina (1:17:13.540)

or just whether it's perception or reality,

Lex Fridman (1:17:17.460)

there's certainly a lot of reality to it too,

Michael Mina (1:17:19.900)

where they're not good stewards of our private data.

Lex Fridman (1:17:25.380)

So there's this weird place where it's like obvious

Michael Mina (1:17:28.900)

that if we do, if we collect a lot of data

Lex Fridman (1:17:33.100)

about human beings and maintain privacy

Lex Fridman (1:17:37.180)

and maintain all like basic respect for that data,

Lex Fridman (1:17:40.900)

just like honestly common sense respect for the data,

Michael Mina (1:17:43.780)

that we can do a lot of amazing things for the world,

Lex Fridman (1:17:46.340)

like a weather map for viruses.

Michael Mina (1:17:48.940)

Is there a way forward to gain trust of people

Lex Fridman (1:17:53.700)

or to do this well, do you have ideas here?

Lex Fridman (1:17:56.740)

How big is this problem?

Lex Fridman (1:17:58.540)

I think it's a central problem.

Michael Mina (1:18:00.740)

There's a couple central problems that need to be solved.

Lex Fridman (1:18:02.700)

One, how do you get all the samples?

Michael Mina (1:18:05.580)

That's not actually too difficult.

Lex Fridman (1:18:07.060)

I'm actually, I have a pilot project going right now

Michael Mina (1:18:10.100)

with getting samples from across all the United States.

Lex Fridman (1:18:14.340)

Tens of thousands of samples every week

Michael Mina (1:18:16.140)

are flowing into my lab and we process them.

Lex Fridman (1:18:19.220)

So it's taking the, it's taking like one of the,

Michael Mina (1:18:22.260)

basically there's biology here and chemistry

Lex Fridman (1:18:26.220)

and converting that into numbers.

Michael Mina (1:18:27.900)

That's exactly right.

Lex Fridman (1:18:28.740)

So what we're doing, for example,

Michael Mina (1:18:30.060)

there's a lot of people who go to the hospital every day,

Lex Fridman (1:18:32.980)

a lot of people who donate blood, people who donate plasma.

Lex Fridman (1:18:36.300)

So one of the projects that I have,

Lex Fridman (1:18:38.540)

I'll get to the privacy question in a moment,

Lex Fridman (1:18:40.260)

but this, so what I wanna do is the name that I've given

Lex Fridman (1:18:43.060)

this as a global immunological observatory.

Michael Mina (1:18:46.980)

There's no reason not to have that.

Lex Fridman (1:18:48.500)

Good name.

Michael Mina (1:18:49.460)

I've said, instead of saying, well,

Lex Fridman (1:18:51.140)

how do we possibly get enough people on board

Lex Fridman (1:18:53.540)

to send in samples all the time?

Lex Fridman (1:18:56.020)

Well, just go to the source.

Lex Fridman (1:18:57.700)

So there's a company in Massachusetts

Lex Fridman (1:18:59.700)

that makes 80% of all the instruments

Michael Mina (1:19:02.260)

that are used globally to collect plasma from plasma donors.

Lex Fridman (1:19:07.140)

So I went to this company, Hemenetics, and said,

Michael Mina (1:19:11.380)

is there a way you have 80% of the global market

Lex Fridman (1:19:15.500)

on plasma donations?

Michael Mina (1:19:18.780)

Can we start getting plasma samples

Lex Fridman (1:19:21.500)

from healthy people that use your machines?

Lex Fridman (1:19:24.220)

So that hooked me up with this company called Octopharma.

Lex Fridman (1:19:26.700)

And Octopharma has a huge reach

Lex Fridman (1:19:28.700)

and offices all over the country

Lex Fridman (1:19:30.860)

where they're just collecting people's plasma.

Michael Mina (1:19:32.780)

They actually pay people for their plasma

Lex Fridman (1:19:35.460)

and then that gets distributed to hospitals

Lex Fridman (1:19:37.100)

and all this stuff is anonymous plasma.

Lex Fridman (1:19:39.340)

So I've just been collecting anonymous samples.

Lex Fridman (1:19:43.100)

And we're processing them, in this case,

Lex Fridman (1:19:45.100)

for COVID antibodies to watch from January

Michael Mina (1:19:48.340)

up through December, we're able to watch

Lex Fridman (1:19:51.420)

how the virus entered into the United States

Lex Fridman (1:19:54.220)

and how it's transmitting every day across the US.

Lex Fridman (1:19:58.780)

So we're getting those results organized now

Lex Fridman (1:20:02.460)

and we're gonna start putting them publicly online soon

Lex Fridman (1:20:06.060)

to start making at least a very rough map of COVID.

Lex Fridman (1:20:10.860)

But that's the type of thinking that I have

Lex Fridman (1:20:12.820)

in terms of like, how do you actually capture

Lex Fridman (1:20:14.700)

huge numbers of specimens?

Lex Fridman (1:20:17.060)

You can't ask everyone to participate on sort of a,

Michael Mina (1:20:20.220)

I mean, you maybe could if you have the right tools

Lex Fridman (1:20:23.020)

and you can offer individuals something in return

Michael Mina (1:20:25.420)

like 23andMe does.

Lex Fridman (1:20:27.900)

That's a great way to get people to give specimens

Lex Fridman (1:20:29.980)

and they get results back.

Lex Fridman (1:20:31.060)

So with these technologies that I've been building

Michael Mina (1:20:34.500)

along with some collaborators at Harvard,

Lex Fridman (1:20:36.140)

we can come up with tools that people might actually want.

Lex Fridman (1:20:39.940)

So I can offer you your immunological history.

Lex Fridman (1:20:43.260)

I can say, give me a drop of your blood on a filter paper,

Michael Mina (1:20:47.100)

mail it in and I will be able to tell you

Lex Fridman (1:20:49.860)

every infectious disease you've ever encountered

Lex Fridman (1:20:52.060)

and maybe even when you encountered it roughly.

Lex Fridman (1:20:55.620)

I could tell you, do you have COVID antibodies right now?

Lex Fridman (1:20:58.820)

Do you have Lyme disease antibodies right now?

Lex Fridman (1:21:00.620)

Flu, triple E and all these different viruses.

Michael Mina (1:21:03.740)

Also peanut allergies, milk allergies, anything.

Lex Fridman (1:21:07.380)

If your immune system makes a response to it,

Michael Mina (1:21:11.300)

we can detect that response.

Lex Fridman (1:21:14.940)

So all of a sudden we have this very valuable technology

Michael Mina (1:21:17.660)

that on the one hand gives people maybe information

Lex Fridman (1:21:19.980)

they might want to know about themselves,

Lex Fridman (1:21:22.020)

but on the other hand becomes this amazingly rich

Lex Fridman (1:21:25.020)

source of big data to enter into

Michael Mina (1:21:28.100)

this global immunological observatory

Lex Fridman (1:21:29.900)

sort of mathematical framework to start building

Michael Mina (1:21:32.260)

these maps, these epidemiological tools.

Lex Fridman (1:21:34.820)

But you asked about privacy

Lex Fridman (1:21:36.740)

and absolutely that's essential to keep in mind

Lex Fridman (1:21:40.380)

first and foremost.

Lex Fridman (1:21:41.900)

So privacy can be,

Lex Fridman (1:21:43.740)

you can keep these samples 100% anonymous.

Michael Mina (1:21:47.100)

They are just, when I get them, they show up with nothing.

Lex Fridman (1:21:49.340)

They're literally just tubes.

Michael Mina (1:21:51.340)

I know a date that they were collected

Lex Fridman (1:21:52.900)

and a zip code that they're collected from

Michael Mina (1:21:54.660)

or even just sort of a county level ID.

Lex Fridman (1:21:59.020)

So with an IRB and with ethical approval

Lex Fridman (1:22:02.300)

and with the people's consent,

Lex Fridman (1:22:03.740)

we can maybe collect more data,

Lex Fridman (1:22:05.100)

but that would require consent.

Lex Fridman (1:22:07.340)

But then there's this other approach

Michael Mina (1:22:09.540)

which I'm really excited about,

Lex Fridman (1:22:10.980)

which is certainly going to gain some scrutiny I think,

Lex Fridman (1:22:14.460)

but we'll have to figure out where it comes into play.

Lex Fridman (1:22:17.900)

But I've been recognizing that we can take somebody's

Michael Mina (1:22:20.660)

immunological profile and we can make a biological

Lex Fridman (1:22:24.060)

fingerprint out of it.

Lex Fridman (1:22:25.700)

And it's actually stable enough

Lex Fridman (1:22:27.300)

so that I could take your blood.

Michael Mina (1:22:28.540)

Let's say I don't know who you are,

Lex Fridman (1:22:30.460)

but you sent me a drop of blood a year ago

Lex Fridman (1:22:34.300)

and then you sent me a drop of blood today.

Lex Fridman (1:22:36.540)

I don't know that those two blood spots

Michael Mina (1:22:38.300)

are coming from the same person.

Lex Fridman (1:22:39.740)

They're just showing up in my lab.

Lex Fridman (1:22:42.380)

But I can run our technology over

Lex Fridman (1:22:46.500)

and it just gives me your immunological history.

Lex Fridman (1:22:49.820)

But your immunological history is so unique to you

Lex Fridman (1:22:52.340)

and the way that your body responds to these pathogens

Michael Mina (1:22:55.380)

is so unique to you

Lex Fridman (1:22:57.180)

that I can use that to tether your two samples.

Michael Mina (1:22:59.620)

I don't know who you are, I know nothing about you.

Lex Fridman (1:23:02.700)

I only know when those samples came out of a person.

Lex Fridman (1:23:06.580)

But I can say, oh, these two samples a year apart

Lex Fridman (1:23:09.100)

actually belong to the same person.

Michael Mina (1:23:10.900)

Yeah, so there's sufficient information

Lex Fridman (1:23:12.340)

in that immunological history to match the samples.

Michael Mina (1:23:16.060)

Or from a privacy perspective, that's really exciting.

Lex Fridman (1:23:18.540)

Does that generally hold for humans?

Lex Fridman (1:23:20.220)

So you're saying there's enough uniqueness to match?

Lex Fridman (1:23:23.780)

Yeah, because it's very stochastic, even twins.

Lex Fridman (1:23:25.980)

So this, I believe, we haven't published this yet.

Lex Fridman (1:23:28.220)

We will soon.

Lex Fridman (1:23:29.380)

You have a twin too, right?

Lex Fridman (1:23:30.540)

I do have a twin, I have an identical twin brother,

Michael Mina (1:23:32.500)

which makes me interested in this.

Lex Fridman (1:23:34.660)

He looks very much like me.

Lex Fridman (1:23:36.460)

Oh, is that how that works?

Lex Fridman (1:23:37.620)

Yeah.

Lex Fridman (1:23:38.940)

And DNA can't really tell us apart.

Lex Fridman (1:23:42.780)

But this tool is one of the only tools in the world

Michael Mina (1:23:45.580)

that could tell twins apart from each other.

Lex Fridman (1:23:48.020)

Could still be accurate enough to say this blood,

Michael Mina (1:23:51.540)

it's like 99.999% accurate to say

Lex Fridman (1:23:56.940)

that these two blood samples came from the same individual.

Lex Fridman (1:24:00.380)

And it's because it's a combination,

Lex Fridman (1:24:01.940)

both of your immunological history,

Lex Fridman (1:24:04.140)

but also how your unique body responds to a pathogen,

Lex Fridman (1:24:09.260)

which is random.

Michael Mina (1:24:10.900)

The way that we make antibodies is, by and large,

Lex Fridman (1:24:14.180)

it's got an element of randomness to it.

Lex Fridman (1:24:17.540)

How the cells, when they make an antibody,

Lex Fridman (1:24:19.460)

they chop up the genetic code to say,

Michael Mina (1:24:22.500)

okay, this is the antibody that I'm gonna form

Lex Fridman (1:24:24.220)

for this pathogen.

Lex Fridman (1:24:26.180)

And you might form, if you get a coronavirus, for example,

Lex Fridman (1:24:29.740)

you might form hundreds of different antibodies,

Michael Mina (1:24:31.940)

not just one antibody against the spike protein,

Lex Fridman (1:24:33.940)

but hundreds of different antibodies

Michael Mina (1:24:35.700)

against all different parts of the virus.

Lex Fridman (1:24:38.300)

So that gives this really rich resolution of information

Michael Mina (1:24:42.180)

that when I then do the same thing

Lex Fridman (1:24:43.620)

across hundreds of different pathogens,

Michael Mina (1:24:45.340)

some of which you've seen, some of which you haven't,

Lex Fridman (1:24:48.300)

it gives you an exceedingly unique fingerprint

Michael Mina (1:24:50.540)

that is sufficiently stable over years and years and years

Lex Fridman (1:24:54.900)

to essentially give you a barcode.

Lex Fridman (1:24:57.740)

And I don't have to know who you are,

Lex Fridman (1:24:59.580)

but I can know that these two specimens

Michael Mina (1:25:01.380)

came from the same person somewhere out in the world.

Lex Fridman (1:25:04.500)

So fascinating that there's this trace,

Michael Mina (1:25:07.020)

your life story in the space of viruses,

Lex Fridman (1:25:11.160)

in the space of pathogen, like these,

Michael Mina (1:25:16.160)

you know, because there's this entire universe

Lex Fridman (1:25:18.680)

of these organisms that are trying to destroy each other.

Lex Fridman (1:25:23.200)

And then your little trajectory through that space

Lex Fridman (1:25:25.920)

leaves a trace, and then you can look at that trace.

Michael Mina (1:25:29.400)

That's fascinating.

Lex Fridman (1:25:30.320)

And that, I mean, there's, okay,

Michael Mina (1:25:33.120)

that data period is just fascinating.

Lex Fridman (1:25:35.520)

And the vision of making that data universally connected

Michael Mina (1:25:40.200)

to where you can make, like infer things,

Lex Fridman (1:25:43.580)

and just like with the weather, is really fascinating.

Lex Fridman (1:25:47.440)

And there's probably artificial intelligence

Lex Fridman (1:25:49.800)

applications there, start making predictions,

Michael Mina (1:25:51.880)

start finding patterns.

Lex Fridman (1:25:53.080)

Exactly, we're doing a lot of that already.

Lex Fridman (1:25:54.880)

And that's how, how do we have this going?

Lex Fridman (1:25:57.280)

You know, I've been trying to get this funded for years now.

Lex Fridman (1:26:00.320)

And I've spoken to governments, you know,

Lex Fridman (1:26:02.640)

everyone says, cool idea, not gonna do it.

Lex Fridman (1:26:05.440)

You know, why do we need it?

Lex Fridman (1:26:07.200)

Oh, really?

Lex Fridman (1:26:08.040)

The why do you need it?

Lex Fridman (1:26:08.860)

Yeah, the why do you need it.

Lex Fridman (1:26:10.040)

And of course now, you know, I mean,

Lex Fridman (1:26:12.200)

I wrote in 2015 about this,

Lex Fridman (1:26:15.720)

why we would, why this would be useful.

Lex Fridman (1:26:18.160)

And of course, now we're seeing why it would be useful.

Michael Mina (1:26:21.240)

Had we had this up and running in 2019,

Lex Fridman (1:26:25.560)

had we had it going, we were drawing blood from,

Michael Mina (1:26:28.520)

you know, we're getting blood samples from hospitals

Lex Fridman (1:26:30.760)

and clinics and blood donors from New York City,

Michael Mina (1:26:32.800)

let's just say, you know, that could have,

Lex Fridman (1:26:36.320)

we didn't run the first PCR test for coronavirus

Michael Mina (1:26:40.640)

until probably a month and a half or two months

Lex Fridman (1:26:43.880)

after the virus started transmitting in New York City.

Lex Fridman (1:26:46.960)

So it's like with the rain,

Lex Fridman (1:26:48.040)

we didn't start wearing umbrella or taking out umbrellas.

Michael Mina (1:26:52.320)

Exactly, for two months, but different than the rain,

Lex Fridman (1:26:55.160)

we couldn't actually see that it was spreading right now.

Lex Fridman (1:26:58.000)

And so Andrew Cuomo had no choice

Lex Fridman (1:27:00.560)

but to leave the city open.

Michael Mina (1:27:02.200)

You know, there were hints that maybe the virus

Lex Fridman (1:27:03.840)

was spreading in New York City,

Lex Fridman (1:27:05.360)

but you know, he didn't have any data to back it up.

Lex Fridman (1:27:07.900)

No data.

Lex Fridman (1:27:08.740)

And so it was just week on week and week.

Lex Fridman (1:27:12.680)

And he didn't have any information to really go by

Michael Mina (1:27:17.060)

to allow him to have the firepower

Lex Fridman (1:27:18.800)

to say we're closing down the city.

Michael Mina (1:27:20.480)

This is an emergency.

Lex Fridman (1:27:21.360)

We have to stop spread before it starts.

Lex Fridman (1:27:25.120)

And so they waited until the first PCR tests

Lex Fridman (1:27:28.300)

were coming about.

Lex Fridman (1:27:29.140)

And then the moment they started running PCR tests,

Lex Fridman (1:27:30.600)

they find out it's everywhere.

Michael Mina (1:27:32.280)

You know, and so that was a disaster

Lex Fridman (1:27:33.840)

because of course New York City, you know,

Michael Mina (1:27:36.440)

was just hit so bad because nobody was,

Lex Fridman (1:27:39.720)

you know, we were blind to it.

Michael Mina (1:27:41.640)

We didn't have to be blind to it.

Lex Fridman (1:27:43.000)

And the nice thing about this technology is

Michael Mina (1:27:45.640)

we wouldn't have, with the exact same technology

Lex Fridman (1:27:47.940)

we had in 2017, we could have detected

Michael Mina (1:27:51.560)

this novel coronavirus spreading in New York City in 2020.

Lex Fridman (1:27:56.320)

Not because we changed, not because we are actually

Michael Mina (1:27:58.860)

actively looking for this novel coronavirus,

Lex Fridman (1:28:01.560)

but because we would see, we would have seen patterns

Michael Mina (1:28:04.300)

in people's immune responses using AI,

Lex Fridman (1:28:06.400)

or just frankly using our, just the raw data itself.

Michael Mina (1:28:10.520)

We could have said, hey, it looks like there's

Lex Fridman (1:28:13.180)

something that looks like known coronavirus

Michael Mina (1:28:15.760)

is spreading in New York, but there's gaps.

Lex Fridman (1:28:18.280)

You know, there's, for some reason,

Michael Mina (1:28:19.800)

people aren't developing an immune response

Lex Fridman (1:28:21.680)

to this coronavirus that seems to be spreading

Michael Mina (1:28:23.500)

to these normal things that, you know,

Lex Fridman (1:28:25.640)

and it just looks, the profile looks different.

Lex Fridman (1:28:29.200)

And we could have seen that and immediately,

Lex Fridman (1:28:31.600)

especially since we had an idea that

Michael Mina (1:28:33.680)

there was a novel coronavirus circulating in the world,

Lex Fridman (1:28:37.560)

we could have very quickly and easily seen,

Michael Mina (1:28:39.960)

hey, clearly we're seeing a spike of something

Lex Fridman (1:28:42.760)

that looks like a known coronavirus,

Lex Fridman (1:28:44.320)

but people are responding weirdly to it.

Lex Fridman (1:28:46.960)

Our AI algorithms would have picked it up,

Lex Fridman (1:28:49.640)

and just our basic, heck, you could have put it

Lex Fridman (1:28:52.760)

in an Excel spreadsheet, we would have seen it.

Michael Mina (1:28:55.040)

So.

Lex Fridman (1:28:56.600)

Some basic visualization would have shown it.

Michael Mina (1:28:58.240)

Exactly, we would have seen spikes,

Lex Fridman (1:28:59.840)

and they would have been kind of like off, you know,

Michael Mina (1:29:02.680)

immune responses that the shape of them

Lex Fridman (1:29:04.440)

just looked a little bit different,

Lex Fridman (1:29:06.320)

but they would have been growing,

Lex Fridman (1:29:07.600)

and we would have seen it, and it could have

Michael Mina (1:29:09.400)

saved tens of thousands of lives in New York City.

Lex Fridman (1:29:12.320)

So to me, the fascinating question,

Michael Mina (1:29:14.040)

everything we've talked about,

Lex Fridman (1:29:15.040)

so both the huge collection of data at scale,

Michael Mina (1:29:18.040)

just super exciting, and then the kind of obvious

Lex Fridman (1:29:23.480)

at scale solution to the current virus

Lex Fridman (1:29:26.320)

and future ones is the rapid testing.

Lex Fridman (1:29:30.200)

Can we talk about the future of viruses

Lex Fridman (1:29:34.440)

that might be threatening our very existence?

Lex Fridman (1:29:39.840)

So do you think like a future natural virus

Michael Mina (1:29:44.160)

can have an order of magnitude greater effect

Lex Fridman (1:29:49.640)

on human civilization than anything we've ever seen?

Lex Fridman (1:29:52.240)

So something that either kills all humans,

Lex Fridman (1:29:56.200)

or kills, I don't know, 60, 70% of humans.

Lex Fridman (1:30:01.520)

So something like something we can't even imagine.

Lex Fridman (1:30:06.600)

Is that something that you think is possible?

Michael Mina (1:30:09.360)

Because it seems to not have happened yet.

Lex Fridman (1:30:11.760)

So maybe like the entirety, whoever the programmer is

Michael Mina (1:30:17.080)

of the simulation that sort of launched the evolution

Lex Fridman (1:30:20.040)

from the Big Bang seems to not want to destroy us humans.

Michael Mina (1:30:24.680)

Or maybe that's the natural side effect

Lex Fridman (1:30:26.320)

of the evolutionary process that humans are useful.

Lex Fridman (1:30:30.280)

But do you think it's possible

Lex Fridman (1:30:31.520)

that the evolutionary process will produce a virus

Lex Fridman (1:30:34.160)

that will kill all humans?

Lex Fridman (1:30:35.720)

I think it could.

Michael Mina (1:30:36.960)

I don't think it's likely.

Lex Fridman (1:30:38.080)

And the reason I don't think it's likely

Michael Mina (1:30:39.640)

is on the one hand, it hasn't happened yet,

Lex Fridman (1:30:45.080)

in part because mobility is a recent phenomena.

Michael Mina (1:30:50.920)

People weren't particularly mobile

Lex Fridman (1:30:52.560)

until fairly recently.

Michael Mina (1:30:55.960)

Now, of course, now that we have people flying back

Lex Fridman (1:30:58.520)

and forth across the globe all the time,

Michael Mina (1:31:02.400)

the chances of global pandemics

Lex Fridman (1:31:05.240)

has escalated exponentially, of course.

Lex Fridman (1:31:08.120)

And so on the one hand,

Lex Fridman (1:31:10.000)

that's part of why it hasn't happened yet.

Michael Mina (1:31:11.920)

We can look at things like Ebola.

Lex Fridman (1:31:14.240)

Now, Ebola, we haven't generally had major Ebola epidemics

Michael Mina (1:31:19.240)

in the past, not because Ebola wasn't transmitting

Lex Fridman (1:31:21.880)

and infecting humans, but because it was largely affecting

Lex Fridman (1:31:25.880)

and infecting humans in disconnected communities.

Lex Fridman (1:31:29.600)

So you see out in rural parts of Africa, for example,

Michael Mina (1:31:34.600)

in Western Africa, you might end up having

Lex Fridman (1:31:36.880)

isolated Ebola outbreaks,

Lex Fridman (1:31:39.360)

but there weren't connections that were fast enough

Lex Fridman (1:31:42.480)

that would allow people to then spread it into the cities.

Michael Mina (1:31:45.240)

Of course, we saw back in 2014, 15 massive Ebola outbreak

Lex Fridman (1:31:53.280)

that wasn't because it was a new strain of Ebola,

Lex Fridman (1:31:58.280)

but it was because there's new inroads and connections

Lex Fridman (1:32:01.400)

between the communities and people got it to the city.

Lex Fridman (1:32:04.800)

And so we saw it start to spread.

Lex Fridman (1:32:07.160)

So that should be a little bit foreshadowing

Michael Mina (1:32:11.000)

of what's to come.

Lex Fridman (1:32:12.720)

And now we have this pandemic.

Michael Mina (1:32:15.360)

We had 2009, we have this.

Lex Fridman (1:32:18.640)

There is a benefit or there is sort of a natural check.

Lex Fridman (1:32:23.760)

And this is like kind of like a Voltaire

Lex Fridman (1:32:26.360)

predator prey dynamic kind of systems,

Michael Mina (1:32:28.680)

ecological systems and mathematics that

Lex Fridman (1:32:32.160)

if you have something that's so deadly,

Michael Mina (1:32:34.560)

people will respond more maybe with a greater panic,

Lex Fridman (1:32:39.960)

a greater sense of panic, which alone could, you know,

Michael Mina (1:32:42.200)

destroy humanity.

Lex Fridman (1:32:43.600)

But at the same time, we now know that we can lock down.

Michael Mina (1:32:47.760)

We know that that's possible.

Lex Fridman (1:32:49.120)

And so if this was a worse virus

Michael Mina (1:32:50.760)

that was actually killing 60% of people as infecting,

Lex Fridman (1:32:53.800)

we would lock down very quickly.

Michael Mina (1:32:55.920)

My biggest fear though, is let's say that was happening.

Lex Fridman (1:32:59.520)

You need serious lockdowns if you're gonna keep things going.

Lex Fridman (1:33:03.000)

So the only reason we were able to keep things going

Lex Fridman (1:33:05.280)

during our lockdowns is because it wasn't so bad

Michael Mina (1:33:08.480)

that we were still able to have people work

Lex Fridman (1:33:10.120)

in the grocery stores.

Michael Mina (1:33:13.360)

Still have people work in the shipping

Lex Fridman (1:33:14.640)

to get the food onto the shelves.

Lex Fridman (1:33:16.640)

So on the one hand, we could probably figure out

Lex Fridman (1:33:18.800)

how to stop the virus,

Lex Fridman (1:33:21.200)

but can we stop the virus without starving?

Lex Fridman (1:33:24.880)

You know, and I'm not sure that that,

Michael Mina (1:33:26.520)

if this was another acute respiratory virus

Lex Fridman (1:33:30.240)

that say had a slightly, say it transmitted the same way,

Lex Fridman (1:33:34.080)

but say it actually did worse damage to your heart,

Lex Fridman (1:33:36.360)

but it was like a month later

Michael Mina (1:33:38.040)

that people started having heart attacks in mass.

Lex Fridman (1:33:41.480)

You know, it's like not just one offs, but really severe.

Michael Mina (1:33:45.640)

Well, that could be a serious problem for humanity.

Lex Fridman (1:33:50.840)

So in some ways I think that there are lots of ways

Michael Mina (1:33:53.680)

that we could end up dying at the hand of a virus.

Lex Fridman (1:33:56.800)

I mean, we're already seeing it.

Michael Mina (1:33:57.800)

Just, I mean, my fear is still,

Lex Fridman (1:34:00.040)

I think coronaviruses have demonstrated

Michael Mina (1:34:02.400)

a keen ability to destroy or to create outbreaks

Lex Fridman (1:34:06.520)

that can potentially be deadly to large numbers of people.

Michael Mina (1:34:10.320)

Flu strains, though, are still by and large my concern.

Lex Fridman (1:34:14.560)

So you think the bad one might come from the flu,

Lex Fridman (1:34:17.600)

the influenza?

Lex Fridman (1:34:18.720)

Yeah, their replication cycle,

Michael Mina (1:34:20.760)

they're able to genetically recombine

Lex Fridman (1:34:22.440)

in a way that coronaviruses aren't.

Michael Mina (1:34:24.360)

They have segmented genomes,

Lex Fridman (1:34:25.920)

which means that they can just swap out

Michael Mina (1:34:27.480)

whole parts of their genomes, no problem,

Lex Fridman (1:34:29.640)

repackage them, and then boom,

Michael Mina (1:34:32.280)

you have a whole antigenic shift, not a drift.

Lex Fridman (1:34:35.520)

What that means is that on any occasion,

Michael Mina (1:34:38.120)

any day of the year, you can have, boom,

Lex Fridman (1:34:40.760)

a whole new virus that didn't exist yesterday.

Lex Fridman (1:34:44.440)

And now with farming and industrial livestock,

Lex Fridman (1:34:49.240)

we're seeing animals and humans come into contact much more.

Michael Mina (1:34:53.440)

Just the opportunities for an influenza strain

Lex Fridman (1:34:58.840)

that is unique and deadly to humans increases.

Michael Mina (1:35:01.800)

All the while, transmission and mobility has increased.

Lex Fridman (1:35:06.760)

It's just a matter of time, in my opinion.

Lex Fridman (1:35:09.800)

What about from immunology perspective

Lex Fridman (1:35:12.880)

of the idea of engineering a virus?

Lex Fridman (1:35:16.320)

So not just the virus leaking from a lab or something,

Lex Fridman (1:35:18.720)

but actually being able to understand the protein,

Michael Mina (1:35:23.560)

like everything about what makes a virus enough

Lex Fridman (1:35:26.560)

to be able to figure out ways to maybe target it

Michael Mina (1:35:33.680)

or untarget it, attack biologics.

Lex Fridman (1:35:36.360)

Subverse immunity.

Michael Mina (1:35:38.080)

Yeah.

Lex Fridman (1:35:38.920)

Yeah.

Michael Mina (1:35:39.760)

Is that something, obviously that's somewhere

Lex Fridman (1:35:43.080)

on the list of concerns, but is that anywhere close

Michael Mina (1:35:48.320)

of the top 10 highlights along with nuclear weapons

Lex Fridman (1:35:51.160)

and so on that we should be worried about?

Michael Mina (1:35:53.200)

Or is the natural pandemic really the one

Lex Fridman (1:35:55.640)

that's much greater concern?

Michael Mina (1:35:58.160)

I would say that the former, that manmade viruses

Lex Fridman (1:36:02.240)

and genetically engineered viruses should be right up there

Michael Mina (1:36:08.240)

with the greatest concerns for humanity right now.

Lex Fridman (1:36:11.880)

We know that the tools, for better or worse,

Michael Mina (1:36:15.240)

the tools for creating a virus are there.

Lex Fridman (1:36:19.720)

We can do it.

Lex Fridman (1:36:20.600)

And I mean, heck, the human species

Lex Fridman (1:36:25.800)

is no longer vaccinated against smallpox.

Michael Mina (1:36:28.160)

I didn't get a smallpox vaccine.

Lex Fridman (1:36:29.600)

You didn't get a smallpox vaccine, at least I don't think.

Lex Fridman (1:36:32.160)

And so if somebody wanted to make smallpox

Lex Fridman (1:36:37.040)

and distribute it to the world in some way,

Michael Mina (1:36:41.080)

it could be exceedingly deadly and detrimental to humans.

Lex Fridman (1:36:46.080)

And that's not even sort of using your imagination

Michael Mina (1:36:51.280)

to create a new virus.

Lex Fridman (1:36:52.240)

That's one that we already have.

Michael Mina (1:36:54.320)

Unlike the past when smallpox would circulate,

Lex Fridman (1:36:57.240)

you had large fractions of the community

Michael Mina (1:37:00.320)

that was already immune to it.

Lex Fridman (1:37:02.720)

And so it wouldn't spread

Michael Mina (1:37:03.880)

or it would spread a little bit slower.

Lex Fridman (1:37:05.320)

But now we have essentially in a few years,

Michael Mina (1:37:07.160)

we'll have a whole global population that is susceptible.

Lex Fridman (1:37:11.760)

Let's look at measles.

Michael Mina (1:37:12.960)

We have an entire, I mean, measles, I have,

Lex Fridman (1:37:18.200)

there are some researchers in the world right now,

Michael Mina (1:37:20.400)

which for various reasons are working on creating

Lex Fridman (1:37:23.880)

a measles strain that evades immunity.

Michael Mina (1:37:26.760)

It's not for bioterrorism,

Lex Fridman (1:37:28.280)

at least that's not the expectation.

Michael Mina (1:37:29.760)

It's for using measles as an oncolytic virus to kill cancer.

Lex Fridman (1:37:34.720)

And the only way you can really do that

Michael Mina (1:37:36.880)

is if your immune system doesn't,

Lex Fridman (1:37:38.880)

if you take a measles virus and there's,

Michael Mina (1:37:41.640)

we don't have to go into the details of why it would work,

Lex Fridman (1:37:43.880)

but it could work.

Michael Mina (1:37:44.960)

Measles likes to target potentially cancer cells.

Lex Fridman (1:37:49.120)

But to get your immune system not to kill off the virus

Michael Mina (1:37:51.840)

if you're trying to use the virus to target it,

Lex Fridman (1:37:53.400)

you maybe want to make it blind to the immune system.

Lex Fridman (1:37:57.560)

But now imagine we took some virus like measles,

Lex Fridman (1:38:00.240)

which has an R naught of 18, transmits extremely quickly.

Lex Fridman (1:38:04.280)

And now we have essentially,

Lex Fridman (1:38:05.800)

let's say we had a whole human race

Michael Mina (1:38:07.560)

that is susceptible to measles.

Lex Fridman (1:38:10.400)

And this is a virus that spreads

Michael Mina (1:38:13.320)

orders of magnitude easier than this current virus.

Lex Fridman (1:38:17.720)

Imagine if you were to plug something toxic

Michael Mina (1:38:20.960)

or detrimental into that virus and release it to the world.

Lex Fridman (1:38:24.960)

So it's possible to be both accidental and intentional.

Michael Mina (1:38:29.360)

Absolutely.

Lex Fridman (1:38:30.200)

Yeah, so Mark Lipsitch is a good colleague of mine

Michael Mina (1:38:32.560)

at Harvard, we're both in the,

Lex Fridman (1:38:35.920)

he's the director of the Center

Michael Mina (1:38:37.000)

for Communicable Disease Dynamics from a faculty member.

Lex Fridman (1:38:40.800)

He's spoken very, very forcefully

Lex Fridman (1:38:42.960)

and he's very outspoken about the dangers

Lex Fridman (1:38:47.200)

of gain of function testing,

Michael Mina (1:38:49.440)

where in the lab we are intentionally creating viruses

Lex Fridman (1:38:53.440)

that are exceedingly deadly

Michael Mina (1:38:56.680)

under the auspices of trying to learn about them.

Lex Fridman (1:38:59.240)

So that if the idea is that if we kind of accelerate

Michael Mina (1:39:02.840)

evolution and make these really deadly viruses in the lab,

Lex Fridman (1:39:07.120)

we can be prepared for if that virus ever comes about

Michael Mina (1:39:11.240)

naturally or through unnatural means.

Lex Fridman (1:39:14.580)

The concern though is, okay, that's one thing,

Lex Fridman (1:39:17.480)

but what if that virus got out on somebody's shoe?

Lex Fridman (1:39:20.940)

Just what if?

Michael Mina (1:39:24.840)

If the effects of an accident are potentially catastrophic,

Lex Fridman (1:39:29.840)

is it worth taking the chances just to be prepared

Michael Mina (1:39:33.580)

a little bit for something that may

Lex Fridman (1:39:34.900)

or may not ever actually develop?

Lex Fridman (1:39:36.660)

And so it's a serious ethical quandary we're in,

Lex Fridman (1:39:40.300)

how to both be prepared,

Lex Fridman (1:39:43.060)

but also not cause a catastrophic mistake.

Lex Fridman (1:39:49.700)

As a small tangent,

Michael Mina (1:39:51.460)

there's a recent really exciting breakthrough of alpha two,

Lex Fridman (1:39:56.220)

of alpha fold two solving protein folding

Michael Mina (1:39:59.300)

or achieving state of the art performance

Lex Fridman (1:40:00.940)

on protein folding.

Lex Fridman (1:40:02.620)

And then I thought proteins have a lot to do with viruses.

Lex Fridman (1:40:09.100)

It seems like being able to use machine learning

Michael Mina (1:40:14.620)

to design proteins that achieve certain kinds of functions

Lex Fridman (1:40:19.540)

will naturally allow you to use maybe down the line,

Michael Mina (1:40:22.860)

not yet, but allow you to use machine learning

Lex Fridman (1:40:26.380)

to design basically viruses,

Michael Mina (1:40:28.940)

maybe like measles, like for good,

Lex Fridman (1:40:31.220)

which is like to attack cancer cells, but also for bad.

Michael Mina (1:40:37.620)

Is that a crazy thought

Lex Fridman (1:40:43.460)

or is this a natural place where this technology may go?

Michael Mina (1:40:46.660)

I suppose as all technologies can,

Lex Fridman (1:40:48.580)

which is for good and for bad.

Lex Fridman (1:40:52.020)

Do you think about the role of machine learning in this?

Lex Fridman (1:40:54.060)

Oh yeah, absolutely, I mean, alpha fold is amazing.

Michael Mina (1:40:59.420)

It's an amazing algorithm, a series of algorithms.

Lex Fridman (1:41:03.580)

And it does demonstrate, to me,

Michael Mina (1:41:07.500)

it demonstrates just how powerful,

Lex Fridman (1:41:10.620)

everything in the world has rules.

Michael Mina (1:41:12.540)

We just don't know the rules.

Lex Fridman (1:41:13.980)

We often don't know them,

Lex Fridman (1:41:14.900)

but our brain has rules, how it works.

Lex Fridman (1:41:17.860)

Everything is plus and minus.

Michael Mina (1:41:19.220)

There's nothing in the world that's really not

Lex Fridman (1:41:21.220)

at its most basic level, positive, negative.

Michael Mina (1:41:25.260)

It's all, obviously, it's all just charge.

Lex Fridman (1:41:28.180)

And that means everything.

Michael Mina (1:41:30.300)

You can figure it out with enough computational power

Lex Fridman (1:41:32.900)

and enough, in this case, I mean,

Michael Mina (1:41:34.980)

machine learning and AI is just one way to learn rules.

Lex Fridman (1:41:40.060)

It's an empirical way to learn rules,

Lex Fridman (1:41:42.620)

but it's a profoundly powerful way.

Lex Fridman (1:41:44.940)

And certainly, now that we are getting to a point

Michael Mina (1:41:49.100)

where we can take a protein and know how it folds,

Lex Fridman (1:41:54.180)

given its sequence, we can reverse engineer that

Lex Fridman (1:41:57.660)

and we can say, okay, we want a protein to fold this way.

Lex Fridman (1:42:01.580)

What does the sequence need to be?

Michael Mina (1:42:03.540)

We haven't done that yet so much,

Lex Fridman (1:42:06.340)

but it's just the next iteration of all of this.

Lex Fridman (1:42:09.500)

And so let's say somebody wants to develop a virus

Lex Fridman (1:42:12.740)

it's gonna start with somebody wanting to develop a virus

Michael Mina (1:42:15.340)

to defeat cancer, something good.

Lex Fridman (1:42:18.620)

And so it would start with a lot of money

Michael Mina (1:42:20.780)

from the federal government for all the positives

Lex Fridman (1:42:25.140)

that will come out of it.

Lex Fridman (1:42:27.300)

But we have to be really careful

Lex Fridman (1:42:29.900)

because that will come about.

Michael Mina (1:42:32.300)

There's no doubt in my mind that we will develop,

Lex Fridman (1:42:35.220)

we're already doing it.

Michael Mina (1:42:36.060)

We engineer molecules all the time for specific uses.

Lex Fridman (1:42:39.460)

Oftentimes, we take them from a lab

Lex Fridman (1:42:41.380)

and then we take them from a lab and then we make them.

Lex Fridman (1:42:44.140)

Oftentimes, we take them from nature and then tweak them.

Lex Fridman (1:42:48.220)

But now we can supercharge it.

Lex Fridman (1:42:49.860)

We can accelerate the pace of discovery.

Michael Mina (1:42:53.340)

To not have it just be discovery,

Lex Fridman (1:42:54.940)

we have it be true ground up engineering.

Michael Mina (1:42:58.180)

Let's say you're trying to make a new molecule

Lex Fridman (1:43:02.460)

to stabilize somebody with some retinal disease.

Lex Fridman (1:43:06.820)

So we come up with some molecule

Lex Fridman (1:43:08.900)

to stability of somebody with retinal degeneration.

Michael Mina (1:43:14.780)

Just a small tweak to that,

Lex Fridman (1:43:16.260)

to say make a virus that causes the human race

Michael Mina (1:43:18.460)

to become blind.

Lex Fridman (1:43:20.020)

I mean, it sounds really conspiracy theoryish,

Lex Fridman (1:43:22.220)

but it's not.

Lex Fridman (1:43:25.860)

We're learning so much about biology

Lex Fridman (1:43:27.500)

and there's always nefarious reasons.

Lex Fridman (1:43:28.820)

I mean, heck, look at how AI and just Google searches,

Michael Mina (1:43:33.860)

those can be, they are every single day

Lex Fridman (1:43:37.820)

being leveraged by nefarious actors

Michael Mina (1:43:39.940)

to take advantage of people, to steal money,

Lex Fridman (1:43:43.180)

to do whatever it might be.

Michael Mina (1:43:45.700)

Eventually, probably to create wars

Lex Fridman (1:43:48.300)

or already to create wars.

Lex Fridman (1:43:50.420)

And I mean, I don't think there's any question at this point

Lex Fridman (1:43:53.700)

behind disinformation campaigns.

Lex Fridman (1:43:55.500)

And so it's being leveraged.

Lex Fridman (1:43:56.900)

This thing that could be wholly good

Michael Mina (1:44:00.700)

is always going to be leveraged for bad.

Lex Fridman (1:44:02.260)

And so how do you balance that as a species?

Michael Mina (1:44:04.580)

I'm not quite sure.

Lex Fridman (1:44:06.300)

The hope is, as you mentioned previously,

Michael Mina (1:44:08.300)

that there's some, that we were able

Lex Fridman (1:44:10.460)

to also develop defense mechanisms.

Lex Fridman (1:44:12.300)

And there's something about the human species

Lex Fridman (1:44:14.100)

that seems to keep coming up with ways to,

Michael Mina (1:44:18.700)

just like on the deadline,

Lex Fridman (1:44:21.580)

just at the last moment,

Michael Mina (1:44:22.780)

figuring out how to avoid destruction.

Lex Fridman (1:44:26.420)

I think I'm eternally optimistic about the human race

Michael Mina (1:44:30.940)

not destroying ourselves,

Lex Fridman (1:44:32.780)

but you could do a lot of things

Michael Mina (1:44:34.500)

that would be very painful.

Lex Fridman (1:44:36.060)

Yes.

Michael Mina (1:44:36.940)

Well, we're doing it already, just,

Lex Fridman (1:44:38.980)

I mean, we are seeing how our regulation today,

Michael Mina (1:44:42.980)

we did this thing, it started as a good thing,

Lex Fridman (1:44:45.860)

regulation of medical products,

Lex Fridman (1:44:48.060)

but now it is unwillingly and unintentionally harming us.

Lex Fridman (1:44:55.020)

Our regulatory landscape,

Michael Mina (1:44:57.220)

which was developed totally for good in our country

Lex Fridman (1:45:00.540)

is getting in the way of us deploying a tool

Michael Mina (1:45:04.060)

that could stop our economies

Lex Fridman (1:45:06.900)

from having to be sort of sputteringly closed,

Michael Mina (1:45:11.020)

that could stop deaths from happening

Lex Fridman (1:45:12.940)

at the rate that they are.

Lex Fridman (1:45:14.620)

And it's, I think we will come to a solution.

Lex Fridman (1:45:19.340)

Of course, now we're gonna get the vaccine

Lex Fridman (1:45:21.100)

and it's gonna make people lose track

Lex Fridman (1:45:23.220)

of like why we even bother testing, which is a bad idea.

Lex Fridman (1:45:25.940)

But we're already seeing that.

Lex Fridman (1:45:28.220)

We have this amazing capacity to both do damage

Michael Mina (1:45:32.860)

when we don't intend to do damage

Lex Fridman (1:45:36.060)

and then also to pull up when we need to pull up

Lex Fridman (1:45:39.020)

and stop complete catastrophe.

Lex Fridman (1:45:41.460)

And so we are an interesting species in that way,

Michael Mina (1:45:46.100)

that's for sure.

Lex Fridman (1:45:47.580)

So there's a lot of young folks, undergrads,

Michael Mina (1:45:50.780)

grads, they're also young, listen to this.

Lex Fridman (1:45:54.180)

So is there, you've talked about a lot of fascinating stuff

Michael Mina (1:45:57.540)

that's like, there's ways that things are done

Lex Fridman (1:46:01.900)

and there's actual solutions

Lex Fridman (1:46:03.540)

and they're not always like intersecting.

Lex Fridman (1:46:05.860)

Do you have advice for undergraduate students

Michael Mina (1:46:09.300)

or graduate students or even people in high school now

Lex Fridman (1:46:12.980)

about a life, about a career of how they might be able

Michael Mina (1:46:17.780)

to solve real big problems in the world,

Lex Fridman (1:46:20.060)

how they should live their life

Michael Mina (1:46:22.140)

in order to have a chance to solve big problems

Lex Fridman (1:46:24.180)

in the world?

Michael Mina (1:46:25.460)

It's hard.

Lex Fridman (1:46:26.300)

I struggle a little bit sometimes to give advice

Michael Mina (1:46:28.580)

because the advice that I give

Lex Fridman (1:46:30.060)

from my own personal experience is necessarily distinct

Michael Mina (1:46:32.940)

from the advice that would make other people successful.

Lex Fridman (1:46:36.580)

I have unending ambitions to make things better, I suppose.

Lex Fridman (1:46:42.300)

And I don't see barricades

Lex Fridman (1:46:44.460)

where other people sometimes see barricades.

Michael Mina (1:46:48.260)

Now, even just little things like when this virus started,

Lex Fridman (1:46:51.700)

I'm a medical director at Brigham and Women's Hospital

Lex Fridman (1:46:54.420)

and so I oversee or helped oversee

Lex Fridman (1:46:56.180)

molecular virology diagnostics.

Lex Fridman (1:46:58.100)

So when this virus started, wearing my epidemiology hat

Lex Fridman (1:47:01.180)

and wearing my sort of viral outbreak hat,

Michael Mina (1:47:03.660)

I recognized that this is gonna be a big virus

Lex Fridman (1:47:05.780)

that was important on a global level.

Michael Mina (1:47:07.860)

Even if the CDC and WHO weren't ready to admit

Lex Fridman (1:47:10.140)

that it was a pandemic,

Michael Mina (1:47:10.980)

it was obvious in January that it was a pandemic.

Lex Fridman (1:47:14.100)

So I started trying to get a test built at the Brigham,

Michael Mina (1:47:18.220)

which is one of Harvard's teaching hospitals.

Lex Fridman (1:47:20.540)

The first encounters I had with the upper administration

Lex Fridman (1:47:25.540)

of the hospital were pretty much, no, why would we do that?

Lex Fridman (1:47:28.460)

That's silly, who are you?

Lex Fridman (1:47:30.540)

And I said, well, okay, don't believe me, sure.

Lex Fridman (1:47:33.900)

But I kept pushing on it.

Lex Fridman (1:47:35.780)

And then eventually I got them to agree.

Lex Fridman (1:47:38.740)

It was really only a couple of weeks

Michael Mina (1:47:40.700)

before the Biogen conference happened.

Lex Fridman (1:47:43.060)

We started building the test.

Michael Mina (1:47:44.460)

I think they started looking abroad and saying,

Lex Fridman (1:47:46.140)

okay, this is happening, sure, like, maybe he was right.

Lex Fridman (1:47:50.340)

But then I went a step further and I said,

Lex Fridman (1:47:52.900)

we're not gonna have enough tests at the hospital.

Lex Fridman (1:47:55.740)

And so my ambition was to get a better testing program

Lex Fridman (1:47:59.540)

started and so I figured what better place

Michael Mina (1:48:03.380)

to scale up testing than the Broad Institute.

Lex Fridman (1:48:06.060)

Broad Institute is amazing, very high throughput,

Michael Mina (1:48:08.580)

high efficiency research institute

Lex Fridman (1:48:10.580)

that does a lot of genomic sequencing, things like that.

Lex Fridman (1:48:13.460)

So I went to the Broad and I said,

Lex Fridman (1:48:15.300)

hey, there's this coronavirus

Michael Mina (1:48:17.340)

that's obviously gonna impact our society greatly.

Lex Fridman (1:48:20.700)

Can we start modifying your high efficiency instruments

Lex Fridman (1:48:25.140)

and robots for coronavirus testing?

Lex Fridman (1:48:27.780)

Everyone in my orbit, in the hospital world,

Michael Mina (1:48:33.340)

just said, that's ridiculous.

Lex Fridman (1:48:35.340)

How could you possibly plan to do that?

Michael Mina (1:48:37.340)

It's impossible.

Lex Fridman (1:48:38.620)

And to me, it was like the most dead simple thing to do.

Michael Mina (1:48:43.380)

It didn't, but the higher ups and the people

Lex Fridman (1:48:46.300)

who think about, I think one of the things

Michael Mina (1:48:48.900)

is to recognize that most people in the world

Lex Fridman (1:48:51.420)

don't see solutions, they just see problems.

Lex Fridman (1:48:53.620)

And it's because it's an easy thing to do.

Lex Fridman (1:48:55.980)

Thinking of problems and how things will go wrong

Michael Mina (1:49:00.260)

is really easy because you're not coming up

Lex Fridman (1:49:03.140)

with a brand new solution.

Lex Fridman (1:49:04.900)

And this to me was just a super simple solution.

Lex Fridman (1:49:07.100)

Hey, let's get the Broad to help build tests.

Michael Mina (1:49:09.500)

Every single hospital director told me no,

Lex Fridman (1:49:12.700)

like it's impossible.

Michael Mina (1:49:13.540)

My own superiors, the ones I report to in the hospital,

Lex Fridman (1:49:16.620)

said, you know, Mike, you're a new faculty member.

Michael Mina (1:49:20.980)

Your ideas probably would be right,

Lex Fridman (1:49:23.540)

but you're too naive and young to know that it's impossible.

Michael Mina (1:49:27.620)

Obviously now the Broad is the highest

Lex Fridman (1:49:30.540)

throughput laboratory in the country.

Lex Fridman (1:49:32.380)

And so I think my recommendation to people

Lex Fridman (1:49:37.020)

is as much as possible, get out of the mode

Michael Mina (1:49:40.260)

of thinking about things as problems.

Lex Fridman (1:49:42.980)

Sometimes you piss people off,

Michael Mina (1:49:44.980)

I could probably use a better filter sometimes

Lex Fridman (1:49:47.180)

to try to like be not so upfront with certain things.

Lex Fridman (1:49:51.380)

But it's just so crucial to always just see,

Lex Fridman (1:49:54.700)

to just bring it, like think about things in new ways

Michael Mina (1:49:57.620)

that other people haven't.

Lex Fridman (1:49:59.380)

Cause usually there's something else out there.

Lex Fridman (1:50:01.300)

And one of the things that has been most beneficial to me,

Lex Fridman (1:50:04.100)

which is that my education was really broad.

Michael Mina (1:50:07.940)

It was engineering and physics.

Lex Fridman (1:50:10.220)

And well, and then I became a Buddhist monk.

Michael Mina (1:50:13.420)

Well, and then I became a Buddhist monk for a while.

Lex Fridman (1:50:15.900)

And so that gave me a different perspective,

Lex Fridman (1:50:18.540)

but then it was medicine and immunology.

Lex Fridman (1:50:20.820)

And now I've brought all of it together

Michael Mina (1:50:23.100)

from a mathematics and biology and medicine perspective

Lex Fridman (1:50:27.780)

and policy and public health.

Lex Fridman (1:50:29.100)

And I think that, you know,

Lex Fridman (1:50:30.180)

I'm not the best in any one of these things.

Michael Mina (1:50:32.940)

I recognize that there are gonna be geniuses out there

Lex Fridman (1:50:36.100)

who are just worlds better than me

Michael Mina (1:50:37.660)

at any one of these things that I try to work on.

Lex Fridman (1:50:41.660)

But my superpower is bringing them all together,

Michael Mina (1:50:43.980)

you know, and just thinking,

Lex Fridman (1:50:45.020)

and that's, I think how you can really change the world.

Michael Mina (1:50:49.780)

You know, I don't know that I'll ever change the world

Lex Fridman (1:50:51.540)

in the way that I hope.

Lex Fridman (1:50:53.820)

But that's how you can have a chance.

Lex Fridman (1:50:55.340)

Yeah, that's how you can have a chance, exactly.

Lex Fridman (1:50:57.100)

And I think it's also what, you know, this to me,

Lex Fridman (1:51:01.380)

this rapid testing program,

Michael Mina (1:51:02.700)

like this is the most dead simple solution in the world.

Lex Fridman (1:51:06.220)

And this literally could change the world.

Michael Mina (1:51:07.660)

It could change the world.

Lex Fridman (1:51:08.500)

It could change, and it is, you know,

Michael Mina (1:51:09.620)

there's countries that are doing it now.

Lex Fridman (1:51:11.180)

The US isn't, but I've been advising many countries on it.

Lex Fridman (1:51:13.980)

And I would say that, you know,

Lex Fridman (1:51:16.980)

some of the early papers that we put out earlier on,

Michael Mina (1:51:19.860)

a lot of the things actually are changing.

Lex Fridman (1:51:22.300)

You don't always, unless you really look hard,

Michael Mina (1:51:24.180)

you don't know where you're actually having an effect.

Lex Fridman (1:51:26.740)

Sometimes it's more overt than other times.

Michael Mina (1:51:30.840)

In April, I published a paper that was saying,

Lex Fridman (1:51:33.260)

hey, with the PCR values from these tests,

Michael Mina (1:51:36.580)

we need to really focus on the CT values,

Lex Fridman (1:51:38.580)

the actual quantitative values

Michael Mina (1:51:39.860)

of these lab based PCR tests.

Lex Fridman (1:51:42.540)

At the time, all the physicians and laboratory directors

Michael Mina (1:51:46.020)

told me that was stupid.

Lex Fridman (1:51:46.980)

You know, why would you do that?

Michael Mina (1:51:48.140)

They're not accurate enough.

Lex Fridman (1:51:49.500)

And of course, now it's headline news that, you know,

Michael Mina (1:51:52.900)

Florida, they just mandated reporting out the CT values

Lex Fridman (1:51:56.380)

of these tests, cause there's a real utility of them.

Michael Mina (1:51:58.940)

You can understand public health from it.

Lex Fridman (1:52:00.500)

You can understand better clinical management.

Michael Mina (1:52:03.580)

You know, that was a simple solution

Lex Fridman (1:52:05.140)

to a pretty difficult problem.

Lex Fridman (1:52:07.440)

And it is changing.

Lex Fridman (1:52:09.000)

The way that we approach all of the lab testing

Michael Mina (1:52:11.040)

in this country is starting to, it's taken a few months,

Lex Fridman (1:52:13.600)

but it's starting to change because of that.

Michael Mina (1:52:15.560)

And, you know, that was just me saying,

Lex Fridman (1:52:18.360)

hey, this is something we should be focusing on.

Michael Mina (1:52:20.480)

Got some other people involved and other people.

Lex Fridman (1:52:22.840)

And now people recognize, hey, there's actual value

Michael Mina (1:52:26.200)

in this number that comes out of these lab based PCR tests.

Lex Fridman (1:52:29.200)

So sometimes it does grow fairly quickly.

Lex Fridman (1:52:33.720)

But I think the real answer,

Lex Fridman (1:52:35.360)

if my only answer, I don't know what, you know,

Michael Mina (1:52:38.280)

I recognize that everyone, some people are gonna be

Lex Fridman (1:52:40.120)

really focused on and have one small, but deep skillset.

Michael Mina (1:52:45.120)

I go the opposite direction.

Lex Fridman (1:52:46.360)

I try to bring things together.

Michael Mina (1:52:48.760)

And, but the biggest thing I think is just,

Lex Fridman (1:52:52.200)

don't see barriers, like just see,

Michael Mina (1:52:55.960)

like there's always a solution to a barrier.

Lex Fridman (1:52:58.200)

If there's a barrier,

Michael Mina (1:52:59.040)

that literally means there's a solution to it.

Lex Fridman (1:53:01.480)

That's why it's called a barrier.

Lex Fridman (1:53:02.560)

And just like you said, most people will just present to you,

Lex Fridman (1:53:06.160)

only be thinking about it and present to you with barriers.

Lex Fridman (1:53:09.320)

And so it's easy to start thinking

Lex Fridman (1:53:10.800)

that's all there is in this world.

Lex Fridman (1:53:12.800)

And just think big.

Lex Fridman (1:53:13.640)

I mean, God, you know, there's nothing wrong

Michael Mina (1:53:15.960)

with thinking big.

Lex Fridman (1:53:17.280)

Elon Musk thought big and, you know,

Lex Fridman (1:53:19.040)

and then thinking big builds on itself.

Lex Fridman (1:53:21.800)

You know, you get a billion dollars from one big idea

Lex Fridman (1:53:25.240)

and then that allows you to make three new big ideas.

Lex Fridman (1:53:27.800)

And there's a hunger for it if you think big

Lex Fridman (1:53:29.840)

and you communicate that vision with the world.

Lex Fridman (1:53:32.040)

All the most brilliant and like passionate people

Michael Mina (1:53:35.240)

will just like, you'll attract them

Lex Fridman (1:53:37.720)

and they'll come to you.

Lex Fridman (1:53:38.720)

And then it makes your life actually really exciting.

Lex Fridman (1:53:41.440)

The people I've met at like Tesla and Neuralink,

Michael Mina (1:53:45.240)

I mean, there's just like this fire in their eyes.

Lex Fridman (1:53:47.200)

They just love life.

Lex Fridman (1:53:48.200)

And it's amazing, I think, to be around those people.

Lex Fridman (1:53:53.520)

I have to ask you about what was the philosophy,

Michael Mina (1:53:57.720)

the journey that took you to becoming a Buddhist monk

Lex Fridman (1:54:01.200)

and what did you learn about life?

Lex Fridman (1:54:07.240)

What did you take away from that experience?

Lex Fridman (1:54:09.080)

How did you return back to Harvard

Lex Fridman (1:54:12.320)

and the world that's unlike that experience, I imagine?

Lex Fridman (1:54:17.360)

Yeah, well, I was at Dartmouth at the time.

Michael Mina (1:54:22.280)

Well, I went to Sri Lanka.

Lex Fridman (1:54:23.320)

I was already pretty interested in developing countries

Lex Fridman (1:54:25.800)

and sort of under resourced areas.

Lex Fridman (1:54:27.440)

And I was doing a lot of engineering work

Lex Fridman (1:54:30.680)

and I went there, but I was also starting to think

Lex Fridman (1:54:33.440)

maybe health was something of interest.

Lex Fridman (1:54:37.440)

And so I went to Sri Lanka

Lex Fridman (1:54:40.840)

because I had a long interest in Buddhism as well,

Michael Mina (1:54:43.520)

just kind of interested in it as a thing.

Lex Fridman (1:54:46.640)

Which aspect of the philosophy attracted you?

Michael Mina (1:54:49.200)

I would say that the thing that interested me most

Lex Fridman (1:54:52.520)

was really this idea of kind of a butterfly effect

Michael Mina (1:54:57.080)

of like what you do now has ripple effects

Lex Fridman (1:55:02.520)

that extend out beyond what you can possibly imagine,

Michael Mina (1:55:07.800)

both in your own life and in other people's lives.

Lex Fridman (1:55:10.640)

And in some ways, Buddhism has, not in some ways,

Michael Mina (1:55:13.160)

in a pretty deep way, Buddhism has that

Lex Fridman (1:55:14.960)

as part of its underlying philosophy

Michael Mina (1:55:18.800)

in terms of rebirth and sort of your actions today

Lex Fridman (1:55:23.000)

propagate to others, but also propagate

Michael Mina (1:55:26.280)

to sort of what might happen in your circle

Lex Fridman (1:55:30.800)

of what's called samsara and rebirth.

Lex Fridman (1:55:32.640)

And I don't know that I subscribe fully

Lex Fridman (1:55:36.640)

to this idea that we are reborn,

Michael Mina (1:55:39.880)

which always was a little bit of a debate internally,

Lex Fridman (1:55:44.840)

I suppose, when I was a monk.

Lex Fridman (1:55:47.760)

But it has always been, it was that

Lex Fridman (1:55:50.480)

and then it was also meditation.

Michael Mina (1:55:52.560)

At the time I was a fairly elite rower.

Lex Fridman (1:55:55.440)

I was rowing at the national level

Lex Fridman (1:55:57.880)

and rowing to me was very meditative.

Lex Fridman (1:56:01.640)

It was just, even if you're in a boat with other people,

Michael Mina (1:56:07.720)

I mean, on the one hand, it's like the extreme

Lex Fridman (1:56:09.560)

of like a team sport, but it's also the extreme

Michael Mina (1:56:13.160)

sort of focus and concentration that's required of it.

Lex Fridman (1:56:16.800)

And so I was always really into just meditative

Michael Mina (1:56:18.880)

type of things.

Lex Fridman (1:56:19.720)

I was doing a lot of pottery too,

Michael Mina (1:56:20.920)

which was also very meditative.

Lex Fridman (1:56:22.480)

And so Buddhism just kind of really,

Michael Mina (1:56:25.720)

there are a lot of things about meditating

Lex Fridman (1:56:28.440)

that just appealed.

Lex Fridman (1:56:30.480)

And so I moved to Sri Lanka,

Lex Fridman (1:56:32.400)

planning to only be there for a couple of months.

Lex Fridman (1:56:35.680)

And then I was shadowing in this medical clinic

Lex Fridman (1:56:37.760)

and there was this physician who was just really,

Michael Mina (1:56:40.360)

I mean, it's just kind of a horrible situation.

Lex Fridman (1:56:43.080)

Frankly, this guy was trained decades earlier.

Michael Mina (1:56:46.040)

He was an older physician and he was still just practicing

Lex Fridman (1:56:49.600)

like these fairly barbaric approaches to medicine

Michael Mina (1:56:52.520)

because he was a rural town

Lex Fridman (1:56:55.560)

and he just didn't have a lot of,

Michael Mina (1:56:58.680)

he didn't have any updated training, frankly.

Lex Fridman (1:57:00.680)

And so, I just remember this like girl came in

Michael Mina (1:57:03.680)

with like shrapnel in her hand

Lex Fridman (1:57:05.920)

and his solution was to like air it out.

Lex Fridman (1:57:08.760)

And so he was like, without even numbing her hand,

Lex Fridman (1:57:12.440)

he was like cutting it open more with this idea

Michael Mina (1:57:16.680)

that like the more oxygen and stuff.

Lex Fridman (1:57:20.040)

And it just, I think there was something about all of this.

Lex Fridman (1:57:23.000)

And I was already talking to these monks at the time.

Lex Fridman (1:57:25.520)

I would be in this clinic in the morning and I'd go

Lex Fridman (1:57:28.760)

and my idea was to teach English

Lex Fridman (1:57:31.520)

to these monks in the evening.

Michael Mina (1:57:34.320)

Turned out I'm a really bad English teacher.

Lex Fridman (1:57:37.080)

So they just taught, they allowed me just to sit with them

Lex Fridman (1:57:40.440)

and meditate and they were teaching me more about Buddhism

Lex Fridman (1:57:42.960)

than I could have possibly taught them about English

Michael Mina (1:57:44.800)

or being an American or something.

Lex Fridman (1:57:50.720)

And so I just slowly, I just couldn't take,

Michael Mina (1:57:52.800)

I like couldn't handle being in that clinic.

Lex Fridman (1:57:55.240)

So more and more, I just started moving to,

Michael Mina (1:57:57.320)

spending more and more time at this monastery.

Lex Fridman (1:57:59.440)

And then after about two months,

Michael Mina (1:58:00.760)

I was supposed to come back to the States

Lex Fridman (1:58:02.200)

and I decided I didn't want to.

Lex Fridman (1:58:04.160)

So I moved to this monastery in the mountains

Lex Fridman (1:58:07.480)

primarily because I didn't have the money

Michael Mina (1:58:09.160)

to like just keep living.

Lex Fridman (1:58:11.200)

So living in a monastery is free.

Lex Fridman (1:58:13.560)

And so I moved there and just started meditating

Lex Fridman (1:58:16.240)

more and more and then months went by

Lex Fridman (1:58:17.680)

and it just really gravitated.

Lex Fridman (1:58:22.160)

I gravitated to the whole notion of it.

Michael Mina (1:58:24.840)

I mean, it became, it sounds strange,

Lex Fridman (1:58:28.440)

but meditating almost just like anything

Michael Mina (1:58:30.720)

that you've put your mind to became exciting.

Lex Fridman (1:58:34.600)

It became like there weren't enough hours

Michael Mina (1:58:36.520)

in the day to meditate.

Lex Fridman (1:58:38.120)

And I would do it for 18 hours a day, 15 hours a day,

Michael Mina (1:58:41.800)

just sit there and you, and like,

Lex Fridman (1:58:46.160)

I mean, I hate sleeping anyway,

Lex Fridman (1:58:48.520)

but I wouldn't want to go to sleep

Lex Fridman (1:58:49.880)

because I felt like I didn't accomplish

Lex Fridman (1:58:51.440)

what I needed to accomplish in meditation that day,

Lex Fridman (1:58:54.120)

which is so strange because there is no end,

Lex Fridman (1:58:57.000)

but it was always, but there are these,

Lex Fridman (1:59:00.520)

there are these steps that happen during meditation

Michael Mina (1:59:02.800)

that are very prescribed in a way.

Lex Fridman (1:59:05.160)

Buddha talked about them and these are ancient writings,

Michael Mina (1:59:08.080)

which exist.

Lex Fridman (1:59:08.920)

I mean, the writings are real.

Michael Mina (1:59:09.840)

They're thousands of years old now.

Lex Fridman (1:59:11.240)

And so whether it was Buddha writing them or whoever,

Michael Mina (1:59:16.640)

there are lots of different people

Lex Fridman (1:59:17.760)

who have contributed to these writings over the years.

Lex Fridman (1:59:22.200)

But they're very prescribed

Lex Fridman (1:59:23.520)

and they tell you what you're gonna go through.

Lex Fridman (1:59:26.880)

And I didn't really focus too much on them.

Lex Fridman (1:59:30.120)

I read a little bit about them,

Lex Fridman (1:59:31.240)

but your mind really does.

Lex Fridman (1:59:32.400)

When you actually start meditating at that level,

Michael Mina (1:59:35.160)

like not an hour here and there,

Lex Fridman (1:59:36.440)

but like truly just spending your day as meditating,

Michael Mina (1:59:39.560)

it becomes kind of like this other world

Lex Fridman (1:59:42.320)

where it becomes exciting and you're actively working,

Michael Mina (1:59:47.760)

you're actively meditating,

Lex Fridman (1:59:49.400)

not just kind of trying to quiet things.

Michael Mina (1:59:51.200)

That's sort of just the first stage

Lex Fridman (1:59:53.360)

of trying to get your mind to focus.

Michael Mina (1:59:54.960)

Most people never get past that first stage,

Lex Fridman (1:59:56.800)

especially in our culture.

Michael Mina (1:59:58.680)

Could you briefly summarize

Lex Fridman (20:00.740)

that we can do something that's maybe aggressive

Lex Fridman (20:03.460)

and complicated is when there's billions and billions

Lex Fridman (20:05.660)

of billions of dollars in it, you know.

Michael Mina (20:08.020)

I mean, on a difficult note, because this is part

Lex Fridman (20:09.980)

of your work from before the COVID,

Michael Mina (20:12.180)

it does seem that I saw a statistic currently

Lex Fridman (20:15.820)

is that 40% would not be taken,

Michael Mina (20:18.380)

of Americans would not be taking the vaccine,

Lex Fridman (20:20.500)

some number like this.

Lex Fridman (20:21.740)

So you also have to acknowledge that all the money

Lex Fridman (20:24.060)

that's been invested, like there doesn't appear

Michael Mina (20:26.980)

to be a solution to deal with like the fear,

Lex Fridman (20:30.340)

distrust that people have.

Michael Mina (20:32.260)

I bet, I don't know if you know this number,

Lex Fridman (20:34.700)

but for taking a strip, like a rapid test like this,

Michael Mina (20:38.300)

I bet you people would say,

Lex Fridman (20:41.100)

like the percentage of people that wouldn't take it

Michael Mina (20:43.060)

is in the single digits, probably.

Lex Fridman (20:45.260)

I completely think so.

Lex Fridman (20:46.820)

And you know, there's a lot of people

Lex Fridman (20:48.060)

who don't want to get a test today.

Lex Fridman (20:50.420)

And that's because it gets sent to a lab,

Lex Fridman (20:53.100)

it gets reported, it has all this stuff.

Lex Fridman (20:55.820)

And we're a country which teaches people

Lex Fridman (20:58.900)

from the time they're babies, you know,

Michael Mina (21:01.060)

to keep their medical data close to them.

Lex Fridman (21:04.500)

We have HIPAA, we have all these,

Michael Mina (21:05.900)

we have immense rules and regulations

Lex Fridman (21:07.700)

to ensure the privacy of people's medical data.

Lex Fridman (21:11.540)

And then a pandemic comes around

Lex Fridman (21:12.980)

and we just assume that the average person

Michael Mina (21:15.540)

is gonna wipe all that away and say,

Lex Fridman (21:17.580)

oh no, I'm happy giving out not just my own medical data,

Lex Fridman (21:20.540)

but also to tell the authorities,

Lex Fridman (21:22.900)

everyone who I've spent my time with,

Lex Fridman (21:24.340)

so that they all get a call and are pissed at me

Lex Fridman (21:26.860)

for giving up their names.

Michael Mina (21:28.100)

You know, so people aren't getting tested

Lex Fridman (21:29.860)

and they're definitely not giving up their contacts

Michael Mina (21:32.980)

when it comes to contact tracing.

Lex Fridman (21:34.860)

And so for so many reasons, that approach is failing.

Michael Mina (21:38.980)

Not to even mention the delays in testing

Lex Fridman (21:41.060)

and things like that.

Lex Fridman (21:41.900)

And so this is a whole different approach,

Lex Fridman (21:44.500)

but it's an approach that empowers people

Lex Fridman (21:46.940)

and takes the power a bit away from the people in charge.

Lex Fridman (21:51.220)

You know, and that's what's really grating on,

Michael Mina (21:54.260)

I think, public health officials who say,

Lex Fridman (21:56.020)

no, we need the data.

Lex Fridman (21:57.420)

So they're effectively saying, if I can't have the data,

Lex Fridman (22:00.540)

I don't want the individuals,

Michael Mina (22:02.180)

I don't want the public to have their own data either.

Lex Fridman (22:04.740)

Which is a terrible approach to a pandemic

Michael Mina (22:06.660)

where we can't solve a public health crisis

Lex Fridman (22:09.820)

without actively engaging the public.

Michael Mina (22:13.700)

It just doesn't work.

Lex Fridman (22:14.860)

And you know, and that's what we're trying to do right now,

Michael Mina (22:17.460)

which is a terrible approach.

Lex Fridman (22:19.180)

So first of all, there's a,

Michael Mina (22:20.580)

you have a really nice informative website,

Lex Fridman (22:22.420)

rapidtest.org, with information on this.

Michael Mina (22:24.900)

I still can't believe this is not more popular.

Lex Fridman (22:26.900)

It's ridiculous.

Michael Mina (22:27.740)

Okay, but our, one of the FAQs you have

Lex Fridman (22:32.980)

is a rapid test too expensive.

Lex Fridman (22:35.180)

So can cost be brought down?

Lex Fridman (22:38.340)

Like I pay, I take a weekly PCR test

Lex Fridman (22:41.820)

and I think I pay 160, 170 bucks a week.

Lex Fridman (22:46.180)

No, I mean, it's criminal.

Michael Mina (22:47.420)

Absolutely we can get costs.

Lex Fridman (22:49.380)

This thing right here costs less than a dollar to make.

Michael Mina (22:53.260)

With everything combined, plus the swabs,

Lex Fridman (22:55.900)

you know, maybe it costs a dollar 50.

Michael Mina (22:58.060)

Could be sold for, frankly, it could be sold for $3

Lex Fridman (23:02.580)

and still make a profit if they wanna sell it for five.

Michael Mina (23:04.740)

This one here, this is a slightly more complicated one,

Lex Fridman (23:08.940)

but you can see it's just got

Michael Mina (23:10.980)

the exact same paper strip inside.

Lex Fridman (23:13.740)

And this is really, it doesn't look like much,

Lex Fridman (23:15.780)

but it's kind of the cream of the crop

Lex Fridman (23:17.060)

in terms of these rapid tests.

Michael Mina (23:19.340)

This is the one that the US government bought

Lex Fridman (23:20.900)

and it is doing an amazing job.

Michael Mina (23:23.260)

It has a 99.9% sensitivity and specificity.

Lex Fridman (23:27.620)

So it's really, it's really good.

Lex Fridman (23:29.540)

And so essentially the way it works is you just,

Lex Fridman (23:31.860)

you use a swab, you put the,

Michael Mina (23:34.180)

once you kind of use a swab on yourself,

Lex Fridman (23:36.180)

you put the swab into these little holes here.

Michael Mina (23:39.020)

You put some buffer on it and you close it

Lex Fridman (23:41.460)

and a line will show up if it's positive

Lex Fridman (23:43.940)

and a line won't show up if it's negative.

Lex Fridman (23:45.780)

It takes five, 10 minutes.

Michael Mina (23:48.500)

This whole thing, this can be made so cheap

Lex Fridman (23:51.980)

that the US government was able to buy them,

Michael Mina (23:54.660)

buy 150 million of them from Abbott for $5 a piece.

Lex Fridman (24:00.460)

So anyone who says that these are expensive,

Michael Mina (24:03.220)

we have the proof is right here.

Lex Fridman (24:05.140)

This one at its, Abbott did not lose money on this deal.

Michael Mina (24:10.300)

They got $750 million for selling 150 million of these

Lex Fridman (24:14.820)

at five bucks a piece.

Michael Mina (24:17.420)

All of these tests can do the same.

Lex Fridman (24:20.460)

So anyone who says that these should be,

Michael Mina (24:22.500)

unfortunately what's happening though

Lex Fridman (24:23.940)

is the FDA is only authorizing

Michael Mina (24:25.860)

all of these tests as medical devices.

Lex Fridman (24:28.380)

So what happens when you, if I'm a medical company,

Michael Mina (24:32.340)

if I'm a test production company

Lex Fridman (24:34.580)

and I wanna make this test and I go through

Lex Fridman (24:37.260)

and the FDA at the end of my authorization,

Lex Fridman (24:40.380)

the FDA says, okay, you now have a medical device,

Michael Mina (24:45.180)

not a public health tool, but a medical device.

Lex Fridman (24:47.880)

And that affords you the ability to charge

Michael Mina (24:50.700)

insurance companies for it.

Lex Fridman (24:53.540)

Why would I ever as a, you know,

Michael Mina (24:55.980)

in our capitalistic economy and sort of infrastructure,

Lex Fridman (25:01.180)

why would I ever not sell this for $30

Lex Fridman (25:03.540)

when insurance will pay for it or $100?

Lex Fridman (25:06.660)

You know, it might only cost me 50 cents to make,

Lex Fridman (25:09.340)

but by pushing all of these tests through a medical pathway

Lex Fridman (25:13.180)

at the FDA, what extrudes out the other side

Michael Mina (25:17.280)

is an expensive medical device that's erroneously expensive.

Lex Fridman (25:20.380)

It doesn't need to be inflated in cost,

Lex Fridman (25:22.900)

but the companies say, well, I'd rather make fewer of them

Lex Fridman (25:27.100)

and just sell them all for $30 a piece

Michael Mina (25:30.340)

than make tens of millions of them, which I could do,

Lex Fridman (25:34.000)

and sell them at a dollar marginal profit.

Lex Fridman (25:39.000)

And so it's a problem with our whole medical industry

Lex Fridman (25:43.740)

that we see tests only as medical devices

Lex Fridman (25:46.420)

and what I would like to see is for the government

Lex Fridman (25:49.340)

in the same way that they bought 150 million of these

Michael Mina (25:51.740)

from Abbott, they should be buying, you know,

Lex Fridman (25:55.660)

all of these tests, they should be buying 20 million a day

Lex Fridman (25:59.140)

and getting them out to people's homes.

Lex Fridman (26:00.700)

This virus has cost trillions of dollars

Michael Mina (26:03.060)

to the American people.

Lex Fridman (26:05.020)

It's closed down restaurants and stores

Lex Fridman (26:07.740)

and obviously the main streets across America

Lex Fridman (26:09.820)

have shuttered.

Michael Mina (26:11.820)

It's killing people, it's killing our economy,

Lex Fridman (26:14.460)

it's killing lifestyles and lives.

Michael Mina (26:17.940)

This is an obvious solution.

Lex Fridman (26:19.220)

To me, this is exciting.

Michael Mina (26:20.300)

This is like, this is a solution.

Lex Fridman (26:21.760)

I wish like in April or something like that

Michael Mina (26:25.660)

to launch like the larger scale manufacturing deployment

Lex Fridman (26:30.860)

of tests.

Michael Mina (26:33.320)

Doesn't matter what test they are.

Lex Fridman (26:35.180)

It's obviously the capitalist system

Michael Mina (26:37.020)

would create cheaper and cheaper tests

Lex Fridman (26:38.940)

that would be hopefully driving down to $1.

Lex Fridman (26:42.340)

So what are we talking about?

Lex Fridman (26:43.940)

In America, there's, I don't know,

Michael Mina (26:46.100)

300 plus million people.

Lex Fridman (26:49.180)

So that means you wanna be testing regularly, right?

Lex Fridman (26:54.140)

So how many do you think is possible to manufacture?

Lex Fridman (26:57.500)

What would be the ultimate goal to manufacture per month?

Michael Mina (27:00.820)

Yep, so if we wanna slow this virus

Lex Fridman (27:03.980)

and actually stop it from transmitting,

Michael Mina (27:05.700)

achieve what I call herd effects.

Lex Fridman (27:07.380)

Like vaccine herd immunity,

Michael Mina (27:09.980)

herd effects are when you get that R value below one

Lex Fridman (27:13.180)

through preventing onward transmission.

Michael Mina (27:14.700)

If we wanna do that with these tests,

Lex Fridman (27:15.980)

we need about 20 million to 40 million of them every day,

Michael Mina (27:20.580)

which is not a lot.

Lex Fridman (27:21.580)

In the United States.

Michael Mina (27:22.420)

In the United States.

Lex Fridman (27:23.580)

So we could do it.

Michael Mina (27:24.540)

There's other ways.

Lex Fridman (27:25.360)

You can have two people in a household swab each other,

Michael Mina (27:29.220)

swab themselves rather,

Lex Fridman (27:31.080)

and then mix, put the swabs into the same tube

Lex Fridman (27:33.520)

and onto one test so you can pool.

Lex Fridman (27:35.400)

So you can get a two or three X gain in efficiency

Michael Mina (27:40.340)

through pooling in the household.

Lex Fridman (27:42.380)

You could do that in schools or offices too,

Michael Mina (27:44.300)

wherever and just use a swab.

Lex Fridman (27:45.580)

You have a, there's two people.

Michael Mina (27:47.780)

I mean, even if it's just standing in line

Lex Fridman (27:50.240)

at a public testing site or something,

Michael Mina (27:52.580)

you could just say, okay,

Lex Fridman (27:53.800)

these two are the last people to test or swab themselves.

Michael Mina (27:57.020)

They go into one thing.

Lex Fridman (27:58.600)

And if it comes back positive,

Michael Mina (27:59.940)

then you just do each person and it's rapid.

Lex Fridman (28:02.140)

So you can just say to the people, one of you is positive.

Michael Mina (28:05.560)

Let's test you again.

Lex Fridman (28:07.960)

So there's ways to get the efficiency gains much better.

Lex Fridman (28:10.540)

But let's say, I think that the optimal number right now

Lex Fridman (28:13.700)

that matches sort of what we can produce more or less today,

Michael Mina (28:16.780)

if we want it, is 20 million a day.

Lex Fridman (28:19.040)

Right now, one company that,

Michael Mina (28:20.580)

I don't have their test here,

Lex Fridman (28:21.740)

but one company is already producing 5 million tests

Michael Mina (28:24.880)

themselves and shipping them overseas.

Lex Fridman (28:27.780)

It's an American company based in California called Inova,

Lex Fridman (28:30.940)

and they are giving 5 million tests to the UK every day.

Lex Fridman (28:36.400)

Not to the, you know, and this is just because there's no,

Michael Mina (28:39.100)

the federal government hasn't authorized these tests.

Lex Fridman (28:42.180)

So without the support of the government.

Lex Fridman (28:44.680)

So yeah, so essentially,

Lex Fridman (28:46.240)

if the government just puts some support behind it,

Michael Mina (28:49.220)

then yeah, you can get 20 million, probably easy.

Lex Fridman (28:53.980)

Oh yeah, this, I mean, just here,

Michael Mina (28:55.340)

I have three different companies.

Lex Fridman (28:57.500)

These, they all look similar.

Michael Mina (28:58.660)

Well, this one's closed,

Lex Fridman (28:59.500)

but these are three different companies right here.

Michael Mina (29:02.220)

This is a fourth, Abbott.

Lex Fridman (29:04.020)

Now, this is a fifth.

Michael Mina (29:05.580)

This is a sixth.

Lex Fridman (29:07.100)

These two are a little bit different.

Lex Fridman (29:08.660)

Do you mind if in a little bit,

Lex Fridman (29:10.060)

would you take some of these or?

Michael Mina (29:11.660)

Yeah, let's do it.

Lex Fridman (29:12.860)

We can absolutely do them.

Lex Fridman (29:15.540)

So you have a lot of tests in front of you.

Lex Fridman (29:17.860)

Could you maybe explain some of them?

Michael Mina (29:20.100)

Absolutely.

Lex Fridman (29:21.300)

So there's a few different classes of tests

Michael Mina (29:24.360)

that I just have here, and there's more tests.

Lex Fridman (29:26.040)

There's many more different tests out in the world too.

Michael Mina (29:28.880)

These are one class of tests.

Lex Fridman (29:31.460)

These are rapid antigen tests

Michael Mina (29:33.700)

that are just the most bare bones paper strip tests.

Lex Fridman (29:36.780)

These are, this is the type that I wanna see produced

Michael Mina (29:42.060)

in the tens of millions every day.

Lex Fridman (29:43.940)

It's so simple.

Michael Mina (29:45.460)

You don't even need the plastic cartridge.

Lex Fridman (29:47.500)

You can just make the paper strip,

Lex Fridman (29:52.180)

and you could have a little tube like this

Lex Fridman (29:55.340)

that you just dunk the paper strip into.

Michael Mina (29:57.660)

You don't actually need the plastic,

Lex Fridman (2:00:00.560)

what's waiting beyond the stage of just quieting the mind?

Michael Mina (2:00:05.560)

It's hard for me to imagine that there's something

Lex Fridman (2:00:08.320)

that could be described as exciting on there.

Michael Mina (2:00:12.320)

Yeah, it's an interesting question.

Lex Fridman (2:00:14.600)

So I would say, so the first thing,

Michael Mina (2:00:18.080)

the first step is truly just to like be able

Lex Fridman (2:00:20.360)

to close your eyes, focus on your breath

Lex Fridman (2:00:23.040)

and not have other thoughts enter into your mind.

Lex Fridman (2:00:26.240)

That alone is just so hard to do.

Michael Mina (2:00:28.320)

Like I couldn't do it now if I wanted, but I could then.

Lex Fridman (2:00:33.320)

But once you get past that stage,

Michael Mina (2:00:38.520)

you start entering into like all these other,

Lex Fridman (2:00:41.600)

you go through the kind of,

Michael Mina (2:00:42.520)

I went through this like pretty trippy stage,

Lex Fridman (2:00:44.640)

which is a little bit euphoric

Michael Mina (2:00:47.600)

where you just kind of start not hallucinating.

Lex Fridman (2:00:49.800)

I mean, it wasn't like some crazy thing

Michael Mina (2:00:51.440)

that would happen in a movie,

Lex Fridman (2:00:53.080)

but definitely just weird.

Michael Mina (2:00:55.320)

You start getting into the stage

Lex Fridman (2:00:56.720)

where you're able to quiet your mind for so long,

Michael Mina (2:01:01.720)

for hours at a time that like for me,

Lex Fridman (2:01:04.640)

I started getting really excited

Michael Mina (2:01:07.640)

about this idea of mindfulness,

Lex Fridman (2:01:09.640)

which is part of Buddhism in general,

Lex Fridman (2:01:11.760)

but it's part of Theravada Buddhism in particular

Lex Fridman (2:01:13.760)

for this in this way, which was you take,

Michael Mina (2:01:19.400)

you start focusing on your daily activities,

Lex Fridman (2:01:21.600)

whether that's sipping a cup of tea or walking

Michael Mina (2:01:25.280)

or sweeping around.

Lex Fridman (2:01:29.520)

I lived on this mountainside in this cottage thing,

Michael Mina (2:01:32.360)

it was built into the rock.

Lex Fridman (2:01:33.440)

And so every morning I would wake up early

Lex Fridman (2:01:36.280)

and sweep around it and stuff,

Lex Fridman (2:01:37.600)

cause that's just what we did.

Lex Fridman (2:01:40.760)

And you start to, you meditate on all those activities.

Lex Fridman (2:01:44.000)

And one of the things that was so exciting,

Michael Mina (2:01:46.240)

which sounds completely ridiculous now

Lex Fridman (2:01:48.720)

was just almost learning about your daily activities

Michael Mina (2:01:54.200)

in ways that you never would have thought about before.

Lex Fridman (2:01:56.880)

So what's involved with like picking up this glass of water?

Michael Mina (2:02:03.640)

If I said, okay, I'm just gonna pick,

Lex Fridman (2:02:05.120)

I'm gonna take a drink of water,

Michael Mina (2:02:06.840)

to me right now, it's a single activity.

Lex Fridman (2:02:10.800)

But during meditation, it's not a single activity.

Michael Mina (2:02:16.360)

It's a whole series of activities

Lex Fridman (2:02:18.160)

of like little engineering feats and feelings.

Lex Fridman (2:02:21.960)

And it's gripping the water

Lex Fridman (2:02:24.240)

and it's feeling that the glass is cold

Lex Fridman (2:02:25.960)

and it's lifting and it's moving and dragging and dragging.

Lex Fridman (2:02:29.280)

And you start to learn a whole new language of life.

Lex Fridman (2:02:34.200)

And that to me was like this really exhilarating thing

Lex Fridman (2:02:37.560)

that it was an exhilarating component of meditation

Michael Mina (2:02:41.320)

that there was never enough time.

Lex Fridman (2:02:44.520)

It's kind of like learning a new computer language.

Michael Mina (2:02:46.360)

Like it gets really exciting when you start coding

Lex Fridman (2:02:48.280)

and all these new things you can do.

Michael Mina (2:02:50.480)

You learn how to experience life in a much richer way.

Lex Fridman (2:02:55.400)

And so you never run out of ways

Michael Mina (2:02:57.000)

to go deeper and deeper and deeper

Lex Fridman (2:02:58.840)

in the way you experienced even just

Michael Mina (2:03:00.480)

the drinking of the glass of water.

Lex Fridman (2:03:02.360)

That's exactly right.

Lex Fridman (2:03:03.280)

And what becomes kind of exhilarating

Lex Fridman (2:03:05.040)

is you start to be able to predict things

Michael Mina (2:03:07.640)

that you never are,

Lex Fridman (2:03:09.280)

I don't even have predictions, right word.

Lex Fridman (2:03:11.180)

But I always think of the matrix,

Lex Fridman (2:03:13.000)

where I forget who it was,

Michael Mina (2:03:15.200)

somebody was shooting at Neo

Lex Fridman (2:03:17.880)

and he like leans backwards and he dodges the bullets.

Michael Mina (2:03:22.840)

In some ways, when you start breaking

Lex Fridman (2:03:24.420)

every little action that your hands do

Michael Mina (2:03:26.200)

or that your feet do or that your body does

Lex Fridman (2:03:27.800)

down into all these little actions

Michael Mina (2:03:29.520)

that make up one what we normally think of as an action,

Lex Fridman (2:03:33.340)

all of a sudden you can start to see things

Michael Mina (2:03:35.360)

almost in slow motion.

Lex Fridman (2:03:37.080)

I like to think of it very much like language.

Michael Mina (2:03:40.280)

The first time somebody hears a foreign language,

Lex Fridman (2:03:44.360)

it sounds really fast usually.

Michael Mina (2:03:45.960)

You don't hear the spaces between words.

Lex Fridman (2:03:48.960)

And it just sounds like a stream of consciousness.

Lex Fridman (2:03:53.960)

And it just sounds like a stream of noises

Lex Fridman (2:03:55.680)

if you've never heard the language before.

Lex Fridman (2:03:57.040)

And as you learn the language,

Lex Fridman (2:03:58.740)

you hear clear breaks between words

Lex Fridman (2:04:01.200)

and it starts to gain context.

Lex Fridman (2:04:02.800)

And all of a sudden like that,

Lex Fridman (2:04:04.320)

what once sounded very fast slows down and it has meaning.

Lex Fridman (2:04:10.160)

That's our whole life.

Michael Mina (2:04:11.440)

Well, there's this whole language happening

Lex Fridman (2:04:13.040)

that we don't speak generally.

Lex Fridman (2:04:15.540)

But if you start to speak it

Lex Fridman (2:04:17.140)

and if you start to learn it and you start to say,

Michael Mina (2:04:19.840)

hey, I'm picking up this glass

Lex Fridman (2:04:21.060)

is actually 18 little movements.

Michael Mina (2:04:24.060)

Then all of a sudden it becomes extremely exciting

Lex Fridman (2:04:27.280)

and exhilarating to just breathe.

Michael Mina (2:04:29.460)

Breathing alone and the rise and fall of your abdomen

Lex Fridman (2:04:31.640)

or the way the air pushes in and out of your nose

Michael Mina (2:04:34.120)

becomes almost interesting.

Lex Fridman (2:04:37.640)

And what's really neat is the world just starts slowing down

Lex Fridman (2:04:41.520)

and I'll never forget that feeling.

Lex Fridman (2:04:44.120)

And if there was one euphoric feeling from meditation

Michael Mina (2:04:47.140)

I want to gain back,

Lex Fridman (2:04:48.960)

but I don't think I could without really meditating

Michael Mina (2:04:51.560)

like that again and I don't think I will,

Lex Fridman (2:04:54.400)

was this like slow motion of the world.

Michael Mina (2:04:57.040)

It was finding the spaces between all the movements

Lex Fridman (2:05:01.440)

in the same way that the spaces between all the words happen.

Lex Fridman (2:05:04.680)

And then it almost gives you this new appreciation

Lex Fridman (2:05:06.960)

for everything, it was really amazing.

Lex Fridman (2:05:10.160)

And so I think it came to an abrupt end though

Lex Fridman (2:05:14.240)

when the tsunami hit.

Michael Mina (2:05:15.440)

I was there in the Indian Ocean tsunami hit in 2004.

Lex Fridman (2:05:19.580)

And it was like this dichotomy of being a monk

Lex Fridman (2:05:22.220)

and just meditating in this extraordinary place.

Lex Fridman (2:05:28.040)

And then the tsunami hits and kills 40,000 people

Michael Mina (2:05:30.700)

in a few minutes on the coast

Lex Fridman (2:05:32.280)

of this really small little country in Sri Lanka.

Lex Fridman (2:05:34.920)

And then my whole world of being a monk

Lex Fridman (2:05:40.440)

came crashing down.

Lex Fridman (2:05:41.820)

And when I go to the coast,

Lex Fridman (2:05:46.160)

and I mean, that was just a devastating visual sight

Lex Fridman (2:05:53.420)

and emotional sight.

Lex Fridman (2:05:54.520)

But the strangest thing happened,

Michael Mina (2:05:56.540)

which was that everyone just wanted me to stay as a monk.

Lex Fridman (2:05:59.620)

You know, people in that culture, they wanted to,

Michael Mina (2:06:03.780)

the monks largely fled from the coastlines those,

Lex Fridman (2:06:07.140)

you know, and so then there I was

Lex Fridman (2:06:09.740)

and people wanted me to be a monk.

Lex Fridman (2:06:11.300)

They wanted me to stay on the coast,

Lex Fridman (2:06:12.300)

but be a monk and not help,

Lex Fridman (2:06:14.420)

like not help in the way that I considered helping.

Michael Mina (2:06:18.740)

They wanted me just to keep meditating

Lex Fridman (2:06:20.560)

so that they could bring me offerings

Lex Fridman (2:06:23.380)

and have their sort of karmic responsibilities

Lex Fridman (2:06:28.460)

attended to as well.

Lex Fridman (2:06:29.380)

And so that was really bizarre to me.

Lex Fridman (2:06:32.540)

It was like, how could I possibly just sit around

Lex Fridman (2:06:36.420)

while all these people, half of everyone's family just died?

Lex Fridman (2:06:40.300)

And so in any case, I stopped being a monk

Lex Fridman (2:06:44.060)

and I moved to this refugee camp

Lex Fridman (2:06:45.540)

and lived there for another six months or so

Lex Fridman (2:06:47.420)

and just stayed there, not as a monk,

Lex Fridman (2:06:54.580)

but tried to raise some money from the US

Lex Fridman (2:06:56.620)

and tried to like, I didn't know what I was doing.

Lex Fridman (2:06:58.920)

Frankly, I was 22.

Lex Fridman (2:07:03.460)

And I don't think I appreciated at the time

Lex Fridman (2:07:06.180)

how much of a role I was having in that community's life.

Lex Fridman (2:07:10.520)

But it's taken me many years to process all of this

Lex Fridman (2:07:14.660)

since then, but I would say it's what put me

Michael Mina (2:07:17.580)

into the public health world, living in that refugee camp.

Lex Fridman (2:07:21.100)

And that difference that happened,

Michael Mina (2:07:22.900)

from being a monk to being in this devastating environment

Lex Fridman (2:07:28.300)

just really changed my whole view

Michael Mina (2:07:30.140)

of sort of why I was existing, I suppose.

Lex Fridman (2:07:34.680)

Well, so there's this richness of life

Michael Mina (2:07:40.060)

in a single drink of water that you experience,

Lex Fridman (2:07:42.700)

and then there's this power of nature

Michael Mina (2:07:46.180)

that's capable to take the lives of thousands of people.

Lex Fridman (2:07:50.100)

So given all that, the absurdity of that,

Michael Mina (2:07:54.020)

let me ask you, and the fact that you study things

Lex Fridman (2:07:58.180)

that could kill the entirety of human civilization,

Lex Fridman (2:08:01.220)

what do you think is the meaning of this all?

Lex Fridman (2:08:03.860)

What do you think is the meaning of life,

Lex Fridman (2:08:05.540)

this whole orchestra we've got going on?

Lex Fridman (2:08:08.060)

Does it have a meaning?

Lex Fridman (2:08:09.940)

And maybe from another perspective,

Lex Fridman (2:08:15.020)

how does one live a meaningful life, if such is possible?

Michael Mina (2:08:22.500)

Well, from what I've seen,

Lex Fridman (2:08:26.100)

I don't think there's a single answer to that by any stretch.

Michael Mina (2:08:29.060)

One of the most interesting things about Buddhism to me

Lex Fridman (2:08:32.300)

is that the human existence is part of suffering,

Michael Mina (2:08:36.860)

which is very different from Judeo Christian existence,

Lex Fridman (2:08:40.980)

which is that human existence is something to be,

Michael Mina (2:08:47.620)

is a very different, it's something to,

Lex Fridman (2:08:50.220)

there's a richness to it.

Michael Mina (2:08:51.740)

In Buddhism, it's just another one of your lives,

Lex Fridman (2:08:55.460)

but it's your opportunity to attain nirvana

Lex Fridman (2:08:59.660)

and become a monk, for example, and meditate

Lex Fridman (2:09:02.420)

to attain nirvana,

Michael Mina (2:09:04.580)

else you kind of just go back into the samsara,

Lex Fridman (2:09:06.820)

the cycle of suffering.

Lex Fridman (2:09:09.180)

And so, when I look at, I mean, in some ways,

Lex Fridman (2:09:14.180)

the notion of life and what the purpose of life is,

Michael Mina (2:09:18.860)

they're kind of completely distinct,

Lex Fridman (2:09:20.940)

this sort of Western view of life,

Michael Mina (2:09:22.980)

which is that this life is the most precious thing

Lex Fridman (2:09:27.220)

in the world versus this is just another opportunity

Michael Mina (2:09:30.460)

to try to get out of life.

Lex Fridman (2:09:33.300)

I mean, the whole notion of nirvana, and in Buddhism,

Michael Mina (2:09:35.880)

it getting out of this sort of cycle of suffering

Lex Fridman (2:09:40.100)

is to vanish.

Michael Mina (2:09:41.380)

If you could attain nirvana throughout this life,

Lex Fridman (2:09:45.680)

the idea is that you don't get reborn.

Lex Fridman (2:09:48.660)

And so, when I look at these two,

Lex Fridman (2:09:51.340)

on the one hand, you have Christian faith

Lex Fridman (2:09:55.100)

and other things that want to go to heaven

Lex Fridman (2:09:57.160)

and live forever in heaven.

Michael Mina (2:09:58.920)

Then you have this other whole half of humans

Lex Fridman (2:10:01.260)

who want nothing more than to get out of the cycle

Michael Mina (2:10:05.740)

of rebirth and just, poof, not exist anymore.

Lex Fridman (2:10:09.100)

The cycle of suffering, yeah.

Lex Fridman (2:10:10.300)

Yeah, and so how do you reconcile those two?

Lex Fridman (2:10:12.500)

And I guess.

Lex Fridman (2:10:13.620)

Do you have both of them in you?

Lex Fridman (2:10:15.760)

Do you basically oscillate back and forth?

Michael Mina (2:10:18.020)

I don't think I, I think I just,

Lex Fridman (2:10:19.860)

I look at us and I think we're just a bunch of proteins.

Michael Mina (2:10:23.080)

That we form and we, they work in this really amazing way

Lex Fridman (2:10:29.560)

and they might work in a bigger scale.

Michael Mina (2:10:31.400)

There might be some connections

Lex Fridman (2:10:33.800)

that we're not really clear about,

Lex Fridman (2:10:35.400)

but they're still biological.

Lex Fridman (2:10:36.560)

I believe that they're biological.

Lex Fridman (2:10:38.360)

How did these proteins become conscious

Lex Fridman (2:10:40.600)

and why do they want to help civilization

Lex Fridman (2:10:43.600)

by having at home rapid tests at scale?

Lex Fridman (2:10:47.640)

Well, I think, I don't have an answer to that one,

Lex Fridman (2:10:50.840)

but I really do believe. I was hoping you would.

Lex Fridman (2:10:53.440)

It's just, you know, this is just an evolution

Michael Mina (2:10:56.320)

of consciousness I don't, I don't personally think is,

Lex Fridman (2:11:02.440)

my feeling is that we're a bunch of pluses and minuses

Michael Mina (2:11:05.400)

that have just gotten so complex

Lex Fridman (2:11:07.160)

that they're able to make rich feelings, rich emotions.

Lex Fridman (2:11:10.880)

And I do believe though, you know, on the one hand,

Lex Fridman (2:11:13.680)

I sometimes wake up some days,

Michael Mina (2:11:16.880)

my fiance doesn't always love it,

Lex Fridman (2:11:18.700)

but you know, I kind of think we're all just a bunch

Michael Mina (2:11:20.160)

of robots with like pretty complicated algorithms

Lex Fridman (2:11:23.400)

that we deal with.

Michael Mina (2:11:26.440)

And, you know, in that sense, like, okay,

Lex Fridman (2:11:28.680)

if the world just blew up tomorrow

Lex Fridman (2:11:30.960)

and nothing existed the day after that,

Lex Fridman (2:11:35.360)

it's just another blip in the universe, you know?

Lex Fridman (2:11:37.920)

But at the same time, I don't know.

Lex Fridman (2:11:40.100)

So that's kind of probably my most core basic feeling

Michael Mina (2:11:42.460)

about life is like, we're just a blip

Lex Fridman (2:11:45.520)

and we may as well make the most of it

Michael Mina (2:11:47.320)

while we're here blipping.

Lex Fridman (2:11:48.620)

It's one hell of a fun blip though.

Michael Mina (2:11:52.280)

It is, it's an amazing blink of an eye in time.

Lex Fridman (2:11:59.120)

Michael, this is, you're one of the most interesting people

Michael Mina (2:12:01.640)

I've met, one of the most interesting conversations,

Lex Fridman (2:12:03.920)

important ones now, I'm going to publish it very soon.

Michael Mina (2:12:07.400)

I really appreciate taking the time,

Lex Fridman (2:12:09.720)

I know how busy you are, it was really fun.

Michael Mina (2:12:12.920)

Thanks for talking today.

Lex Fridman (2:12:14.100)

Well, thanks so much, this was a lot of fun.

Michael Mina (2:12:16.440)

Thanks for listening to this conversation

Lex Fridman (2:12:19.420)

with Michael Mina and thank you to our sponsors.

Michael Mina (2:12:22.260)

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Lex Fridman (2:12:25.220)

but has more privacy preserving features.

Michael Mina (2:12:27.860)

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Lex Fridman (2:12:30.460)

that I start every day with to cover

Michael Mina (2:12:32.320)

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Lex Fridman (2:12:34.100)

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Michael Mina (2:12:37.140)

to protect my privacy on the internet.

Lex Fridman (2:12:39.240)

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Michael Mina (2:12:42.660)

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Lex Fridman (2:12:45.380)

to get a discount and to support this podcast.

Michael Mina (2:12:48.940)

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Lex Fridman (2:12:51.380)

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Michael Mina (2:12:53.740)

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Lex Fridman (2:12:56.340)

or connect with me on Twitter at Lex Friedman.

Lex Fridman (2:12:59.620)

And now, let me leave you with some words

Lex Fridman (2:13:01.940)

from Teddy Roosevelt.

Michael Mina (2:13:03.800)

It is not the critic who counts.

Lex Fridman (2:13:06.780)

Not the man who points out how the strong man stumbles

Michael Mina (2:13:10.180)

or where the doer of deeds could have done them better.

Lex Fridman (2:13:13.620)

The credit belongs to the man who actually is in the arena,

Michael Mina (2:13:17.860)

whose face is marred by dust and sweat and blood,

Lex Fridman (2:13:21.260)

who strives valiantly, who errs,

Michael Mina (2:13:24.500)

who comes short again and again,

Lex Fridman (2:13:27.180)

because there is no effort without error and shortcoming,

Lex Fridman (2:13:30.700)

but who does actually strive to do the deeds,

Lex Fridman (2:13:33.780)

who knows great enthusiasms, the great devotions,

Michael Mina (2:13:37.460)

who spends himself in a worthy cause,

Lex Fridman (2:13:40.260)

who at the best knows in the end that triumph

Michael Mina (2:13:43.580)

of high achievement, and who at the worst, if he fails,

Lex Fridman (2:13:47.380)

at least fails while daring greatly,

Lex Fridman (2:13:50.560)

so that his place shall never be

Lex Fridman (2:13:53.220)

with those cold and timid souls

Michael Mina (2:13:55.460)

who neither know victory nor defeat.

Lex Fridman (2:13:58.060)

Thank you for listening and hope to see you next time.

Michael Mina (30:00.100)

which I'd actually prefer,

Lex Fridman (30:01.320)

because if we start making tens of millions of these,

Michael Mina (30:03.440)

this becomes a lot of waste.

Lex Fridman (30:05.340)

So I'd rather not see this kind of waste be out there.

Lex Fridman (30:07.420)

And there's a few companies,

Lex Fridman (30:08.660)

Quidel is making a test called the Quick View,

Michael Mina (30:11.560)

which is just this.

Lex Fridman (30:12.880)

It's a, they've gotten rid of all the plastic.

Lex Fridman (30:16.500)

And for people who are just listening to this,

Lex Fridman (30:18.380)

we're looking at some very small tests

Michael Mina (30:20.460)

that fit in the palm of your hand,

Lex Fridman (30:22.260)

and they're basically paper strips

Michael Mina (30:24.300)

fit into different containers.

Lex Fridman (30:26.320)

And that's hence the comment about the plastic containers.

Michael Mina (30:29.620)

These are just injection molded, I think.

Lex Fridman (30:32.140)

And they're, you know,

Michael Mina (30:34.440)

they can build them at high numbers,

Lex Fridman (30:36.900)

but then they have to like place them in there appropriately

Lex Fridman (30:38.940)

and all this stuff.

Lex Fridman (30:39.780)

So it is a bottleneck,

Michael Mina (30:41.420)

or somewhat of a bottleneck in manufacturing.

Lex Fridman (30:44.300)

The actual bottleneck, which the government, I think,

Michael Mina (30:47.260)

should use the Defense Productions Act to build up,

Lex Fridman (30:49.860)

is there's a nitrocellulose membrane,

Michael Mina (30:52.740)

a laminated membrane on this,

Lex Fridman (30:54.480)

that allows the material,

Michael Mina (30:57.220)

the buffer with the swab mixture to flow across it.

Lex Fridman (31:02.320)

So the way these work,

Michael Mina (31:03.280)

they're called lateral flow tests.

Lex Fridman (31:05.180)

And you take a swab,

Michael Mina (31:07.220)

you swab the front of your nose,

Lex Fridman (31:10.040)

you dunk that swab into some buffer,

Lex Fridman (31:12.880)

and then you put a couple of drops of that buffer

Lex Fridman (31:15.540)

onto the lateral flow.

Lex Fridman (31:17.460)

And just like paper,

Lex Fridman (31:19.060)

if you dip a piece of paper into a cup of water,

Michael Mina (31:21.820)

the paper will pull the water up through capillary action.

Lex Fridman (31:25.000)

This actually works very similarly.

Michael Mina (31:26.340)

It flows through somewhat a capillary action

Lex Fridman (31:29.700)

through this nitrocellulose membrane.

Lex Fridman (31:32.260)

And there's little antibodies on there,

Lex Fridman (31:33.860)

these little proteins that are very specific,

Michael Mina (31:36.140)

in this case, for antigens or proteins of the virus.

Lex Fridman (31:39.380)

So these are antibodies similar to the antibodies

Michael Mina (31:42.740)

that our body makes from our immune system,

Lex Fridman (31:45.660)

but they're just printed on these lateral flow tests,

Lex Fridman (31:48.380)

and they're printed just like a little, a line.

Lex Fridman (31:50.580)

So then you slice these all up into individual ones.

Lex Fridman (31:54.580)

And if there's any virus on that buffer,

Lex Fridman (31:56.660)

as it flows across, the antibodies grab that virus,

Lex Fridman (31:59.860)

and it creates a little reaction with some colloids in here

Lex Fridman (32:03.220)

that cause it to turn dark.

Michael Mina (32:04.900)

Just like a pregnancy test,

Lex Fridman (32:07.420)

one line means negative, it means a control strip worked,

Lex Fridman (32:11.540)

and two lines mean positive.

Lex Fridman (32:13.060)

It means, you know, if you get two lines,

Michael Mina (32:16.060)

it just means you have virus there.

Lex Fridman (32:17.100)

You're very, very likely to have virus there.

Lex Fridman (32:18.580)

And so they're super simple.

Lex Fridman (32:21.520)

It is the exact same technology as pregnancy tests.

Michael Mina (32:23.900)

It's the technology, this particular one from Abbott,

Lex Fridman (32:27.940)

this has been used for other infectious diseases

Michael Mina (32:31.020)

like malaria, and actually a number of these companies

Lex Fridman (32:34.300)

have made malaria tests that do the exact same thing.

Lex Fridman (32:37.480)

So they just coopted the same form factor

Lex Fridman (32:41.260)

and just changed the antibodies

Lex Fridman (32:43.340)

so it picks up SARS CoV2 instead of other infections.

Lex Fridman (32:46.580)

Is it also, the Abbott one, is it also a strip?

Michael Mina (32:48.740)

Yep, yeah, this Abbott one here is,

Lex Fridman (32:51.020)

there's the, in this case,

Michael Mina (32:52.140)

instead of being put in a plastic sheath,

Lex Fridman (32:53.700)

it's just put in a cardboard thing and literally glued on.

Michael Mina (32:56.900)

I mean, it looks like nothing, you know, it's just,

Lex Fridman (32:59.780)

it looks like a, like,

Michael Mina (33:02.620)

I mean, it's just the simplest thing you could imagine.

Lex Fridman (33:04.860)

The exterior packaging looks very Apple like, it's nice.

Michael Mina (33:07.580)

It does, yeah, yeah.

Lex Fridman (33:09.420)

Yeah, so it's nice when it comes in a,

Michael Mina (33:11.820)

this is how they're packaged, you know,

Lex Fridman (33:14.820)

so, and they don't have to, you know,

Michael Mina (33:17.980)

these are coming in individual packages against,

Lex Fridman (33:20.340)

again, because they're really considered

Michael Mina (33:21.900)

individual medical devices,

Lex Fridman (33:24.180)

but you could package them in bigger packets and stuff.

Michael Mina (33:27.020)

You wanna be careful with humidity

Lex Fridman (33:28.740)

so they all have a little,

Michael Mina (33:30.260)

one of those humidity removing things

Lex Fridman (33:33.540)

and oxygen removing things.

Lex Fridman (33:36.020)

So that's, this is one class, these antigen tests.

Lex Fridman (33:39.940)

If we could just pause for a second, if it's okay,

Lex Fridman (33:42.580)

and could you just briefly say what is an antigen test

Lex Fridman (33:47.740)

and what other tests there are out there,

Lex Fridman (33:49.580)

like categories of tests?

Lex Fridman (33:50.900)

Sure.

Michael Mina (33:51.740)

Just really quick.

Lex Fridman (33:52.700)

So the testing landscape is a little bit complicated,

Lex Fridman (33:55.180)

but it's, but I'll break it down.

Lex Fridman (33:56.900)

There's really just three major classes of tests.

Michael Mina (34:00.900)

We'll start with the first two.

Lex Fridman (34:02.780)

The first two tests are just looking for the virus

Michael Mina (34:06.300)

or looking for antibodies against the virus.

Lex Fridman (34:10.060)

So we've heard about serology tests,

Michael Mina (34:12.540)

or maybe some people have heard about it.

Lex Fridman (34:14.540)

Those are a different kind of test.

Michael Mina (34:15.860)

They're looking to see has somebody in the past,

Lex Fridman (34:19.220)

does somebody have an immune response against the virus,

Michael Mina (34:21.460)

which would indicate that they were infected

Lex Fridman (34:23.220)

or exposed to it.

Lex Fridman (34:24.740)

So we're not talking about the antibody tests.

Lex Fridman (34:26.780)

I'll just leave it at that.

Michael Mina (34:27.820)

Those, they actually can look very similar to this,

Lex Fridman (34:31.740)

or they can be done in a laboratory.

Michael Mina (34:35.380)

Those are usually done from blood

Lex Fridman (34:37.580)

and they're looking for an immune response to the virus.

Lex Fridman (34:40.580)

So that's one.

Lex Fridman (34:41.740)

Everything I'm talking about here

Michael Mina (34:43.020)

is looking for the virus itself,

Lex Fridman (34:44.660)

not the immune response to the virus.

Lex Fridman (34:46.940)

And so there's two ways to look for the virus.

Lex Fridman (34:49.100)

You can either look for the genetic code of the virus,

Michael Mina (34:51.300)

like the RNA, just like the DNA of somebody's human cells,

Lex Fridman (34:55.460)

or you can look for the proteins themselves,

Michael Mina (34:57.380)

the antigens of the virus.

Lex Fridman (34:59.740)

So I like to differentiate them.

Michael Mina (35:02.380)

If you were a PCR test that looks for RNA in,

Lex Fridman (35:08.740)

let's say if we made it against humans,

Michael Mina (35:10.900)

it would be looking for the DNA inside of our cells.

Lex Fridman (35:13.060)

That would be actually looking for our genetic code.

Michael Mina (35:16.500)

The equivalent to an antigen test

Lex Fridman (35:19.060)

is sort of a test that like actually is looking

Michael Mina (35:21.980)

for our eyes or our nose or physical features of our body

Lex Fridman (35:25.420)

that would delineate, okay, this is Michael, for example.

Lex Fridman (35:30.420)

And so you're either looking for a sequence

Lex Fridman (35:33.620)

or you're looking for a structure.

Michael Mina (35:35.940)

The PCR tests that a lot of people have gotten now

Lex Fridman (35:38.620)

and they're done in labs usually

Michael Mina (35:40.620)

are looking for the sequence of the virus, which is RNA.

Lex Fridman (35:43.620)

This test here by a company called Detect,

Michael Mina (35:46.940)

this is one of Jonathan Rothberg's companies.

Lex Fridman (35:50.380)

He's the guy who helped create modern day sequencing

Lex Fridman (35:54.180)

and all kinds of other things.

Lex Fridman (35:56.020)

So this Detect device, that's the name of the company,

Michael Mina (35:58.820)

this is actually a rapid RNA detection device.

Lex Fridman (36:01.980)

So it's almost, it's like a PCR like test

Lex Fridman (36:04.140)

and we could even do it here.

Lex Fridman (36:06.100)

It's really, it's a beautiful test in my opinion,

Michael Mina (36:09.100)

works exceedingly well.

Lex Fridman (36:10.940)

It's gonna be a little bit more expensive.

Lex Fridman (36:12.380)

So I think it could confirm,

Lex Fridman (36:14.180)

could be used as a confirmatory test for these.

Lex Fridman (36:16.460)

Is there a greater accuracy to it?

Lex Fridman (36:19.740)

Yes, I would say that there is a greater accuracy.

Michael Mina (36:21.780)

There's also a downfall though of PCR

Lex Fridman (36:23.940)

and tests that look for RNA.

Michael Mina (36:26.460)

They can sometimes detect somebody

Lex Fridman (36:29.940)

who is no longer infectious.

Lex Fridman (36:32.340)

So you have the RNA test

Lex Fridman (36:33.900)

and then you have these antigen tests.

Michael Mina (36:35.780)

The antigen tests look for structures,

Lex Fridman (36:37.860)

but they're generally only going to turn positive

Michael Mina (36:40.580)

if people have actively replicating virus in them.

Lex Fridman (36:43.580)

And so what happens after an infection dissipates,

Michael Mina (36:48.260)

you've just gone from having sort of a spike.

Lex Fridman (36:51.260)

So if you get infected, maybe three days later,

Michael Mina (36:53.500)

the virus gets into exponential growth

Lex Fridman (36:56.220)

and it can replicate to trillions of viruses

Michael Mina (36:59.060)

inside the body.

Lex Fridman (37:00.820)

Your immune system then kind of tackles it

Lex Fridman (37:02.900)

and beats it down to nothing.

Lex Fridman (37:04.900)

But what ends up in the wake of that,

Michael Mina (37:07.180)

you just had a battle.

Lex Fridman (37:08.020)

You had this massive battle that just took place

Michael Mina (37:10.340)

inside your upper respiratory tract.

Lex Fridman (37:12.900)

And because of that, you've had trillions and trillions

Michael Mina (37:16.180)

of viruses go to zero, essentially.

Lex Fridman (37:19.660)

But the RNA is still there.

Michael Mina (37:21.540)

It's just these remnants.

Lex Fridman (37:23.020)

In the same way that if you go to a crime scene

Lex Fridman (37:24.820)

and blood was sort of spread all over the crime scene,

Lex Fridman (37:28.820)

you're going to find a lot of DNA.

Michael Mina (37:30.740)

There's tons of DNA.

Lex Fridman (37:31.580)

There's no people anymore, but there's a lot of DNA there.

Michael Mina (37:35.220)

Same thing happens here.

Lex Fridman (37:36.340)

And so what's happening with PCR testing

Michael Mina (37:38.660)

is when people go and use these exceedingly high sensitivity

Lex Fridman (37:42.460)

PCR tests, people will stay positive for weeks or months

Michael Mina (37:46.820)

after their infection has subsided,

Lex Fridman (37:49.700)

which has caused a lot of problems, in my opinion.

Michael Mina (37:51.540)

It's problems that the CDC and the FDA and doctors

Lex Fridman (37:54.900)

don't want to deal with.

Lex Fridman (37:56.780)

But I've tried to publish on it.

Lex Fridman (37:58.140)

I've tried to suggest that this is an issue,

Michael Mina (38:01.660)

both to New York Times and others.

Lex Fridman (38:02.980)

And now it's unfortunately kind of taken

Michael Mina (38:04.620)

on a life of its own of conspiracy theorists

Lex Fridman (38:06.700)

thinking that they call it a case demic.

Michael Mina (38:10.020)

They say, oh, you know, PCR is detecting people

Lex Fridman (38:13.420)

who are no longer, who are false positive.

Michael Mina (38:16.020)

They're not false positives.

Lex Fridman (38:17.340)

They're late positives, no longer transmissible.

Michael Mina (38:20.780)

I think the way you, like what I saw in rapidtest.org,

Lex Fridman (38:25.100)

I really liked the distinction between diagnostic

Michael Mina (38:27.180)

sensitivity and contagiousness sensitivity.

Lex Fridman (38:30.060)

That's, it's so, that website is so obvious

Michael Mina (38:36.380)

that it's painful because it's like, yeah,

Lex Fridman (38:38.220)

that's what we should be talking about is

Lex Fridman (38:41.020)

how accurately is a test able to detect your contagiousness?

Lex Fridman (38:46.260)

And you have different plots that show that actually

Michael Mina (38:48.980)

there's, you know, that antigen tests,

Lex Fridman (38:52.780)

the tests we're looking at today, like rapid tests,

Michael Mina (38:55.540)

are actually really good at detecting contagiousness.

Lex Fridman (38:58.460)

Absolutely.

Michael Mina (38:59.300)

It all mixes back with this whole idea that,

Lex Fridman (39:02.420)

of the medical industrial complex.

Michael Mina (39:04.500)

You know, in this country, and in most countries,

Lex Fridman (39:07.540)

we have almost entirely defunded

Lex Fridman (39:10.900)

and devalued public health, period.

Lex Fridman (39:13.900)

You know, we just have.

Lex Fridman (39:15.660)

And what that means is that we don't even,

Lex Fridman (39:20.060)

we don't have a language for it.

Michael Mina (39:22.100)

We don't have a lexicon for it.

Lex Fridman (39:23.340)

We don't have a regulatory landscape for it.

Lex Fridman (39:25.860)

And so the only window we have to look at a test today

Lex Fridman (39:30.140)

is as a medical diagnostic test.

Lex Fridman (39:32.780)

And that becomes very problematic when we're trying

Lex Fridman (39:37.060)

to tackle a public health threat

Lex Fridman (39:40.100)

and a public health emergency.

Lex Fridman (39:42.100)

By definition, this is a public health emergency

Michael Mina (39:44.660)

that we're in.

Lex Fridman (39:45.900)

And yet we keep evaluating tests

Michael Mina (39:48.820)

as though the diagnostic benchmark is the gold standard.

Lex Fridman (39:52.780)

Where if I'm a physician, I am a physician,

Lex Fridman (39:55.660)

so I'll put on that physician hat for a moment.

Lex Fridman (39:59.260)

And if I have a patient who comes to me

Lex Fridman (40:01.740)

and wants to know if their symptoms are a result of them

Lex Fridman (40:06.740)

having COVID, then I want every shred of evidence

Michael Mina (40:10.060)

that I can get to see, does this person currently

Lex Fridman (40:12.780)

or did they recently have this infection inside of them?

Lex Fridman (40:17.260)

And so in that sense, the PCR test is the perfect test.

Lex Fridman (40:21.220)

It's really sensitive.

Michael Mina (40:22.940)

It will find the RNA if it's there at all

Lex Fridman (40:25.100)

so that I could say, you know, yeah,

Michael Mina (40:26.940)

you have a low amount of RNA left.

Lex Fridman (40:28.820)

You might've been, you said your symptoms

Michael Mina (40:30.860)

started two weeks ago.

Lex Fridman (40:32.380)

You probably were infectious two weeks ago

Lex Fridman (40:36.100)

and you have lingering symptoms from it.

Lex Fridman (40:38.980)

But that's a medical diagnosis.

Michael Mina (40:41.540)

It's kind of like a detective recreating a crime scene.

Lex Fridman (40:44.580)

They wanna go back there and recreate the pieces

Lex Fridman (40:48.420)

so that they can assign blame or whatever it might be.

Lex Fridman (40:52.860)

But that's not public health.

Michael Mina (40:53.820)

In public health, we need to only look forward.

Lex Fridman (40:56.020)

We don't wanna go back and say,

Michael Mina (40:57.260)

well, was this person, are there symptoms

Lex Fridman (40:59.540)

because they had an infection two weeks ago?

Michael Mina (41:01.780)

In public health, we just wanna stop the virus

Lex Fridman (41:04.820)

from spreading to the next person.

Lex Fridman (41:06.260)

And so that's where we don't care

Lex Fridman (41:08.900)

if somebody was infected two weeks ago.

Michael Mina (41:11.620)

We only care about finding the people

Lex Fridman (41:13.580)

who are infectious today.

Lex Fridman (41:15.860)

And unfortunately, our regulatory landscape

Lex Fridman (41:19.780)

fails to apply that knowledge

Michael Mina (41:23.860)

to evaluate these tests as public health tools.

Lex Fridman (41:26.100)

They're only evaluating the tests as medical tools.

Lex Fridman (41:29.220)

And therefore, we get all kinds of complaints

Lex Fridman (41:32.660)

that say this test, which detects 99 plus,

Michael Mina (41:37.540)

99.8% of current infectious people,

Lex Fridman (41:43.620)

by the FDA's rubric, they'll say,

Michael Mina (41:45.340)

no, no, it's only 50% sensitive.

Lex Fridman (41:48.460)

And that's because when you go out into the world

Lex Fridman (41:50.460)

and you just compare this against PCR positivity,

Lex Fridman (41:53.620)

most people who are PCR positive in the world right now

Michael Mina (41:56.820)

at any given time are post infectious.

Lex Fridman (42:00.500)

They're no longer infectious

Michael Mina (42:01.660)

because you might only be infectious for five days,

Lex Fridman (42:04.940)

but then you'll remain PCR positive

Michael Mina (42:06.700)

for three or four or five weeks.

Lex Fridman (42:09.180)

And so when you go and just evaluate these tests

Lex Fridman (42:11.340)

and you say, okay, this person's PCR positive,

Lex Fridman (42:13.980)

does the rapid antigen test detect that?

Michael Mina (42:17.140)

More often than not, it's no.

Lex Fridman (42:19.020)

But that's because those people don't need isolation.

Michael Mina (42:23.020)

They're post infectious.

Lex Fridman (42:24.100)

And it's become much more of a problem

Michael Mina (42:27.780)

than I think even the FDA themself is recognizing

Lex Fridman (42:31.300)

because they are unwilling at this point

Michael Mina (42:33.500)

to look at this as a public health problem

Lex Fridman (42:37.100)

requiring public health tools.

Michael Mina (42:38.820)

We'll definitely talk about this a little bit more

Lex Fridman (42:41.060)

because the concern I have is that

Michael Mina (42:43.380)

a bigger pandemic comes along.

Lex Fridman (42:45.340)

What are the lessons we draw from this

Lex Fridman (42:47.100)

and how we move forward?

Lex Fridman (42:48.020)

Let's talk about that in a bit.

Lex Fridman (42:50.060)

But sort of, can we discuss further the lay of the land here

Lex Fridman (42:55.220)

of the different tests before us?

Michael Mina (42:56.940)

Absolutely.

Lex Fridman (42:57.780)

So I talked about PCR tests and those are done in the lab

Michael Mina (43:00.900)

or they're done essentially with a rapid test like this,

Lex Fridman (43:05.180)

the detect, and we can even try this in a moment.

Michael Mina (43:07.820)

It goes into a little heater.

Lex Fridman (43:09.380)

So you might have one of these in a household

Michael Mina (43:11.340)

or one of these in a nursing home or something like that

Lex Fridman (43:14.420)

or in an airport.

Michael Mina (43:16.460)

Or you could have one that has 100 different outlets.

Lex Fridman (43:19.380)

This is just to heat the tube up.

Michael Mina (43:21.340)

These are the rapid tests.

Lex Fridman (43:22.620)

They're super simple, no frills.

Michael Mina (43:25.620)

You just swab your nose and you put the swab into a buffer

Lex Fridman (43:30.860)

and you put the buffer on the test.

Lex Fridman (43:32.180)

So we can use these right now if you want.

Lex Fridman (43:34.340)

We can try it out.

Lex Fridman (43:35.180)

And all the tests we're talking about,

Lex Fridman (43:36.820)

they're usually swabbing the nose.

Michael Mina (43:39.900)

Like that's the...

Lex Fridman (43:41.100)

That's still the main, yeah.

Michael Mina (43:43.220)

There are some saliva tests coming about

Lex Fridman (43:45.940)

and these can all work potentially with saliva.

Michael Mina (43:48.180)

They just have to be recalibrated.

Lex Fridman (43:50.180)

But these swabs are really not bad.

Michael Mina (43:52.740)

This isn't the deep swab that goes like way back

Lex Fridman (43:57.180)

into your nose or anything.

Michael Mina (43:58.380)

This is just a swab that you do yourself

Lex Fridman (44:01.900)

like right in the front of your nose.

Lex Fridman (44:03.820)

So if you wanna do it.

Lex Fridman (44:04.660)

Yeah, do you mind if I?

Michael Mina (44:05.620)

Sure, yeah.

Lex Fridman (44:06.820)

Yeah, why don't we start with this one?

Michael Mina (44:08.140)

Because this is Abbott's Buy Next Now test

Lex Fridman (44:10.660)

and it's really, it's pretty simple.

Michael Mina (44:12.620)

This is the swab from the Abbott test.

Lex Fridman (44:15.740)

That's correct.

Michael Mina (44:16.580)

That's the swab from the Abbott test.

Lex Fridman (44:18.420)

So what I'm gonna do to start

Michael Mina (44:21.500)

is I'm going to take this buffer here,

Lex Fridman (44:23.980)

which is, this is just the buffer

Michael Mina (44:26.340)

that goes onto this test.

Lex Fridman (44:27.940)

So this is a brand new one.

Michael Mina (44:28.780)

I just opened this test out.

Lex Fridman (44:32.100)

I'm gonna just take six drops of this buffer

Lex Fridman (44:34.820)

and put it right onto this test here.

Lex Fridman (44:40.020)

Two, three, four, five, six.

Michael Mina (44:43.540)

Okay.

Lex Fridman (44:44.380)

And now you're gonna take that swab, open it up.

Michael Mina (44:48.100)

Yep, and now just wipe it around inside the,

Lex Fridman (44:50.940)

into the front of your nose.

Michael Mina (44:52.380)

Do a few circles on each nostril.

Lex Fridman (44:58.260)

That looks good.

Michael Mina (45:03.660)

This always makes me wanna sneeze.

Lex Fridman (45:05.380)

Yeah.

Michael Mina (45:07.100)

Okay, now I'm gonna have you do it yourself.

Lex Fridman (45:11.860)

I'm getting emotional.

Michael Mina (45:13.500)

Hold it parallel to the test.

Lex Fridman (45:14.940)

So put the test down on the table.

Michael Mina (45:16.260)

Yep, and then go into that bottom hole.

Lex Fridman (45:19.020)

Yep, and push forward

Lex Fridman (45:20.180)

so that you can start to see it in the other hole.

Lex Fridman (45:22.820)

There you go.

Michael Mina (45:23.660)

Now turn, if it's, once it hits up against the top,

Lex Fridman (45:26.460)

just turn it three times.

Michael Mina (45:28.060)

One, two, three, and sort of, yep.

Lex Fridman (45:30.980)

And now you just close,

Lex Fridman (45:32.980)

so pull off that adhesive sticker there.

Lex Fridman (45:37.140)

And now you just close the whole thing.

Michael Mina (45:41.460)

And.

Lex Fridman (45:42.820)

And that's it.

Michael Mina (45:43.980)

That's it.

Lex Fridman (45:44.820)

Now what we will see

Michael Mina (45:46.180)

is we will see a line form.

Lex Fridman (45:49.180)

What's happening now is the buffer that you put in there

Michael Mina (45:53.140)

is now moving up onto the paper strip test,

Lex Fridman (45:58.820)

and it has the material from the swab in there.

Lex Fridman (46:02.820)

And so what we'll see is a line will form,

Lex Fridman (46:05.420)

and that's gonna be the control line.

Lex Fridman (46:08.220)

And then we'll also see the,

Lex Fridman (46:11.540)

ideally we'll see no line for the actual line.

Michael Mina (46:14.940)

We'll see no line for the actual test line.

Lex Fridman (46:17.660)

And that's because you should be negative.

Lex Fridman (46:20.300)

So one line will be positive and two lines will be negative.

Lex Fridman (46:24.260)

That's very cool.

Michael Mina (46:25.100)

There's this purple thing creeping up

Lex Fridman (46:28.860)

onto the control line.

Michael Mina (46:31.740)

That's perfect.

Lex Fridman (46:32.580)

That's what you wanna be seeing.

Lex Fridman (46:35.300)

So you want to see that,

Lex Fridman (46:37.860)

so right now you essentially want to see

Michael Mina (46:41.220)

that that blue line turns pink or purply color.

Lex Fridman (46:45.740)

There's a blue line that's already there printed.

Michael Mina (46:49.220)

It should turn sort of a purple pink color.

Lex Fridman (46:52.660)

And ideally there will be no additional line for the sample.

Lex Fridman (47:00.620)

And if there is,

Lex Fridman (47:02.260)

that's the 99 point whatever percent accuracy on,

Michael Mina (47:06.700)

that means I have, I'm contagious.

Lex Fridman (47:09.140)

That would mean that you're likely contagious

Michael Mina (47:11.180)

or you likely have infectious virus in you.

Lex Fridman (47:14.220)

What we can do,

Michael Mina (47:15.060)

because one of the things that my plan calls for

Lex Fridman (47:19.500)

is because sometimes these tests

Michael Mina (47:21.540)

can get false positive results, it's rare.

Lex Fridman (47:24.620)

Maybe 1% or in the case of this Binex now,

Michael Mina (47:27.620)

this Abbott test 0.1%.

Lex Fridman (47:30.180)

So one in a thousand, one in 500,

Michael Mina (47:31.940)

something like that can be falsely positive.

Lex Fridman (47:34.420)

What I recommend is that when somebody is positive

Michael Mina (47:38.060)

on one of these,

Lex Fridman (47:39.300)

you turn around and you immediately test

Michael Mina (47:41.300)

on a different test.

Lex Fridman (47:42.380)

You could either do it on the same,

Lex Fridman (47:43.420)

but for good measure,

Lex Fridman (47:45.620)

you want to use a separate test

Michael Mina (47:48.220)

that is somewhat orthogonal,

Lex Fridman (47:51.380)

meaning that it shouldn't turn falsely positive

Michael Mina (47:54.180)

for the same reason.

Lex Fridman (47:56.100)

This particular test here,

Michael Mina (47:58.140)

this detect test because it is looking for the RNA

Lex Fridman (48:02.020)

and not the antigen,

Michael Mina (48:03.580)

this is an amazingly accurate test

Lex Fridman (48:05.740)

and it's sort of a perfect gold standard

Michael Mina (48:09.420)

or confirmatory test for any of these antigen tests.

Lex Fridman (48:12.780)

So one of the recommendations that I've had,

Michael Mina (48:14.820)

especially if people start using antigen tests

Lex Fridman (48:17.820)

before you get onto a plane

Michael Mina (48:20.100)

or as what I call entrance screening,

Lex Fridman (48:22.860)

if somebody is positive,

Michael Mina (48:24.620)

you don't immediately tell them,

Lex Fridman (48:26.380)

you're positive, go isolate for 10 days.

Michael Mina (48:28.740)

You tell them, let's confirm on one of these,

Lex Fridman (48:31.980)

on a detect test.

Michael Mina (48:33.260)

That is because it's completely orthogonal,

Lex Fridman (48:36.660)

it's looking for the RNA instead of the antigen.

Michael Mina (48:40.420)

There's no reason, no biological reason

Lex Fridman (48:43.580)

that both of these should be falsely positive.

Lex Fridman (48:47.500)

So if one's falsely positive and the other one is negative,

Lex Fridman (48:50.540)

especially because this one's more sensitive,

Michael Mina (48:53.740)

then I would trust this as a confirmatory test.

Lex Fridman (48:56.940)

If this one's negative, then the antigen test

Michael Mina (49:00.420)

would be considered falsely positive.

Lex Fridman (49:02.220)

It does look like there's only a single line,

Lex Fridman (49:04.180)

so this is very exciting news.

Lex Fridman (49:05.580)

That's right, yep.

Michael Mina (49:06.500)

It says wait 15 minutes to see both lines,

Lex Fridman (49:10.940)

but in general, if somebody's really gonna be positive,

Michael Mina (49:14.100)

that line starts showing up within a minute or two.

Lex Fridman (49:17.180)

So you wanna keep the whole,

Michael Mina (49:18.420)

we'll keep watching it for the whole 15 minutes

Lex Fridman (49:20.380)

as it's sitting there, but I would say

Michael Mina (49:22.740)

you're knowing that you've had PCR tests recently

Lex Fridman (49:25.740)

and all that.

Michael Mina (49:26.900)

The odds are pretty good.

Lex Fridman (49:27.980)

The odds are very good.

Michael Mina (49:28.820)

The packaging, very iPhone like.

Lex Fridman (49:30.780)

I'm digging the sexy packaging.

Michael Mina (49:33.660)

I'm a sucker for good packaging, okay.

Lex Fridman (49:36.020)

So then there's this test here,

Michael Mina (49:37.740)

which is, this is another, it's funny.

Lex Fridman (49:41.500)

Let me open this up and show you.

Michael Mina (49:42.860)

This is a really nice test.

Lex Fridman (49:44.300)

It's another antigen test.

Michael Mina (49:45.620)

Works the exact same way as this, essentially,

Lex Fridman (49:48.220)

but what you can see is it's got lights in it

Lex Fridman (49:51.100)

and a power button and stuff.

Lex Fridman (49:52.260)

This is called an allume test, which is fine,

Lex Fridman (49:57.980)

and it's a really nice test, to be honest,

Lex Fridman (49:59.900)

but it has to pair with an iPhone.

Lex Fridman (50:04.020)

And so it's good as a,

Lex Fridman (50:05.660)

I think that this is gonna become,

Michael Mina (50:08.740)

there's a lot of use for this from a medical perspective,

Lex Fridman (50:11.740)

where you want good reporting.

Michael Mina (50:13.020)

This can, because it pairs with an iPhone,

Lex Fridman (50:15.940)

it can immediately send the report

Michael Mina (50:19.380)

to a department of health,

Lex Fridman (50:20.420)

whereas these paper strip tests, they're just paper.

Michael Mina (50:23.340)

They don't report anything unless you wanna report it.

Lex Fridman (50:26.580)

Okay, so I'm gonna just pick it apart.

Lex Fridman (50:28.860)

And so you can see is there's fluorescent readers

Lex Fridman (50:32.180)

and little lasers and LEDs and stuff in there.

Michael Mina (50:34.700)

You can actually see the lights going off.

Lex Fridman (50:37.140)

And there's a paper strip test right inside there,

Lex Fridman (50:39.380)

but you can see that there's a whole circuit board

Lex Fridman (50:41.380)

and all this stuff, right?

Lex Fridman (50:44.380)

And so this is the kind of thing

Lex Fridman (50:48.100)

that the FDA is looking for,

Michael Mina (50:52.340)

for home use and things like that,

Lex Fridman (50:54.780)

because it's kind of foolproof.

Michael Mina (50:56.420)

You can't go wrong with it.

Lex Fridman (50:58.340)

It pairs with an iPhone, so you need Bluetooth.

Lex Fridman (51:00.580)

So it's gonna be more limited.

Lex Fridman (51:01.780)

It's a great test, don't get me wrong.

Michael Mina (51:03.180)

It's as good as any of these.

Lex Fridman (51:05.220)

But when you compare this thing with a battery

Lex Fridman (51:08.420)

and a circuit board and all this stuff,

Lex Fridman (51:10.900)

it's got its purpose, but it's not a public health tool.

Michael Mina (51:14.100)

I don't wanna see this made in the tens of millions a day

Lex Fridman (51:17.020)

and thrown away.

Michael Mina (51:18.860)

This is just.

Lex Fridman (51:19.700)

But FDA likes that kind of stuff.

Michael Mina (51:20.540)

FDA loves this stuff,

Lex Fridman (51:22.020)

because they can't get it out of their mind

Michael Mina (51:23.980)

that this is a public health crisis.

Lex Fridman (51:26.020)

We need, I mean, just look at the difference here.

Michael Mina (51:29.340)

Something with flashing lights is essential.

Lex Fridman (51:32.060)

It's got batteries, it's got a Bluetooth thing.

Michael Mina (51:34.020)

It's a great test, but to be honest,

Lex Fridman (51:36.620)

it's not any better than this one.

Lex Fridman (51:39.780)

And so I want this one.

Lex Fridman (51:43.380)

It's nice and all.

Michael Mina (51:44.380)

The form factor is nice,

Lex Fridman (51:46.460)

and it's really nice that it goes to Bluetooth.

Lex Fridman (51:49.020)

But it goes against the principle of just 20 million a day.

Lex Fridman (51:52.980)

The easy solution, everybody has it.

Michael Mina (51:54.900)

You can manufacture and probably,

Lex Fridman (51:57.580)

you could've probably scaled this up in a couple of weeks.

Michael Mina (52:00.060)

Oh, absolutely.

Lex Fridman (52:00.900)

These companies, I mean, the rest of the world has these.

Michael Mina (52:04.220)

They can be scaled up.

Lex Fridman (52:05.300)

They already exist.

Michael Mina (52:06.700)

You know, SD biosensors,

Lex Fridman (52:08.100)

one company's making tens of millions a day,

Michael Mina (52:10.460)

not coming to the United States,

Lex Fridman (52:11.860)

but going all over Europe,

Michael Mina (52:13.420)

going all over Southeast Asia and East Asia.

Lex Fridman (52:16.980)

So they exist.

Michael Mina (52:17.900)

The US is just, you know, we can't get out of our own way.

Lex Fridman (52:21.100)

I wonder why somebody,

Michael Mina (52:22.380)

I don't know if you were paying attention,

Lex Fridman (52:23.620)

but somebody like an Elon Musk type character.

Lex Fridman (52:26.860)

So he was really into doing

Lex Fridman (52:28.460)

some like obvious engineering solution,

Michael Mina (52:30.580)

like this at home rapid test

Lex Fridman (52:33.980)

seems like a very Elon Musk thing to do.

Michael Mina (52:37.220)

I don't know if you saw,

Lex Fridman (52:38.140)

but I had a little Twitter conversation with Elon Musk.

Michael Mina (52:41.820)

Does he not like, what is he,

Lex Fridman (52:43.420)

do you know what his thoughts are on rapid testing?

Michael Mina (52:45.500)

Well, he was using a slightly different one,

Lex Fridman (52:47.180)

one of these, but that requires an instrument

Michael Mina (52:49.180)

called the BD Veritor.

Lex Fridman (52:50.860)

And he got a false positive,

Michael Mina (52:52.020)

or no, I shouldn't say,

Lex Fridman (52:53.020)

he didn't necessarily get a false positive.

Michael Mina (52:54.580)

He got discrepant results.

Lex Fridman (52:55.900)

He did this test four times.

Michael Mina (52:57.860)

He got two positives, two negatives,

Lex Fridman (53:00.780)

but then he got a PCR test

Lex Fridman (53:02.260)

and it was a very low positive result.

Lex Fridman (53:05.020)

So I think what happened is he just tested himself

Michael Mina (53:07.940)

at the tail end of an,

Lex Fridman (53:09.060)

this was actually right before he was about to send those.

Michael Mina (53:11.060)

It was the day of essentially that he was sending

Lex Fridman (53:12.700)

the astronauts up to the space station the other day.

Lex Fridman (53:15.060)

So he was using these rapid tests

Lex Fridman (53:17.740)

cause he wanted to make sure that he was good to go in

Lex Fridman (53:20.020)

and he got discrepant results.

Lex Fridman (53:23.100)

Ultimately they were correct,

Lex Fridman (53:25.140)

but two were negative, two were positive.

Lex Fridman (53:26.860)

But what really happened once he shared his PCR results

Lex Fridman (53:30.660)

and they were very low positive.

Lex Fridman (53:32.820)

So really what was happening is,

Michael Mina (53:34.540)

my guess is he found himself right at the edge

Lex Fridman (53:37.100)

of his positivity, of his infectiousness.

Lex Fridman (53:39.900)

And so the test worked how it was supposed to work.

Lex Fridman (53:42.500)

It probably had he used it two days earlier,

Michael Mina (53:45.740)

it would have been screaming positive.

Lex Fridman (53:47.420)

He wouldn't have gotten discrepant results,

Lex Fridman (53:49.460)

but he found himself right at the edge

Lex Fridman (53:51.140)

by the time he used the test.

Lex Fridman (53:52.780)

So the PCR would always pick it up

Lex Fridman (53:55.060)

cause it's still, cause that will still stay positive

Michael Mina (53:57.340)

then for weeks potentially.

Lex Fridman (53:59.100)

But the rapid antigen test was starting to falter,

Michael Mina (54:02.660)

not in a bad way,

Lex Fridman (54:03.740)

but just he probably was really no longer

Michael Mina (54:06.860)

particularly infectious.

Lex Fridman (54:07.860)

And so it was kind of when it gets to be a very low viral

Michael Mina (54:10.740)

load, it becomes stochastic.

Lex Fridman (54:12.740)

It's fascinating this duality.

Lex Fridman (54:14.380)

So one you can think from an individual perspective,

Lex Fridman (54:18.420)

it's unclear when you take four and half are positive,

Lex Fridman (54:23.060)

half are negative, like what are you supposed to do?

Lex Fridman (54:25.660)

But from a societal perspective,

Michael Mina (54:28.100)

it seems like if just one of them is positive,

Lex Fridman (54:30.900)

just stay home for a couple of days, for a while.

Lex Fridman (54:34.580)

So when you're a CEO of a company,

Lex Fridman (54:36.180)

you're launching astronauts to space,

Michael Mina (54:38.020)

you may not want to rely absolutely on the antigen test

Lex Fridman (54:43.180)

as a thing by which you steer your decisions

Michael Mina (54:47.380)

of like 10,000 plus people companies.

Lex Fridman (54:50.420)

But us individuals just living in the world,

Michael Mina (54:53.780)

if you can, if it comes up positive,

Lex Fridman (54:57.020)

then you make decisions based on that.

Lex Fridman (54:59.340)

And then that scales really nicely to an entire society

Lex Fridman (55:01.980)

of hundreds of millions of people.

Lex Fridman (55:03.620)

And that's how you get that virus to stop spreading.

Lex Fridman (55:07.420)

That's exactly right.

Michael Mina (55:08.300)

You don't have to catch every single one.

Lex Fridman (55:10.420)

And the nice thing is that these will,

Michael Mina (55:12.700)

these will catch the people who are most infectious.

Lex Fridman (55:15.740)

So with Elon Musk, it generally that test,

Michael Mina (55:19.140)

we don't have the counterfactual.

Lex Fridman (55:20.460)

We don't have his results from three days earlier

Michael Mina (55:23.260)

when he was probably most infectious.

Lex Fridman (55:26.180)

But my guess is the fact that it was catching two

Michael Mina (55:30.020)

out of the four, even when he was down at a CT value

Lex Fridman (55:33.220)

of really, really very, very low viral load on the PCR test

Michael Mina (55:36.740)

suggests that it was doing its job.

Lex Fridman (55:39.900)

And you just wanna, and the nice thing is

Michael Mina (55:42.220)

because these can be produced at such scale,

Lex Fridman (55:45.820)

getting one positive doesn't immediately have to mean

Michael Mina (55:49.140)

10 days of isolation.

Lex Fridman (55:51.740)

That's the CDC is more conservative stance to say,

Michael Mina (55:55.620)

if you're positive on any tests,

Lex Fridman (55:57.580)

stay home for 10 days and isolate.

Lex Fridman (55:59.180)

But here, people would just have more tests.

Lex Fridman (56:01.740)

So the recommendation should be test daily.

Michael Mina (56:04.540)

If you turn positive, test daily

Lex Fridman (56:06.900)

until you've been negative for 24, 48 hours

Lex Fridman (56:09.220)

and then go back to work.

Lex Fridman (56:10.180)

And the nice thing there is right now,

Michael Mina (56:12.820)

people just aren't testing

Lex Fridman (56:13.980)

because they don't wanna take 10 days off.

Michael Mina (56:15.700)

They're not getting paid for it.

Lex Fridman (56:16.940)

So they can't take 10 days off.

Lex Fridman (56:18.540)

Do you know what Elon thinks about this idea

Lex Fridman (56:21.820)

of rapid testing for everybody?

Lex Fridman (56:23.340)

So I understood I need to look at that whole Twitter thread.

Lex Fridman (56:26.660)

So I understand his perhaps criticism of,

Michael Mina (56:30.860)

he had like a conspiratorial tone from my vague look at it

Lex Fridman (56:34.660)

of like, what's going on here with these tests?

Lex Fridman (56:37.900)

But what does he actually think about

Lex Fridman (56:40.340)

this very practical to me engineering solution

Lex Fridman (56:42.980)

of just deploying rapid tests to everybody?

Lex Fridman (56:45.100)

It seems like that's a way to open up the economy in April.

Michael Mina (56:48.540)

Well, to be honest,

Lex Fridman (56:49.380)

I've been trying to get in touch with him again.

Michael Mina (56:51.460)

I think, take somebody like Elon Musk

Lex Fridman (56:54.900)

with the engineering prowess within his ranks,

Michael Mina (56:57.740)

to easily, easily build these at the tens of millions a day.

Lex Fridman (57:04.380)

He could build the machines from scratch.

Michael Mina (57:07.100)

A lot of the companies,

Lex Fridman (57:08.180)

they buy the machines from South Korea or Taiwan, I believe.

Michael Mina (57:12.820)

We don't have to, we can build these machines.

Lex Fridman (57:15.060)

They're simple to build.

Michael Mina (57:16.980)

Put somebody like Elon Musk on it,

Lex Fridman (57:20.180)

take some of his best engineers and say,

Michael Mina (57:21.980)

look, the US needs a solution in two weeks.

Lex Fridman (57:26.900)

Build these machines, figure it out.

Michael Mina (57:29.060)

He'll do it, he could do it.

Lex Fridman (57:30.100)

This is a guy who is literally,

Michael Mina (57:33.060)

he has started multiple entirely new industries.

Lex Fridman (57:37.820)

He has the capital to do it without the US government

Michael Mina (57:40.820)

if he wanted to.

Lex Fridman (57:41.860)

And you know what, it would,

Michael Mina (57:43.500)

the return on investment for him would be huge.

Lex Fridman (57:47.500)

But frankly, the return on investment in the country

Michael Mina (57:50.420)

would be hundreds of billions of dollars,

Lex Fridman (57:53.500)

because it means we could get society open.

Lex Fridman (57:55.620)

So I know that his first experience

Lex Fridman (57:58.740)

with these rapid tests was confusing,

Michael Mina (58:01.620)

which is how I ended up having this Twitter

Lex Fridman (58:04.300)

kind of conversation with him very briefly.

Lex Fridman (58:06.980)

But I think that if he understood

Lex Fridman (58:09.380)

sort of a little bit more, and I think he does,

Michael Mina (58:11.060)

I really love to talk to him about it,

Lex Fridman (58:13.340)

because I think he could totally change

Michael Mina (58:14.980)

the course of this pandemic in the United States,

Lex Fridman (58:17.340)

single handedly.

Michael Mina (58:18.420)

He loves grand things.

Lex Fridman (58:19.980)

Yeah, I think out of all the solutions I've seen,

Michael Mina (58:24.700)

this is the obvious engineering solution

Lex Fridman (58:29.700)

to at least a pandemic of this scale.

Michael Mina (58:32.860)

I love that you say the engineering solution.

Lex Fridman (58:35.340)

So this is something I've been really trying to,

Michael Mina (58:38.100)

I'm an engineer, my previous history was all engineering,

Lex Fridman (58:42.700)

and that's really how I think.

Michael Mina (58:44.620)

I then went into medicine and PhD world,

Lex Fridman (58:46.700)

but I think that the world,

Michael Mina (58:52.180)

like one of the major catastrophes,

Lex Fridman (58:53.940)

or one of the major problems,

Michael Mina (58:55.340)

is that we have physicians making the decisions

Lex Fridman (58:57.980)

about public health and a pandemic,

Michael Mina (59:01.300)

when really we need engineers.

Lex Fridman (59:03.300)

This is an engineering problem.

Lex Fridman (59:05.220)

And so what I've been trying to do,

Lex Fridman (59:06.580)

I actually really want to start a whole new field

Michael Mina (59:10.500)

called public health engineering.

Lex Fridman (59:12.860)

And so I've been, eventually I want to try

Michael Mina (59:15.220)

to bring it to MIT and get MIT

Lex Fridman (59:16.940)

to want to start a new department or something.

Michael Mina (59:19.260)

That's a doubly awesome idea.

Lex Fridman (59:21.540)

Yeah.

Michael Mina (59:22.380)

That, this is really, okay.

Lex Fridman (59:24.940)

I love this, I love every aspect.

Michael Mina (59:26.660)

I love everything you're talking about.

Lex Fridman (59:29.820)

A lot of people believe,

Michael Mina (59:30.900)

because vaccines started being deployed currently,

Lex Fridman (59:34.460)

that we are no longer in need of a solution.

Michael Mina (59:39.460)

We're no longer in need of slowing the spread of the virus.

Lex Fridman (59:45.340)

To me, as I understand,

Michael Mina (59:46.500)

it seems like this is the most important time

Lex Fridman (59:49.700)

to have something like a rapid testing solution.

Lex Fridman (59:52.500)

Can you kind of break that apart?

Lex Fridman (59:54.620)

What's the role of rapid testing currently

Lex Fridman (59:57.060)

in the next, what is it, three, four months maybe?