L.O.G. 106 Year 2 of the pandemic with Dr. Peter Bryant Greenwood

Hey everyone, thanks for tuning in. I'm Brian, I'm the host of The Human Behavior Podcast. You're going to be watching the video version of our audio podcast. Please, guys, if you like the video, like it, subscribe to the channel. There's going to be more content on there if you're already a subscriber and a better way for us to get you guys some more stuff. If you have any questions or comments, go ahead, leave them below. Check out our links down below to get a hold of us and to actually find out more places where you can get more information about this. Please like and subscribe. Follow us on Facebook at HBPRNA.

Remember, all these cases that we discuss and all these discussions that we have are through the lenses of what we call Human Behavior Pattern Recognition and Analysis. So please like it, share it, tell your friends about it, and we hope you enjoy the show. Thanks.

All right, we're good, man. Okay, so we'll just go ahead and jump right in and get started. Dr. Peter Bryant Greenwood, or PBG, as sometimes he's referred to affectionately, thank you so much for coming on and talking to us today. I'm excited to have you on.

Great, Brian. Greg. It's great to be here.

Well, thanks, man. So we've known you for a little bit, so I'd like to kind of just start out real quick if you could give a little bit of a background about yourself and what you do specifically as a doctor and what your specialty is, because we're going to be talking about year two of the pandemic and what that looks like. But I want to give the listeners just in your words a little bit about yourself and what you do.

Sure. I'm the doctor that no one sees unless you're dead. I am a pathologist. When we field questions from family members or relatives, I remind them that I am a pathologist. There is very little I can do for you other than help with a diagnosis. So, as a pathologist, we run lab tests and we specialize in laboratory medicine, and I've been doing that now for a very long time, it seems, 25 years. I have done that capacity for hospitals as well as private laboratories, as I am now.

When the pandemic hit in January of last year, I was the head of Molecular Diagnostics and the overall laboratory director of Advanced Diagnostic Laboratories at National Jewish Health. I left that job at the end of June of 2020. I then began a private laboratory dedicated to respiratory disease and, obviously, COVID, and that is where I presently am.

Okay, so I know that was, you're modest about your accolades and your experience. For everyone listening, that was a brief overview, but you've done a ton of really cool stuff. You, I, and Greg kind of hit it off when we met as part of that project, right? You were standing at the lab and this other stuff we're doing in terms of pandemic recovery. We kind of hit it off, and you're obviously uniquely qualified in this situation for everything you listed.

For folks listening, you're at National Jewish Hospital there in Denver, which is, I believe, like the leading respiratory hospital in the world if I'm not mistaken, or was always traditionally, I guess. So, talking about the pandemic and COVID and how it affects your respiratory system, you're kind of one of the leading experts in this area, I would say. Just so everyone's listening, that's kind of where you fit in this whole big picture. All right?

Yeah, that is. That's great. To be fair for PBG, we're going to put all your stuff on our website so the viewers can be able to pull it down and see the enormity of your intellectual acumen. The thing that also parallels Brian, both PBG and I live high in the Colorado Rockies. We both have hugely talented supermodel wives, both clearly good-looking enough to be on this video. That's terrific.

But I appreciated talking to you guys because I went into medicine from a non-traditional route. So being involved in understanding how COVID impacts our community, our society, and our families are the kind of questions we need to be asking. It's always refreshing for me to talk about those issues.

My background before medicine was in the School of Foreign Service at Georgetown University as a Science, Technology, and International Affairs person. And so, the deeper you get into science and medicine, that tends to become an all-consuming moment. So these kinds of opportunities to reflect on what has worked, what hasn't worked, and where it's going is very important and obviously a great respite from the normal medical laboratory drudgery that you guys could imagine. It is now dominated basically by a single test, right? This is not very exciting. So there you go.

Even this morning, I wake up, I have my coffee. My family is traveling to Hawaii on Saturday. And so I have to get all three of them tested in parallel – a wife and two kids – through telehealth, watching them fit into a tube so that they can get their travel pass to Maui. So, it is a dominating thing in everything that I do. So yeah, it is what it is. Looking forward to not having that one day as I'm sure everyone can appreciate.

Well, Brian, quickly looking back, I think one of the reasons, PBG, that we coalesced so quickly is we loved your clinical approach to what was happening in the world. And we loved the idea of forensics and pathology being tied together to come up with the human answer. You know that I was bringing to the table the sociological, psychological, physiological, and Brian was on the other end of the table talking about the tactical and operational strategic imperative. And we were then just the three of us completely alone in the room, even though the room was packed with other scientists and geniuses, because they all wanted to approach it with a thing, with a tool, with a box, with a spoon. And we were trying to answer it from the human aspect. I think that's a big reason to get it off.

Yeah, so on that, because one of the things that, you know, we learned a lot about just upper respiratory disease, communicable diseases, and these types of pandemics, right, and how they occur. A lot from you and how you kind of explained it to us, and it was great learning all the stuff. It was incredible. And what I was obviously super impressed by too is not just your knowledge in this area, obviously your expertise, but pretty much everything you said, "Here's what's likely going to happen with the disease and how it affects society," has come true, right?

Because you were giving kind of grim predictions going like, "Look, hey, it's going to spread like this. We're not doing anything. Then what you're going to see, it's going to come to level off. Then what's going to happen in the fall around this time is you're going to see a massive spike again, and then eventually the virus has to mutate to stay." Like, you went through everything, and I look back now and go, "Damn, you were right on all this stuff."

So, which is incredibly frustrating for one, because then you're sitting here going like, "Well, there's people that know what's going to happen, but we're not putting any measures in place to mitigate that," which is a constant, right? Throughout any type of threat mitigation or prediction stuff that you do, people always go, "Well, we'll just deal with that when it comes up." And you're like, "Ah, that's not the best answer."

But, let's kind of start here because we want to get into what we think is likely going to happen this next year and what does year two of a pandemic look like? And typically, incorrectly, very wrong here, like any past, I always go to, "Hey, what's going to happen in the future? Well, let's look to what's happened before the past, right? What's happened with other pandemics?" And they last a while, right? They last a few years, like two to five years, I think is the average one. Now, how deadly or communicable they are or whatever, that changes, that might be different. But is that right? Like, typically, this lasts a little while. So, what are our predictions kind of going forward with this?

Yeah, that's a really good question. When we look at some of the last pandemics, obviously everyone touches on the great flu epidemic of 1918. But there have been other epidemics in the past. Many of those ones that precede 1918 killed a ton of people, but we don't really know what they were. And so, I guess we can say, at least now we know what is killing us, right?

In terms of length of pandemic, we are really in a great experiment. As you said quite accurately, these things normally run a three-to-five-year course before we really attain that herd-type immunity. Essentially, to Greg your point, the unhealthy among us have been culled at that point.

And so we are in a different age now, right? We have invested trillions of dollars on really extending our life expectancy in this country, despite a host of comorbidities that, without medicine, would have claimed many of us 10, 15, 20 years before we are now. So, lots of technology, lots of therapeutics, very high-intensity level of healthcare has gotten us to this point. And you see that reflected in the speed and diversity of treatments that we have for this virus.

Now, having said all that, are we looking at a logarithmic reduction or geometric reduction in the time of the total time for this pandemic? And I think not. I think we're probably, with all our technology, with all our investments, we will probably reduce the overall time by about 33 to 40% overall. So that's a huge gain, and we should be thankful for that. It scares me certainly to look at a three-to-five-year process and understand with all that is going on globally, how you can basically put us into the equivalent of an ice age, right, for five years with something like this. And we are relying now on those technologies to mitigate the length of that ice age and help us push through.

So I think we are probably one-half of the way there at the level of severity. So you're looking at 2021 as really a critical year. And then as we get into 2022, it will still be a problem. We're still going to be having this discussion, but it will form a less dominant piece of the conversation. It will be there, but by then, the systems that we all collectively work in will have more appropriately adapted to this problem, and those technologies that I talk about will be more fully vetted and more fully deployed.

That's one. Again, this is why I love having all these conversations with you, because you're very clinical and sobering with some of this stuff where no one still to this day—we're one year in—and I don't think a lot of people realize like, "Hey, yes, there's a vaccine that came out, but that's not—that's a tool for the toolkit to fight this. That is just one tool." And our whole approach was a strategic, like Greg said, strategic, operational, tactical. But we took it as, "This isn't going anywhere." So it's not, "How do you operate in this environment that's not going to change for a while?"

You have to face the fact that this isn't, and you know, people argue about masks and opening things up and the economy got shut down, and that was our whole approach was, "Yes, like you have to learn to operate in this new environment that will go away eventually, but it isn't going to be for a while." And I think, in general, that's hard for people to really grasp and understand. All of this stuff is, and I think we forget that sometimes, is that, you know, if I can't see it, if I can't taste it, if I can't touch it, if I can't smell it, if I don't immediately see these effects, it's very hard for me to see something as a threat or a danger. Like, I can have it, not know it. So I know there's a lot of confusion kind of in there.

But this comes into how we deal with it going forward. And like you said, it's just having that realization that you have to learn to operate in this environment where there's this potential risk and you have to put risk mitigation in there. And so everyone kind of goes, "Well, we've got a vaccine now, so hey, we should be good in six months. We're going to have this effect." So tell us kind of how this vaccine, which I would describe it as a tool in the COVID-fighting toolkit, what does that actually mean? And what does that mean for the entire general population and how it works and how they get rolled out and what effect will it actually have?

Well, I think it's important, obviously, you know, it is that which we have been waiting for for a year. We are, as a scientist and clinician, we are obviously excited about the preliminary data that came from some of these clinical trials as to efficacy, in other words, how well it works and how well it protects you. That is a tribute to the NIH, the National Institutes of Health, and their pharmaceutical partners that have been pushing this technology for the past 10 years.

When we—I have some, obviously, many people do, criticisms of Dr. Fauci and others during this pandemic. But one thing you cannot fault them for is understanding that a pandemic would eventually be upon us and remaining committed to product development in a long-term, 10-year process requires great commitment and great discipline. And these are the technologies that form the basis of this vaccine now. And that has been lost in the conversation. There is a host of people who have spent really the pinnacle and a huge chunk of their careers developing this technology that is now being deployed. But that was a long grind, it was a long haul, and they're real heroes in this discussion.

So, that's where we are. We have a vaccine. It's a new technology. It has been deployed for high-risk people and frontline tier-one healthcare workers based on two months of follow-up data. Okay? To put that in perspective, I mean, that's not a lot of data.

No.

And so there's, they were great. They were, having read their Emergency Use Authorization approvals, trying to understand how they ran their collective trials, but follow-up, et cetera, et cetera, is limited. And so we'll see, we'll see what happens.

At the beginning of the vaccine process, really in September, October for me, I was very reticent and pessimistic about both the efficacy and safety of this technology. Having had COVID, which was for me Thanksgiving Day all the way through Christmas, it changed my attitude in terms of the severity of the illness and danger of that virus, to understand the weight of benefit that the vaccine can give us, despite the absence of long-term follow-up. In other words, most, if not all, the complications that we would see from this vaccine, we can treat, we can save you. But there's very little we can do for COVID. We literally watch people die every day. Everyone can see these numbers, and there's nothing we can do. We just sit there and we support. We give supportive measures. Ventilators are supportive. Oxygenating your blood with ECMO is a supportive measure. Bombing you with steroids and antibiotics is really reaching quite deep into the basket of modalities that we have in hoping they will work. So, we don't have a lot to do.

So we have to deploy these vaccines, have to make them available. Obviously, we have a federal government that is creating a tiered structure for distribution that's probably very realistic and very good. It would be an absolute disaster if we just threw this limited resource up into the air and let people just fight each other for it. So as inefficient or as challenging, I should say, the logistics behind this distribution are, you have to have that. It is not easy. There's obviously cold storage issues around preserving this vaccine for patients that are significant. And that has required investment on the part of hospitals and departments of health to really secure that cold chain supply, storage, and distribution required to execute this vaccine. So that, that's really where we are at this time, Brian.

So there's clearly not enough vaccine, right? I mean, that's the big issue. You guys may have seen in LA—I don't want to pick on LA, but it always sounds better to pick on LA because it's so believable, right?—where you have concierge, you have concierge physician practices that are catering to a very wealthy clientele, and they want that vaccine, right? They want that vaccine. And I would imagine being a rich guy, how frustrating that would be to say, "I could write a check for $25,000 for a vaccine, and I can't get it." That's very frustrating, right? I would be very aggravated as a rich, successful guy in Silicon Valley not to have access to a vaccine.

And if I can't get it in the U.S., let me tell you, I am pulling out my iPhone and my extensive contact list. I'm calling all my friends in Mexico, Canada, Asia, and say, "My $25,000 may not be good in the U.S., but it's going to be good in India. Let me tell you, I'll FedEx that Novavax over to you for $25,000 in a heartbeat." So I think the black market for vaccine is obviously going to exist, right? It will exist internationally, not within the confines of this country at this time.

So where will it happen in this country? That's totally dependent on supply. Right now we have such limited supply, and the criteria for getting this vaccine is super limited. You have to be a healthcare worker actively treating COVID patients and/or you have to be above a certain age. So that's your tier one. Tier two is again, more healthcare workers, more elderly who are at risk, more at-risk comorbidities, perhaps. And then finally, you get into tier three or phase three of this rollout where it becomes more of a free-for-all. So as that curve increases in vaccine supply, you're going to see more of that demand pick up and people getting in line ahead of people with, being able to buy their way, if you like, to the front of the line. And we're seeing that now.

They're prepping these concierge practices and clinicians who are dealing with phone calls on a daily basis from angry clients demanding a vaccine. What are we seeing? We're seeing a run on these very expensive minus-80 freezers. Like, I can't buy them for my laboratory because there's a physician concierge practice in Palm Springs that has ordered one. They would never normally be in that place, right? But you need that cold storage to be able to buy these vaccines, to deliver to your clients. So it's sort of like investing in a future, right? Like, what kind of cold storage do I need to be able to serve this clientele and keep them engaged and happy?

This is why I kind of wanted to get you on here as well, because not only is your expertise as a molecular pathologist, you can speak about COVID and everything that it does to you just medically, but also you have a really great understanding of how this affects other areas, meaning like our economy and how people behave and different supply chain issues, like you just brought up. Because this is how these are also the major, major effects of it.

So when it comes to specifically like the deployment of this vaccine, I looked at it maybe a little differently, or maybe you could help me understand this a little bit, because like, I get it: one, obviously you got to get healthcare workers, people who are in the fight, first responders, law enforcement folks, like, you need people who are out there dealing with this situation on the ground, right? They need that protection. Absolutely.

All right, so once you start to open that up, and again, I would assume everything would be in healthcare first, because those are the people dealing with it. Like, after that, to me, it would seem like, "Well, why are we targeting people who are, like you said, elderly or nursing homes or things?" If that's it, and they're already quarantined, yes, they're at the highest risk, but they're also not going anywhere, right? If we want to, meaning if we want to, like, open up the economy and get things moving and get people out, wouldn't it make more sense to then go, "Well, people who are out, those types of people need to get this vaccine so that they can be," you know, I'm just looking at it from almost like a targeting perspective of, "Where's the best place to drop our bombs? Where's the best place to put it?" Absolutely. I mean, so, it's, I wasn't quite sure like, why is it that way? Or why should it be those people? Or should it be different?

I think you bring up a very good point in terms of allocation of scarce resources, right? And traditionally, when we, when we come up with ethical or justice-driven constructs for scarce resource allocation, we can look at an individualistic model or a societal model, like what is best for society. What is very unique here is that you and I in this discussion have committed to what is best for the most people, right? And now we have an argument, now we have a disagreement. And that is, on one hand, what you're saying is if all is the better, our economy, the faster our economy is online, we should be deploying that scarce resource to do that.

My best example is Roger Goodell, Super Bowl, saying, "We are going to fill the seats of the Super Bowl with vaccinated healthcare workers." I love that. But you see that your argument is very valid, like, "Shouldn't that be the model? Get the people who are engaged in the economy vaccinated so that we can move forward." You could make a very salient argument that instead of, instead of, I think the healthcare workers and first responders are always going to be the top of everybody's list. But instead of nursing home elderly people that have very few quality live years left, that we should be actively vaccinating airline pilots, flight attendants, baggage handlers, bartenders. I mean, we got to get the economy going. Like, that's where we should be. If we could protect the bartenders, oh my Lord, I'm in, right? We're good. We're going to get things. There is such a pent-up demand for restaurants. I would vaccinate restaurant workers. We'll get the economy moving, don't you worry, right? And we will start building that vaccine base of people who can go to a restaurant and enjoy that.

So that's one side. The other side has everything to do with our healthcare system. And to understand the allocation presently delineated for this vaccine and why it's that way, it is purely our healthcare industrial complex. You guys know healthcare represents a huge component of our gross domestic product. I don't know what it is. Basically, once it passed 15%, I gave up monitoring it, right? So at this point, I presume it's probably 20% of our economy.

When we look at healthcare and our healthcare system as a whole, there is not a lot of capacity in that healthcare system. Every single hospital, inpatient, outpatient type facility is forced and has been forced over the last 20 years to evolve in a very lean process. So everyone looks at what we pay for healthcare, but I can tell you that the margins on those healthcare dollars to support that infrastructure is very lean. If you find a hospital system that is more than 4% positive to margin, it's incredible, right? You're doing a fantastic job.

So our healthcare system, in being inherently lean, there is no capacity, right? Any waste or capacity has been effectively eliminated. Healthcare is a service-type industry, right? You can't intubate someone with a robot yet. Like, we're probably 20 years, 10 years from that. So you have a naturally inefficient system, which is very service-oriented, very intensively service-oriented. What does that mean? You have to have high-end, overly educated "ding-dongs" like me in a brick-and-mortar structure waiting for people to come in sick. And when they come in sick, you don't just get one doctor, you get a bevy of them, right? And you get nursing specialization. There is highly specialized technology, but there is no capacity, right? It's very limited. And you see that now, you see that in what's going on all throughout this country where, "Wow, it didn't take long, did it, to overwhelm our ICUs?" It did not take long to overwhelm our outpatient and emergency room departments. So that's a key thing.

So the healthcare industrial complex, changing that model, my goodness. I am old enough to understand what sort of the first attempt at healthcare reform in my generation was Bill and Hillary Clinton, right, with that failed attempt to change healthcare. We have not really changed. It's a very slow, methodical process. Look at Obamacare, you go through ACOs (Accountable Care Organizations). It takes a ton of time to shift this huge segment of our economy. You have to fundamentally strip it down and change how things are paid for, and it's very difficult to do that.

So the distribution you see now is about healthcare system capacity and ability. And everyone is worried about, the longer this goes, what is really going to happen to healthcare 24 or 36 months from now? And so, I know we're talking globally about how COVID affects our economy, but ultimately, a big part of our economy is healthcare. I think no one really is 100% sure about how this is going to impact healthcare delivery in the long term. I think we can hypothesize, I think we can be pretty accurate, but it is a fundamental shift if this is the catalyst for a change in healthcare, right? And I think that's going to be really challenging. But I think therein lies the opportunities. I think every healthcare entrepreneur over the last year is looking into a crystal ball to understand what those dynamic forces are that they need to capture to take advantage of those changes over the next 36 to 60 months.

That's, you brought up a number of great points and also kind of showed how complicated and how big and massive the healthcare industry is, as you call it, the healthcare industrial complex, which I love. But you brought up something that we even talk about, and this is why so much of what you do and what we do goes kind of hand in glove and it's so prototypically similar, it's the same, right? In terms of a lot of the way we look at things. And you talk about capacity, and we just had a discussion about the bombing in Nashville on Christmas with our good buddy Mike Syracuse. I think you met, you're on a call with him, he's a really, really smart guy, information scientist. But he always talks about capacity versus capability.

Like, we're capable of doing some amazing things. Like, we built a vaccine for this thing in under a year and pushed it through, made it happen. But we don't have the capacity sometimes to handle this stuff. And you talk about it, you kind of said it here at the end, when you said, "COVID is a catalyst for change in healthcare," and I kind of believe that in a number of ways and just in general what this pandemic does and how it can be a catalyst for amazing things. And that's why I even look at, like, look at what happened after the 1918 flu, and that took a few years and that led into a whole bunch of other things. I mean, that was actually post at the end of World War One, so there was a lot of other economic and geopolitical factors of change. But then you had the 20s, which was this massive, massive boom in innovation and cultural change and especially in the United States. So, maybe we're going to start seeing that in a couple years.

But one of the things you did say too is about talking about changing the system, and everyone talks about that with different types of healthcare initiatives and, "Well, we've got to change how this happens," and, "Hey, it's these damn pharmaceutical companies," or, "It's the damn insurance companies," or, "It's the damn whatever this." And you're like, like you just said, the actual, like, there's a lot of money in healthcare, but there's not a lot of profit in healthcare, right? Like you just talked about. And I look at it as, you talk about a catalyst for change, and maybe, instead of focusing on the system, is what if we focused on people? What if everyone, every adult in the United States, this year, lost 10 pounds or 5 pounds? What would that do at scale to the healthcare industry? How would that, I mean, something that small at scale, like we're talking about, not in, because now with COVID, we're talking about the world, not just the United States and different health issues, right?

It's almost sometimes that people don't realize, you know, it's like wearing a mask. Everyone goes, "This is the dumbest thing ever. How does this prevent the spread of COVID?" And it's like, "Well, it doesn't completely prevent it, it's a mitigation." So maybe it cuts it in half. Well, that might not mean anything to you and your family at home, but globally that's massive, right? And I think sometimes to go from a tactical level to a big overall strategic level, it can be difficult sometimes. I don't know, it's just kind of some of my thoughts on what you said, and Greg, I don't want to skip over you because I know you have some points you want to bring up as well.

Brian, you brought up exactly what I had written down, and I just want to go a little deeper on that, PBG, because when we talk about comorbidity and we're talking about the highest rate of severe acute respiratory distress, those personnels are likely the people that are rapidly deteriorating even in ICU with more expensive care. Because a lot of folks don't understand that their lifestyle choices, their characteristics within the patient population, speak directly. Now, there's going to be outliers, there's going to be a kid that dies or there's going to be a healthy person that dies, but that's just with anything that'll happen with a car wreck or an accidental drug overdose.

But what Brian is bringing up is what nobody wants to talk about. And going forward, because we're talking about year two here, is literally prevention. And no vaccine, no inoculation is going to undo pre-existing medical conditions which we brought upon ourselves because we're old or fat or lazy or stupid. And people don't want to hear that. And Brian calls that chasing a TTP (Tactic, Technique, or Procedure) where what we spend all our time and money doing is saying, "Here's that thing! Oh, good God, the vaccine is here! Now we can go back to our morbid obesity."

And the problem with being able to talk about that in the clear light of day is that most people that I see that violate the policies that Brian and I prepared an entire program for a major company to assist them in the transition to not only "at bang" thinking but "left the bang" thinking before, which is prevention, and after the bang, how to recover from it. And frankly, a lot of people don't listen.

Now, I'm in Gunnison, I'm five hours from PBG up in the mountains. And I see a guy pull into Safeway, and he's got an extra set of headlights on his vehicle. He's got a lift kit on his truck. He's driving with tire chains. He's got a four-foot jack in the back, and all this additional safety equipment and a beautiful gun and a gun rack. And the son of a... isn't wearing a mask. The idea here is that this is not a thing about religion and about your rights and about your freedoms. It's that you have an obligation as a human in a society to take additional steps: washing your hands, making sure that you're wearing a mask, disposing of your garbage, creating physical distancing.

PBG, I know that you see it every day, but how can we get the message out there that simple psychological or sociological factors in your daily life can increase your survivability of a pandemic? How do we get that across to people?

I think the concept of wellness has been circulating certainly within healthcare over the last five years, and we have seen large employers be more engaged in wellness. One program that I'm aware of personally is Quest Diagnostics, obviously a very large diagnostic company. Obviously, I follow them, et cetera. They have pivoted and are actively developing these wellness products for these large employer groups.

As we said, COVID is a catalyst for change. It is also an accelerator of those change points that were going to happen anyway, right? I don't think that individuals, so let's take it at an individual level, and then let's take it at a corporate level, and then let's take it at a societal level, okay? Because really it is the onion of that you require to really change this.

The lowest level is the personal level, right? You, me, I, we can reflect upon COVID, like in my circumstance, and go, "Wow, I almost died. Let's not have that happen again. Let us see what I can do to change my lifestyle so that I am better off for not just the next pandemic, but understanding the direct correlation between the decisions I make and my overall health." That's what COVID has done for many people. It has lifted the veil. It has given many people an insight for the first time of, "I do not want to be susceptible to disease. I don't want to be pandemic fodder in 20 years when there's another virus that emerges out of China." You know, I'm politicizing that on purpose. But, you know, "I want to, I don't want to be a decrepit old person in a nursing home where I can't see my loved ones because they can't come and visit, or I'm going to die alone in some hospital room somewhere."

I think that we have lost the naivete that healthcare, your own healthcare, is something you can kick down the road and keep kicking it down the road until you're 70 and go, "Hmm, I think I need some technology to keep me going." I think the concept of becoming healthier early and maintaining that has great benefit, not just in terms of these comorbidities, but also, I think the general appetite for people seeing their doctor has plummeted. Like, "I don't want to see a doctor. Why do I want to? I didn't want to see a doctor before the pandemic. Right now, I really don't want to see a doctor," because they'll just find something wrong, right? Like, "I don't want you to find stuff wrong. Now give me a shot at modifying my lifestyle, and then when I feel good about myself that I have done the things that I secretly know I really need to do, then I'll go and see a doctor to get the good feedback."

I cannot take bad feedback anymore, right? This pandemic has, and Greg, you've touched on this, it's a mental health issue. I've had enough bad news. I don't need more bad news. I don't need some "ding-dong" to tell me I'm overweight. I know I am. I know I'm hypertensive. I get reminded every morning when I have to take my ACE inhibitor and my Lipitor. We know I'm in danger, I'm in bad shape. I need to do something about it. Doctors, physicians, healthcare systems do not do that well. Where is the support network now for people that are looking to make that change, right? It doesn't exist, quite honestly. That's a big problem.

So now we're going to get to the corporate level, where I spend most of my active life is in my workplace environment. And so corporations that are looking to build wellness products into their workforce, I think, is going to be very, very important because now, for the first time, you have a receptive audience. They tried to do this before, but now you have a receptive audience, and I think that that's very important. So if we were, if we were a focus group for an investment forum, we would say, "Look, wellness products are very important because it is the only vehicle by which you accept people for who they are, right? The bad decisions we've all made, right? And say we're going to give you good feedback now on how to get there." So you know what? You're not going to need a lot of doctoring. You don't want to be exposed to the cost of comorbidity management. You're not going to die alone, a demented, low performance status person in a nursing home. You got to keep your abilities as long as you can, and that is obviously directly impacts your financial outcome. So I think the corporate investment in wellness is critical. I think the tools that monitor compliance and outcome are evolving. They are not there, but clearly you need to be able to provide that feedback and encourage people, coach people, et cetera, et cetera.

I think the last layer around that is the societal component. I think that as we have all said, changing healthcare is very difficult. Changing acute care is near impossible. Like if you get hit by a truck or you have cancer, right, you need these systems in place to deal with these life-threatening circumstances. These systems are woefully incompatible with longitudinal prospective management. They are healthcare, but they're two completely separate systems that we need. Okay, how they interface, we will have to figure that out.

But when you're looking at prospective longitudinal management, what are you looking at? You're looking at positivity, you're looking at prevention. You're looking at a system that doesn't exist but in only a nascent form, which is our public health system. It is not coincidental that if we look at, say, Biden's platform, you will see a massive investment in that public health infrastructure to hopefully support or complement or accentuate a wellness that is or is not delivered at a corporate level. If you can't get it at a corporate level, we must deploy that in a societal or community level around Department of Health programs. We have had a really limited history of doing that, and what history we have is not impressive. Things like smoking, alcohol cessation, do you wear your seatbelts? These are simple, right, compared to Brian what you said. "Yeah, you really need to change your life."

I've heard from many thought leaders, powerful thought leaders on YouTube, I love them, where, you know, your performance and your expectations are the sum of the five people you spend most of your time with. Okay? So that's very interesting. I immediately reflected on that while I was laying in bed with COVID, and I was thankful for YouTube because I checked, though I always say, "At least I have two of the five that are going to get me there." I have Joe Rogan, right, that's three. My dog is pretty smart. I'm going to get there. But ultimately, there you could say the same thing for your health, right? And that is, you, you're the sum totality of the five healthy things you do in your life. That was a very sobering thought because I had to think about five things that I was doing healthy, and it was challenging to come up with those. And that begins the discussion, right? And some of those things are positive, active things like, "I need to incorporate more exercise in my life. I need to cut out alcohol." Some of those things are negative, like, "Cut out smoking," et cetera, et cetera. So that should begin the discussion, but you need support in that process. Okay? You need support. And if that support isn't there, it is a very lonely journey to actively take up and go through.

To your point, Greg, I think there is a group of people that will naturally do that, but I think that is, I don't know what percent of the population will do that, generally speaking, right? If we look at a normal distribution, the standard deviation from the mean, they're like two standard deviations. They've already bought the Lululemon wall thing, they have the Peloton. They were not worried about COVID. They look great, they're energetic. On the converse side, you have the other side to the mean, one, two standard deviations. They're already disabled, they're on, they've already had the kidney transplant. There's nothing much we can do. It's too late at a fundamental level, right? So we can make, we can probably move the needle closer to the mean from the active side, but without the support, everyone, a lot of people at the mean or below the mean in terms of health and outlook, it's going to be, it's still very hard to motivate them and get them engaged. I think wellness programs are going to focus more and more on engagement and not just monitoring.

And I'll give you guys a great example of that. My mom, who I love dearly, scientist, PhD, years doing biomedical research, she spends more time on 23andMe and Ancestry.com than worrying about when her next colonoscopy or mammogram is, et cetera. I mean, the tools for patient engagement, there is a Venn diagram that overlies wellness, and this is what I'm interested in, and that is testing, right? When you look at Ancestry.com and 23andMe, you're talking about testing. How can testing become a tool for patient engagement? Well, I can tell you, it ain't cancer screening. Like, "I don't want to do that." Like, that's horrible, right? But if I can be involved in testing that tells me what I need to do to prevent my hairline from receding anymore, all of a sudden, that's a hell of a lot more interesting than like, "Am I going to die of cancer?" I can't deal with that. Like I said, it's negativity, it's junk. It's very easy for me to be in denial about that. So how do we manage the mean and below in terms of health? I think that's what we got to do is patient engagement. I think that's very important.

But I got to tell you that there is a huge segment between the clearly disabled and the not ready to motivate that are in a real problem right now. This is a group, a large group of our society, that has now endured two major crashes to their economic reality. I can tell you, you could put me in front of those people and I can talk about wellness, about positivity, and whatnot. They have moved from the skeptical to the cynical, and they have every right to be. Okay? What needs to be done to engage those people? I think is unknown and very challenging.

I think both of you guys have touched in the past on something very important, and that is mental health. I think that that group, after enduring these massive, having your entire life and family turned upside down, that scars you for life, man. This is a horrible hazard. You get the PTSD. You get PTSD from combat. Let me tell you, when all of a sudden you can't make rent, you can't buy food, you have no economic outlet, you are in a horrible, horrible place. Obviously, we're not going to, there are conflicting ways on how to mitigate that and understanding the government's role in that, I totally get it. That is beyond the scope. But in terms of mental health and support for people going through that process, we have done, we have done a terrible job. Make no mistake.

How to, how to create the structure for mental health and support given the fragmentation of our society? COVID has stripped our societal communities down to what, a nuclear family. We have returned to like, us versus the world. My tribe is now my nuclear family, right? "I didn't get any help from the government, man." And these people didn't get help from a lot of their employers. There is terrible mental health damage and terrible distrust. You guys saw out there where the managers and directors of Tyson Foods had a pool on how many people were going to get COVID and die in their workforce. You talk about loss of trust among people who were already leading fairly unhealthy lives because of stress and having to perform in a global economy, and you superimpose that on them. I committed very hard to engage them going forward. And I can tell you, I'm not naturally a pessimist, but I think, I think it's, we can't, I think they may well be lost.

I think when we count the costs of this pandemic, it is the cost of lifting the veil on how alone we all really are and how vulnerable we all really are. And not a lot of people can cope with that. My wife is a primary care practitioner. Prior to COVID, or the second economic disruption, about 15% of her patients had a psychiatric—I say a mental health, not fair to call it psychiatric—a mental health or mental stress in their bundle of comorbidities. With this second economic disruption around COVID, not only is it now buried in the problem list like number eight, "You suffer from anxiety," now all the stuff buried is at the top of the list, right? It's, "I am anxious. I want to just, I can't function." But now it's gone from 15% to about 40%. And that's a huge problem. We do not have enough healthcare workers, mental healthcare workers, to deal with this. It will take a generation to train them, and you have to change, back to what you said, Brian, you have to change the system on how you have to make it a priority. You have to pay them. You have to create the structure for that for those mental healthcare workers to be valued and be successful. And that is a generational plus type-level change that will, that will get there, but it will be very challenging. But the public health system will be how we would probably end up doing it.

These are the real discussions that should be happening, meaning, this is like, I don't need another screen on a cable news show counting deaths and infection rates. That doesn't do anyone any good. Look, we're still dealing with that at a tactical, operational, and strategic level, and there needs to be more changes. But everything you just brought up about resilience, and you brought it up at a personal level, and you broke it down like personal, corporate, societal. And Greg will break it down as physiological, psychological, and sociological. I'll break it down as tactical, operational, strategic. We're all talking about the same thing. And that's the idea.

Even going back to what you said, COVID is a catalyst for change. It's a catalyst. It needs to, it is a catalyst for change whether you want it to be or not. So, what do you want that change to be? And this goes into what are we looking at for the next year? What's the predictions? Because everything you went through is just horrible and sobering, but really, really talking about what the actual issues are. And it's hard to get there. It took us an hour in this conversation to even get to that point, right? Because there's so much to get through. But at the heart of it is everything that you're talking about, and you talk about resilience.

So, which is, you know, how do you, you know, I get knocked down but I get up again, right? How do we—we all got a huge gut punch. Some harder than others. Some had it worse. Some, meaning some people died from it. Some people got really sick. Some people didn't have any of those problems and didn't know anyone, but they're out of a job and they can't pay their bills. So we're all affected by this. And so what you're good at is going, "Hey, here's what it looks like going forward," and you're good at these predictions because you take it from a clinical approach and you don't pull any punches. And I know you're not a pessimist, right? You know, otherwise you probably wouldn't have this great body of work. So what is it that is going to look like for this next year knowing all that? Not just how do we fix it, because man, there's a lot of issues.

Like you said, we have a new incoming administration, so they're going to, they already talked about, "Hey, we're going to have more funding for healthcare and testing and this and that." So there's top-down approaches that need to happen, which are always ugly and there's always unintended consequences and not all your money gets spent the best way. That's welcome to the government, you know? But what, what is this, what do you think is likely going to happen this next year? How is this going to change, meaning, is there going to be more mandates and shutdowns and things? How is this, how is this next administration coming in based on what you've seen so far and what they'd like to implement and what they're talking about implementing? And what does that do for our economy and our society? What does that do for my family and me in 2021? You don't have to have all the answers. That was a lot, right?

In terms of this year, 2021, what we will see is the very beginning of that infrastructural build-out that will be necessary to solve the riddle that you have proposed. If we look at Western social liberal democracy, for which I have been a great beneficiary, I bought into that system, boys and girls. I went to school in the UK at Malvern College, I went to Georgetown. I mean, I have embraced that and been successful in it. It was, it has been naive of me to think that that was a fair system.

And what we need to understand is, infrastructurally, the number one assumption in social liberal democratic circles and therefore globalization—because obviously I use those synonymously, right—is a great overestimation of the resilience of humans in our society. We have, I have personally taken, because we're all born with different capabilities, if I happen to be very resilient and I see people not being resilient, it is to understand that that doesn't make me exceptionally good, that just makes me lucky. And what will happen over time is if we allow that to occur, you will see the further disintegration of our society in the U.S. You will see more and more schism and more and more separation to the point where we are probably at now where we don't really even want to talk to each other, right?

So the resilience question is at the core of our discussion. What we have realized is that, yes, health, your health is clearly part of that resilience equation, but it is not enough, right? We have to understand that if we just double down on healthcare and address your underlying health issues, that is not going to go anywhere without understanding how to make humans in the U.S. across the board more resilient to change, because that's the only constant here, right, is change. We can talk about the next pandemic, we can talk about an environmental catastrophe or change, if that's real or not. We can talk about nuclear accidents, whatever, and global economic meltdowns. The only for sure thing is change, and the systems that we invest in are not Republican, they're not Democrat, they have to be concerning how to increase resilience. That's how we should approach that. What are those systems? How do we behave internationally and domestically to assure that globally?

It's very clear, right? We, there is an enormous retreat from the globalization context because the lack of resilience, boys and girls, is not unique to the U.S. It is across the board, and it is having a great impact on a lot of these, on all our societies, liberally democratic or not. I guarantee you, if we were having a conversation within the closed doors of the Chinese Communist Party, they would be sweating the same details as we are today, right? Make no mistake. The societal lockdown of Hong Kong is a reaction to that lack of resilience as a whole, right? It's across the board. So that's what I think the next level of discussion is.

So you're going to see a retreat from the externality of global competition to focus internally on understanding how to protect these populations. The immigration narrative that we have all seen, and this is non-judgmental, it is about resilience. You cannot park waves and waves of immigrants into my society and think I'm going to function better. I'm not resilient to that, so you have to stop it. So that's sort of where I'm approaching this from conceptually in terms of what is the infrastructure around resilience. There's no book on this, there's not a lot of literature on us, there's no real thought leaders on this.

We have identified some of those issues, right? Trade, job security, right? That's very important. Without that, you're lost. I think health, we've all decided, is a big one, and in the context of health, like really own health, not acute care medicine. Having a great acute care medicine system is not its health, it's saving you for a little while. But I think that's important. That's an infrastructural change.

I think that probably education is an infrastructural change. I have no idea how that's going to go. I know that the available students who can bury themselves in student loans for the purpose of the social liberal democratic educational system is retreating. And so you have to think of alternative educational platforms and content that can build resilience. That doesn't exist. I look, I see the content that my kids get, you know what I mean? It is a classic curriculum, U.S. history, math, we'll make you read some good literature. None of that is resilience, man. None of it. I have to teach my children resilience. I'm lucky that I'm pretty resilient. If I'm not resilient, how the heck am I going to teach them that? You have to find other support structures to teach that. That it doesn't exist. It is a paradigm shift, but people will find it some way.

I would make the argument that probably in the 50s and 60s, when you looked at a community contract like the Boy Scouts, right? Let's look at that. What was that? That was a socially acceptable construct to teach resilience. It wasn't about building a fire in your garage, like I did. It was about teaching you that you are ultimately responsible for yourself. Like when we hear the word Eagle Scout, "Oh, like Brian was an Eagle Scout." What do you feel? You feel that guy's mega resilient, man. You're going to throw, it will take a lot to bury that guy. Okay, but we don't teach resilience. Over the last 20 years, it has become socially irresponsible to put youth in positions of vulnerability to teach resilience. I mean, that's painful. That's painful. We have done, we have become dumber and less resilient over time.

I mean, I look at Ari, my son, who plays a lot of video games, especially during COVID. It's hilarious. He doesn't get resilient from school. You're going to get resilience from, you're going to laugh. Like when he's playing Call of Duty with Marines in Afghanistan. I walked in and the "S-bombs" and stuff going on, I almost passed out. And I yelled at him, and I was so proud of him because, you know why? He didn't apologize. He just went and he closed his door. Oh, yeah, right, that's the way to do it. It's not the end of the world. You're just going to make some different friends out there who are role models for resilience.

If you look at societally, like our, you know, the divide between social democracy and what I call individual freedom democracy, a core issue of that is resilience and the prioritization of resilience. If you look at Second Amendment issues, is that not a manifestation of who is going to be resilient and who is not? And so we have a huge issue here and discussion. I'm a Democrat, but even I am aghast at the "snowflakes" that we have created amongst us. I mean, you think we got a lot of non-resilient people now? Oh my Lord, we're going to have some real problems down the road. And it ain't going to be pretty, folks. So we have to change that. I don't think that we have lost that, and we're going to need to find it because...

But I would say, I would say that this is what, like, COVID now, or look at your generation, and then my generation, and then the generation of the little insurgent I got running around here at home, like how it all affects us differently, right? And that return to that and understanding of it. Well, well, you know, no one really got my generation didn't get that at a global scale until now, meaning, like, yeah, I did, I went to war, you know, our country got attacked. So, at a personal level, but that was such a small amount of the population in the United States. Like, I understood that. Like, we kind of got that feeling on 9/11, like, "Holy crap, we're not invincible. We, there are threats out there that could." But because no one had to really sacrifice for that, other than the people who served. Like, it was different. You weren't, you weren't having to buy war bonds and donate stuff to the effort. So, so you didn't get that.

And then, meaning now with this COVID, now maybe that's what it is. And this is the chance instead of going, "Hey, let's go around and nerf the world and make all the playgrounds rubber and tell you no, you can't believe it." Let's go correct everyone else. Let's maybe just focus internally what I can with my, with the little one I got running around at home, and how do you cope with this? Because she's now learning resilience now because of this. She can't go out and go play with friends. Dude, I just had, you know, with my parents over the holidays, I was like, "You guys would have killed me if this happened during when I was that age." They're like, "Oh, you'd be dead. We already had your little brother. We had your sister with different medical conditions. We had a new baby, and then we had you. If you had been on lockdown and not gone to school, like, we would have only had two kids." I was like, "Oh yeah, you would have buried me in the backyard and no one would have found out about it." Meaning, it's affecting everyone now. And so that next generation is the ones going, "Hey, like, we need to be more self-reliant." That's what resilience is, part of it is too. Like, the more I can rely on myself and don't need other people and don't need my city or state or federal government, well, that makes the whole process at scale, if everyone focused on it, that makes the whole process better because we're leaner, we're more resilient. We don't need all of this massive healthcare industrial complex anymore, right? That goes, some of that goes away because we're taking care of ourselves.

So I always try to bring it at that personal level of what you're talking about here, and you brought up, you know, I like your line as the great overestimation of the individual resilience of the people. And I think that summarizes everything that's going on and especially in the U.S. right now. I mean, it really, really does. With people getting upset, rightly so in some areas, and how it's become hyperbolic and you've got all this anger and people yelling, and I look at it and go, "Jesus, man, like, what do you, how does that anger you? How do you get that upset over this issue which I know doesn't affect you as much as you're portraying?" So, I think that goes into our resilience at an individual level. I mean, even like you use a term like "snowflake." I've heard that from so many of my friends and people that I know, they use it and they go, and I'm sitting there as they're calling someone a snowflake going like, "You, you, you're horrible at taking any criticism or you get upset over ridiculous things. Like, you don't get to call someone that," right? Because you're flipping out.

So, I agree with you, Brian. We have created this situation over the last 30 years. And we're going to have to abandon the presupposition that a utopia is either attainable or something we should get, because in pursuit of that utopia, that is not, obviously, it's a loaded question, it is not attainable, and it is really antithetical to happiness and the human state. It's not a right, it's an unattained, that's not something you should go for. It should be something important, it should just constantly improve your position, constantly improve yourself, and if everyone did that, we would constantly improve. So that there's different ways to do that.

But I know, Greg, I know you've been taking notes and haven't had any comments.

I want to, first of all, when I'm listening to PBG, I just want to shut up and listen. You're so much fun to listen to because you're a brilliant guy. But Brian, I can synopsize my entire closing and my predictions in two minutes. But I do want to set aside maybe an additional 30 seconds for those pundits that are already wanting to tar and feather young PBG there, because at the very beginning of the conversation he was talking about, "Hey, I had COVID and almost died from it, and my wife and kids are going to Hawaii." His wife and kids are going to Hawaii because they live in Hawaii. He works in Denver and Nashville. And even when he almost died, he was out there working for you as a forensic pathologist trying to chase down this illness. So don't throw the baby out with the bath water.

Stop separating health and mental health. When we deal with one, we deal with both. And if you're not dealing with it, then you don't have a 360 attack on what's good for you and what's good for you as a member of a tribe, a set, a cult, a society. So every time that we separate that, we do ourselves a disservice.

I wrote down, Brian, that two things that people hate most are change and the "right now." So everybody that wants to fight something, you want to fight with us right now. Nobody goes, "Hey, you know, in 1897 that guy really pissed me off." They're pissed off at what's here and now and what they're listening to. So look, being on lockdown means you can shut out those additional influences and focus on you a little bit and focus on your family. And if you need mental health, there are people that will visit you via your computer now. I understand not everybody has a computer, not everybody has that means. So there's other ways of doing it. Even the U.S. Postal Service, even though it's going to be there a month later than you expected it, you can write people, you can reach out, you can text for help. These are things that you can do.

And Brian, I would say this: we take things for granted. And I would say 200 years ago, Helen Keller would have been drowned in a creek in a burlap sack. A hundred years ago, Stephen Hawking, outside the wheelchair and the computer, would have been locked in a room with 30 or 40 other people just to vegetate and ultimately die. What we have to do is we have to take a look at these gems that are around us. And I agree, stop conflating happiness with utopia, because they can, they can exist outside of the purview of what these people keep getting thrust down their throat. All the most beautiful things in life—the poetry, the great films, the romance that drives all of this stuff—are still available in a pandemic. And that comes from humans that are resilient, humans that are built to be critical thinkers, Brian. And the fact that we don't use confirmation bias just to wave a wand and say, "This testing is invasive and the surveillance is Gattaca-like and that there's a theme behind everything that's meant to degrade me." If we turn that around, if we change that narrative, Brian, I think we're going to have a lot more people that are happy and resilient.

Yeah, I would, I would hope so. But that, everything you talked about there is, you know, it's almost like you're incentivized by the market, you know, just market incentivization of what you want to do, right? And when it comes to if you look at resilience in that way and say, "Okay, I'm going to, my view of the world is a lot of people are having a hard time handling the situation and everyone's screaming and shouting and there's a lack of resilience." Well, then guess what? That would mean that if I can become resilient and the more resilient I am, the more marketable, more profitable I am, the better it is for me in some way. Meaning, it's your, you are incentivized to do that because that means you're getting ahead of what everyone else is doing. Meaning, you're not just, you know, you brought it up earlier, I always refer to chasing TTPs (Tactics, Techniques, and Procedures).

So, I'm sure PBG, a lot of what you talked about too, is even this we call TTPs, tactics, techniques, procedures. And most people go, "Okay, this is going on right now, I'm just going to react to that and fix that problem." And then the next thing comes up. "Okay, here's what it is. Oh, okay, now I have to react to this." Well, that's, I mean, that's, that's Twitter, that's Facebook, that's everything. But so if you're not doing that, if you're getting ahead of it, if you're developing yourself and developing that resilience for you and your family and your community, well, guess what? You will get ahead. I mean, it's, there's almost a marketplace for that.

Brian, I think it's one step further before I hand it back to PBG. I think that COVID shows us that there are asymptomatic and pre-symptomatic people, and that testing works in finding this. Well, that means that's the power of scientific planning and experimentation and discovery. So right now, what are the big things, back to my truck example, "Hey, I want to prepare for the survival because, you know, there's going to be an apocalyptic crash." Right now, try to go out and buy ammo or try to buy reloading stuff, and you can't find it. Why? Because people go there first. Brian, resilience is about not going there first. Resilience is about opening those doors and putting away the gosh-darn duct tape and the transparent window coverings and looking out and asking your neighbor, "Hey, can I help you?" As long as you're six feet away and wearing a mask, of course. But this isn't apocalyptic. We will rebound from this. PBG, you got to agree with that.

Yeah, I totally agree. I think that I think the people who have navigated this will come out educated, sober, and better off. I think we will have to count the casualties of this process beyond the last vaccine dose, much as the way we look at the communities around Chernobyl, right? We dealt with the immediate problem, but we had to deal with the sequelae of that event for many years after the fact. So the fact that we can have that discussion and understand that, I think, is very important because as a society, as a community, as a nation, our preeminence is really going to be dependent on the weakest link, right? And I think that's a very appropriate concept that the further your leaders get from the whole, the more they get cut off, the more irrelevant they become, and then they fall back into that morass, if you like.

We can have that argument as to whether that exists. I'm sure if I had $180 billion in the bank, as some of the Forbes listers have, I can actually create my own reality. But hey, those are the exceptions, not the rules. So focusing on the vulnerable and operationalizing the capacity of people's talents who are presently on the sideline will be critical for our maintenance of the success of this great country and how we can continue to be leaders in the global community.

Yeah, I mean, I think that's a great, it's a great way to look at it. So we kind of, we covered a lot, and, you know, of course, it boiled down to mental health and resilience. I mean, that's not, that's not surprising to me that it ended up there, meaning going down, because it's, that's what it means going forward, right? Okay, we've had this one-year experience. Hopefully everyone learned a lot about themselves and others and our system and process and how it works. And it can be really good, it can be bad, it can be slow, it can be fast. I mean, really what did happen, what you talk about with the vaccine stuff and how quickly that occurred, was pretty amazing, but it was because it was built on technology and a process that has been around for a decade, like you said, and it's really, really advanced. And finally, the moment in time came.

And there's a lot going forward that we need to look at. And, you know, I always say, you know, what is it, how can you fix yourself before, you know, PBG, you're the worst at it because you are a doctor, it's "physician, heal thyself," right? Because you're so focused on what you have to do as a job and taking care of other people that you let yourself go. And we do that.

And almost died because of it.

Yeah. We do that with our families and kids, and people are focused. And you know, we always bring it back to what, what do they tell you on the airplane? "Hey, if those oxygen masks fall down, you put yours on first, and then you help the kid out." Because the kid's not going to do any good if you're passed out dead because you didn't put your mask on or whatever. You know, it's always that. It seems selfish, but it's not a selfish move. Taking care of yourself allows you to be a better asset to your family and community and country and world and all that. So I think that's the way I tend to look at it. I don't know if you guys have any, I think it's a good place to kind of end on, unless you guys have any...

I agree with that. I would just say, Brian, I would add one thing to that, and sage advice for everybody. But PBG, it's amazing talking to you. We love having you around. You're a doctor of some prestige in your community, but you also know how to throw back a bourbon and tell it like it is.

Well, I was going to say, when I saw you drinking bourbon out of a champagne flute, that was the only receptacle we had left in that place because I was using the planter. I knew we were going to be good friends.

Yes. Absolutely. And you know, we're looking forward to, you know, 2021 is an important bridging year, right? And that's how people should view this. It is not the, it is not a final, you know, "get out of jail" of pandemic year. It is the bridge year that we lay the foundation for really coming out of this on the other side. So, amen. It's sort of sobering because, you know, everyone wants a quick solution, but this isn't. But we're getting there. But people need to pay attention to what they do today will pay great dividends in 2022, 2023, and '24. So, though it is chaotic, it is great to have these types of discussions on some of the core concepts of what is going to be valuable and what is not.

Amen, absolutely. I think that's a good point to end on. I appreciate you coming on. We'd love to have you back on here. Everyone listening, don't forget that training changes behavior.