Big Covid Questions, the Nursing Shortage Crisis and a Friend of Pivot on the upcoming Elizabeth Holmes Trial

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Hi, everyone.

This is Pivot from New York Magazine and the Vox Media Podcast Network.

I'm Kara Swisher.

Scott Galloway is still out trying to get cast in the bachelor.

So I'm joined by my brother, Dr.

Jeffrey Swisher, chair of the Department of Anesthesiology at California Pacific Medical Center.

Jeff, how are you?

I am great.

How are you doing, Kara?

Good, good.

We have a lot to talk about today.

I'm bringing in my brother because many people on Twitter have called for it, really.

I know.

I want to thank all my fans on Twitter and Dr.

Subramanian in particular.

And several have asked for me to be here.

So great.

Well, I am only here, not because you're my brother, because you have a lot of information I need.

As you know, I'm stuck in a house with our mom because we got near my cousin's partner who had COVID, and here I am.

So I have a lot of questions.

Our tests are

feel like what Donald Jr.

must feel like, or, you know, Megan McCain or something, you know, as far as an epitome goes.

But I'll take it.

Okay.

You'll take it.

But here I am.

You've got to get me out of this house with Lucky.

Anyway, so let's start just, but before let's start with a couple of things.

There's an update on the story about Catholic priests.

You and I are both lapsed Catholics.

And Grinder, the conservative news blog, The Pillar, put out more reporting on cell phone data that seems to show priests using the gay hookup app.

Not a surprise to either of us, of course.

The first report led to the resignation of Monsignor Jeffrey Burrell in late July.

There have been two reports since then.

The latest reports didn't name names, but claim more than more use of the app in the U.S.

and at the Vatican.

So what do you think about this?

I mean, it's an, you know, we're, we, we are, well, we didn't, we haven't been in the church in years, but what is this, this outrage of, uh, is, is the bigger outrage priests violating their celibacy or the privacy?

Well, okay, first off, I don't think you were ever confirmed.

I don't believe that.

Yes, I was.

Really?

I don't remember it.

I think I remember it.

Yes, I in a white dress.

Yes.

All right, That's fine.

So, Jeffrey Burrell, now he was the guy, wasn't he the head of the U.S.

Conference of Bishops?

He's the guy who wanted to deny Joe Biden the ability to take communion.

Isn't that correct?

There is a hypocrisy going on, Jeffrey.

Yes, a great hypocrisy.

He's also the person who was extraordinarily anti-LGBTQ rights.

He wanted to deny them adoption rights.

He wanted to do all kinds of

pretty horrible things.

This is often the case.

And often self-hate.

So he deserves it?

He deserves privacy violations?

Well, no, actually, so this is, there's all kinds of yuck here, right?

I mean, the fact that Pillar, which is the organization which looked into him, were tracking his cell phone movements.

They were tracking which sites he visited from, I suppose, metadata

and actual data itself.

I mean, the fact that that's available should scare everybody.

So I don't think there's any winners here.

I mean, I think it's gross on both sides.

I think this group of people has an agenda.

You know, this is Pillar.

It's sort of the concern.

They're sort of attacking Pope Francis.

There's a whole fight going on within the Vatican, the the more liberal wing, just like there is in this country, like everywhere else.

And they are using this, which has been an issue for many years.

In a lot of ways, it's not the same as the scandals around pedophilia because these are presumably consenting adults.

And at the same time, they've made a vow of celibacy.

So I think what's difficult here is the people that are doing this, pretending they're trying to help morality in the church, are really just doing it for their creepy political agendas.

Well, keep in mind that celibacy in the priesthood is actually a relatively modern thing.

The Council of Trent in 1563.

You're going to the Council of Trent.

Yes, actually, it goes before that.

It goes to

the Lateran Council of 1139,

where they everybody, Jeff, got into Stanford and I didn't.

But go ahead.

The Council of Nicaea, which was even before that, Constantine, they actually rejected the fact that priests should not be celibate.

But the point

is not dogma.

It is regulation.

The Pope tomorrow could say priests could get married, and that would be fine.

So the whole concept of celibacy is a very unusual one, I think.

This catching stuff is just, I go on the privacy side.

I don't care how hypocritical it is.

I think the privacy issues are much more important here.

I 100% agree.

Tracking people and being able to use these apps.

Let's differentiate between pedophilia and homosexuality.

They're totally different things, right?

100% different.

Like, obviously, but they're, you know,

this is a bigger, wider problem in the Catholic Church, but it seems like in this case, tracking these priests is as creepy as it is tracking anybody.

And

I'm not for outing people in any way, shape, or form.

Yeah, it's an interesting thing.

So let's talk about the Big Jeopardy controversy.

This

is

Jeopardy.

Just to bring everyone up to speed, Sony named the show's EP, Mike Richards, as the new host, along with Maya and Bialik.

Then the report came out in the ringer about sexist and racist comments he'd made in the past, and he stepped down.

I just, I don't want to talk about it a lot.

I don't know if you watch Jeopardy.

I know some are writing.

Who are you for as the host?

You know, I love LeVar Burton.

I really like him, and I think that he would be great.

I don't think his inner, his uh, his tryout was all that great.

I think he stumbled a few times.

He also wasn't given the full opportunity.

I think he only had five shows versus the 10.

But, you know, the fact that this guy, Mike Richards,

was the executive producer and he's the one who chose the people and he chose himself.

Well, they supposedly he put himself out of it.

Well, ever.

I mean, the point is, is that, I mean, you know, I think the whole controversy is kind of silly and overblown.

But, I mean, what's going to be the next Jeopardy category?

Like, mammary glands, silly names for 100.

You know, I'll take that for 100.

Just referring to a podcast this guy did, which was in plain sight.

It's amazing Sony didn't check.

Tony Vinseguera, I know very well, the head of Sony, I'm shocked he didn't check.

But nonetheless, you want LeVar Burton, and I want Ken Jennings.

I think he'd be good.

I think it'd be nice to have a woman, and it'd be great to have a woman of color, too.

I mean, I think that's

that is true.

They have Mayan Bialik, who is going to be a host of specials or stuff like that.

That's Blossom, of course, for those who don't know.

She's fantastic.

She is indeed.

So, lastly, before I want to talk mostly about medical stuff, let's start.

The White House is pushing Joe Biden's plan to lower the cost of prescription drugs, letting Medicare negotiate prices with drug makers.

The administration is selling this as a winning issue for House Democrats.

Is it a win for patients?

What do you think about this?

I do, actually, you know, because Medicare,

as the rules as they exist, don't allow the government to, or you know, people to negotiate for drug prices.

But I don't know if you've looked into it, but I'll be 65 in four years and ready for Medicare, and I'm going to start studying now.

I mean, literally understanding how Medicare works between Part A, Part B, Part C, Part D.

So, what you're talking about here is the Part D part of Medicare, which is the prescription drug coverage.

And it's very complex.

And I think that, you know, most people over age 65 are on medication.

I mean, I'm on two at age 60, 61.

And

the importance to the senior population can't be overstated.

So bringing the prices down.

Absolutely.

And they're a voting block.

And I think that the Democrats can bring in that cohort by helping out their lives.

I mean, it's insane what the prices of some drugs are.

I mean, like, take insulin, which is something that is needed by so many people.

The prices have skyrocketed over the years.

And that doesn't even count some of these other more expensive medications that

make delays in getting them because of various things.

There was, I think, a hurricane or something like that, or a tsunami at one place where they were making...

You're an anesthesiologist, so you use a lot of drugs.

I do, but I use them in the operating room.

I'm not a prescriber, actually.

I mean, well, I do.

I have the ability to prescribe, but my drugs are actually given by me in the operating room to patients directly.

But we have a shortage, I mean, of drugs in the operating room.

It's insane about which drugs are always on shortage.

I get a list every day of what drugs that are basic medications that I, you know, have to come up with alternatives for.

So, will the ability to negotiate help that?

Or is that as that?

I don't know about drug shortages.

That's more of a function of manufacturing and supply.

But I think

the drug prices is something which

you negotiate with different insurance companies for different prices.

So, the same drug, depending on the insurer, there was an article, I guess, in the New York Times yesterday that I read about the price of an MRI, for instance.

With the same MRI with different manufacturers,

the price could by 4x can change the price.

Now, that's not the price that the patient pays necessarily,

you know, unless it's self-pay.

But that's

that being said, I mean, it's crazy the system.

It's a patchwork system.

You're going to study it for four years and you're a medical doctor before you figure it out.

No, no, I don't know many medical doctors who understand Medicare nor understand drug pricing.

I mean, we hire people to do this for us

to figure out our insurance reimbursement.

Okay, Jeff, time for our first big story.

The FDA has given full approval to Pfizer's COVID vaccine, which makes it the first COVID vaccine to go from emergency use authorization to full FDA approval.

Explain it for the people in very pithy terms.

Explain what that means.

Okay, so do you remember?

Well, let's just start with FDA approval of a medication.

So the FDA

manufacturers apply to the FDA for approval of a drug, and they have to submit all kinds of data, patient trials, they have to do phase one trials, phase two trials, and it's a huge amount of work and expense to get a drug approved through the FDA.

So in this particular case, the mRNAs were really, even though they've been worked on for many years for other indications.

Like 15 years.

Yeah, for a long time.

They really rushed and...

with a lot of data to back it up, the mRNA approval for the Pfizer vaccine.

And so they got what's called called emergency use authorization.

You know, even before that, you can have what's known as compassionate use authorization.

For instance, I guess we'll talk a little later about Regeneron.

But when President Trump got the antibody cocktail, now this is not the Pfizer drug, but the antibody, he got that under compassionate use before it had the EUA.

So Pfizer and all the other mRNA vaccines and the Johnson Johnson, which is an adenovirus vaccine, has

EUA right now, emergency use authority.

So what is the difference?

Full approval makes people feel like it's real, right?

Presumably or something.

I guess.

I mean, I don't think that most people.

Well, they've been using it to say, I'm not going to get the vaccine.

So does it make it easier for schools and workplaces to enforce vaccine requirements?

Yes.

I think that is important.

It allows, it gives cover for people to basically say, you know, yeah, we can enforce these vaccine mandates.

You know, my hospital has a vaccine mandate.

Yeah.

You know, as of September 20th, I believe you have have to be vaccinated.

What about peace of mind?

You were telling me about people that you were treating that didn't have the vaccine and what you're seeing in San Francisco.

Explain.

Not just people I was treating, but I mean, people I work with.

I mean, I had a long and very heated conversation with one of the surgical techs the other day.

He's not vaccinated.

And I was like, why aren't you vaccinated?

He says, well, because it's not approved.

I said, it is approved under EUA.

I said, but a lot of things that you do are not approved.

I mean, there's a lot of off-label use of medications.

And then he said, well, you know, I don't want to take it because they're making me.

And I was like, well, they make you take polio vaccine.

They make you take measles, mumps, rubella.

I mean, the list is enormous.

If you join the military, it's like 15 vaccines you have to have.

Sure.

So I don't really understand this argument.

I think it's...

What did you tell him?

You had heated.

What did you kick him out of the?

No, you know, as of September 20th, he's not going to be able to work there.

I mean, this is, you know, but I mean, it's difficult to argue with people who've already made up their mind about something and, you know, logic doesn't seem to work on them.

Yeah.

So what do you do?

What do you do?

I mean you're seeing most of the people hospitalized that you're seeing are unvaccinated, correct?

Well, interesting.

You know, Israel is the great place to look at for that data because they have the longest history

and we're not talking that long.

I mean, remember, this isn't that old a virus.

We're talking about early 2019.

So, but they got people vaccinated early.

And if you look at the Israeli data, right now, it's actually about 50-50 unvaccinated versus vaccinated who are getting sick.

But still, the vast majority of people hospitalized.

Hospitalized, that's what I'm saying.

Hospitalized, not infected, but hospitalized are unvaccinated.

I looked at the numbers from my hospital today, and actually about two-thirds are unvaccinated, one-third is fully vaccinated.

So I think as we, as immunity wanes from

the hospital, in the hospital.

That doesn't necessarily mean in the ICU, intubated or proned or anything like that.

Those are mostly unvaccinated, correct?

Mostly unvaccinated.

And then if you look at the death rates, the people who are dying as a result of COVID now,

they are the vast majority.

We're talking about fractions of percent who are unvaccinated.

Most people are unvaccinated who are dying.

Delta is a different beast, though.

And I think some of the data coming out of Israel shows that the Delta virus, not only is it more infectious, but it potentially is more lethal as well.

More lethal.

And you know, I'm stuck.

I am not joking.

I'm actually, we, we,

someone in our family got COVID, even though he had been vaccinated.

And then we had lunch with him outside mostly.

We were inside for a very short amount of time, but we are sitting here trying to figure out if, you know, just getting tested, which is because of, because

of the virulence of the infection here.

But the administration is rolling out booster shots for many Americans starting September 20th, speaking of that date.

First off, is there a difference between a booster and a third shot?

It's the same thing.

It's the same thing.

A booster, I mean, the whole point of a booster is to spike your immune system again.

And remember, I mean, unfortunately, immunology is really complex.

You know, when you talk about immune

status, you're mostly talking about antibody levels, B cells.

Remember, there's another set called T cells, which are T memory cells.

So the idea is to spike the immune system by activating T memory cells to produce more antibodies, to build your antibody level.

That's what I talked about with Dr.

Patrick Soon Xiong on this.

Right.

But it's to increase that, the, the, the, spike the memory of the body.

It's like, oh, yeah, I've seen this before so you produce a lot more of these t memory cells in addition uh t helper cells and all these other things which uh which uh i'm not an immunologist so i don't want to

do you think are you seeing lawn jumping on these people who just decided oh well i'm just going to get one before there's a rush but you know what's interesting is if you look at the you know walgreens and you know other drugstores.

I looked the other day.

There's so many open appointments now for that the booster shot.

I was tempted, you know, I had a break in the operating room to go down and get mine because I got vaccinated in December for my first shot and January for my second.

And again, looking at the Israeli data, we're seeing that

they have one of the highest rates now of Delta.

I think it's like 650 per million population.

And that is a population that is 80% vaccinated.

Right.

But

wear masks, et cetera.

Correct.

There's confounding variables, though.

So keep in mind that the people who are vaccinated first were the elderly, the immune compromised, et cetera.

So we may see that as a confounding variable in why they're getting sick in Israel.

But I would pay attention to the Israeli data.

There's a few researchers.

I would get a booster shot.

I would definitely get a booster shot when you're able to.

Yes.

Right.

So there's so much stress also going back to school now.

You're talking about with Delta.

I just interviewed the head of one of the teachers' unions, Randy Weingarten.

And particularly in Florida, she was pointing out they're seeing a surge in cases.

Your wife is a school teacher.

She teaches school.

What kind of conversations are you having about this?

Although schools have proven to be pretty safe in terms of transmission.

That's correct.

I mean, not only only my wife, but my daughter is a school teacher, too.

She is just starting teaching in Jackson, Wyoming.

And my wife teaches second grade, and my daughter teaches preschool.

You know, it's interesting.

In Marin County, where I live, we've had very good

safety measures.

In fact, Dana went back teaching in October.

of last year.

She was one of the earliest districts to go back teaching.

Now, they did it via cohorts and they had plexiglass barriers, which of course they found that those don't seem to help.

In fact, they may hurt.

All of the kids are wearing masks, every one of them.

All of the teachers are wearing masks.

They don't eat lunch together.

They eat lunch separately.

So they put in basic safety

protocols.

Ventilation, better ventilation.

And better ventilation, keeping the doors open.

And they try to do outdoor teaching as much as they can.

I mean, my wife is a big garden advocate, and she is doing a lot of outdoor education about modern butterflies and gardening, et cetera.

And so they're trying to do, you know, integrate those kind of things in the curriculum.

But I have to say, I asked her this morning when she went off to work.

She started last Wednesday.

Every single teacher is completely thrilled that they're back in the classroom.

Zoom teaching was very hard.

And I don't think it served children well.

No, I did not.

And it certainly didn't.

I think a lot of teachers resigned or retired because of it.

We'll be talking about the nursing shortage, but there's a teacher shortage too.

It was a really stressful year for them.

So in terms of going back, you're not worried about that.

Just take the booster and do the same kind of safety things.

And it's schools.

For teachers, obviously.

Children aren't vaccinated.

There's no children under the age of 12

who are, you know, have been.

So what to do for parents?

Just go wear the masks.

Yes, wear the masks.

Practice, you know, don't send your child to school if he or she is sick.

And remember, the signs of COVID are very simple.

I mean, it's a coronavirus, right?

So, you know,

the coronaviruses are the common cold virus.

So it mimics and it looks, because it is, a coronavirus.

So children, fortunately, don't seem to have suffered the consequences as much as adults have as far as morbidity and mortality.

Delta may be changing things a bit, though.

So we're seeing more children hospitalized with coronavirus.

And they can't get, and that, of course, will be into the into the fall.

Right.

Right.

That's right.

That's right.

And in the fall, it will get worse because more people are inside.

Yeah.

Right.

And we'll see.

But on good news on that front, the Secretary of Education said that public schools who want to institute mask mandates can't be denied federal funds.

Of course, there's a huge argument over masks mandates, people screaming back and forth, the science being thrown around.

It's still confusing at best, no matter what the pressures are facing from the state government.

Governor Greg Abbott of Texas lost the battle to ban mask mandates in the state Supreme Court.

He just did.

Let's talk about this guy.

He tested positive, and then four days later, he posts this video.

Let's run it.

I am now testing negative for COVID.

I'm told that my infection was brief and mild because of the vaccination that I received.

So I encourage others who have not yet received the vaccination to consider getting one.

My wife also continues to test negative.

I will continue to quarantine at the recommendation of doctors.

During that time, however, I will continue to work on issues that are important to the state of Texas, including opening infusion centers for antibody therapy treatment across the entire state of Texas.

What's an infusion center?

Boy, I'm glad I didn't see that before.

I would have gotten nauseous.

Infusion center.

An infusion center.

Yeah, I get this treatment of these antibodies.

That's a great thing.

It's my greatest.

Well, maybe.

I mean, it's what Donald Trump got when he, under compassionate use.

The company Regeneron makes, as well as other companies, Eli Lilly, et cetera.

But Regeneron is the one that you hear most in the news.

It's a company that makes an antibody cocktail that consists of two monoclonal antibodies that they package into one vial and they inject them into people.

Now, you have to go to an infusion center for an intravenous injection.

You know, people don't talk about that, but that's not cheap, right?

To go to an infusion center.

So even though the drug might be supplied free of charge, I doubt very much going to an infusion center, getting an IV, sitting in a place for an hour and a half to monitor side effects.

Better to take the free vaccine, correct?

That's right.

Yeah.

I mean, it's like the, you know, it's like the whole cows leaving the barn thing i mean just

why is he focused what do you think why is he focused on the infusion centers versus the i mean he did he did say to go get vaccinated he certainly did which is good i mean although he didn't use to say that right yeah and uh and neither did you know trump initially etc i mean all these people he sort of anti-vaxxers i mean they they created doubt i mean this should not have been politicized ever the same thing with mask wearing it should not have been politicized but it was And as a result of that, we have all these problems now because people are

following.

And they're focusing on these antibody treatments.

Florida, Missouri, Texas are promising millions of people.

These are expensive treatments, Kara.

I mean, you know, they actually.

Are they effective?

They work if you get the antibody.

They work 80% of the time.

If you get within 10 days of having the first infection or knowing that you have an infection.

So you have to not be hospitalized pretty much when you get them, but before you're hospitalized.

In fact, there's data that suggests that once you're hospitalized and on oxygen, et cetera, they actually may be harmful.

So it's confusing.

So the idea is get a vaccine.

Get a vaccine.

It's just, it's a no-brainer and it's so much less expensive.

I mean, each of these antibody treatments can cost anywhere from, you know, the actual true cost is about, you know, $5,000.

I mean, Regeneron is a multi-billion dollar company.

So it's like doing diabetes treatment when you could start with don't eat so much sugar or whatever, don't eat and have a bad diet.

For type 2 diabetes, yeah.

Right.

Yeah, for type 2 diabetes.

So it's just,

it's a thing that comes way too late.

Correct.

Right.

It's like, it's like having the cows leaving the barn, gone in the fields, and then buying a whole bunch of Segways and riding around trying to round up the cows.

It's silly.

You know?

Yes.

Okay.

All right.

So, but

what's really, but when you notice all this as a doctor, and I'm going to get to nurse the next story in a second, but the politicization, now, medicine has been politicized over years in lots of different ways, and there's political elements of entering.

What is this like as a doctor?

Well, it's frustrating.

I mean, when you're treating people who could have with a, you know, I mean, a lot of prevention stuff is treatable.

I mean, massively, you know, morbidly obese people who, you know, you know, they can't always help it.

It's, it can be an endocrine issue.

A lot of things that it's frustrating.

Smoking is a good example.

I mean, don't smoke, right?

It's not good for you.

But, you know, we treat these diseases as a result of,

you know, not taking into account the value of prevention.

exercise, you know, the common sense things.

But in this case, it's vaccines.

In this case, it's vaccines and social distancing and wearing a mask and common sense thing.

Now, keep in mind that masks, you know, don't necessarily, they're not, especially surgical masks, not N95s, but surgical masks aren't that good for reception of

viral particles because they've got holes in the sides, et cetera.

N95s are a lot better, obviously.

But what you're doing is a reverse of the tragedy of the commons, essentially, which is you're wearing a mask to protect other people from you.

That's why we wear masks in surgery.

When I, you know, I've been wearing a mask every day for the last 31 years as an anesthesiologist.

We're trying to prevent my spit from getting into your wound.

Not so much that I'm afraid that your bacteria is going to come into me.

But that is very important to keep in mind.

You are basically, just like wearing seatbelts, you're preventing accidents.

You are doing things

even if you're good.

Yeah.

Yeah.

It's so weird that it's gotten to be this on something like mess.

By the way, I haven't gotten one cold this in the past eight years.

years neither have i neither have i i mean because you know again we're wearing you know people are wearing masks in in in areas they do that in japan and china i mean this is very common in ancient countries yeah i'm gonna be wearing masks a lot more but i think i look good yeah yeah i mean i i would i mean i think uh you know even in you know counties that have

you know removed the mask mandate i'm not going to the grocery store without a mask um you know or places like that and we have to wear in the hospital forever forever

well that's a good question i think you know,

I think when I came on Pivot last time, I had a quote that was in one of those little red, you know, rimmed things at New York Magazine.

I said, you know, COVID is going to be with us.

You know, 2021 is going to be the year of COVID.

Yeah, it's going to be here.

And you said, all year?

And I said, yeah, all year.

Well, I'm going to extend that into next year.

This is going to last a couple of years.

Endemic.

Endemic.

You know, the 1918 flu lasted until 1920.

I mean, that killed a lot of people.

Well, Jeff, you're a bummer.

Okay.

I know.

I'm a bummer.

Sorry.

All right, let's go on a quick break.

When we come back, our second big story, and then we'll talk to a friend of Pivot, John Kerryrew,

when we get back.

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Jeff, we're back for our second big story, zeroing in on the many terrible side effects of the pandemic.

A nursing crisis reported in stark detail in the New York Times over the weekend.

One in five ICUs are at least 95% capacity makes it difficult to maintain standard of care.

Nurses have already been in the trenches for 17 months, and the work isn't letting up with a Delta variant.

Nursing shortages are a problem long before the pandemic, as you know, you've talked about it with me.

But now, a lot of them are retiring, moving to non-emergency room jobs, or just getting out.

They're also sick of people.

You know, you've seen all these amazing interviews with them where they just are so tired of treating people who won't be treated.

I just want to play a quick clip from a video log of a Tennessee ICU nurse, Catherine Ivey Sherman.

Not everyone has the luxury of being able to stick their head in the sand and ignore the world around them.

I am so tired of the people who are creating their own reality where COVID is not a problem.

And then they have the audacity to get mad at people like me when we try and show them that, no, this is real.

You are the one living in a delusion.

You don't get to be mad at us for figuring out how to deal with the reality.

Yeah, it's heartbreaking.

Well, there's a lot of that, Jeff.

I've seen so many stories.

It's either stories of people who wish they had gotten the vaccine and are dying or

healthcare people.

So, how are you and your colleagues seeing this play out in hospitals, especially with nurses who are so critical?

You've always been a supporter of nurses compared to most doctors.

They're the backbone of the hospital, nurses and techs.

I mean, I don't want to minimize it.

I mean, I just give a shout-out to the nurses that I work with.

I mean, one of the nurses I work with, Kara, is a huge fan of yours, Katie Hacker.

And I want to say hi to her.

But these people are tireless, tireless workers.

And they

deserve everything that they get in terms of compensation and

consideration from the hospital.

The problem is there is a huge shortage of nursing.

And some of it's retirement.

Half a million retired.

There were baby boomers.

There's not a short-term.

There's an easy fix.

And nursing schools are struggling to train.

That's right.

There's not enough faculty to teach nurses.

You know, for a long time,

nurses were recruited from other countries, a lot of Filipino nurses in San Francisco because there's a shortage of nurses, American nurses being trained.

And we're seeing that in our hospital.

In fact, it directly impacts me in the sense that my surgical schedule has turned into a more of a horizontal schedule to a more vertical one.

And I'm routinely working late into the evening, 9, 10, 11 p.m.

every night, just to get through the elective surgical schedule because we have to close down operating rooms because we can't staff them.

This is true of hospital beds.

I mean, even though hospitals might not be full to capacity, they have to have nurses to staff the beds.

Right.

And this is a problem.

Yeah.

So, what are the long-term options?

Well, we have to train more nurses.

I mean, you know, maybe we can solve two problems and start recruiting Afghani nurses from Afghanistan, you know,

as immigrants.

I think that it's a difficult problem because it takes years to train a nurse and it takes even more years to train a specialist nurse.

And so we're behind the eight ball for many, many, many years behind.

So I don't know the solution.

I mean, throwing money at the problem seems to be what they're doing right now.

Traveling nurses

who go from place to place.

This is who work under contract.

For people who don't know, they work under contract rather than at a particular hospital.

It's

real phenomenal.

There's bidding wars for these travel nurses.

I mean, I'm hearing numbers,

you know, $150 an hour and up for some of these nurses.

I mean, that's crazy because this is the problem is the nurses who live and work and are permanent nurses don't get paid anywhere near that.

And so what they're doing is it's emptying out hospitals and places that you most need it.

Underfunded areas.

Right.

Which are the hotspots, right?

Right.

What if a Mississippi nurse or a nurse from Tennessee is looking at California and saying, hey, you know, I can make $960,000.

I'm going to come to California.

And believe me, I've seen an influx of nurses from those states working as travelers.

They're all wonderful people and they all are very compassionate and caring people, but there's a limit.

Right.

And so what can you do?

So money is not necessarily a good option.

It's a good thing to pay people more, but it creates all kinds of weird incentives.

Doctors are obviously affected by this.

Is there anything particular that doctors can do or should be doing or the federal government?

Well, doctors can write letters to congressmen and to senators, I suppose, and get involved in local politics.

I mean, you know, we can support our nurses by not being jerks.

That's one of the biggest things that, you know, just to respect and

it's a collegial environment.

And, you know, the old school of doctors being the captains of the ship, et cetera, et cetera, that's that's you know, that's gone.

And, you know, I have a great relationship with the nurses in my hospital because we all understand what our roles are and what how we contribute.

And nurses are an amazing bunch of people.

They're just amazing people.

What would you say to someone who is thinking of doing this?

What would be this pitch?

What would be the pitch you would make to them to do it?

Besides, here's some more money.

To be a nurse?

I would say it's a it's a it's a people job.

It's a job where you can use science and your skill.

And you're the frontline person dealing with patients.

You're a healer.

Although, what do you say to that woman?

And she's like,

she's had it.

She's out of fucks, I would say.

Out of fucks.

Yeah, she's out of it.

I don't blame her.

It's exhausting.

I think we're in the middle of the crisis.

I think that there's going to be a lot of post-mortem analysis, not to use a medical pun, on this crisis when it's over.

Well, kind of post-clinical.

All right, my last question here, if we get to John, there was a doctor in Alabama who refused to treat people who were unvaccinated.

What do you think about that?

I had mixed feelings.

I'm like, okay, that makes sense.

You know, I mean, people talk about, you know,

I'm writing a piece right now, actually, on the misunderstanding of what the Hippocratic oath is.

I mean, as a physician, you know, I didn't sign up.

uh to say i'll treat some people and not others i mean i mean i listen i routinely when i worked at sf general in the in trauma, I routinely treated people with, you know, swastika tattoos and murderers.

And, you know, you can't look at that.

You have to treat people as people.

I mean, that's what we do, right?

Even when they're saying, what do you think of this doctor when he did this?

I mean, he had a very cogent argument about why he didn't want to do it.

I mean, I understand his argument, but I think that, you know, unvaccinated people are unvaccinated due to

ignorance.

And they've been fed this ignorance by, you know, people who who should know better.

People like Ron DeSantis and

Abbott and Trump and people in the administration.

I mean,

it's just nakedly political

and

to generate votes among their coalition.

I don't know what it's for.

Did you ever think as a doctor you'd be dealing with that kind of thing?

No.

No.

I mean, you were counting.

But I do remember, you know,

I was in medical school during a lot of the early HIV, you know, AIDS crisis.

And, you know, I came out then.

And to me, there was no question, there was no issue that you treated these, you know, these are people, right?

And even though we didn't know a lot about HIV when it first came out,

you know, that didn't,

you know, that didn't stop anybody that I know, any physician I know, from treating them.

And so you still will, no matter what, yeah, treat anybody.

I will treat anybody no matter what, whether they're vaccinated or unvaccinated, because that's what I do.

Okay.

Let's bring our friend of Pivot.

John Kerryrew.

John is an award-winning investigative reporter and author of the best-selling book, Bad Blood: Secrets and Lies in a Silicon Valley Startup.

He was the first to break the scandal of the blood testing company Theranos in 2015 in the Wall Street Journal.

I've done a long podcast with him about it.

But he's got a new podcast out this week called Bad Blood, the final chapter about the Elizabeth Holmes trial, which is about to start.

In the years leading up to this trial, things have gotten complicated.

A missing laboratory database.

There are a lot of people who would do anything to destroy all that.

Fractured relationships.

The notion of being abused, perhaps mentally, by an older man.

And.

Toto plot twist.

Obviously, she was going to get pregnant.

Holmes is accused of massive fraud and lies and the capabilities of her technology.

John, it's good to have you back.

It's good to be here.

Thanks for having me.

I brought a doctor.

He's related to me, but I brought a doctor to help.

Hey, John, how you doing?

with this.

This is my brother, Jeff, Dr.

Swisher.

So let's just start with, you know, you've reported on the story from the beginning.

What new information do we expect to see come to light in the podcast?

Tell me about making this and where we are now.

Set the table for us for Holmes and what's going to happen.

Right.

So we're on the eve of her trial, which starts next week, August 31st.

Jury selection is August 31st.

And this is a trial that's been a long time coming.

You know, I first reported on this in late 2015, so it's been six years.

The wheels of justice have turned especially slowly here.

We're going to see Holmes walk into that courthouse in San Jose.

One big question is whether she's going to be carrying her newborn and a baby Bjorn.

She will.

There have been, you know, I talked to a lot of people connected to this case and a lot, there was a lot of cynicism about the timing of this pregnancy.

So we'll see if that, you know, if there's theater around that that plays a role in this trial.

In terms of the podcast, yes, there is new material in the sense that

I got my hands on a lot of new material since I wrote my book, which was published three years ago.

Basically, I got my hands on almost every SEC case exhibit.

As you know, the SEC did its separate civil investigation that resulted in a settlement with Holmes.

But but the Balwani, her ex-boyfriend, never settled.

So that case is still ongoing.

The SEC case overlaps a lot with the criminal case, at least one aspect of the criminal case, which is the investor fraud charges.

So those SEC case exhibits gave me a lot of insight into what's coming.

One of the most fascinating parts is

this file with

thousands of text messages between Sonny and Elizabeth that span about five years.

Some are redacted, but most are not.

And those text messages, which are the subject of episode three of my podcast, give you insight into their relationship.

And

as you know, we can talk about this.

Their relationship is going to be front and center at this trial.

Right.

So let me, so I'm going to give Jeff ask a medical question in a minute.

But from what we know, what will her defense look like?

Is she going to testify?

Well, we don't know yet, but it looks like from

filings that have come out, it looks like a central part of her defense is going to be to allege that her ex-boyfriend, who was a number two of the company, Sonny Balwani,

was her Sengali, that he had this psychological grip on her.

They may even allege that he abused her

physically.

They were certainly going to allege that he had a hold on her psychologically, that she was in his thrall, and that as a result, she kind of lost sight of right and wrong.

No, he's not being, he's this is not his case that's coming, correct?

Well, they were charged together, but their cases were severed because precisely because of this, because they've turned on each other, and so he's going to be tried after she's tried at the beginning of next year.

Uh, so it looks like I call it the Svengali defense.

Yeah, um, it looks like she's going to try to shift a lot of the blame to Sonny.

Um, and she'll have to testify, she can't just assert it.

It's going to be dead again.

We don't know, but I would bet that she does testify because I think it's not going to be enough for a psychologist who examined Holmes to go on the stand and

testify to

basically the fact that Sonny allegedly abused her.

I think the jury is going to want more than that.

The jury is going to want to hear it from her.

And I think a jury is going to want to see her go on the stand and explain exactly.

what this abuse was all about and how it led her to participate in this alleged fraud.

Jeff, question?

Well, I mean, I'm just amazed that she doesn't go on the stand and test, you know, and basically try to say that she's insane by basis of sociopathy and severe personality disorder.

I mean, I'm not a psychiatrist

and I have never examined her.

So, as a physician, it's unethical for me to say that.

However, you know, I mean, Kara, do you remember back in

All Things Digit, All Things the D conference that she wanted to come?

And you asked me very early on about Theranos, and I just basically said it's insane.

I mean, if you told me that an alien race from 10,000 years in the future came back and gave this technology, I would have believed that more than the technology that

asked a question of John, the expert.

Well, I mean,

why do you think that no scientist or no physician ever signed on with Theranos at the beginning and blew the whistle on it?

Well, there were a lot of experienced scientists and

PhDs who joined the company at various points.

And

the reason there weren't any whistleblowers earlier in the history of this company is, one, that the stakes were a lot lower when

it was a company in stealth mode that hadn't gone live with its technology, that hadn't gone to the marketplace and wasn't offering its blood test to consumers.

That only happened in the fall of 2013.

That's when the stakes got a lot higher, 10 years into the life of the company.

And then it took about a year and a half, two years for

one whistleblower, in particular, the former lab director who had just left the company when I contacted him to

gather up their courage and blow the whistle.

Why weren't there whistleblowers earlier?

I would say it's also because

um you know litigation was always in the air.

The threat of litigation was always in the air at Theranos.

Elizabeth had sued employees early on in the early years of the company.

And everyone knew that Boyes, you know, was the attorney.

David Boyes was the

attorney for the company.

She had also sued Richard Fuse, a childhood neighbor, alleging that he had stolen a patent.

Sonny was who was kind of the guy running the company day to day, was very aggressive and

firing people all the time and screaming at people.

So

there was a very toxic workplace.

And I think there was a lot of fear of retribution.

And in fact, I saw it firsthand when I was, you know, doing my first stories for the Wall Street Journal.

And then when I went on book leave, even to report out the book, a lot of people, you know, were scared to speak to me because Holmes and Valwani had not been indicted yet.

And they worried that

they might not be and that they'd come for them.

And so I had to do a lot of hand-holding and, you know, convince a lot of people to

become sources.

Yeah, one of the things that was very,

talk, I get blood tests all the time.

They're very onerous.

Where is the technology right now?

Have you continued, John, to follow where this tech, because this is, there's no technology here, correct?

There's nothing to

this day, no one has been able to do what she claimed she had achieved, which is to do hundreds of tests off a tiny pinprick of blood, you know, from a fingertip.

There's two basic problems with that.

One is that capillary blood, which is the the medical term for blood that you get from a finger, is less pure than blood you get from a vein in the arm with a syringe, and it's polluted by tissue and cells, and

those interfere with

certain tests.

The other issue is that there are basically four big types of blood tests.

And

When you've used your tiny sample of blood to do, say, a handful of blood tests from one of those four categories, you've exhausted your sample.

There's no sample left to then use the completely different methods and laboratory instruments required by those three other classes of blood tests.

No one has solved this issue to this day.

You know, 2021, she was making these claims in 2013, 2014.

To this day, no one has solved this.

Well, John, that goes to my point is that, you know, early on as a physician who basically uses, i'll just take one example potassium i mean potassium is a you know ion in the blood which is critical uh for cellular conduction uh neurochemical conduction cardiac conduction etc if the potassium is off by you know one or two millie equivalents per deciliter i cancel a case and the error bars in that are very small and if if you know something if you dilute a sample out like 50 100 times you have to increase the error bars by that same amount so we knew this was nonsense from the very beginning from a physician standpoint.

And then, like you say, you're talking about ELISA tests, electrochemical tests, you know, antibody tests, all these.

It's just not, physics is impossible.

There is no physics on the planet Earth that allows

her to do what she said she could do.

And this was known at the beginning.

And that's my point: why did no doctor come in and say, this is impossible?

Most of them tend to be very respectful and they wait for data before

they start you know making public claims and so most most of those people who were being quietly skeptical were waiting for some sort of study or some sort of data to to come out before

they said anything and but you know when i when i started my investigation in early 2015 one of the first things i did was i i called you know the chairs of laboratory departments at uh big medical uh academic centers.

UCSF was one of them.

And

these guys over there were telling me immediately that, you know, they didn't believe that this was possible.

And in fact, in my first story that was published at the end of 2015, I had one of them expressing very strong doubts about the feasibility of the technology.

So what happens beyond Homes yourself, you know, this idea of the reason we didn't cover it was one, Jeff warned me.

And two, I didn't think it was technology and I didn't think I knew enough about it.

But what will this mean for Silicon Valley sort of fake it till you make it, Culture?

culture there's lots of people who have done things that are fraudulent obviously not someone that has impact on people's health um but what do you what what what's the result of your book what what is the conclusion do you think your podcast and the book and this final chapter is going to to make if she's do you believe she's going to be convicted or if she isn't what does that um

whether this has an impact on the fake it till you make it culture of Silicon Valley, I think is the central theme here.

You asked me if I think she's convicted.

I still think she's going to be convicted if I had to bet on it, because I think the prosecution has so much written evidence, documents, but also tons of witnesses.

And there's a part of the case that's very hard to defend, which is the patients and the erroneous blood tests that they received.

But I think that if she is convicted, then potentially this will be a wake-up call in Silicon Valley for venture capitalists and especially for young entrepreneurs that you can't, you can only push the envelope so much that you, you know, if you hype and you exaggerate to the point that you're outright lying, then it becomes securities fraud.

And especially if your product is not software, but it's a medical device where, you know, lives are in the balance.

If, on the other hand, she's acquitted.

which is certainly a possibility,

then I think

this culture is going to continue.

There's not going to be a course correction.

I think it's probably probably only going to get worse.

You'll have a bunch of young entrepreneurs running around Silicon Valley saying, yeah, you know, I sort of pushed the envelope, but look at Elizabeth Holmes.

Look at what she got away with.

She ended up doing no prison time.

And I'm not as bad as she is.

You know, I'm keeping things more under control than she is.

And I have one more last quick question.

Why her?

Because there's so many people.

I mean, you can, some of the stuff isn't illegal.

Some of these entrepreneurs do.

Like, it isn't like I'm thinking of WeWork, nothing illegal.

He told them what he was doing.

You know, it was all out in the open, but it was

something.

It was a lot of P.T.

Barnum kind of stuff.

Why her, do you think?

Yeah, I mean, I think the difference between a WeWork and a Theranos and

all these other Silicon Valley companies where entrepreneurs also exaggerate is that this was a medical device.

You know, this was a company that was operating in the healthcare arena where the stakes are extremely high.

It's not a software.

It's not a smartphone app.

If you release a buggy version,

you can't rely on the first people to use it to iron out the kinks.

If you're putting out a blood test, finger stick test with a device that doesn't work, then lives are being affected by that and lives were affected by that.

And

we're going to hear that from about half a dozen patients at trial,

one of whom was falsely diagnosed by theranos with HIV when she was perfectly healthy.

You know, a couple other patients

had viable pregnancies and were told that they'd lost their babies.

So those are, there are real, really stark, real world consequences to, you know, adopting the software culture and applying it to medicine.

And there's more to that to come, by the way.

That's, you know, is that what you're working on?

I think there's more of that to come in the sense that Silicon Valley, it used to be, you know, Silicon Valley was the computer industry.

And increasingly, we're seeing Silicon Valley set its sights on other arenas such as

self-driving and, you know, drones and smart homes and medicine.

And,

you know, if entrepreneurs from Silicon Valley keep applying the fake it till you make it, the software ethos to these new arenas where lives are actually, you know, at stake.

I mean, if you think about that Uber car that ran over a woman a couple of years ago in Tempe, Arizona.

Yeah, so there are very real, real world consequences to some of the things that Silicon Valley

is doing these days.

It's no longer just software or computer hardware.

And so, yeah, I think it's a trend that that convergence of these other industries with Silicon Valley is going to continue.

And I think it's going to potentially create more of these situations, which is why I think it's important for there to be a guilty verdict in this case.

Otherwise, this won't be a cautionary tale.

So we're going to watch this podcast.

It's going to go on until the case has ended.

Correct.

This Bad Blood, the final chapter.

And where's the movies?

There were like none.

There was the movie Kate McKinnon.

There was Jennifer.

It was optioned by Legendary

Pictures

and by Adam McKay.

And

the movie is still in development.

We have a screenplay

that will probably

get touched up by McKay based on what happens at the trial.

Jennifer Lawrence is still attached

to Playholmes.

She's attached.

She's attached.

And yeah,

it's still moving forward.

McKay's production company and Jen Lawrence's production company will produce.

The studio is legendary.

And

I'm actually expecting

news on that front in the next couple of weeks.

All right.

Well, we will be listening to Bad Blood the Final Chapter, but people can't get enough of this story.

She's become some sort of symbolic icon in a way that's really fascinating.

And watching her walk into this courtroom, I think she hasn't changed one little bit, I suspect.

Yeah.

That's my feeling.

So, sorry, Jeff.

Thanks for your book.

Thanks for your book, John.

That was a fantastic book.

And it was very well researched.

And from a medical standpoint, extraordinarily accurate.

So thank you.

Thanks very much.

That's great to hear.

All right.

Thank you so much, John.

Thank you.

All right, Jeff, that was fascinating.

God, I am such a huge fan of his.

He's really, he did an amazing reporting job.

He's a reporter.

He's a great reporter, no matter what he covers.

Yeah.

One more quick break.

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Okay, Jeff, wins and fails.

Wins and fails.

What do you got?

Well, for wins,

we already talked about two of them.

I think that the big winner are the teachers and the nurses.

I think that specifically, you know, of course, near and dear to my heart because of my wife and daughter, but the teachers have really, I think, are the big heroes.

I remember when we started with this COVID thing, there was the nightly howl for the doctors and the caretakers.

I think we should reinstitute a nightly howl for teachers and for nurses because they need it.

They need our support and they're my big win.

All right.

And what's your fail?

Oh, there's so many this past week.

I mean, I, I, you know, I wanted to say that the media, uh, how they're portraying the Afghan withdrawal and, you know, trying to lay the blame on Biden is, is, I think that's a horrible fail.

Your mom is doing that, just so you know.

Yeah, of course, I know she is.

You know, you know, remember in 1979, when the Soviets invaded Afghanistan, I was a sophomore in college.

And, you know, there was a history before that, obviously.

And, you know, friends of mine who may or may not have worked for the CIA went in, were with the Mujahideen, who were that, what, freedom fighters, right?

Well, that's the Taliban that we know today.

This is such a complex history.

And I think the media is not doing anybody

service.

Yeah.

I mean, it's just heartbreaking what we're seeing.

But that's, I think the big fail is how they're basically simplifying it.

I mean, keep in mind, Trump made this deal in May of this past year with the Taliban.

And, I mean, Biden was given a giant steaming cauldron of shit and he said, don't drop this.

Well, nobody could not have dropped this.

And I'm not saying that, you know, I don't know if that's true.

I think they're.

Well, listen,

I think that

certainly as president, he's responsible for what happens on his watch.

And I think that some of the messaging coming out of the administration was not good.

But the Afghan problem is very complex.

And I think that

the fail is of the media trying to portray it in a more simplified manner.

The other fail is DeSantis and

Abbott.

I mean, those guys are just losers with the capital L.

Okay, all right.

And I give my win is

the FDA approval for the Pfizer-Biantech coronavirus vaccine, and the others are to come.

I got that vaccine.

I actually interviewed the creators of it, and I actually emailed them to thank them for it when I got it.

And

I plan to get a booster and everything else.

I think that's really the win.

And I think I hope they get vaccines for young people, younger people.

When is that coming for people people who have children under 12, Jeff?

I'm going to guess it's not going to be for a while because they have to get enough, like I mentioned about FDA trials.

It's not going to be for several months, if not longer, before we have an under 12.

It'll be age five to 11.

They do this in cohorts.

So the next cohort is going to be five to 11-year-olds.

But I wouldn't anticipate we're going to see it until late, you know, maybe mid-next year.

Oh, wow.

That makes me worried.

I have small children, as you know.

Yeah, I know you do.

Yeah.

She's gorgeous, by the way.

Yeah.

Yeah.

So we'll see how that goes.

Jeff, I really appreciate it.

Thank you so much.

I appreciate being here.

I mean, I hopefully that I made some sense and I didn't confuse people.

Yes.

And you also took the place of Andrew Ross Sorkin, whose power went out in the henri.

I think it's all right.

What an august company.

You've had some great guests.

I do miss Scott, though.

I think I really miss Scott.

Everybody does.

But you know, having Bahara and having

George Conway and all these people.

Hey, Stephanie Ruhl.

And you.

Ben Smith and Barretunde.

My fine brother, my fine brother.

Yes.

Well, I'm always, I'm always happy to come back, Carol.

All right, great.

We'll be back on Friday, by the way, from where I think Sorkin is probably coming back for that.

Go to nymag.com/slash pivot to submit your questions for the Pivot podcast.

The link is in our show notes.

Jeff, do you have the script and you can read us out?

I do.

So go ahead.

Go for it.

I will.

Today's show is produced by Lara Naiman, Camila Salazar, Evan Engel, and Taylor Griffin.

Ernie Endradot engineered this episode.

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