Episode 20 – Dr. Paul Offit

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human experience is entering your right ventricle and subsequently your bloodstream my co-host dr. G’s at the helm for this episode our guest tonight is dr. Paul Offit professor in the division of infectious diseases and the director of the vaccine Education Center at the Children’s Hospital of Philadelphia dr. off it welcome to hxp thank you hey dr. Alfred dr. G here read your recent book bad faith and before we get into that can you tell us a little

more about how you got to where you are in the medical community and some of the projects projects you’ve been involved with on your journey to being this unofficial spokesperson for vaccinations well I guess in this sort of usual arbitrary and capricious ways that people end up where they end up i did a pediatric residency because i guess i was drawn to to children’s health I was in a polio word when I was five years old I saw children in that ward suffer

and it just always stuck with me I think that’s probably why I also picked infectious diseases I started working with a group at Children’s Hospital of Philadelphia was interested in trying to understand rotaviruses which are a virus that cause fever and vomiting and diarrhea and young children and and in the world kills about 2,000 children every day from dehydration so I worked for 25 years with that team ultimately we developed a series of strange that

became the rotavirus vaccine Road attack which was licensed and recommended for all children in 2006 and I guess I guess the this the bigger issue is is I guess with that I kind of learned how difficult it was to make a vaccine I mean to show that vaccines were exactly what they claim to be and then I guess associated with Andrew fields claim that the measles mumps rubella vaccine caused autism I I found out how easy it was to damn them so hard

to make them easy to damn them and I think that got me interested in trying to explain the science of vaccines to the public and this is dr. Wakefield from the UK who can you tell us a more about that was the MMR vaccine and the his article in The Lancet was it exactly so there was an article published in 1998 in The Lancet claiming a combination measles mumps rubella MMR vaccine caused autism it was a wasn’t really a study it was a case series of

eight children who developed autism within a month of receiving that vaccine at best what you can say is that dr. Wakefield raised the hypothesis he certainly didn’t test it that hypothesis has since been tested in many studies and found to be incorrect Emma more doesn’t cause autism a choice not to get a measles mumps rubella vaccine only increase your risk of getting those diseases and doesn’t decrease your risk of getting autism and this is from

extensive studies and extensive research that are we going on right now god I think they’re probably been 14 studies that have looked at millions of children retrospectively to see look at those who did or didn’t receive MMR vaccine to see whether the instance of autism was greater than the vaccinated group and clearly it wasn’t again and again and again as studies have been done on three different continents I think the questions been asked and answered so I

know the Safari or the the major research initiative for all the things that are basically autism-related and they gave a report recently that stated that you know that we should probably look deeper as a hole into some of the environmental factors that occur during this first year of major childhood development and I know there’s at least from my pediatric rotation at least what 25 or 26 vaccines during that period I mean outside of purely genetic factors

what do you think are some of the issues going on during this first year of development that could be an issue here with the with this autistic boom that’s going on I think it’s what is it one in 60 till dhryn is is expected to have autism yeah well there are 14 different vaccines given in the first piece of life i guess you can get as many as 26 different inoculations to prevent 14 different diseases I actually I don’t think there is an environmental factor

at least not one that’s present after birth clearly I mean there is there is a genetics taught ISM the the genes appear code for development proteins that are typically expressed in the first and second trimester and although I think there can be environmental exposures while the child is still in the womb things like valproic acid and falooda might have both been shown to increase the risk of autism I really don’t think I think if

you’re autistic at five your autistic it to your autistic when you’re born so although I understand there’s sort of a lot of interest in trying to figure out what it is postnatally that’s causing autism honestly I prediction is going to be they’ll find nothing hmmm dr. Arvid if I just bouncing here how do you feel about the anti-vaccination movement and the people who are vehemently against vaccines taking vaccines well I guess

there’s I guess I see it as two different groups the I think most people are not part of an anti-vaccine movement I think most people just don’t fear the diseases um as a consequence they they don’t feel compelled to get vaccines they’re looking for reasons not to get them and certainly you can find plenty of reasons i’ll be at false ones on the internet to support your fear on the true anti-vaccine but i’m talking about the professionals groups like the

national vaccine information center were moms against mercury or safe minds or Generation Rescue I mean those people the people who dedicate themselves to putting out bad information about vaccines on the Internet I think that they do a tremendous disservice to the children in this country in a better world they wouldn’t be allowed to put out that kind of Miss informations like shouting fire in a crowded movie theater puts children and people at risk do you

think your position at Merck might have I mean there’s there’s an article that says that do you still agree with this position that a baby can safely handle as many as 10,000 vaccine safely during infancy first of all I don’t have a position at Merck I’m like a professor of pediatrics in the division of infectious disease the Children’s Hospital photo have never had a position at Merck okay what do you mean by that it certainly though when we created the

strains in the in the 1980s and late 80s and early 90s that we thought could be the rotavirus vaccine wrote attack we went to several different pharmaceutical companies in the hopes of finding one who would be interested in making it I mean I don’t see what the choice was I’d love to hear what you think a choice might have been pharmaceutical companies is the only ones that had the resources and expertise to make a vaccine an effort to

cost a little over a billion dollars so that’s what that was the statement that you made that a baby can handle as many as 10,000 vaccine safely during infancy DS to agree with that position no I think I probably understated it I was asked the question how many different antigens can one handle in the first in the first say in the first year of life and so one can calculate that you know the number of B and T cells that are that are released by the bone marrow

which is Anna ten to the ninth a region you know the number of epitopes which is to say distinct immunological reasons regions that are present on various antigens and so you can calculate how many different epitopes one could theoretically respond to if you add up actually all the not all the immunological components in vaccines it totals about about 155 160 which is trivial and so we make 10 to the 9th nubian T cells every day I think

probably the number is probably closer to a hundred thousand and that would be sort of per day I because we’re constantly making new B&T so I think unfortunately that that statement got interpreted by the media is saying that I think children should get 10,000 vaccines a day obviously that’s not what I mean I was just answering the question how many could they get and I think that’s I stand by that statement do you feel that there should be a little more

integrity as far as journalists and as far as you can call themselves an expert in certain field especially concerning science technology and health sure that would be nice I’d love to live on that planet as it stands we the people who choose to represent a science information to the public often have little expertise in science or medicine um and so what they tend to do is they tend to tell a two sides of the story when only one side is supported by the

science I would argue that in the name of balance they think that this is the right thing to do I would argue that that I think in a better world their mantra would not be bounced but would be perspective I think that their their their job should be to educate the public not simply to prevent present everything as a controversy when some things aren’t controversies it’s a very weird time because you know most people have considerable accessed in

nation and they can you know for the most part intelligently decipher the science and research and shouldn’t they be able to make these decisions for themselves and what I’m kind of getting at is are we approaching an era where you know patients no longer see us as physicians as this kind of white cloak God and more in this consultant role well I certainly when I was a little boy I mean my my physician would make house calls which Doug held I am and and my

mother thought of him as God I think you know anything he said when she never question anything he said I think this is a woman who was perfectly willing to question people but she never questioned him and it was a very sort of paternalistic arguably condescending time I think we wanted to shake that off and so we want parents to be participants in the decision and then the notion again I know this is going to be unpopular but I think it’s a false

one I think the notion that one can truly educate themselves about vaccines it by looking at information on the internet is false one I mean so for example if you’re if you’re interested in trying to decide whether or not your child should get a chickenpox varicella vaccine you should read the 300 articles that are out there on chickenpox vaccine so you can figure out I mean what is the difference between a vaccine virus and the wild type virus what are the

sequence differences how does the vaccine virus reproduce itself in the body is compared to the wild type virus what are the data on safety what are the data and efficacy and I think to do that I mean to look through those 300 studies and then know that you would have to have some sort of background in in virology immunology statistics epidemiology I think few parents have that I think few parents frankly kenken redoes article and I think the same

thing is true of doctors I don’t I think most doctors frankly have that kind of expertise and so what do we do we rely on groups at least to collectively have that expertise groups like you know the the Advisory Committee for immunization practices to the Centers for Disease Control and Prevention or the committee of infectious diseases for the you know for the american academy of pediatrics and those groups have served as well but

again i mean i think you’re right it’s very hard to say you know trust that’s where experts we like to think that people should be able to participate in their own a health and so we want the parent to make the decision but if we’re going to do that then we have to be willing to stand back and watch parents make bad decisions they can put their children in harm’s way and and and ultimately result in their child being hospitalized or die

we certainly see that in our Hospital there is not a year that goes by where child doesn’t come into our hospital and dies of the vaccine preventable disease invariably because the parent made that choice and it’s a maid choice it seems very clear that there is this growing distrust for whatever reason between the two as far as health care professionals and patients but doesn’t share the onus beyond Western healthcare and us as

physicians to facilitate or kind of bridge this widening chasm that’s going on I mean how do we reconcile this I think our job is physicians is to help parents through the dense thicket of information to make the best decisions for themselves and for their children III think that that means providing information and a passionate and compassionate way i’m not sure what the term Western medicine means i think there’s there’s medicine and then

there’s not medicine i mean good medicine is based on good science independent of where where where its origins were and so i think that’s our job so I mean it’s clear that we’ve kind of we’ve definitely lost control as far as in the role of patient care at least in this country for the most part and it seems that there’s a lot of suits and industry executives that are kind of running hospitals and most medical centers now what’s your take on this I’m

not sure which for me about that question I think that um that your job my job as a pediatrician at Children’s Hospital frankly is to pay little attention to the suits or executives that are running our hospital and to do my job and my job is to try and provide the best medical care i can in to try and educate the best way and i guess i’m not quite as as as down on the relationship between the physician and the patient um I sure there’s distrust

but i think you know if you if you act in a trustworthy manner and people see you as caring then i think that can all be bridged so i really i really enjoyed um in your book you spoke at length this is bad faith about the particulars of several of i guess these religious cults that i wasn’t to heard of christian science of her the other ones but i was actually kind of startled by some of the belief structures within these indoctrinations what groups do you feel

pose the greatest threat right now as far as just need it states alone well certainly the faith healers I mean there’s tens of thousands of groups that are faith healers which is to say that when their children have bacterial pneumonia or bacterial meningitis or they have they may choose prayer instead of antibiotics they choose prayer instead of insulin for diabetes they choose prayer instead of of anti-seizure medicines for epilepsy

or prayer instead of bronchodilators for asthma I mean those children’s don’t always die but they certainly suffer and and we stand back so I think it’s one group that’s certainly a problem i think the Jehovah’s Witness group who choose not to give themselves with their children blood transfusions providing a lesser problem in the sense that there’s clearly supreme court verdicts that don’t allow you to deny a life-saving blood transfused your child you can do

that to yourself you’re allowed to martyr yourself to your own religion but you’re not allowed to more to your child to your religion and there are other practices I mean there are um I think you guys are counting from California but any certainly in the Northeast and in Lakewood New Jersey in Brooklyn New York there are ultra Orthodox Jewish Royals Royals being the person who performs a ritual circumcision that instead of cleaning off the wound with

sterile gauze you know will use their mouth to clean off the wound which puts the child at risk for a herpes which can cause permanent brain damage or be fatal we see that we see at least 14 deaths from from that and is that still going on oh sure yes so dr. Rafat do you do you think that the vaccine injury risk and weighing the risks versus taking a vaccine and and the disease I mean it what what is that I mean how do you calculate that what are the risks I mean

I would say you know it certainly if you look on the internet you would you would assume falsely the risks associated with getting a vaccine includes to include a variety of chronic diseases like autism or diabetes or multiple sclerosis or chronic bowel disease all of which are incorrect have been shown to be incorrect I mean if you if what are the real risks of vaccines certainly pain and tenderness at the site of injection the swine flu vaccine that was given in

1976 was found to be a rare cause of something called young ray syndrome which was an ascending paralysis but hasn’t happened before or since um the yellow fever vaccine has been associated with about fifty five deaths since its inception in the in the night 1930s so on and and that’s been primarily in the elderly measles containing vaccine can cause a lowering of the platelet count so-called thrombocytopenia which can cause a

transient you know Tiki I so-called it’s like broken blood vessels but that is transient um I think that the pandemics of vaccine that was used in Scandinavian countries which was that sort of you know 2009 swine flu strain was admitted with squalene seemed to be a rare cause of narcolepsy which is a disorder of wakefulness and that’s it honestly I think that’s it what do you do not sorry I think about there also you can if you

are severely allergic to gelatin there are some vaccines which have gelatin in that so you can have an immediate type hypersensitivity or allergic reaction that which is why you’re asked to stay in a doctor’s office for about 15 minutes after you get a vaccine but but that’s it so with that said should vaccines be forced on a populist forest that’s the word we want to use um it’s striking to me that somebody like chris Christie in New Jersey will say that

when it comes to vaccines it’s a parent’s choice that’s what he said um now he lives in a state that has a carseat requirement you you if you live in the state of New Jersey and you were found not to put your child in the car seat while you’re in the car you will get a ticket there’s a name for the program it’s called the click it or ticket program there’s no philosophical exemption two car seats there is no religious exemption two car seats the

reason car seats are safe and effective and they save lives I would argue that vaccines are no different why me why should you be allowed to put your child at unnecessary risk because of a false belief you have about vaccine safety why and this is pure devil’s advocate here but I mean as far as as far as slippery slopes go where does this go as far as civil liberties are concerned as far as you know compulsory vaccinations why is

it your right to put your child at risk why is that as that as simple Liberty do we have did I would argue the child also has rights and frankly if you look at the Fourteenth Amendment it allows for equal protection under the law which is to say children also should be equally protected even if they happen to have parents that have false beliefs beliefs about vaccine I mean I don’t I don’t understand why children’s rights aren’t also part of

this I mean I think that in a better world you wouldn’t need to have vaccine mandates because anybody who really understood the data about vaccine safety and efficacy would get them every time I mean I think I have a pretty good understanding about backs needs both of my children are fully vaccinated and therefore I benefit my children and I benefit society I think that if if everyone had a good understanding about vaccines they would all do that but some

people have have misunderstandings about vaccine safety so they decide to put their child at unnecessary risk which can occasionally kill them and so I don’t see why that should be your right as a parent to point your child and unnecessary right any risk any more than it should be to not put your child in a seatbelt or in a car seat that should also should not be you’re right doctor of it if sorry to interrupt here but do you do you hold is this true or not true

do you hold a patent on a vaccine that you developed through mark I am I research with the Children’s Hospital of Philadelphia me and my two co-inventors have a pad to have a patent so you’re not you’re not earning millions of dollars on royalty through a patent that you dealt with Merck that’s correct I’m not I make as much money off the sale of a rotavirus vaccine as you do which I’m assuming is nothing okay fair enough so so then the question becomes why am i

doing what I’m doing because it’s the right thing to do I think it’s surprise to some people that I take this this position it forcefully they assume I must be in somebody’s pocket and i am i’m in the pocket of of children I other children’s because I care about children that’s why I do what I do it’s why we created a vaccine and it’s why I continue to do this even though I’m asked questions like this about why you know I thought I must be in someone’s

pocket I’m not there’s a there’s a whole you know there’s a whole stream of information on the internet that really disagrees with you I mean it if you’re hated on the internet it was a list so you’re saying to me is that maybe it’s possible to you’re allowed to lie on the internet I’m just saying that people perceive you in a certain light and so that’s what we’re doing here we’re clearing that up yeah here use the way it works I think that if

there were clear data that vaccines caused the problems that they cause we would hear about those data but what happens is is that it’s like the old you know legal mantra the aphorism you know when the laws on your side you argued law when the facts are on your side you argue the fact when neither on your side they attack the witness and so I that’s that’s what happens to me I think I’m attacked at personally because there aren’t data to support that point of

view and so and they know that the media loves that sort of story that you know the person who’s in the pocket of industry story that’s a story that will always sell even when it’s not true and if you keep doing that if you keep repeating a lie over and over again then you know some people will believe it’s true even when it’s not true we appreciate you know the transparency the clarity for our listeners it’s just I think it goes back we originally talking

about as far as having that that seed of distrust that I think people have with the medical establishment and they just probably they might be looking for any angle to kind of plant that seed or let it grow a little bit but I mean we can we can let’s shift back a little bit more to your book right now and as far as you’re talking about faith and these religious cult where do you where do you draw the line between faith and delusion

that is a great question and i would say that when i wrote this book that was the question i struggled with the most i wrote a book about what they wrote one chapter about him in a name larry parker who wrote a book called we let our son died which may sound like it’s ameya culpa but it wasn’t actually while he let his son died he saw this is an expression of his faithfulness that he was able to maintain his faithfulness so throughout that night this was a man who

was very sophisticated medically I had a chance to talk to him on the phone he was he had his son and his eldest son had type 1 diabetes he’d been giving that son insulin and then he just decided to stop and pray for his insulin for his diabetes to go away he was part of a mainstream Church in barstow california wasn’t a faith healing church people were arguing with him that he shouldn’t do that but he did that he he he prayed until his son died he watched

him die over a several day period he knew he knew exactly what the symptoms were of someone who had too much into little injury insulin because it was very sophisticated meadow medically when his child died he then at the funeral service tried to res wrecked him he declared the the funeral site as holy ground he has people to take off their shoes and then when his son wasn’t resurrected spoiler alert here on his son wasn’t successfully

resurrected he then didn’t go to the funeral to the actual burial portion because he believed that his son would be resurrected after four days much as Jesus was resurrected here for four days and so then that’s how I didn’t even go that that’s just science I mean everyone has that so so so so is he is he delusional i think is he is heaps I ghiroli psychotic I mean does he does it I think the answer to that question is in a better world yes I think he’s

phenomenally delusional but remember that that there were many people in his prayer prayer group who along with him were praying we’re praying for his son instead of giving him insulin there were hundreds of people that went to that to the the funeral service where he was to be resurrected we just open had called he wanted to come a lot of people wanted to come watch that resurrection I mean people like Oral Roberts who’s a popular

evangelist has claimed that he’s done resurrections and no one sort of put him in in non institution after he made that claim in many of his believers her followers believe that that’s true too so I mean if we’re going to label him psychotic that we have to label tens of thousands of faith healers and psychotic if we’re going to label him as psychotic because this belief about resurrection similarly we’ll have to label a lot of

people that way too so it becomes sort of ignore you know that the these kinds of beliefs it’s a hard question to answer I wish I had the answer it’s you actually we’re going to you answer the next question to ask you because according to you know the dsm-5 and for our listeners that’s basically the Bible for mental illness and psychiatric disorders I mean if you look at some of the beliefs you know not to denigrate Christianity but contemporary

Christianity you mentioned Oral Roberts according to dsm-5 and the the diagnostic Stan a manual that’s psychosis so what’s what’s going to happen between science and religion and this gap or this this amalgamation of the two in the coming years that you see well it i think the fix is actually easy the fixes of legislative fix i mean this this faith healing stuff doesn’t happen in England it doesn’t happen in Canada if you do that if you medically neglect

your child in the name of God you will you will likely go to jail and you would your children will be placed in foster homes that’s a real disincentive to do that and so they don’t have that problem and frankly we didn’t have that problem in this country up until the mid-1970s but in you know under Richard Nixon’s administration there was something passed a called CAPTA child abuse protection and treatment act ironically it was a chance for the federal

government to provide millions of dollars to States to States to help them recognize child abuse and and and treat it and prevent it but there were two prominent Christian Scientists and Richard Nixon’s administration who saw an uncomfortable light about to be shown on their religion then so they insisted that you couldn’t get federal money until you had a religious exemption to child abuse neglect including medical neglect on the books in your state and

so all 50 states passed those laws in the mid-1970s this is the cap the cap to act you’re talking about so yeah so cap that’s right and if you read that caveat that’s put in the codicil that’s put into that cap that it’s clearly written by a Christian Scientist I mean they describe the person who praised as a practitioner they describe the prayers as treatments that’s the way Christian Scientists describe their their their healings and those two men ultimately

went to jail one of them was Nixon’s chief of staff Bob Haldeman the other was the domestic policy advisor John Ehrlichman both went to jail for the role in Watergate but they did this right before they went to jail so I mean you don’t have to answer this but I’m assuming off it is a Jewish name are you a fellow member of the tribe off it is a shortened form of the name option it’s and yes I’m sure the healthcare programs are a lot bhama care how do you feel

about them well you know I’m probably not the one to ask that question I mean I’m a basic science researcher and so although I do practice medicine I do it solely for inpatients in our hospital I think you’re probably the the people who are who you should talk to her the people who were executives in our hospital they probably have much better sense than I do I’m that’s below mine it’s way above my pay grade I don’t know I’m not being honest like I should know

more I actually don’t know I you know I just we see our patients we bill other people take care of that hopefully it’s all working out I don’t know the reason i ask the Jewish thing I was just curious as what to you know what religious upbringing was as far as your background growing up and how that’s changed with your medical practice writing this book you know even the process of writing this book how’s your spirituality or your take on religion

changed well my father was was very religious as are currently my brought my father since passed away but my brother and sister are quite religious um I’m not I you know I I’m not religious and frankly when I wrote this book you know after sort of talking to these parents and writing a story after story of people medically neglecting their children in the name of God I thought I would sort of come down in the way that you know that Christopher Hitchens are

Richard Dawkins or sam Harris did that’s sort of you know kind of militant atheism that you know the religion is is is a logical and potentially harmful but I didn’t actually I mean I actually read through the Old Testament and New Testament pretty carefully and and and although I’m Jewish I was really taken by the figure described as V soon as Erick I was I you know I mean it’s practically just independent of whether you believe in the existence of the

Supreme Being and I don’t but or you believe that Jesus was the son of God and I don’t um because I don’t believe in the existence of Supreme Being or you if you don’t even if you don’t see the Gospels at least the four Gospels that made it into the final Canada’s as an accurate reflection of Jesus’s life and work you you know Jesus lived between roughly 4 BC and 30 a date you have to be impressed with the figure described as Jesus of Nazareth I mean this was a

man ahead of his time he had his time you know a child abuse was the crying vice of the Roman Empire um you know abandonment was common infanticide was common children didn’t matter they were property they were really no different than slaves that wasn’t geez I mean Jesus stood up with the the quote that I actually wrote a piece in The New York Times called what would Jesus do about measles but the quote that I use that’s Matthew 25 40 verily I say unto you what

you what you do on to the least of my brethren you do unto me I mean that that could be emblazoned on the entranceway of every Children’s Hospital in the world I’m just you just really impressed by that and I don’t understand what I lived through the 1991 Philadelphia measles epidemic and you know we had fourteen hundred cases of measles and I nest and centered on to fundamentalist churches that refuse not only vaccines but medical care for their children I

mean that statement that was used when these children with the I was you know Jesus was my doctor I don’t get it I really don’t get how you arrived at that conclusion from reading the New Testament and quite frankly I was really upset that members of the Christian community in 1991 in Philadelphia didn’t stand up and say this isn’t us this is an unchristian thing to do to put your children in harm’s way dr. Rafat you I think you were quoted in a New York

Times editorial in 2013 that people should skip the supplements uh I mean why do you say that well I mean it’s like all things i think i think there’s no such thing as alternative medicine i think the medicine works and it’s then it’s then it’s medicine and or an alternative medicine works as medicine alternative medicine doesn’t work then it’s not an alternative my feeling about dietary supplements is that they should be held to the same standard as drugs I

mean they are drugs they have a physiological or pharmacological if that’s what’s test this drugs let’s see whether they really are safe and effective let’s see whether or not you know the label actually reflects what’s in the bottle these things are manufactured under Good Manufacturing Practices I mean where is the evidence that that these did these substances are with their claim to be I just think we’re getting duped that we allow

ourselves to be doomed I think a lot of the issues are at hand or that a lot of the studies have shown the synthetic by OMA the synthetic vitamins and the synthetic molecules and there’s some studies that show you know increases in cognition and mood for bioavailable vitamins and minerals but it’s it’s all in notes there’s lies damn lies and statistics you know we could we could generate any kind of information we want from anything that we look at yeah but

you know it’s it’s ever since 1994 this industry has been loosed from the Food Drug Administration and and that’s not a good thing um so it’s the wink and nod of the industry right i mean they don’t make specific medical claims because they can’t if they made a specific medical claim then you know they would be regulated by the update so they say things like you know for saw palmetto that it supports prostate health even no the studies have been done show that

it does nothing to shrink prostates and men who have benign prostatic hypertrophy or that you know the garlic is concentrated garlic is good for cardiovascular health the week and not being you know that it lowers very low-density lipoprotein which it doesn’t and that’s been shown again and again so I it’s whatever these these products have been put to the test i think there’s 80,000 of them in the market there’s probably not 20 of them that

have been really tested in any sort of prospective controlled way they never seem to do with your claim to do you know so shouldn’t shouldn’t the consumer be upset about that hmm that’s a very good point dr. ave we really do appreciate your time there you do have a new book out where can people find more about your work so you cannot well that mean the book is called bad faith when religious belief undermines modern medicine it can be purchased in

bookstores or on the internet so um take a look and your website actually do have a website it’s um embarrasses have a website sure it’s the one who put it out I just thought that kind of person that has that but it’s it’s Paul dash off it dot com I think you’re calm okay Paul dashed off it calm well dr. Rafat thank you so much for being here this is the human experience my name is Xavier my co-host dr. G and we are out of here

thank you so much for listening thank you thanks doctor