Live from IDWeek 2025: Infectious Diseases Hot Takes

Buddy Creech: [00:00:14] Hi, everybody. This is Buddy Creech. Paul Sax and Mati Hlatshwayo Davis with Let's Talk ID. We're so glad you joined us today. We're sitting in person for the first time in a long time in Atlanta, Georgia for the 2025 IDWeek. And I just want to say it's really good to see you all.

Mati Hlatshwayo Davis: [00:00:32] It's a good-looking bunch.

Buddy Creech: [00:00:34] I'm loving it.

Mati Hlatshwayo Davis: [00:00:35] If I do say so myself.

Buddy Creech: [00:00:36] I know you had jacket on. You had jacket off. You're flexing in a different-

Mati Hlatshwayo Davis: [00:00:40] Menopause will do that to you, friend. So here we are.

Buddy Creech: [00:00:42] Paul and I were just talking about that earlier. We weren't. We actually weren't. No, that's. I made that up. I just wanted to have some solidarity there. Solidarity is the buzzword right now.

Mati Hlatshwayo Davis: [00:00:50] Love a good he-for-she advocate.

Buddy Creech: [00:00:51] Because we're all in it together. Yeah, I love it. We don't exactly know how this is going to go. We wanted to get together and think about things that have been on our minds over the last little bit. Last year we talked about what we were excited about with IDWeek. This year we thought we'd be a little more, I don't know, provocative?

Mati Hlatshwayo Davis: [00:01:07] Spicy.

Buddy Creech: [00:01:08] Spicy. Okay, a little hot lava takes. This is a chance for us to have some hot takes that we've thought about over the last little bit and have a dialogue, and I have no idea where we're going to go. But, Paul, you're the smartest of the three of us. In a smoothy silky voice.

Paul Sax: [00:01:21] Flattery will get you everywhere.

Buddy Creech: [00:01:22] No, I saw you gargling with olive oil earlier. So you got those smooth, buttery tones. I want you to be able to come out of the gate fast with your first hot take.

Paul Sax: [00:01:30] Well, I'm going to tackle the elephant in the room, which is the really the decimation of the great agency that is the CDC. I've thought a lot about it, and I've spoken to a lot of people about it, including some people who are behind what's going on. I've come to the conclusion that the dominant motivation is anger over Covid 19 policies. Some would say, oh, they were going to do this anyway, but I don't think that's the case. I think it is, they're looking back at prolonged school closures, masking of children in particular, those two things beyond everything, some other restrictions and public freedom, maybe vaccine mandates. And they are saying, you blew it. We're going to punish you now. Now, I think it is possible to hold two things in your mind at once. 

Buddy Creech: [00:02:16] No. No. 

Paul Sax: [00:02:17] Yes. One is that there were some mistakes made in hindsight. Hindsight is 20/20. And the second thing is that the CDC is such a valuable agency.

Mati Hlatshwayo Davis: [00:02:26] Thank you.

Paul Sax: [00:02:26] And we cannot see it being destroyed because what's left after it's destroyed chaos. So that's my hot take.

Mati Hlatshwayo Davis: [00:02:34] Paul, I couldn't agree with you more. I was hoping we could argue up front, but there's no argument here. Right? As a public health leader, as an ex-director of a major city, this is painful to watch, because I don't think the average American understands how this intentional dismantling of infrastructure for a public health system that was already fragile, already underfunded, already under-resourced is not something we'll be able to build back for decades. I have people who believe that, you know, let the midterms come. We can bring this back. Some of this may be not, right? And what I would even raise you is, it is the anger. It is willful decimation of these policies. But it's coupled with a suppressive communication strategy so that the epidemics and some of the public health crises that a lot of me and my colleagues know are happening in an increasing fashion across the country, are not even being communicated.

Paul Sax: [00:03:26] Yeah.

Mati Hlatshwayo Davis: [00:03:26] It's very disheartening.

Buddy Creech: [00:03:28] What do we think about that? What do we do about that? I mean, in our area in Tennessee, a fairly conservative state, a blue city in Nashville, some would consider that sometimes historically to be the special sauce where there's balance between different viewpoints. And maybe when those come together, you can have maybe the design that was there originally, which was, there are different views. They're going to have to abut each other frequently and we can do that. We can hold two things at once. We can have differing views. Do we have some apologizing to do?

Paul Sax: [00:03:59] Right.

Buddy Creech: [00:03:59] Do we have some mending to do? I mean, as one person. Yeah. It was sort of strange that we closed schools in different areas for different lengths of time. It is strange that we were so quick to mandate vaccines when all they had were emergency use authorization at the time, and maybe looking back, I guess that's the question, would we do it differently?

Paul Sax: [00:04:19] So you've learned from the mistakes and you move on. You don't hold the agency responsible. The entire agency responsible for what was it, you know, let's face it, an unprecedented situation and one that was terrifying and killing lots of people. It is appropriate to acknowledge that mistakes were made. It is appropriate even to apologize for those. But that should not lead to the destruction of this agency.

Mati Hlatshwayo Davis: [00:04:43] Thank you.

Paul Sax: [00:04:43] It's so painful.

Mati Hlatshwayo Davis: [00:04:44] I'm the first to say it right. I'm one of those people that folks came with the pitchforks for, right? I got the death threats multiple times, actually, over the last four years. And when you don't know and you're dealing in a population health level and you're the guy to make the decision. We often operated from an abundance of caution. We should have probably pivoted faster, especially when kids are on the line. I will never be apologetic for an abundance of caution, but we didn't pivot quick enough. And the language we used. I think we can be super condescending in medicine.

Paul Sax: [00:05:18] Oh totally.

Buddy Creech: [00:05:18] Yeah.

Mati Hlatshwayo Davis: [00:05:18] And we don't trust people to be able to handle complex messages. I'd like to say that I was one of the people that I hope did a better job. I think it's okay to tell people the truth and to be humble and to say, I don't know. But also what we know to be a central tenet of ID that especially viruses mutate change over time. So it goes hand in hand that the things that we tell you will also change over time. We didn't do a good job, right? But I couldn't agree more with Paul, is that you cannot hold us hostage and eliminate all of these infrastructures that you say you care about. I had the most incredible and I was worried about it, opportunity to sit across the table with some other public health leaders, with leaders from the MAHA movement. And one of the things I said there is we agree on your central message. I want America to be healthy. You say again, I say all the time, consistently. I care about chronic diseases. All of ID does actually, it's kind of what we do well. Right, in partnership with primary care. Explain to me, what do you think is being achieved here? And you know, the message I heard all over again is you didn't listen to us. You condescended us. And while I empathize, that's the reason for this?

Buddy Creech: [00:06:30] I do want to land on it just for a second and ask the question, does it move the needle to have some of our more visible leaders more visibly, more clearly, not apologize necessarily, but-

Paul Sax: [00:06:43] Acknowledge?

Buddy Creech: [00:06:44] Acknowledge.

Paul Sax: [00:06:45] Yes.

Buddy Creech: [00:06:45] And I wonder what that actually looks like?

Mati Hlatshwayo Davis: [00:06:47] But I do believe this is a grassroots-

Buddy Creech: [00:06:49] Oh 100%. Yeah.

Mati Hlatshwayo Davis: [00:06:49] You build back trust at the grassroots, but yes, it's a both end.

Buddy Creech: [00:06:53] 100% yeah. That's great.

Paul Sax: [00:06:54] I'm done with my first one. My next ones are going to be much more mundane ID topics.

Mati Hlatshwayo Davis: [00:06:58] Bring it.

Paul Sax: [00:06:58] No no no no. We're gonna rotate.

Mati Hlatshwayo Davis: [00:07:02] I punt to Buddy because I kind of rode the wave of Paul's.

Buddy Creech: [00:07:05] Yeah, no that's good.

Mati Hlatshwayo Davis: [00:07:06] I'm still there. Quite frankly. I need to move.

Buddy Creech: [00:07:09] You know what? Okay. So this is going to be interesting. I'm going to stay on the theme for Mati's sake. I wanted to stay on this vaccine issue. I just came from a session that Kathy Edwards moderated and had a beautiful conversation around trustworthiness and vaccine hesitancy and building confidence in vaccines. Did we reap what we had sown in years prior by being what I might consider overly paternalistic with our strategy of if you don't follow my specific vaccine recommendations, I'm going to fire you and your family from our practice.

Mati Hlatshwayo Davis: [00:07:42] Oh yes.

Buddy Creech: [00:07:43] And this was I remember as a resident, I had to fight to maintain care for a couple of families that were vaccine hesitant, because that's not what Vanderbilt wanted us to do as residents. And many of those families came around and they took an alternative schedule. But my hot take is that the combination of our sometimes overly paternalistic approach to vaccines, plus an unprecedented and laudable move towards a new vaccine with Covid, several new vaccines with Covid, that that one two punch really hurt us, and we're going to have to dig ourselves out of that a little bit.

Paul Sax: [00:08:14] Yeah good point.

Mati Hlatshwayo Davis: [00:08:14] I had to implement a mandate for city workers in Saint Louis, right? Civil service workers. And that was rough, man. If I were to take one thing back, it wouldn't even be the community based. It was the folks who say, you affected my livelihood like you came for my job at the time, right?

Paul Sax: [00:08:33] Yes, yes.

Buddy Creech: [00:08:34] Yes.

Mati Hlatshwayo Davis: [00:08:34] We fubbed that so bad. And I'm the first to put my hands up and say, absolutely.

Paul Sax: [00:08:38] Yeah. No, I think that you bring up a good point to my hot take number one. This is, you know, three ID doctors in here, acknowledging that mistakes were made. I saw the data from the Pfizer and Moderna studies. I saw those incidence curves, and I just thought we're done. This pandemic is over. I did not appreciate the waning of protective antibodies. I did not appreciate the effect of variants. I gotta tell you, I was partially, it was wishful thinking. Of course, you know, I wanted the pandemic to be over. So in the spring of 2021, I oversold these vaccines, you know, both in efficacy and safety.

Buddy Creech: [00:09:22] My son's a senior at Vandy, and he took a class last year on the history of pandemics. And it was taught by someone whose expertise is in late 14th century Florence, not early 15th century, not early 14th, late 14th century Florence. Um, which is just only something you can get at a university setting, I think. And it was really interesting to see some common themes throughout, whether that's controlling message too much, controlling finances too much, lack of effective communication, general mistrust of everything that's going on. And there are so many things that lay the foundation for that happening. So my not so hot take is that we enter into a time where we can have a presumptive model for encouraging vaccination without being presumptuous. We can be presumptive and we can ask questions. We can motivationally interview. We can invite conversation without demanding conversation, and we can provide autonomy again, if we took it away to our patients and their families, without suggesting things that are bad for their health.

Paul Sax: [00:10:24] Yeah.

Buddy Creech: [00:10:24] We can still hold the line. To your point, we can have two things in our head at one time. We can say this is what we should do, but I'm still going to provide care for you.

Mati Hlatshwayo Davis: [00:10:33] I'm on not so hot. So I'm glad you said that because I think being in public health, there aren't a lot of hot takes. I'm not gonna lie to you. I think it's just we've ignored messages that we've known to be true for decades. Literally decades. I have a slide set that I do when I lecture to medical students, and it's from a book that was published in 1982. Right? And I look at it and I'm just like, we tried to sell them as hot takes now, but they're not hot. So my not so hot take is we need to spend less time in our ivory towers, in our very senior, highly awarded positions, and more time in community. And we need to accept that not all of us are comfortable in community. And so we need to start calling upon the experts. And I use that word with intention, because a lot of times we feel like we're the experts and God, they're just so lucky to have us in community, to speak down to them and tell them how smart we are and how we know everything. But I do believe that the fight is grassroots. To get back the trust of the community, to figure out novel strategies to build back public health. And in so doing, we've got to come out of our ivory towers and into community. What does that look like? I think there's some places that are doing this very well. I think there aren't enough truly integrated collaborative partnerships in academia between our schools of medicine, our divisions, our departments and our schools of public health. I think we do it superficially, but I think there's so much more innovation that can happen there. So that's my not so hot take. I just don't think that this war is going to be won from our ivory towers, even from our very well-intended and very impactful Capitol Hill days. I mean, even Amanda Jezek would tell you, most of the people that are most impactful on Capitol Hill are folks who have understood how to have these conversations at the local and state level.

Buddy Creech: [00:12:16] I actually like that. I think those conversations are important. I think that one of the challenges that we run into is that I've been maybe too compelled by Jonathan Height's thesis in The Anxious Generation that social media isn't or aren't neutral. They're not emotionally- 

Paul Sax: [00:12:34] Good grammar! 

Buddy Creech: [00:12:36] Well, you like that? [laughs]

Paul Sax: [00:12:36] That's impressive. Social media-

Buddy Creech: [00:12:39] I'm trying, I'm trying. I try to do it with English football, too. And I break down their Chelsea R. That just doesn't make any sense to me. But nevertheless, they're not emotionally neutral. And as a pediatrician, I have to admit I worry about us kind of as a group, leaning so hard into social media and trying to navigate the algorithms and try to have our message there. It would be my wish that very few people were as dedicated to social media as they are. But this idea of being in the community, having one on ones, having one on 20s, where we're inviting conversation. I mean, some of us do that. Paul, you do that with a blog, you do that with other grassroots kind of things, and it's very effective.

Mati Hlatshwayo Davis: [00:13:18] It is! So, not so hot, but it's hot.

Paul Sax: [00:13:21] Okay. It's good. I'm going to do something that is very ID doc related.

Mati Hlatshwayo Davis: [00:13:29] Yes.

Paul Sax: [00:13:31] Which is staph aureus bacteremia?

Mati Hlatshwayo Davis: [00:13:34] Yes. Do it!

Buddy Creech: [00:13:36] I'm so nervous right now.

Paul Sax: [00:13:37] So this is the scourge of adult ID and everyone who does inpatient ID consults. This is probably the most common reason for an ID consult on a seriously ill person. Whether it's endocarditis or osteomyelitis or community acquired injection. Drug use related. Line related. This thing is just awful. Okay, my hot take is we have had two transformative clinical trials in the past year that really should change practice and-

Mati Hlatshwayo Davis: [00:14:06] Hit us with them.

Paul Sax: [00:14:07] One is the Snap trial, which basically told us that Cefazolin is better than Oxacillin Nafcillin. Finally we know. With penicillin susceptible strains, you can use penicillin, but that's a little parenthetical. And then most recently the DOTS trial of Dalbavancin. Oh my goodness.

Buddy Creech: [00:14:25] Yeah, yeah.

Paul Sax: [00:14:25] Wow. You know, one dose on day one and a second dose on day eight. And you forget about all that OPAT and you're basically you're done. So as long as that drug comes down in price, which it will one day with generics, you know, as long as someone looks at the big picture of how all healthcare is paid for and not just the pharmacy budget, that's how staph aureus bacteremia and endocarditis should be managed. Now, granted, the second study excluded people with left sided endocarditis and prosthetic heart valves, and the highest risk weren't included. But one day maybe.

Mati Hlatshwayo Davis: [00:14:57] I think so, man. And as the retired OPAT supervisor for the John Cochran VA Medical Center in St. Louis.

Buddy Creech: [00:15:05] You hit that retired language hard. That was hard.

Mati Hlatshwayo Davis: [00:15:07] That was the one that did it for me, Paul, because I just think what it does for access, what it does for patients who have such a hard time with compliance. I don't think people really appreciated that. There's not enough rah rah about that.

Paul Sax: [00:15:20] The way we got our OPAT program funded in our hospital, a person very high up in administration had a family member who needed to be on home IV therapy and saw what chaos it was, and how much their family member hated being on home IVs, you know? And so, yes, you know, so OPAT programs are important. Home IVs are important. But the less we do it, the better.

Mati Hlatshwayo Davis: [00:15:45] And shout out our rural communities too. Like it changes the game.

Buddy Creech: [00:15:48] 100% again, kids aren't little adults and I want to be mindful of that. But we treat staph aureus bacteremia syndromes in children all the time. Typically they're secondary bacteremia is after an osteo which obviously started with a transient bacteremia and seeding. And we've had great results with that.

Paul Sax: [00:16:04] So that's an oral therapy.

Buddy Creech: [00:16:04] Yeah. With oral therapy, right.

Paul Sax: [00:16:05] I mean and that's where we're going.

Buddy Creech: [00:16:07] Of course.

Paul Sax: [00:16:07] And we're going to get there.

Buddy Creech: [00:16:08] But I get the challenge though. And I'm taking derivatives of Paul's hot takes, which I really like. This is safe ground for me. We'll call it that. I'm just piggybacking. It's perfect for those scoring at home. I've got zero hot takes so far. I'm just like subordinated here. Is that the problem with some of our ID advances, is that, unlike the oncologists in the world, if there were a new chemotherapy agent that improved the likelihood of survival for AML by like 5%, it would be ubiquitously used tomorrow, and it would change practice immediately for a new anti-infective.

Paul Sax: [00:16:47] Yes.

Buddy Creech: [00:16:48] We put it behind a glass thing that says break in case of emergency and do not use it.

Paul Sax: [00:16:53] Too expensive! [laughs]

Buddy Creech: [00:16:54] Yeah, it doesn't matter that it's better. It doesn't matter that we only have to give two doses of it. It doesn't matter that it may have a more narrow spectrum. We did this with Daptomycin for the longest time. We've done this with anti-MRSA cephalosporins. We did it for linezolid. And for some of that it's because of a cost issue. But quite frankly, if you're a development company and you're trying to find the next great anti-infective, you might reach the Holy Land of getting it approved and still go bankrupt because no one uses the drug. And so we've got to figure out how to differently incentivize that? I love dalbavancin I mean, I think this is. It would be revolutionary if we would use it. It's more narrow. There's no gram negative activity.

Paul Sax: [00:17:35] It's well tolerated.

Mati Hlatshwayo Davis: [00:17:37] So well tolerated. 

Buddy Creech: [00:17:39] Right, I love it. This is good. 

Mati Hlatshwayo Davis: [00:17:39] I just think Paul needs to keep going and we keep layering on top. But I because I'm almost like, quit while we're ahead. This is better than I thought it was going to go. Paul, do you have anything else for us?

Paul Sax: [00:17:51] I'm gonna say that this drug, when it gets approved, will be a fascinating, a fascinating test of something out there that's still present. And it brings me back to my first one, which is, believe it or not, people still do get Covid 19. And I'm talking about the antiviral ensitrelvir, Paxlovid-like drug with no booster, but it's still got a lot of drug interactions that has been shown in a clinical trial that's about to be published. In full disclosure, I'm a co-investigator, to reduce the risk of household transmission of Covid 19 by 67%, two thirds reduction.

Mati Hlatshwayo Davis: [00:18:25] 67?

Paul Sax: [00:18:26] Post-exposure prophylaxis, 67% reduction. That will be FDA approved sometime in the next 6 to 12 months. I don't know the timeline, so it'll be just fascinating. Are people going to use this? Are people going to say, gosh, someone in my house has Covid, but big deal, I'll get Covid anyway? Or are they going to like, want a pill to take one pill for five days? Are they going to take post-exposure prophylaxis for Covid? What do you think?

Mati Hlatshwayo Davis: [00:18:49] From a public health perspective, I think it comes down to messaging. Nobody wants to talk about it anymore. Right? And I think we sucked at marketing to begin with, in a certain way. So I think that while you guys are in your six month to 12 month, you get the heavy hitters on messaging, you partner with folks in the community. 

Paul Sax: [00:19:08] I mean, primary target from my mind are the older, vulnerable individuals.

Buddy Creech: [00:19:14] That's good. Yeah.

Paul Sax: [00:19:15] Or people who are immunocompromised. You know, if that's the group that we have to protect now from Covid 19. I mean, I don't anticipate that many young, healthy adults will want to take 12 days of an antiviral unless they have an upcoming wedding or something like that.

Mati Hlatshwayo Davis: [00:19:29] My issue is nobody wants to talk about it. So how do we make it a message that is as easily received as fluids, right? Everybody knows we're going to start talking about flu around August, September, right. What's your rollout and what's the right timing and what's the cadence?

Buddy Creech: [00:19:43] But I think we can learn from flu in that half our population at best get vaccinated for flu.

Mati Hlatshwayo Davis: [00:19:48] Yeah.

Buddy Creech: [00:19:48] Different pockets, obviously different vaccine uptake rates, but the rates of oseltamivir use are quite low compared to what they should be. 

Paul Sax: [00:19:55] That's true.

Buddy Creech: [00:19:55] Based on viral efficacy, post-exposure prophylaxis, and prevention of severe influenza disease in high-risk hosts. So if Covid follows the influenza route, we've got some work to do because I think probably right now derivative hot take number seven, people probably fear Covid far less than they fear influenza. And the fear of influenza isn't very high. And I think one of the reasons for that is it almost feels personal opinion that maybe a fear of Covid has a political implication in their mind. So the more they dismiss Covid, that puts them on one side of the aisle or another. Flu doesn't have that same political nature.

Mati Hlatshwayo Davis: [00:20:34] I don't know, Buddy, because I didn't see this hot take coming. So we're just going with the flow and we're building we're building momentum here. I do think an audience that's very concerned still, and feels like other people aren't concerned because of the over politicization, are immunocompromised folks.

Paul Sax: [00:20:49] Yeah.

Buddy Creech: [00:20:49] Sure.

Mati Hlatshwayo Davis: [00:20:50] And I definitely think the elderly and I think caregivers, ltax, i think there's target audiences. And I think if they are engaged, but also if there's a strong message that's clearly for them, I think this could take off. The immunocompromised feel are panicky.

Paul Sax: [00:21:04] Very vulnerable.

Mati Hlatshwayo Davis: [00:21:05] They are.

Paul Sax: [00:21:05] Exactly, exactly. And it's a fairly large proportion of the country. I mean, it's obviously a minority, but there are a lot of people who could be defined as immunocompromised.

Mati Hlatshwayo Davis: [00:21:14] I agree.

Paul Sax: [00:21:14] Anyway. It'll be fascinating. It'll also be interesting how people will struggle. How to pronounce it. Ensitrelvir is a very funny word, and I'm pretty good at pronouncing drugs.

Buddy Creech: [00:21:23] They're going to have their work cut out for them for the trade name. It's got to be. It's something easy.

Paul Sax: [00:21:27] Yeah, I know.

Buddy Creech: [00:21:27] Like just get rid of Covid. Just one word. Get rid of Covid. No? Mati is telling me no, that's not a good choice. Yeah, she's looking at me like, what are you saying right now? This is awesome.

Paul Sax: [00:21:38] Okay, you know, I had an idea for how to wrap this up. Each of us have interesting names. They've all been botched in some way at some point in our lifetime. And Mati, can you share with us?

Mati Hlatshwayo Davis: [00:21:49] Did I know that I would likely pick it off? I feel like the one that's botched the most is not the one that you think bcause most people just avoid, rudely avoid Hlatshwayo, I mean, for obvious reasons, right? I work very hard, but was given a lot of critiques. Thank you, Buddy. On the phonetic spelling of my name. I will provide that. But Mati gets butchered ,y'all. Oh, I'm Maddie, Hatty Katty Fatty Maddie, I'm Mardy. You know Party Hardy Mardy.

Buddy Creech: [00:22:17] Just adding consonants. Just for kicks and giggles?

Mati Hlatshwayo Davis: [00:22:20] But my favorite. My favorite version is from predominantly in the black community. Ma-tee. It's very spicy. It's like a Matee. It's got a little attitude behind it. So Mati's the one that I sometimes forget to help people with. And that's where. Surprise! You're a Marty today, or you're Maddie today. Um, but Hlatshwayo, I think I'm a little bit more of a sympathizer because, man, that "Hltashwa," it's not for everybody.

Buddy Creech: [00:22:44] I don't know how to do that naturally.

Mati Hlatshwayo Davis: [00:22:46] You nailed it.

Buddy Creech: [00:22:46] Well, that means a lot. My name is about, quite frankly, as white as a name can be. I mean, it is like this Scottish-

Paul Sax: [00:22:53] You two have great names.

Buddy Creech: [00:22:55] Okay, so first off, no, Creech comes from this like Scottish area in Fife. And so I'm basically built for like snowstorms and potato famines. And hopefully that'll work out for me. Plenty of thermogenic brown fat. Um, but Buddy Creech. So Buddy was actually my dad's name as well. And so when I was born, my mom really wanted me to be named after my dad. But he said, look, we're in Chattanooga, Tennessee. If I name him Buddy Jr., he has no future whatsoever. So I became Buddy the second, but it got butchered. Buddy becomes booty pretty easily. Creech can become some weird versions as well. My favorite was a music professor, Michael Rose, at Vanderbilt University. When I was a freshman, I took a Mozart class from him. Highest grade I've ever made on a test. I had to write something. I had to do some project in sonata form.

Paul Sax: [00:23:44] Wow.

Buddy Creech: [00:23:44] Like Mozart wrote sonatas.

Paul Sax: [00:23:45] You composed it?

Buddy Creech: [00:23:46] No. So it was something other than music.

Paul Sax: [00:23:49] I see, okay.

Buddy Creech: [00:23:49] So I wrote a recipe for chocolate brownies in sonata form. I got a 130 on that assignment.

Mati Hlatshwayo Davis: [00:23:56] Common, Buddy.

Buddy Creech: [00:23:56] Which I didn't think was possible. He grabbed me one day after class and he goes, Buddy, I can't stop thinking about this. If you take the first part of your last name and the first part of your first name and you switch them, you get Cruddy Beach. That's the best thing ever. So for the rest of college, he wrote one of my letters for medical school. He called me Cruddy. It stuck with my friends and it was great. So that's the origin of my name.

Paul Sax: [00:24:16] Okay, Cruddy.

Buddy Creech: [00:24:16] Yeah.

Mati Hlatshwayo Davis: [00:24:17] I am waiting with bated breath...how...

Paul Sax: [00:24:19] My name is very simple, but over the telephone. Cell phone, standard phone. My last name Sax sounds like F, as in Frank, ax. And I have had innumerable people when I tell them my name is Paul Sax and then I say spelled S-a-x. They hear F-a-x and they then will send me like a letter, a form that actually says Dr. Fax on it, like fax machine. And all of those people who actually have done that. I want to say to them, have you ever met anyone named Fax? That is not a common name. You know, Sax isn't that uncommon. So now what I say to protect against this, is I say my last name is Sax, like the musical instrument saxophone. And that almost always-.

Mati Hlatshwayo Davis: [00:25:11] Protects you?

Paul Sax: [00:25:12] Protects you.

Buddy Creech: [00:25:12] You're not getting faxophone at all? No faxophone.

Mati Hlatshwayo Davis: [00:25:15] I didn't see that coming. Yeah, I feel like we were always in community. I feel even more bonded in community.

Buddy Creech: [00:25:21] Oh, okay. So this is going to be my last hot take. It's an original. Good friend. And this is one of the themes for IDWeek for us is PIDS is that we're better together. Comes back to our first conversation about wanting to have solidarity with those groups that we know are struggling right now, whether that's CDC or local public health officers, folks in academia losing their funding, folks that are struggling to keep up clinical hours, all of the places where all of us are struggling. We've had a good time here, but we also want to acknowledge that folks are having a hard time. Have a good friend who has the following quote. He says, "When people get together and they share their successes, it tends to breed competition. When they get together and they share their challenges, it breeds community." And so I think one of the things that's special about our community, and it's on full display here at IDWeek, is that there are times when we celebrate, there are times when we have fun. There are times when we say, how's it going? And someone's brave enough to say, it's not great right now. And that actually deepens our bonds with each other and makes us truly, truly stronger. And I certainly feel that way with you guys.

Paul Sax: [00:26:19] Well said.

Mati Hlatshwayo Davis: [00:26:20] There's no better way to end it. Thank you friends.

Paul Sax: [00:26:23] Thank you.

Buddy Creech: [00:26:24] All right. This is Let's Talk ID. We'll see you soon.