Significant Health Breakthroughs and Future Outlook

Hi, everyone from New York Magazine and the Vox Media Podcast Network. This is On with Kara Swisher and I'm Kara Swisher. Over at CNN, I've been working on a series, Kara Swisher Wants to Live Forever. The title is a nod to the growing obsession among the tech billionaire class with longev ity. But it's not just folks like Amazon CEO Jeff Bezos or Brian Johnson, leader of the Don't Die movement. Longevity has grown into a multi-billion dollar industry filled with influencers, charlatans, scam artists, and occasionally some good advice. I did a lot of different reporting for that series, including looking at the science behind a lot of longevity, which is really promising. But there's many other things to talk about , and I want to continue the conversation. So we're bringing you a special series on hacking longevity. For the next four episodes, I'll be talking to some of the leading experts on longevity and the science behind ing increas your health span. It's a big topic and requires a lot of reporting and a lot of facts and a lot of the stuff that traffics on social media, which can be very dangerous or expensive, or just down right silly. Later in this episode, we'll hear from health policy expert and oncologist Dr. Zeke Emanuel and two members of my own personal care team, my cardiologist, Dr. Dave Daniels, and my personal trainer, J ason Braun. But we'll start with Dr. David Agus. He's an oncologist and researcher. He's also the founding CEO of the Ellison Medical Institute, where researchers are using AI to create cancer fighting drugs. Plus, as we'll discuss , he played a critical role in my own health. I went to Dr. Eggis because I started to get interested in this area and I had met him a long time ago when he was treating a bunch of different tech CEOs and I wanted to talk to him about where things were going and in the course of it I had a uh checkup and one of the things he noted was that a stroke I had had many years before uh was the result of a hole in my heart, uh, of all things, and that I should get it uh fixed, and that there were new technologies that were much better than the treatment that had happened at the time, which was open heart surgery. And I was very nervous about having any heart surgery. He convinced me to do so. I had a very simple procedure and I am much healthier and safer from dying of something stupid than I was before. So I really appreciate Dr. Ag us. It's a really interesting discussion and we'll be doing this over the next couple of weeks, plumbing further what works and also giving you good advice on what doesn't and what you should avoid so stick around Support for this show comes from Kohler Health. The body sends you answers to important questions every day. How's your digestion? Are you drinking enough water? But most of us don't know how to interpret them. For over 150 years, Kohler has redefined innovation and craftsmanship in the bathroom. Now Kohler Health is reimagining its role in personal health with Dakota. Dakota is an attachment that fits discreetly on your toilet. Learn more at KohlerHealth.com and use the code KARA1EAR for a free annual app membership when you purchase Dakota . Dr. David Ag us, thank you for coming on on. Thank you, Kara. It's a privilege to be here with you. So uh just for people to know, we know each other and you have treated me um and helped me, I want to to to get it out there. You have you convinced me to get uh a p my PFO repaired after I had a stroke many years before I met you. Um I'd love you to talk a little bit about it. I'm fine you talking about it, but just I want to get people a sense of how we met and uh and I had known you only because you had treated Steve Jobs and s and had had started this institute with Larry Ellison and things like that. Aaron Ross Powell You came to see me and a couple things were very obvious. One is you had a risk factor for having clots , right? You inherited a mutation where you had too much of a protein called thrombin, which means you were more likely to develop clots . And the thing about clots is most of the time they go to the leg and the lung In your case, there was a little hole in the atrium, the top of the heart, so that clock could go through and go to the brain. And that got us scared. And so right away, you know, fix that and we hit the root cause. And I had had the stroke. I had or whatever. You had a TIA, so you know, which is a a stroke that just resolves itself, which is fantastic. But that's what makes it scary. And so when there are those risk factors, you know, hit root cause, fix that so it won't cause a problem going forward. Yeah. And you had you had warned me, what you one, I could have it happen again, and two, the uh problems with dementia and uh without having it fixed. And the reason I didn't fix in the first place is because it was open heart surgery when I first had the stroke and that and then it changed, which I hadn't been aware of. Yeah, I mean things are changing dramatically. Prostate surgery, now you can go home the same day. Yep. They can fix a valve where it used to be a week in an ICU on a ventilator and literally you go home later that day. It's a wild time with what's going on technology in healthcare. Absolutely. Now you've said and one of the things I was a little bit uh nervous to have heart surgery at the first time when it was presented to me many years before. I was like, there's no way I'm having open heart surgery, all the complications, everything else. And you've said in the past, and you said to me m only maybe only half jokingly that part of your job as a doctor is to be a pain in the ass. Um explain that to people and we can explain it in the context uh 'cause you were a pain in my ass in a good way, I guess. I don't know how to explain that. You know the there's a notion that there's one right decision for everything in medicine, and it's just not true. It's the right decision based on a value system and the value system of the patient. My job is to educate and to get the patient to understand what are the risks and what are the benefits, they can make a truly educated decision. At the same time, I want every number perfect. So I am a pain in the ass to make sure people take the right medicines for prevention, that they're compliant with them, that we get them to the levels they want, which in today's world is getting harder and harder because of social media. You can go on social media and everything I do, every drug I give, you can find somebody who's saying it is causing you to have three legs, it is causing you to have no you name it, it'll be there. So it's very hard to filter out the noise, so I have to be a pain in the ass in a sense to rise above Aaron Powell Talk a little bit about that because I I find you I don't c find you conservative, but you're conservative, right? And people expect because you're at this institute for uh aging that you're gonna be on the cutting edge of everything. But you're actually not in a lot of ways. Not that you aren't open to them, but it's one of the things that's happened, this noise has been created. Aaron Ross Powell Yeah. I'm as aggressive as you can get. I mean, don't get me wrong, but at the same time, I'm data-driven. So unless there's data, I' know were what we call a complex emergent system. So making one little change has tremendous ramifications. So unless we follow and know the long-term outcome, most of the time little changes that may make you feel good today are gonna significantly hurt you tomorrow. And so I am a stickler for going by the data because in most, if not all cases, when I haven't done that or Medicine Hunt hasn't hasn't done that, we're wrong. Mm-hmm. And in today's world, you know, all of a sudden we can collect data and analyze data like never before. Right. And so we're seeing that, right? A shingles vaccine, which is a very simple thing to prevent recurrence of chicken pocket Right. Reduces Alzheimer's by over fifty percent. That is wild. But at the same time, the the noise creates a problem for doctors, right, that are going by the data because there's too much data, presumably. Aaron Powell You know every day somebody comes in in my office and these are very educated smart people with a bag of vials and says, I'm taking this and this and this and people who've gone to the greatest schools or leading companies, politicians, you name it. And I go, Really? Why? Well, I it was good for this. And I go, have you seen the data? And they're doing things to intervene in their health without really understanding the whole nature of it. Right. Let's talk a little bit about getting people to trust their doctors again, because that's something that seems to have become broken during uh during COVID especially. Yeah, you know, I mean COVID was tough, right? Is uh all of a sudden science became political, what you believed, you know, was really a political belief rather than a science belief. And the data are what the data are. Um and you know, my job is to educate people in that regard. Science without leadership dies and nobody listens. And we are sorely lacking leadership to get normative behavior change in this country for health So talk about that idea because right now that kind of health care is is is concentrated in the very few. It's an issue I talk about a lot, is that it's not for the whole. Uh something like a shingles v accine would would have follow on effects. Uh GLP1s is something that many doctors feel like it has great potential for a lot of people. Healthcare feels like a privilege right now and not a right. How do you look School to learn how to type into a keyboard and enter in information. Yep, probably half of my time with patients is entering information into a computer. The same is true with the nurse and all the people in the healthcare system. So if we can get AI to take over some of those tasks, we can see more patients, we can be more efficient and spend more one-on-one time with the patient. The way you get compliance and best outcome is if the patient understands what's going on. And so with understanding, it only comes from the conversations back and forth. And that's what's critical. A lot of people don't have access to a doctor like you to take charge of their health. You have a a a sort of a 360 system . Um it's a version of concierge medicine, but it's the idea that you get to evaluate it, you get a lot of data, then you get a lot of instruction. Talk a little bit about how you look at AI, 'cause a lot of people are terrified of it, and the polling is very clear that people are scared of it because first of all I'm not a concierge doc. I have no fees, I just take what Medicare insurance pays. Because I really believe with you know with volume comes quality, right? The ten thousand hours you require. So I want to see a lot of patients so I can be good at what I do at my craft. The beauty of what AI systems can do is it can tell the doc, hey, you just saw Kara Swisher, did you look at her factor two level and because she had a blood color, maybe you want to check it if you haven't checked it yet. And so it can give clues and cues so everybody you know that old commercial be like Mike? Everybody can be like Mike in a sense. And doctors can have the same practice uh uh all across the country and do the same things. You know, when I first got to my hospital, I had a thing where every doctor had to give the pathology report uh to our institution for reading. And at the bottom we put their positive biopsy rate in the community's positive bio psy rate. So if a bioctor biopsies and they're 80% positive and one twenty percent positive, one may be biopsying too much and one too little. Three standard deviations on day zero, forty-five days later, point seven standard deviations . Doctors are on an island. They don't know what other people are doing, and if you can bring them information, it's powerful. Right. Explain what you're doing at the Ellison Institute and what you're excited about . I know you're using AI to create molecules that target breast and prostate cancers. It could have taken years in the past. I discussed this, that that they i it really uh collapses the amount of time to design a molecule and get into testing and the and getting the pipeline of drugs there faster in terms of that. Explain some of the things you're doing there. Aaron Ross Powell Yeah it's game changing. You know, uh the drug for breast cancer I helped make. It took 10 years to make and about seven years to test. In the last five months, we've made six drugs. You know, remarkable groups in England and in the United States have been able to develop computer programs that can predict the shape of proteins. And so I say, hey, here's a protein I want to bind. Find me something that binds right here in the body. I don't want it to bind to those. And with those constraints, I can literally print proteins overnight and then try them. And then I see how they bind, I put that data back into my model, which gets better, and then I run the model again. And so if I can do this for several weeks, I can come up with a drug to targets that have before been undruggable. And then literally I can do the testing and then I go into patients and clinical trials and see if they work. The production still, most of it is done in China. We don't have a lot of drug producing here in the United States to make the ingredients f for these drugs. And so that always scares me in a sense. But at the same time, we're now with AI able to make drugs that will radically alter and change disease. So when you talk about that issue in China, given what's happened here, the ability to manufacture here, the cuts that have been happening with the Trump administration, et cetera, talk a little bit about that because w we've been ahead in these areas Aaron Powell It's no question in healthcare we are the most innovative country in the world by far over the last several decades. But what we're starting to see is that the chemical constituents to make drugs, whether it be your Lipitor Those constituents require, you know, big chemical factories that have a lot of chemistry waste that has to be deposited. Nobody in the United States wants that in their backyard. And so developing a strategic plan so we have that backup we can build them here in the United States going to be critical. We need someone to step up and say, yes, we need this critical infrastructure. Um we need a strategic plan for the next decade for health in the United States. And I haven't seen that. And I want to see that. Have you seen it anywhere? From any state? From any of the No. I mean listen, we we're arguing over you know budget things at the NIH, we're arguing over CDC. We're arguing over budget things. We're not talking at all about a strategic plan for the country. Which I do think we need to do. We're at that point now where technology will enable us to make huge impact, but we have to build the rails to let that happen. What is something AI can't do for us as you begin working with it, you know, there. You know, you're backed by a very wealthy person, right? So you have that luxury there to do that. But do that's for one, the money obviously is the the expenses are enormous. But do you see a limit to the kinds of research AI can help with just if you had unlimited funds like this? Aaron Powell Well I mean there are the two aspects. I mean in the care part we're going to need humans, right? You know when I look at you in the eye, the oxytocin hormone goes up, the love hormone, your blood pressure goes down, you start to trust what I say, you don't get that interacting with the computer, period. So I do think the human interface is how we're going to do healthcare for the foreseeable future. Um you know the difficult thing about health and these large language models, which everybody is transitioning to is they're literally programmed to give you the answer that makes you happy and that you want. And that's very difficult to do with health. We are a zero fault tolerant business. And when something does have fault, even if it's a small amount, in our field we get worried about it. And that's difficult. So how do we develop the guardrails, develop the transparency . If a data set was trained on people from Kansas and you're from Missouri, maybe it's not applicable to you. And so we have to get better about how we use it. We know it's powerful. We know we're going to use it , but we haven't yet built the structure. And again, that needs leadership. You know, if I ask people now who is the surgeons or we don't have one right now, but if I ask who they were over the last 10 years, nobody would know who it was. Right. Probably only you and I will remember. But since C. Everett Coop, nobody remembers who the Surgeon General Vic Murphy. But go ahead. But even Vic Murphy, I mean his big platform was loneliness. Right. Really important. And you know, I'm I'm not against it, but that wasn't a strategic plan for health in the country and that wasn't the leadership we needed per se. I I thought you explained the work of the Ellison Medical Institute. Some people think you're just trying to stop aging. Obviously Larry has been talked about that in various ways, but what do you feel like your goal is there? We're a unique place in that we're a nonprofit that has clinic where we see patients, we develop drugs, and we do clinical trials, so we have the entire enterprise in one building as you know you were here. And you know, every wall is glass. So you walk by, the patient sees the researcher, that's hope personified. The researcher sees the patient, they double down and hopefully work a couple extra hours. Um you know, the the easiest way to make people live longer is to prevent disease. So almost all of our efforts now are fed are new drugs for cancer, new drugs for inflammation, to prevent cancer, because obviously that's where our expertise is. Over decades, we build all the models for that. And that's a way we can help people live much longer. Am I, you know, developing the secret uh serum that will make people live a decade longer? No. Am I figuring out ways to change your stem cells? No. I do think that will happen, but we're not there yet in science. Once that science is there, we'll certainly be implementing it, improving it, but it's still evolving. Aaron Powell You know, one of the things that a lot of it has morphed into with Silicon Valley people is this it's beyond health care for everybody. It's like life extension in a way that seems narcissistic. Do you agree with Right. The goal is in our seventies, our eighties, and nineties that we play with our grandchildren. We roll in the grass. That would be the dream of everybody. And certainly the goal is to get there. The way we do that is to put money into science, to understand basic biology, and to translate that into ways to basically change our system. Remember, evolution said, hey, once you had your kid, I don't really care about you. In fact, if you got cancer or heart disease, that's more food and housing for the next generation. So in order to live that long and have a healthy health spam, we need to hack our system a little. Statins are a way we hack our system. Measuring our sleep and gaming it so we get that deep sleep and things we need are a way to hack our system. So figuring out ways to do that. And yes, some of the people with a lot of resources in our country are saying, hey, I'm going to put resour real ces to it so hopefully it becomes a science. Hopefully it becomes something that can be globalized and everybody can benefit from it. Not necessarily in a narcissistic way because NIH historically funds a basic science . And nobody had funded this kind of thing before, and it was fringe, and hence many of the things are fringe with very little data. So I love the fact that people are putting resources to looking at ways to make people live healthier longer. Trevor Burrus See, I find some of it kind of somewhat ridiculous in an experiment of one versus for the broader public. Well experiment of one makes no sense. Are doing is literally a disservice to the public and makes no sense. Will you explain why? I have I I did a long interview with him, but I'd love you to explain why that is. First of all, the experiment makes it means nothing, right? Experimental one, as you alluded to, doesn't mean anything. But at the same time, most of the things he's doing is not data driven. And so people say, oh my gosh, this very wealthy figure who's smart as hell is doing this, therefore I should do it. And what happens is many of those interventions can have serious negative health ramifications. And that's what I worry about. So you know, I do believe that if you are a public figure, you have an obligation to do things in a data driven fashion and to really explain it. And so when you do things and then you sell the product I don't think doctors should be selling things and promoting things, especially when there are no data behind them. Yeah, you've never tried to sell me anything like that. It's interesting. I'd like to go through a l some of those trends that are that are sort of popping on there. Um talk a little bit about GLP one. I I believe y you sort of were wary of it initially and then you're not as wary of it, correct? I mean there's no question. It's a hell of a drug. Right. It came from the saliva of a Gila monster. Right. Gila monsters have crazy slow metabolism and they can eat you know very prolonged periods in between meals. And so they identified that at a company called Nova Nordisk, and that's where Wagovi and Ozepic, same drug, just different names, different indications, were initially developed for diabetes, and they found it changed metabolism, it slowed the GI tract so you fell full. And it also affected the brain in terms of wanting food and the craving for food. And so in that regard, it has been dramatic. So people with an elevated body mass index, that is a calculation based on height and weight over 28 makes total sense to get health there's a health benefit to being on them. People with a fatty liver, some types of heart disease. There are clear data that being on a GLP work. So I am not against GLPs at all. The only thing I'm wary of is we don't have a lot of long term data. Right. And so our data stream now is eight, nine years of really good data. I want to see what So if you, you know, you're going to the summer and you're a little bit overweight, taking it for a month or two so you can wear a bathing suit probably isn't the smartest thing in the short run until we have a lot better data. At the same time, we know there are some side effects, right? You can get what we call sarcopenia, lack of muscle. Right. If you're older and you have lack of muscle, you can fall, break your hip. That's not good. It causes inflammation of the pancreas many times, and you can find pancreatic inflammatory proteins in the blood. Some people don't feel well on them. And so they're not innocuous drugs. of these sort of trends that you see. What are ones that you think don't get enough attention and what are ones that you're like, oh good God, please no. I would think hyperbaric chambers, for example, you can do it. Hyperbaric is a great example. So the hyperbaric word were developed for people who, you know, went dying in the ocean and would come up real quickly and it would treat the bends because you can slowly release pressure and it would help with oxygen release. Hyperbaric does increase blood flow to certain areas of the body. That's clear. The problem is, is that if you look at it, you know, I do I know this is going to sound weird, you're going to give me a mean look, but I'm going to say it anyway. I do autopsies on most of my patients. Oh. And that's how I learned what I went wrong. I thought that was scar tissue in the lung. Well that turned out to be cancer. And that's how I get better and I realized, you know, things that what I thought wasn't always the case. What I find, pati aent had lung cancer ten years ago was cured with surgery. On autopsy, I could still find l little clumps of lung cancer cells in the lung, yet they weren't growing. That seed didn't like that soil for whatever reason. And what happens with hyperbarics is you change the soil pretty dramatically. And so I do worry lots of health care ramifications down the road, but do you want to feel good today or do you want to play with your grandchildren tomorrow is a critical question. Trevor Burrus Right. Right. What are some of the things you think don't get enough attention? Aaron Ross Powell Well listen, I mean sleep is the key one, right? It's boring. Everyone is all of course you need sleep. So you know I'm one of those geeks that measure my sleep, and whether it be a ring, a watch, a band, they're all great. I don't think any one is better than the other. But I wanna make sure that I get my hour of deep sleep at night. I wanna make sure that I wear blue light glasses The second one is it's not just what you eat, it's when you eat. Right? People who graze on a calorie-adjusted basis have dramatically lower metabolism and actually gain a lot of weight and don't do as well, think as well, or exercise as, well as people who eat their meals at a regular sketch with nothing in between. One snack can throw you off for two or three days, no matter how healthy the snack. So the key is regularity in when you eat. The next one is just, you know, the one everybody knows but nobody does, movement over time. Our bodies were designed to move. The rhythmic contraction of the muscles on your legs when you walk, that make your body work. Yet we sit all day, we engineer our lives, you know, we have a bathroom in every room in our house, so we don't have to walk room to room to go to the bathroom. It's kind of crazy in many regards. Those simple things are enormously important. And then one of the largest studies in Europe showed that every year you delay Right. So you don't have to do your primary job. But the notion that you gotta keep this engaged, you need to become uncomfortable. Have social connections. is critical This is exactly the stuff I was saying. People get so bored. I'm like, no, really, just have a friend. That would work much better than almost twenty other things you could do or that you find on the internet. So if you were U.S. surgeon General or with more power, the head of the HHS. Um what would you do and you had power to do so? First of all is I would put a group together um that has you know no financial ties , to be a normative body to talk about everything going on. So I do think we need to start to have healthcare leadership and we need to promote that. We used to have it somewhat with the World Health Organization, but it became an organization that is amazing for developing countries and it kind of moved away from developed countries. And we don't have a normative body for health to talk about here's our, you know, uh what we think about peptides, here's what we think about X, Y, and Z , et cetera. The second is I would build, like we alluded to early, the infrastructure for data transmission across the United States and change it that states don't have a right to all health data. It needs to go to the federal government. There needs to be a national stripe to health data. There's the Mayo Clinic data set, there's the Harvard data set, there's the University of Arizona data set. That makes no sense. We need a national stripe to data. In order for that to happen, we have to do something that every other industry has done that succeeded, we haven't yet, which is make data standards. You need to call it a broken leg, not a fractured leg, a broken leg. We need to have the same terminology, the data standards for everything going on in health. And that way it can in your ways now with large language model, you can harmonize different words and all that kind of thing. But we need a structure for it so that we can have that Is the government involved enough? Because a lot of this stuff, you know, you're doing it private you have private money. You got two hundred million dollars, is that correct, from Larry Ellison? Um is it possible to do it without the kindness of billionaires at this point? I mean there listen, NIH still is the biggest funding body of science on the globe by far . NIH and many of the other organizations and the government and other foundations are funding many things with innovation and health care. So it is very doable all of these ideas and these frameworks. And I think we need to do it. All right. Doctor Agus, I really appreciate it. You're a terrific doctor. I really you you uh you really did help me get that surgery I desperately needed. Well I'm proud you. I mean first of all you stood up and you did it, but also talking about Yeah. And so it's a heroic thing to do and I appreciate that. Yeah. Well when I had more kids, I kinda had to I had to do it. It was such a stupid thing to die of. You know. I'm waiting to get murdered by one of these tech billionaires. That's Okay. Thank you so much. Thank you, Car . We'll be back in a minute . Support for this show comes from Kohler Health. What if the most routine part of your morning could give you valuable insights about your health? Kohler Define the Modern Bathroom. It's where your daily routine already happens. Now it's bringing health tracking into that same space. That means automatic insights into your hydration, gut health, and irregularities that often signal a flare-up. How? Kohler Health Dakota slips seamlessly onto your toilet and passively captures your everyday biometrics. Without any manual logging, you'll see hydration and digestion patterns and even be alerted about the presence of blood in the Kohler Health app giving you a clear picture of your internal health and helping you build habits that truly work for your body. I'm very excited actually I have a lot of these things like the aura ring and an Apple Watch and things like that. And it's actually something used in other countries. And so far I just installed it into it. It was super easy to put on. Now I'm really eager to find out how healthy I am and and figuring out ways I can make changes for my health based on the information I learned. So learn more at KohlerHealth.com and use the code CARA1YEAR for a free annual membership to the Kohler Health app when you purchase Dakota. We're back now with a conversation with a panel of people I trust very much to go deeper into the role doctors are playing in medicine right now. The first is Jason Braun. He's the founder of Title Elite Performance Center in Washington and a certified personal trainer. He's my personal trainer in addition to being very knowledgeable all things training, he has a wicked sense of humor, as you'll hear. He loves to insult me, so I'm sure all of you will enjoy that. He's also incredibly straightforward about things. He doesn't go for ridiculous trends. He's very interested in the science of everything, and I appreciate that. We're also joined by Dr. David Daniels, a cardiologist at Sutter Health in San Francisco and the founder of Solo Pace. He's an innovat or in his field and has developed many new surgical techniques. He repaired the hole in my heart that led to my 2011 stroke, and I'm forever grateful for that. But I really appreciate it because he's an entrepreneur doctor, and I think it's really important that doctors start to think a lot about the business and try to do things 'cause they know best 'cause they're on the ground what to help patients best. And a lot of medical devices, a lot of medicine right now is done by people who are not in the field as Dr. Daniels is. And finally, Dr. Ezekiel Manuel, an oncologist by training and vice provost at Penn. He's also advised the Obama administration on the Affordable Care Act, and he's someone whose opinion I very much respect in health care, health policy, and wellness. For people who don't know, he also is an excellent honeymaker. It's actually something he does to improve his cognitive health. If you do difficult and challenging things that you're not used to, it's really good for your health. He uh has written a book called Eat Your Ice Cream, which is about this and other things that he does, and he's just very funny. Uh gentlemen, welcome to the show. Great. Thanks for having me. Yeah. Thank you. So this is a series about longevity health span medicine technology and we'll get all into that, but I wanna do quickly here at the start, uh I I want the single best piece of advice you can give someone to lead a healthy life. I know The most important thing is to uh have family and friends and to uh participate with them. Um I like to think of uh doing what I call wellness trifectas. Do one activity that has all of it rolled together. And for me, that's a dinner party. Because you've got friends who are coming over, you usually have very good, uh interesting conversations that keep you mentally sharp,. plus Plus you're eating good food and enjoying yourself. So that gets most of the wellness you need right there. Right there. All right, Jay. Um I I'm sure you'll be shocked to know that that I'm gonna go with resisted activ ity. I mean you've gotta load your body and you've gotta exercise regularly and that's more than two or three times a week. Exercise has to be part of your life and um a bunch of that has to be done properly with resistance. Resistance. So strength training is what you're saying, essentially. Sure. Yeah. Resistance training. All right. Dave? Yeah, so I'll I'll second that and I'll make it maybe a little bit broader and tie the two together. So I think um movement , food , and consistency. Right. So you know when you when you think about what feels good to you in your in your body in those in those moments that you're like, wow, what I what what I just did was was good for me, right? You you can tell. You gotta move, right? And that's everything from flexibility to resistance training to cardio . You have to, right? We're just an animal, like animal running around outside my window here. But it it doesn't work out unless you do that. Food is important. You know, there's as we all know, just so much trash out there and you can tell, right? When you quiet yourself and you eat something really good, you can tell the impact on your body. And then the third one I think is incredibly important, which is consistency. We're such creatures of inconsistency, right? We go on this, you know, uh uh orange theory, you know, run for four weeks and uh, you know, to make our little uh scorecard, and then we go try a different program and a different program. And I think it doesn't really matter what it is. And those can transition, but I think, you know, the right food, the right movement and do it with consistency. I think that's important for for longevity and for health. So the reason I wanted to talk to this group is to explain why conversations with doctors and providers and various other people are important rather than the do-it-yourself research world that has emerged all over the place, especially with online uh influencers, etc. And I think most people forget that these technologies and cures they see in their feeds are not just for everyone, may even be dangerous for some people. It's some of them pointless and expensive, but not necessarily good. Zeke, I want you to to explain the role providers and actual experts need to play in this environment. I think part of it is, frankly, that the medical profession has left uh wellness and staying healthy uh off its agenda in interaction with patients. Doctors get paid to take care of sick people um and uh by and large that's what they do . We are actually embarking on a study to look at physician-patient interactions and how often they talk about wellness. But you know, half of the population is basically out of the healthcare system in any given year, you know, e either goes to the doctor once or not at all. And so if all you're talking about is is to sick people, you're missing half the population. And the half of the population that you know really could uh engage in wellness behaviors and preempt a lot of health care problems. And I think this bias of ours, uh, in the medical profession to treating the sick, which is, you know, again, how they get paid, so it's not surprising they have that bias. And not attending to people who are, you know, want to know what they can do to stay healthy is a serious problem. Right. Absolutely. So uh uh Dr. D uh Dave, I'll just say Dave. I call you Dr. Dave. I'm gonna call you Dave here. So fixed my heart. Okay. So let's let's talk about the danger' gsetting it wrong and and i in that same question for you. People might say, Well, I'll take this supplement or that drug, I'll it doesn't stop it, it'll uh I'll stop it if it doesn't work. Donald Trump famously said what what do you have to lose when he was asked about taking malaria drug during COVID-19 pandemic. Now it's it's not always such a high profile example, but it could be over the counter. Talk about what people have to lose. I mean Dr. Google I know drives my brother crazy. It drives a lot of doctors crazy and you must get even you, a a specialized cardiologist, must get the same thing. Yeah. It's also it's also a doctor chat, yeah. And and deep dives on on uh artificial intelligence platforms and that's uh you know in another interesting spin. Um so one thing I'll say is that medicine is completely malaligned from wellness um in the in the sense of everything is problem-based and what can be billed for and what can be coded for, right? So the construct by which we approach patients that's sort of forced upon us by the infrastructure that we live upon in is related to what's their problem, what's the procedure, what's the treatment, right? And and sort of documentation that just sort of supports supports that. So but when you come to me, Cara, with a problem , you're not coming with like the coding manual , like I've got this code, and you know, it's like a computer just puts puts it out. To your point, you're coming with a set of questions in which most intelligent people have talked to friends um and have gotten on Dr. Google, right? And and and tried to sort of figure out what where it is. I think the challenge comes in um with respect to context and at least for the foreseeable future, you know, what my , I think I once calculated it, I made it through 29th grade in the traditional grading system. Uh all that education actually doesn't mean much. It's the experience that comes after when you actually get into practice and you're dealing with real humans with real problems and trying to gauge what that problem and this is the art of medicine gauging how that problem impacts the human in front of you, how impacts their life and how you can either improve that life or not with the particular service or procedure or whatever it is that you that's the art of medicine. That's what AI is not going to be able to reproduce for a while, right? Um that's what we um need to help our patients understand. In that vein, Jay, tell me an example of knowing someone's health and injury history, as Dr. Daniels just talked about, that led you to make a decision in guiding them. Because you can use me as an example if you want, but I mean the your industry is plagued by all manner of change all the time. Not just diet, but exercise Packaging issue. Fitness and lifting and training, and it it is it's it's such an enormous part of that whole Instagram and influencer popul ation that that we have such an impossible time with trying to figure out, okay, well, it as a trainer, it's it's who's the person that's in front of me, uh, what are their goals, what do they actually even have available to them to use? And then how much of this stuff can they tolerate? And you have to answer all those questions all the time when you're in front of your clients. Now, unfortunately, health and fitness right now is completely dominated by people that are attractive. It's as if everyone was to pick out their dentist by whoever had the nicest smile. And it's like you got a great smile, you're gonna be my dentist. And that's how they pick out trainers. And that's how they get information. And it's like look at the look at the delts on that dude. I'm gonna listen to what he has to what do, he says . And unfortunately, our bodies are so amazing at adapting and overcoming challenge and stress until they're not, but they're so amazing at that initially that you could see some absurd workout and a hundred people could see this absurd sledgehammer hitting a tire, then flipping the tire over and then doing backflips. And you could have a hundred people go try that and ten people will get amazing results. Forty people will have to go to get orthopedic surgery, and then the the what whatever's left is gonna be somewhere in between. But those ten people are gonna swear by that workout, they're gonna then get that body and now all of a sudden that's the workout that they tell everybody to do. Right. And then unfortunately, whatever someone gets told, it doesn't matter the expertise I have, and I'm sure the doctors have experienced this. As a trainer, I'm just a trainer. And so I could give someone the most sound, reasonable , understanding, and and bona fide evidence-based response to a should I wear this Velcro scuba suit around my waist to give me abs And if they have two people that tell them that they should, doesn't matter what I say because they want to hear what they want to hear. Right. Right. And their body could respond with that. Can I draw an analogy? First of all, you know what I'm thinking to myself when you're talking, which is like if that's how they pick the dentist and the trainer, how do they pick the heart surgery? You're very handsome, Dave. That's how I did it. But I'm listening to Jay here and I'm thinking to myself, there's a there's a bit of analogy to what I was talking about, which is that I could go on a fitness website, right, and I could say the sledgehammer tire, I didn't really follow it, that bang, that looks good. I don't try it. But you know, the thing that that probably rings true and if to most people and if it doesn't, once they experience it, I think they will become a convert, is that I suspect that I could go to you, Jay, and you can look at my body, and you can look at the way I lift, and you can look at all the things and say, okay, this is what we're gonna do here, right? And that's you know, ultimately what Dr. Google or fitness Google can 't do, you know, or your influencers, is give people that sort of personalized um analysis of their situation. And I I think that that that's the same in medicine, right or can I dissent a little bit? I am not a big advocate of that much personalization about the the the general rules for staying healthy and uh well . Um they're pretty clear. Um, you know, no one should be eating ultra-processed or a lot of ultra-processed foods. I don't care who you are, I don't care what your biology is um, you know, uh fruits and vegetables, uh certain amount of protein. There are outliers to everything, but most of us, and most of us I mean 90 plus percent are pretty similar. Exactly how much weight you have to lift or how much of uh how high you have to get your heart rate. Again, there are pretty good general rules. It's going to be some tailoring, but it's not that much tailoring in most of tailoring. Most of these are I'm gonna strongly disagree with you. It's all contextual in the sense of listen, I have a micro tear in my my my rotator cuff, okay? And it's been bothering me for a few years , right? And if I just don't pay attention and I go on look at the influencers saying, hey, do this and I'm like this mindless bot, right? Then that's a problem, right? And I think that the truth lays in the middle in the sense, which is always true, in the sense that there are general rules to live by, right? But I think around the edges of whether it's training or, you know, you've got 15 problems that you're going to the doctor for, which is the one that actually is most likely to that's I think where profession als and those with experience in all these different fields can provide value beyond the AI. And that's all I'm Okay, all right, Jay. Jay Yeah, and and unfortunately, the one of the problems is is with exercise and with with working out, the the thing the it's an insulting degree of of amount of times that I will be told I oh my God, I went to this class and I had such a great workout, I was sweating so much by the end of it. And so temperature regulation is what ninety percent of the people think that great workouts are. It's just the ability to for your body to uh to unheat itself. But when it comes to specification, doctor, when I when when I would say I would disagree with just with the broad generalization is I think if you take a big enough pie, yeah everything in the middle can be can be usable and yes you you should simply walking and moving around for a broad spectrum of the population could be enough. But at some point there's got to be some kind of challenge that's going to require some kind of adaptation . We'll be back in a minute. Support for this show comes from Kohler Health. Everyone's looking for more information about their health, watches, rings, and monitors can give you a snapshot, but they don't always show the full picture. Meanwhile, what if you've been flushing away some of your most valuable data all along? You probably have. Kohler has spent 150 years redesigning the bathroom. Now its new venture, Kohler Health, is building on that expertise with its Dakota tracker. From fingerprint authenticated sessions to data, privacy is designed into its features. Obviously, it's very important in this case. Dakota fits seamlessly onto your toilet and works discreetly in the background. The Kohler Health app then translates the signals your body is sending so you can see patterns in your gut health and hydration and get flagged when there's blood present. That's really important . I just installed it and it's gonna be really interesting to see because I use a lot of these different things like these rings and watches and things like that. It's really important so you can make changes to your diet or whatever else you need to do once you learn this information. Learn more at KohlerHealth.com and use the code CARA1 EAR for a free annual membership to the Kohler Health app when you purchase Dakota . Let's get a little reality check about how people seem to have gone a bit crazy with health in a lot of ways because of bad information and it's one of the themes I touch on a lot in my series. Um I'm gonna read a couple of headlines and just ask each of you to react to them. Um I'm gonna direct them to you specifically. Okay? Just briefly. The test. What to know about okay it's a test. What to know about the risks of protein maxing Zeke. Is there a reason for someone should eat protein to the exclusion of all other things? And I know each of you has an opinion if you want to work quick, but Zeke, you get this one first. Look, uh people should get about 1.2 grams uh of protein uh per kilogram of body weight. So if you're a seventy uh kilogram person, uh that's you know somewhere around eighty-five, ninety uh grams a day. Uh here's the secret. Almost all Americans get that, no problem. Uh you get it from meat, and on average Americans eat ten to twelve ounces of meat a day. Uh you get it from beans, you get it from dairy products and all sorts of th ings. Uh there are two uh exceptions probably to that broadly. One is, you know, if you're training for an Iron Man or, you know, the twenty bridge swim in New York or something like that, you'll need a lot more protein. Um and as you get older you lose protein and so as you get older you will need more protein per kilogram over s uh uh roughly sixty years of age . Real deficiency we have in our diet in America is fiber. Ninety-three percent of Americans don't get enough fiber in their diet. Um and that's really important for the microbiome for the good bacteria to grow. You need a variety of lengths of fiber and it also coats the colon to make sure that it's protected. So you know we're emphasizing the wrong thing at the exclusion of what most people don't get a lot of fiber maxing doesn't sound as sexy. Dave, this one's for you. The cholesterol deni ers. Uh, this is about the anti-statin movement. Right. So there are these drugs called stat ins. Um, lipitor , great example of of that. And that sort of spin this belief that you know it's all about big pharma and that's who's pushing all this down our throat and all this stuff. Well, got news for you. Lipitor, the generic is torbostatin, has been generic off patent, off anybody can manuf acture it, right? It's about whatever manufacturer can make it the cheapest, and that's who gets the content. This is not something that's getting driven from a profit perspective. What is absolutely true about these statin drugs is that they do have side effects. Okay? They have known side effects, whether it be a very common side effect like muscle soreness that is completely reversible when you stop taking them. Um a less proven but interesting um uh concept around uh uh cognitive changes, right? That that may or may not be true and there's been a lot of data against um that it's just cohorting because it's the same types of people that that have cognitive problems that have heart problems. But what is definitely true about this set of drugs is in absolute terms, they decrease the risk of a stroke, a heart attack, or dying from the same. And if these people don't take these drugs , they are sort of willingly flushing that down the toilet and significantly increasing the risk of a major problem down the road. All right, my favorite here is Is the secret to men's longevity a great butt? Jay, answer to that question. Did you see that story? Men's butt. Like if you have a great butt, you will have longevity. It's always peach season. That's the yeah. Of course it would why wouldn't it be? Well, it's again, because of the packaging that my industry has. Yeah. The the biggest problem is getting people to do exercises. And so for women more specifically than men, doesn't matter the exercise, if you just tell them it's good for their butt, they're gonna do it. Could be push-ups, could be bicep curls. It's just a matter of getting that in. But what about men's log ic? This is a new thing that was in the Wall Street Journal that men are c convinced that your butt So So I I wonder if it goes uh if it's if it goes with the uh grip strength being the uh the the center of longevity, not the fact that like having good grip strength means you're probably low with arthritis, low arthritis, you've been exercising for a lot, you have like good mobile joints, and so that leads to the health, but they're using the grip strength as the reference point, which has nothing to do with longevity. So a good butt? Anybody well so no, so what what goes with a good butt? If you if you have a good butt, you have strong gluteal muscles, which probably means that you can stand erect, which probably means that you're doing a great job at of of not of uh fighting gravity and winning. And uh and you can you can stack your bones so that you can move efficiently because the further pitched forward you are, the more stress you have in your spine and so then all of those other things sort of go along with it. And so yeah, uh having a good butt means you stand up better. So you snack your head over your hips in order to Okay, so we're four men's good butts. Okay. Okay, I want to switch gears to finish up. We talk about some things promising things that are happening l in tech and and AI, et cetera. Although the tech people behind this are always saying, oh, this will cure cancer, this will end all disease. That's one of their favorite things to get up there. I just saw a panoply of tech people who have no medical expertise predicting the end of all disease. And when you press them on it, they of course back off or qualify it somehow. And but there's still some reasons for optimism. Zeke, what's something you're paying attention to or impressed by? And then Dave I'd like you to weigh in here too. I am actually pretty bullish on AI. It's not there yet, but I do think it is there's a lot of good indications that it will uh really augment almost everything doctors do. And the area I'm most excited about is the possibility that it could help patients manage their chronic illness. AI could intervene every day with patients who have hypertension, high cholesterol, diabetes, and help them manage better autonomously without doctors necessarily . is is going back to the to the GLPs. I mean honestly, if I have to look at the impact this drug has had on my patients , diseases, wellness, all of it. And I watch patients literally trim their med list from ten meds down to three meds. I mean, how can that not be good for you, right? All right. Okay. Now, Jay, what about for you? What do you look at? I know you laugh and joke every time I bring in one nutty thing, although I'm apparently right about butts. Um what what do you see in the space that you think would be helpful for someone in your like because you're you're with people day to day. You have a bit more I talk to you more than any of the doctors I talk to in a lot of ways. Yeah. mean I think I think we talk about a lot um getting those uh getting those those numbers and that data set um about you personally and about what you can do and about your body and about how you're designed that kind of thing cellularly. I think can be can be really good. We did a VO2 test on you. That was fun. Letting somebody know how efficiently their muscles can actually use and produce oxygenated blood can be real helpful when it comes to that person's uh exercise plan. Now, it's expensive. And so how do we how do we get to a place where that's something that that more people can do, that more people can take advantage of. Because unfortunately, the stuff that's the stuff that gets marketed and sold right now from a technology basis is just junk. It's just junk technology. It's it's vibrations and wobbly and then it's just a very good idea. Yes, I did. Excellent. I I I haven't told her yet, but I adjusted the metrics so that we get down to the street. But not stupendous. So I we're Dave, one of the things you've done is you know that you're an entrepreneur. You're creating you're you're sort of trying to see ways to make things cheaper in terms of the things you're making. Um just really briefly explain what you're making and and what is what are the what's standing in the way of faster progress for innovations, especially for medical people with the CDC, the FDA and so on. Um my first company was about making a procedure that we do very commonly in the United States called transcatheter aortic valve replacement, where we replace the aortic valve in 2 minut0es going through an artery in your leg, making it simpler based on a specific part of the procedure that we need to pace the heart very, very, very fast for about 15 seconds while we implant this valve. So my first company was about making a medical device to really facilitate that and make it purpose built. The second company we're lifting off the ground sort of as we speak, which is if you look in this country, about 10% of people who get at their valve replaced, you need a pacemaker. And trust me, these things can cause all sorts of long-term problems if they're not needed. So what we've learned is that of those pacemakers that go in every single year in this country related to the valve replacement, probably 80% are unnecessary long-term. So the second company that we're, you know, just kind of getting moving, it's it's called PaceNet, we're developing a temporary pacemaker to allow the surgeon to implant it to be cheaper for the healthcare system significantly , to be better for the patient because they'd get a therapy in a time-limited manner and then to get it out within 30 days and not burden them with all of the complications and and downstream problems of a permanent pacing device. Trevor Burrus So if you look at um for example drug development, we now have AI that's facilitating developing and designing the drug. Um and then we've got The first slow part is really an attitudinal part on the par on uh behalf of Americans, which is you know, I don't want to be in clinical trial. Someone else should take the risks and I'll get the benefits. Um I think and and so enrolling people in clinical trials is ground I won't say ground to a halt. It's slowed and it's the rate limiting step of conducting trials to see if something works or doesn't work. And it's a serious problem. I think Americans have to understand that they get the benefits of all of these miraculous innovations. They have to participate in the trials. And the second is we know in during COVID, the FDA was able to review uh applications for new drugs, new uh devices very, very quickly. Instead of taking, you know, a year and a half or something to look at the data and and massage it and talk to the company about the data and r uh analyze it, you could do it in, you know, a couple of months. It that's partially manpower, it's partially expertise. Um uh but you know it doesn't help that the FDA summarily fired thousands of people with expertise. We actually need to build that up because getting things out the door faster, reviewed more quickly is critical, right? Uh it changes the economics, so therefore the pricing of things. It changes the incentive of inventors. And you know, every minute that we're wasting is is money for inventors, but also the healthcare system and patients might be deprived of real breakthroughs like the GLP ones. So last question for Ichue, what's the single most significant health breakthrough of the last five years? Could it be research, product, and idea that's taken hold. If we think back, you know, 30 years ago, the only way to to to affect the the function of somebody's heart valve is open heart surgery. And you know, what does that look like? Well it's pretty gruesome, right? We literally open your chest, saw through your breastbone , put tubes in your heart, run your blood through an external circuit with oxygen and a pump. We stop your heart for anywhere up to 45 minutes to five hours. We do the work and then we try to put it all back together. It's a lot of trauma on the body, right? And about uh thirteen years ago, a technology called transcatheter or valve replacement cavra allowed us to replace one valve um without open heart surgery by going through the leg. Takes me now twenty twenty minutes to do that procedure, literally. So Jay, what's the single most significant health break through the last five years from your perspective of in training? Aaron Powell It's the fact that doing what I'm doing effectively for people is hard work. And we unfortunately societally look for quick and now. I think some of the innovations that are coming out um as far as the ability to now uh get really portable resistance um the the expansion of people using bands or um electronic resistance, which is a really small kind of you know, you can get 80 pounds to a hundred pounds of resistance in a small like lunchbox size thing that you can attach to anything and you can manipulate all the the profiles to create as many different exercises and resistance feels as you want is really cool so that it's it there's a there's a component of opening up the ability to go do something where you're not attached to a gym where it's like in order for me to get good workout, yeah, I've got to go to this gym with all these different pieces of equipment. I I can get this thing either for my house that I can take somewhere outside or I can it just it just makes makes resistance training more more . Right. So it's not as costly, right? Not as costly. And and it's really the and I I mean again it's it's really about it's not lifting weights as much as challenging your body with resistance, whatever that is. All right, Zeke, you finish up. Well, I I think from a biomed ical science standpoint, there have been a lot of breakthroughs over the last uh five or ten years, which are pretty amazing. Gene therapy, you know, having a baby get CRISPR and be cured of not have to worry about their disease. Um that's pretty amazing stuff. And you know, it uh like Dave said, it was science fiction not too many years ago, or CAR T therapy that we've developed at Penn here, and you know, taking people who are literally on their deathbed from cancer and you know , as best as we can tell, curing them. I mean, those are pretty amazing breakthroughs that I think we don't stand back and appreciate enough how just uh magical they are. Um but from a popul ation standpoint, they're not going to change the health of the population. The things that you know we need to do to change the health of the population really are the basics, you know, get people to be more social, get people to eat better. and uh balance and flexibility. I mean those are are the basics. Um and I do totally agree with Jay. One of our problems in society is we want it fast. It's like dry January as if that's gonna make you healthy. You know, wellness is about a lifestyle, it's about a habit that you're gonna be able to do for decades. And changing that mindset in the population so it's not, you know, take rapamycin and it's gonna make you live forever. All right. On that note, uh thank you so much, all of you. All right. Thank you, Kara, so much for having me. Thank you Today's show was produced by Tracy Hunt, Emma McNamara, and Dave Shaw. Nishot Kurua is Vox Media's executive producer of podcasts. Our engineers are Fernando Aruda and Rick Kwan and our theme music is by Tracademics. 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