Systemic Barriers to Universal Health

You know, the hyperbaric chamber stuff. I go into one. And I was like, There I th what did you think? I was like, Are you fucking kidding me? Unless you have the bends or a wound, I wouldn't recommend it. You know, oh, I get tired. I was like, you don't need more oxygen. Just breathe . Hi everyone from New York Magazine and the Vox Media Podcast Network. This is on with Kara Swisher and I'm Kara Swisher. My guest today is Dr. Eric Topel, a cardiologist researcher and the founder and director of the Scripps Research Translational Institute, one of the largest nonprofit biomedical institutions in the country. Explores the actual science behind anti-aging and longevity. Spoiler, it's not found in pricey supplements. Dr. Topel is a physician scientist and an expert leader who oversees millions in research funding. He's uniquely positioned to distinguish the real breakthroughs from the hype and offer guidance on a topic rife with pseudoscience and fraud. It's also a timely conversation ahead of my new CNN series, Kara Swisher Wants to Live Forever, premiering this Saturday, April 11th. It's gonna go on for six weeks. It is full of science and evidence and proof and reporting, and I urge you to watch it. But mostly I want you to listen to Dr. Topel because he is articulating exactly what I was trying to do, which is in this world of wellness grifters in people that are offering instant solutions to very significant health problems, there needs to be people who break through all this noise and show you the signal, which is there are amazing breakthroughs. So let's get into my conversation. Our expert question today comes from Amy Laraca, journalist and author of How to Be Well, Navigating Our Self-Care Epidemic, one dubious cure at a time. She's also in the documentary series. It's an important conversation. We're going to be having it for a while, listeners, so stick around. If you're tired of endless scrolling to figure out where to eat, same. I'm Stephanie Wu, editor-in-chief of Eater . We've just launched the new-ish and way better Eater app. It has all the restaurants we love, gives you personalized picks wherever you are, and serves up smarter search results just for you. You can find my list of the best places for martinis and fries in New York City. And save your favorite spots, share lists, follow editors, and book right in the app. Download the Eater app at Eater. app com. It's free for iOS users . Dr. Topel, thank you so much for coming on on. Great to be with you, Kara. So in your latest book, Superagers, you write that we're at a unique moment in medicine where we've seen a quote historic convergence of breakthroughs, end quote, particularly around anti-aging. After a year of reporting on this is exactly the conclusion I came to, except a lot of it is being masked by a lot of nonsense at the same time, which probably happened the last time we had this happen. But briefly walk us through the most significant breakthroughs and explain how they've conver ged because this moment in anti-aging science is different than where we were 10 to 15 years ago. Exactly. It is really a a turning point. The science of aging is where we've made these big strides. So there's a lot of noise out there, as you well know. But the signal is that we can quantify aging and understand the biology much better. So for example, we now have these organ clocks, so that within our body we can tell if our brain is aging differently than our immune system and our heart and arteries and whatnot. So we didn't have anything like that before and so we also understand that inflammation, so-called inflammation, and immunosinescence, the immune system, are big drivers of age-related diseases. So while so many are working on reversing aging, Cara, the real opportunity here is actually accept that we're gonna age, but let's squash the age related diseases since so much understanding has been enhanced. You know, you talked about immunosinescence. Right. Talk about each of the parts you just talked about. It's essentially knowing how to fix age-related things on parts, correct? Or is that kind of too idiotic way of saying we used to think that everything was genetically driven about health span and lifespan. But it is in part, but less than particularly health span, less than had been previously accepted. So i in the book you introduce the concept, which I think is an important one of health span versus lifespan, a goal is to max out our total number of healthy years of life as opposed to solely focusing on longevity. Yeah . So when we looked at, for example, 1,400 people who were almost 90 and never been sick on no medic ations, and we looked at their whole genome sequence, we you know we didn't find very much to account for that. But the immune system seems to be the real e explanation for many of these people reaching such advanced age that their immune system has very high integrity. It hasn't lost its protection against cancer, and it also isn't hyperactive, for example, in the artery wall for atherosclerosis or in the brain to promote uh reaction to these misfolded proteins . So the three big diseases of aging, neurodegenerative, cancers, and cardiovascular, the common threat is that we need an intact immune system, because if we don't, then we start to see this process of inflammation get unleashed. And when that happens, you know, then these diseases go into an accelerated phase. So even though they take twenty years or more to incubate in our b odies, our immune system keeps us healthy. And there's many things, of course, that we can do to promote that. And we got to do even more things in the future. But that's been the biggest breakthrough to understand that the brain, which is the master command central for the immune system, uh, and the brain and the immune system together are largely accounting for this remarkable health span that we've seen in people. Now when you talk about significant breakthroughs, there's a couple I one of them, of course, someone everyone always asks me and I'm like, well friends and family are actually much more important than you think, scientifically and personally. I said, but one of the things is don't be poor and don't be under stress , right? And I don't mean stress is like your husband was mad at you or something, you know, or whatever, you got in a fight with your kids or whatever. It w it was something else. It was sort of this idea of don't be in situations that stress the immune system in that regard, whether it's by food or by sleep. And I was interviewing one of these billionaires, and he goes, well, if people just slept more, you know, and I was like, well, some people can't because they're poor, like, you know what I mean, which is interesting. So maybe stack rank them a little bit for me. Yeah, I mean I think what's going to be the biggest what we start to see now is that AI is gonna make it I think its singular biggest contribution over the ye ars is that it can have remarkable accuracy in prediction 20 years ahead, which leads to prevention of cancers, which now at best we can detect with their already cancer. But we're talking now about prevention. The same for Alzheimer's. I mean we're starting an Alzheimer's trial later this month to prevent the disease. We've never even thought about that before. And also uh for cardiovascular. So uh the fact that we have these markers of aging, that we can track the immune system and inflammation, and we have AI to pull all the layers of data for each person, this enables prevention. So that's the future. Everybody's talk about AI and healthcare, but I think that ultimately, of course not yet, but ultimately it'll turn out to be its singular most important contribution. But otherwise, you know, for example, the biggest breakthrough in neuroscience in decades has been a marker for Alzheimer's disease, P tau 217, which tells us even two decades ahead that someone is really at high risk and it's uh can be modified by exercise and lifestyle improvements and hopefully medications. The GLP1 drugs have outperformed any expectations, and they have become realistically the most potent way to knock down inflammation in the brain and throughout the body that we know, the safest and most potent. So it has diverse potential to even help us ultimately to prevent these diseases. Which require more and more study about it, how as it moves into the population, which it is at a rapid pace. Absolutely. You know, we've seen it have these weight loss independent effects in heart disease, liver, kidney, and even arthritis, osteoarthritis, psoriatic arthritis, but whether it's going to pan out as a prevention for Alzheimer's disease and prevention of these other age-related diseases to be the first extending health span drug that, is obviously has to be proven. That's going to take some years ahead. So giving the the advances in anti-aging medicine, talk about this idea of a health span because I think what people don't realize is most people spend most of their money in sick care, like not health care, at the last many years of their lives. So talk about someone who's healthy at 70. What does that mean? What is the realistic health span in 2026? In certain countries, I've visited Korea because the women there are showing remarkable health spans, um, which is for lots of different reasons, but they're studying it now. But talk a little bit about what that means, a realistic health span. Yeah. So the average American has already one of these age-related chronic diseases by 6 4 . So that's the end of their health span. Whereas the average American has a life expectancy, life span , of 79. So there's a 15-year gap among Americans on average. Of course, many Americans by 64 have multiple chronic diseases. But that 15-year gap is difference between health span and lifespan. And that's why when I saw Kara Swisher wants to live forever, I said, Well, you gotta add uh when I'm completely healthy. If I'm completely healthy. I hope you get the joke. Oh ridiculous. Yeah, no, no, I do. But y you know, the life span, you know, we can keep someone alive on life support forever, but what kind of life is that? So what we really want is to extend health span And you know, I think we're on the brink of that. And that's what's exciting is that preventing age-related diseases will get us that extension of health span. We want to close that gap. That when people are 80, that they live most of their life healthily. Trevor Burrus Standing up, right. I mean Ezekiel Manuel when I interviewed in the show talked about that. He goes, if you had to spend the last 15 years of your life in a wheelchair debilitated, that's not a life essentially. Something else. So you say uh there's a lot of hyper on anti-aging, which you say is misplaced and not aligned with evidence in people. I couldn't agree more. You criticize the longevity lifespan circus, the carnival barker scientists who make and I'm quoting you, make false claims and Hawk's supplements. Talk about what this is and who are some of the ringleaders of this longevity lifespan circus. I have worse words for them, but circus works. Grifters is the word I use, right, grifters. This is deep. There's so many influencers who have such big impact and they're selling they're selling supplements, uh expensive supplements like A G one and claiming, you know, these anti aging properties that have never been proven. They're also now pushing peptides really heavily, none of which have any data. And they have all sorts of other anti cs, but of course they're always admixed with some truth. So it's hard for the public to separate that out. And we have longevity clinics, even at, you know, prestigious institutions that are promoting this idea that we can keep your you pay us enough money and we can keep you with extending your lifespan. You know, so it's all over the place. We even have our HHS secretary as part of this because he's promoting peptides. We have people like, you know, Peter Atia, uh one of the biggest influencers, promoting rapamycin, which has no proof in people, uh cold plung es, protein, out-of-control amount of protein. Out of control. You wrote a great column about that. You know, Andrew Uberman is another key force or supplements. But I always tell people if you really want to have somebody you can rely on, the first step is that they're not selling something. If they're already hawking something or you know, whether it's protein bars or supplements or something anti-aging, because we don't have anything anti-aging, okay, outside of the healthy lifestyle, which you don't have to market that. But if if they are selling something that's automatic credibility question mark. Right. And especially just drill down just very briefly on peptide. That's the latest one. The last test was fourteen people. Like there isn't tests on this stuff. And also the danger of using mixed compound You've touched on a couple of these things. So first of all, right now, most of these are from China. There are some compounding labs in the U.S. that are also questionable, but if you actually analyze what people are getting as one of these peptides, twenty percent of them have all sorts of impurities or are not even the peptide that they're pur ported to be. As you mentioned, they might not be sterile and you're getting these into your bloodstream. So people think I'm just putting it under the skin. No, it's getting into your bloodstream through the capillary network. So it's a very dangerous thing to self inject when there's no proof of safety or of any efficacy that is helping. So it's a misplaced trust and it's also a tremendous amount of confirmation bias, Kara, because these are very expensive. So when you take these injections, and some of them are taking stacks of peptides, why would it not work? You paid so much money. You must feel better from that, right? So it 's just so sad to see. We're not talking about GLP one peptides. We're talking about the Right. No, no, no. I think that the complaint they make is that, oh, it's the FBA trying to keep this from us secretly, which is also part of a plot. Now, when you talk about this, what do you think the biggest problem with these sort of circuses are . Is it that they can reach people more quickly? Is it the new social media environment? I mean this has gone on since Ponce de Leon, like let's be clear. Kellogg's was started as sort of a scheme of serial. So it's not a new and it's not an American phenomenon either, by the way. Yeah, well but that's because concurrent to all this uh, you know, n noise and grifters and whatnot, there has been a big push in the biotech world to try to reverse aging. And there are very intriguing science approaches, like for example, the so-called cellular reprogramming or the synolytics, stem cells and so there are some real science initiatives that are exciting. Yeah, they look good in you know rodents and mice and rats. We have no data in people, and there's some dangers about going forward in people. But the point is so that is helped to take this into center stage. So you have some real science, then you have the pseudoscience marketing stuff, and then you have this other area that I'm most uh enthusiastic about, which let's just not try to reverse aging so much because it may not ever work. There's a lot we can do right now just to have a better life that is longer anyway. So what talk about the upper limits of health span and what age which biology wins in the human body starts to break down, no matter how good medicine gets. I mean, Scott Galloway, we always joke biology is undefeated so far um on this planet. So you studied in two thousand eight the welderly or people who are at least eighty who have never been sick or had a chronic illness. As you noted, more than ninety percent of Americans over sixty-five have at least one chronic disease. So talk a little about the upper limit of this which you're trying to do here? Yeah, I mean I think the upper limit is we can certainly get most people we should be uh uh pushing towards everyone being as super ager as defined by 85 plus , without cancer, without cardiovascular disease, and without any neurodegenerative disease. That's what we should aspire to achieve. We may not get, you know, way beyond that on average. There will be people like Lee Russell, the patient of mine in the book, who just is about to celebrate her hundredth birthday totally intact. But even if we get to most people at 85 with intact health span, you can see that Oh gosh. Just as you say, Kara, the the economic burden is just you, know , i ginormous. And so no less the the health burden. So that's what we should be pushing on. It's you you can see that this is achievable in the years ahead. There is it all t starts with the prevention. So today everything is treat, treat, treat. We have to go into prevent, prevent, prevent, and we never really had the way to do that before. That's what's really new here. Talk about the key findings when we think about aging genetics. I know there was a study published earlier this year in the journal Science suggests that longevity appears to be about 50 percent heritable. If genes can reveal more about aging, how does that shift the focus on longevity research and ultimately impact what research is funded? If the FDI is dicking around on peptides, which they are, what is most important to be focused in on when you're thinking about this welderly population. Yeah. So the genetics of health span is very different than the genetics of lifespan. Because if you're again, if you have those 15 years, that gap, and you're incapacitated one way or another, that's your genetics maybe it has 50%. But the health span, as we've studied in others, has a lesser genomic role because a lot of that depends on your lifestyle . And so that is really one of the essential things which we don't do enough. And hopefully when we have individualized forecasting, we'll do much better. Because before we could say, well, you're at risk for something, but we could never say when. So you could risk for Alzheimer's when you're 66 or when you're 99. That's a big difference. Now we can say when. That's a huge difference. And when we tell a person when, who's receptive, they may actually start really getting on a lifestyle kick, of course, which is not just diet, exercise, and sleep. There's many other factors as you well know. So that's the beginning of a prevention story is when you can forecast accurately . We'll be back in a minute. Support for this show comes from Quince. If your spring cleaning also involves cleaning out that closet, you're gonna want to restock it with pieces that are well made, versatile and last throughout the years. That's exactly what Quince offers, elevated fabrics, thoughtful design, and pricing that actually makes sense. Quince makes beautiful everyday pieces using premium materials like 100% European linen, organic cotton, and super soft denim, with styles starting around $50 . Their spring pieces are lightweight, breathable, and effortless, the kind of things they say you can throw on instantly and look put together. Quince works directly with top factories, cutting out the cost of the middleman, so you're not paying for a brand markup just quality clothing. I have gotten Quince, I love Quince. Acallytu I, just got a cardigan for spring. I think I look great in it. I also got a pair of jeans that are incredibly comfortable. Now I look kind of nice when I go out there uh for the my spring jaunts that I do. And right now they have a lot of great seasonal colors and prints for spring that'll make getting dressed a breeze. Refresh your spring wardrobe with quince. Go to quince.comslash cara for free shipping and three hundred and sixty-five day returns. Now available in Canada too. Go to Quince Q I N Quince dot com slash Kara Support for this show comes from Delete Me. Delete Me makes it easy, quick, and safe to remove your personal data online at a time when surveillance and data breaches are common enough to make everyone vulnerable. It's a terrifying reality that this is something Delete me can help protect you and your family's personal privacy and the privacy of your business from doxing attacks before sensitive information can be exploited. I have been using Delete Me for years. I think it's a great experience. I find out a lot about myself online, much of which is untrue, but at the same time it's collated in a way that's really troubling. It's really important to get a hold of your data and I use their very smart dashboard. Last year the New York Times wire cutter named Delete Me, their top pick for data removal services, is not a surprise, so might be the time to try it for yourself. Take control of your data and keep your private life private by signing up for Delete Me now at a special discount to our listeners. Get twenty percent off your delete me plan when you go to join delete me dot com slash cara and use the promo code Cara at checkout. The only way to get twenty percent off is to go to join delete me. com slash kara and enter code kara at checkout. That's joindeleteme.com slash kara k-a-r-a code kara . So now might be the time to try it for yourself. Hi everyone, it's Kara Swisher. I'm excited to put something new on your radar from the Vox Media Podcast Network. It's called Project Swagger with the one and only Robin Arzon, and it's all about helping you trust yourself, level up your mindset, and actually make the changes you've been thinking about. Robin is Peloton's vice president of fitness programming and head instructor. She's also a 27 -time marathon and ultra-marathon runner, founder of Swagger Society Media Company, and a two-time New York Times best-selling author. In under 30 minutes, Robin shares the rituals, routines, and mental shifts that fuel her hustle and show you how to apply them in your own life. In the very first episode, she opens up about the moment that forced her to transform her inner voice and the strategies that helped her become what she calls a self-talk You can find Project Swagger with Robin Arzon on YouTube or wherever you get your podcasts. New episodes drop every Tuesday . We've known for a long time that as you said, factors like diet, exercise, sleep play a big role in long and healthy life. And actually I say that people like, yeah, yeah, it's not the most important. It's a combination of all of them. I mean, to an extent, don't eat fried foods and don't not sleep. Like welcome to Donald Trump. But you've expanded the concept to what you call lifestyle plus to include other factors. You write about the often overlooked heavy influence of big food on our health, ultra-processed foods, something the only thing I think both of us agree with Robert Kennedy Jr. on, but that's kind of a duh kind of thing. Let's start with that. Talk about the f the big food and ultra processed foods first. Yeah, so this is a big part because um bad food intake or beverages can promote inflammation and also knock down our immune system. So we have to pay a lot more attention to that. And America is the highest consumption of ultra-processed foods, and acknowledging that not all ultra-processed foods are bad, but within that group, there are some that are really noxious, that really rev up inflammation in our body. So we want to minimize those. And there's things that we could do to change that American diet to make it healthy and it doesn't align with what changes have been made recently. So it is up to the individuals to avoid ultra-processed food or should there be legislation and regulation to curb the abundance of ultraprocessed food in our diets? Yeah, so big food is of course in command here and it seems to be beholden to the Department of Agriculture and our government has really not done enough to take it on, of course, uh, has tremendous lobbying power. But what we want to get out there is that we know the diets that are anti-inflammatory, that are Mediterranean and plant based, of low red meat content, um, you know, trying to eradicate the harmful group within ultraprocessed food. So getting that out without the distortion that we're seeing, you know , currently is important . So, you know, animal protein overall is not our best source of protein. And also don't want to overdose on protein, because if you take too much of that in, particularly the animal derived , you're going to promote inflammation too. So the balance of food is really important. And we're way off as a country. Yeah. The reason I went to Korea is because I went to a school where they were feeding the kids. Astonishing lunch. There was rice, of course, but they but there was also fermented foods, uh miso, healthy proteins, tofu, miso. Now they do eat junk food too, but it's a really interesting basis and every school had a nutritionist. It was really quite something to watch. Like why aren't we doing this? It's that's exactly what should be done. Yes. Right, exactly. But moving on from food, the in the book you reference a quote, outspoken forty seven year old sentimillionaire taking over a hundred and ten supplement pills a day. I think I know who you're talking about. New research suggests the roughly two hundred and nine billion dollar global market for dietary supp lements is projected to double by twenty thirty three. Talk about why so many people are convinced that vitamins and supplements are effective ways to increase our health span. Now let me just say some are good for you, but often like for example, someone was eating a fish oil supplement and they're like, Kara, what do you think of this? I'm like, it's fine, but eat a piece of fish would be a better choice. Like I guess if you're not eating fish, and it's not a bad supplement necessarily , but you know, and there's a couple that are probably a good idea. Talk a little bit about that, because they get mixed in with the ones that aren't. Yeah, so this supplement part is really where the gaps are. The vitamins, uh I mean if you include something like a multivitamin, which has at least uh some randomized trial data, a bit, it it doesn't have a big effect in older people, but it has at least a small benefit. But when you get into the supplement side, unless you have a deficiency, if if you're a healthy person and you have a good diet as you alluded to, you're better off to ha get those uh things from your diet, from your normal intake, then you know t you'd have to take a lot of uh omega-3 fish oil supplements to get what you could get in your diet. If you just concentrate on a uh on the right diet, that takes out the supplement story, you know, and you save a lot of money. Are there any supplements you think are worthwhile besides uh multivitamin, which I think maybe, maybe not, is what I've come to the conclusion. Well, the one that's gotten so much play in recent times is creat in. And creat in, you know, the only data that really exists that's solid is that if you work out, you do a lot of strength resistance training, it'll reduce muscle soreness afterward. But beyond that, does it help the brain function or other things? We don't know. The data are inconclusive. So that one has lots of attention. People are all on this creatine kicks, high dose creatine. There's just nothing to support it. Right. No, I I do accredition after I work out. That's the exact time. That's the only thing I use it for. And one people are like, oh, you're taking it. And I said, only for that. What what's interesting about the supplement is they think it's gonna solve twenty other problems, right? I'm like it's good for that. Or, you know, the hyperbaric chamber stuff. I go into one and I was like they're uh th what did you think? I was like, Are you fucking kidding me? Unless you have the bends or a wound, I wouldn't recommend it. You know, oh I get tired. I was like, you don't need more oxygen, just breathe. Like I it was it was really interesting and I did it on purpose to say this is fucking ridiculous. Even if it's you know, uh the same thing a lot of them, all of them. I did a cold plunge. I'm like i it's fun , I guess, or a sound I did a sound thing. That's a stress test for heart disease. That's correct. Um you did v your b blood vessels totally constrict and if you have atherosclerosis in your arteries of your heart Yes. Yeah. So to advocate things like that with no dat a, particularly where there's danger, it's great that you're on this because you all have the anti influencer uh impact. Yes, that's what I am. I'm the opposite. I'm ups but some of them like are if you have work out a lot for your team, sure. Sure. Why not? Like or a multivitamin, you're not getting enough fish, sure. Right. That sounds good. But the thing that gets me, Kara, is they just making up doses of it. So, you know, uh they'll say, oh, take three times the normal creatine and then it'll do all these other things No. Because there's show me the data. Yeah. More means better. So you include environmental tox ins, which I think are is important in the lifestyle plus, which include factors like air pollution and microplastics. You write it was one thing to document the pervasive presence of microplastics in our air and water, but another to find it in our arteries, brains, blood clots, liver, gut, lung, plastic So talk about the solution for regular people who don't have a lot of time and money, because it often we feel like we're surrounded by ultra-processed foods, plastics, and toxins. Yeah. Well the the micro-nanoplastics worries me because as a cardiologist to see the remarkable study of these microplastics in the artery inducing, you know, vicious inflammation locally, and then a four to five fold higher rate of heart attacks and strokes, uh, in the follow up of a couple of years. Uh this was study to me, there are others, but that really took the plastics worry to the highest level, and we're not doing enough to to try reduce that in our air and our water supply and whatnot. So the what you're bringing up is central in that our inequalities, that is, the people who have the worst exposure, air pollution, microplastics, forever chemicals, um, the ultraprocessed foods, they need help uh of all the folks. They're the ones that have the highest burden of this. So we have to really work on that. And that's not been part of the uh longevity mainstream. It's all about catering to the affluenza , which are the people who don't need this the most . It's it's the people who are uh in the lowest socio and econom ic category that are the ones who are most to benefit. Aaron Powell Yeah. One of the things it spends I spend a lot of time talking about inequality, actually, which is, you know, I I think w I interviewed a doctor who's working on obviously CRISPR and sickle cell anemia and I it was it one uh she said, you know, if Elon Musk got sickle cell anemia, you'd be sure this would be a very inexpensive process, right? And now two million dollars is very expensive and eventually it won't be. But um but one of the things I kept stressing them is that really like everyone was like, What's the answer? I'm like, don't be poor. And they're like, that's not a good answer. I'm like, I'm sorry I can't sell you a supplement, but really the biggest dip in longevity has been among those who are getting killed by obesity with processed foods in polluted areas with enormous amount of stress. Homelessness is a health issue. No question about that. If you think of it that way, then it's economic to me. So every episode we get an expert to send us a question. Let's hear yours. Hi, I'm Amy LaRaca, the author of How to Be Well. My question for Dr. Eric T op el has to do with the inform ation that last week the American Heart Association issued new dietary guidelines that directly contradict the dietary guidelines that were issued by Robert Kennedy . And given that so many doctors have their own proprietary lines of supplements and protein powders and other nutritional products. Where in the world are Americans meant to look for safe, reliable health and nutritional advice to increase and improve their health spans. Yeah well that's a great one because firstly the American heart as you might imagine got it right. Uh they actually had evidence based guidelines about diet as opposed to what was done through So if you want to follow where there's the facts. Explain the difference between them. Between what RFK said what? RFK is, you know, been advocating well, uh fat, um the wrong oils, you know, raw milk. I mean stuff that's just you know loony tunes. Now some of it is right, that is we want to foster the high consumption of fruits and vegetables and plant-based uh but to have meat, red meat, which is advocated by HHS, is wrong. We it's okay to have red meat , but it should be i infrequent rather than something that you should have at the top of a food pyramid, right? So some things are just completely unfounded in the current, uh hopefully short term US HHS, whereas the American Heart went through all the data and that guidelines piece is is well done and it sets the record straight. The problem, of course, in general, I mean, you you brought up some of the people like Brian Johnson and then there's Gary Breca and all these people. And a lot of these are very close to RFK and having a effect even on him. Is that they have ideas that are not substanti ated by any evidence. And this is of course really unfortunate. But you can tell that the basis for ideas are things that they're selling typically. And so that's where you really elimin ate the uh the lack of evidence combined with, oh, you can buy this supplement or you get this peptide or whatever. Then you already know that you stay away because it's just not going to help you to follow a person or you know a a group that's working in a fact-free world. And we have a lot of really good evidence for these things. Yeah, the American Heart Association basically said to eat a Mediterranean diet heavy on legumes, fruits, and vegetables, whole foods, and light on animal proteins. Not getting it out of your system, it's just lighter on it. Get your protein through fish or you know spinach and your fiber through whole foods like an avocado for example people don't realize how full of fiber an avocado is for food. Oh yeah yeah fiber maxing that's good uh f fruits vegetables legumes, great. Um and yeah, protein great from fish, uh obviously many other great sources, yogurt, uh tofu . So there's so many great foods out there that provide the the kind of ideal intake that is anti-inflammatory. And we have randomized trials for the Mediterranean or Mediterranean like diet. We have huge cohorts followed for 20 plus years that show the people that have the greatest health span are people that are help are following a very healthy diet. So it this is there's pretty much this is incontrovertible, but what's happened is that we have some actors who are trying to subvert what the evidence shows. Right, right. In order to sell things. I mean I did a long interview with Brian and I said, you are a study of one, which means mean it's meaningless. He's like, I'm just sharing it. It doesn't matter what your experience is. It's sad, but you know what's really bad about this, Cara? So for example, he and uh Atia and so many others were they were on the rapamycin leaderboard. How much rapamycin they take? They all had different doses, you know. Well these people stopped taking their apamycin because they were getting a lot of infections. No surprise, because it's a very potent blocker of our immune system. And so here you go, this is oh, this is going to extend your health span, your lifespan, no data in people. And you have these influencers who got everybody onto this rapamycin kick, uh all the bro folks, you know, then this is a typical thing where then they stop taking it because they have all these side effects, but uh that all these people are already hooked. Yeah. Yeah. The problem is the answers are very basic and simple and inexpensive. And so it's not a quick fix. And I think there's is an element of quick fixiness that people desperately need. And it's the same thing with diet, right? It's pretty basic in terms of how you change your lifestyle. Yeah. I mean there's another dimension to this that I'm sure you're on it, which is getting unnecessary tests. This is also heavily promoted, whether it's a total body MRI or hundreds and hundreds of blood tests and and on on. And this is another part of that no evidence, but I do it and I you come to my clinic and I'll I'll do all these things. And so the I went to one. Oh gosh. I was like, what do you need this to know for? Why is this information helpful to me? Now it sometimes works. My brother a doctor, went to speaking of cardiology, um hadn't had a calcium test. Turned out he had one when he went into Medicare and he had huge blockage, the widow maker blockage, essentially. And it was great. That was a great test to get. And he removed it, then he was fine. Then he he just had the surgery, which was really quite non as less invasive than it's ever been. Um really astonishing with the situation. Right. Right. Right. So I think people are hoping for those ideas that you find something drastic. Yeah, the problem is when when you get at to the real data, particularly for the total body MRI, uh and there are ways to assess a coronary artery non-invasively better than just getting a calcium score. But you you wind up withep, the balance is Yeah. The the balance about this is that uh more people are hurt right now. We don't have any evidence that the there's a net positive. And on all these rabbit holes of chasing down incidental findings that are spurious. So this is a real problem because that goes hand in hand with the supplements and the peptides. It's all part of that mix. Explain how people are hurt by these tests. Yeah. Besides having way too much fucking information. Like the I've had patients with total body MRI who found a pulmonary lung nodule, then they had a uh biopsy eventually, and then they had a collapsed lung. And they had to have to be in the hospital with a chest tube. I've had patients who had a liver nodule , which actually turned out to be a benign cyst, but in the process of a biopsy almost bled to death. So when this leads to getting tissue to find out what it is that you never really wanted to know in the first place, you can have pretty severe, uh potentially even life-threatening consequences. No less big expense and big anxiety. Yeah, it's like a bad facelift, which I've seen many on some of these guys . We'll be back in a minute. Some say the bubbles in an aerotruffle piece can take 34 seconds to melt in your mouth. Sometimes the very amount you're stuck at the same red light. Rich, creamy, chocolatey arrow truffle. Feel the arrow bubbles melt. It's mind bubbling . The test aments, an evolution of the Handmaid's tale, has arrived on Hulu on Disney Plus. Based on the Margaret Atwood novel, The Testaments is a dramatic coming-of-age story set in Gilead. It follows teens, Agnes, and Daisy as they navigate the gilded Halls of Aunt Lydia's elite Preparatory School for Future Wives, where obedience is instilled brutally and always with divine justification. Stream now only on Hulu on Disney Plus. Got PC Optimum Points? Visit Shoppers Drug Mart for the bonus redemption event and get more for your points. Friday, April 10th to Wednesday, April 15th. Val it in store and online let's talk about real biotech interventions because as you said astonishing high tech breakthroughs in the biomedical area and they're transforming our approaches to diagnosti cs, for example. You've talked about how AI could propel the biggest transformation in the history of medicine. Talk about how important AI will be in drug discovery. had AI when GLP1 drugs were getting their legs, but the problem is we didn't, and it took 25 years when it started out as a diabetes drug to become an obesity drug. Had we had AI back then, we would have said, oh, hey, test this for obesity. But now we do have AI and we're seeing drugs that are truly discovered by AI . And, you know, we have some that are at pretty advanced clinical trials now, for example to get rid of scarring of tissue, which we never thought would be possible. I mean uh in medicine we thought if it's scarring that's it's done, you know, and we're seeing drugs starting to crop up in late trials, that is, they've already passed, they're safe, and they may wind up having lots of efficacy in areas that were not envisioned previously. So that's led to some people, like Demas Hasabas, to say, you know, we're gonna cure uh all the diseases. I have a different look on this. My thought is we are gonna have a big jump uh and speed breath in drug discovery, but I call them PREV Meds. They're not going to be treatment medications. They're going to be preventive medications. Right. Which you don't even know you got it in the first time. Yeah. So you know the GLP one story is an exemplar, but what if you had drugs that could really knock down brain inflammation? So you never got Parkinson's or Alzheimer's? And you know, we have many candidates in the pipeline now that we didn't have before. So there's a gold rush with AI for drug discovery. And it isn't just even to discover new molecules, it's to be able to go high velocity and get it right. He's a terrific guy. And one of the things he's working on is hepatitis to prevent liver issues, which leads to cancer. But it you never get the hepatitis in the first place, you never get the cancer in the second place. Which seems very promising to me. But explain, say one of the things you talk about, the GLP ones should have been studied much earlier, and they have potential life-changing potential beyond weight loss, which is a good thing too in some ways. Talk about a counter argument to any of this because once patients with GLP and stop taking will go Verozempic and and now there's pills coming out which will be more on a maintenance schedule without the the shot required or the refrigeration. Um it is a lifetime commitment very similar to a statin, for example. Talk about the idea of how you keep people on these kind of things that can be life changing and helpful for other diseases. So they understand it better. Yeah, so I I I don't like forever drugs. Uh and as you mentioned, statins, blood pressure medicines are examples of that. And so we don't need to add another forever drug if we can avoid that. Right now we don't have a good mechanism to wean people completely. But I actually think that will be possible in the future that we don't have to have them on, you know, high doses of GOP one. So we have these now two pills that are Right. They're from they're from Eli Lilly and Novo Nordisk. Right. And they're both peptides that are packed into a pill with it very hard to get m eke out much out of that. But there are pills, low costs, small molecules, can be manufactured at scale, with the actual cost is pennies. So we're going to get the cost way down, and that will make it a global for you know all people, not just for those who can afford it. And then the next thing is can we get to a uh a strategy, whether it's a lower dose small molecule pill or some other way that we can get people so that maybe they're taking it but you know much lower quantities or not at all. We know for example the muscle mass that you lose when you lose weight. There are a lot of these companies in these muscle building adjuncts. But actually, uh, you know, if you do strength training while you're taking these drugs. Right. Combination. I end up interviewing a woman who lost several hundred pounds started off as an obesity drug, but then they gave her a whole program of nutrition teaching how to cook correctly, combine it with exercise. And so it creates the three things together are what's critical, I think. Absolutely. So, you know, I think we're going to learn about this in the future because the idea that it expanded now to many other indications that would people would take it , we have to figure out a longer-term strategy. The companies, the duopoly, if you will, they don't really have a great motivation to wean people from the drug. But we do. I mean, we if we can get away with keeping the weight off or having the sustained benefit of the inflammation in the body, that'd be great. I should add though, there are many other candid ates in in the pipeline that have similar effects on the immune system and inflammation , that that we might turn to those as a longer term maintenance strategy. They're just not as far along in in the in the whole process. Right. Right. You wrote an article in your ground truth substack explaining why all mammograms should incorporate AI. Talk about the use of AI in mammograms and how it could lead to improved accuracy and how long will it take until AI is incorporated into not just mammograms but all diagnostics. Now I know there's been some like one of the tech people like no more radiologists. I'm like, no. Again, they're always so all or nothing on everything. And I'm like, it's an aid. It's a tool. So talk about incorporating mammograms, for example. Yeah. So this is frustrating because we now have three ways, three different AIs that should be part of every mammogram. So every woman uh should have, for example, the better detection, because we know from the National Cancer Institute that 20% of breast cancers are missed by mammograms today. And AI picks those up and then some. So it's it increases the yield by about almost 30 percent. Then the next one is that we have a if it's normal mammogram in a woman, well what about the risk in the next three to five years? And we have an FDA cleared AI to do that. Then we also have one that picks up heart disease risk from the breast artery calcification very accurately to say that oh you have this woman has a very high risk for heart disease, which would often be not even uh in the awareness of that woman. So we have three AI tools, and almost no women in the United States are having the advantage of these. And the only one that they are getting exposed to in this rad net network. They have to pay out of pocket $40 to get the AI initial interpretation, which isn't the other two AIs. So it's frustrating because we have, we've iced this. The data are clear, the FDA approvals are out there, but we're not incorporating into medical practice. And this is where a lot of people, there's a backlash to AI out there in the public, but they don't realize that there are a lot of good things that AI can bring to us. Right, exactly. No, exactly. The thing but that's because they're they promise them as an all solver. You know, the same thing with supplements. Like some supplements are fine. Anyway, let's end by talking about some of the structural and institutional barriers preventing the universal expansion of health span. Many of the ways we alter the pace of aging carry a serious risk of cancer. Explain the connection to cancer and how you weigh the positives and negatives when you think about that? Aaron Powell Well, I I mean I think we know that the risk of cancer, there's a lot of preventable aspects to it. And we reviewed now lifestyle factors. We also know that the immune system is a big driver if when it starts to lose its protection as we get older, that's when um the the ability for a cancer to develop and spread in our body is is mak es us so much more vulnerable. So we have to counter that. And what the way we're going to do that in the future, which we never had before, what's amazing about this care is here it is 2026. And we have no test to say your immune system is healthy or it's it's down, it's you know, you're vulnerable. And that's something that we're on the window of having, not only through an immune clock, a piece of aging of your immune system, which will someday be routinely available. But now we also have this thymus that is the gland that everybody thought was involuted and became fatty and worthless over the after after our teenage years. Well, it turns out when you do AI of the thymus, you find out that even people in their 70s and older have some some of them have intact thymus. And guess what? They also have intact health span. So the point here is that we're right on the brink of being able to say, particularly when people are 50 and older, your immune system is starting to show signs of vulnerability. So we're going to give you a vaccine to amp it up. Or we're gonna do this or that to amp it up. Because we have so many ways to rev up the immune system that we've learned for cancer treatments. So many ways. And we're it that's something that's in the a high velocity Of how we can rev up an immune system in people who have cancer to treat them. But now we have these two ways and probably more subsequently. If we start to get on top of the immune system before a person has cancer and get them like for example, the shingles vaccine has had an incredible impact to reduce Alzheimer's. Un unexpected. I've had mine. There's two of them folks. Yeah, because it revs up your immune system. Not because it works against a virus. Well, the same thing for cancer. And these could be generic vaccines that are not against a uh a virus, but rather vaccine that's just trying to get your immune system uh amped up. So that's where I think we're going to see some big advances. And it's just because the system that lets cancer take hold in our body and allow it spread, we didn't have a way to measure it. And that's one of the aspects of the excitement in the science of aging is understanding and respecting and also, you know, this whole idea that maybe we could keep the thymus healthy in everyone Which would provide enormous benefit. Absolutely. And you you you you stuck on vaccines, which we didn't get into, but I interviewed the the guy who just who won the Nobel for the mRNA vaccines uh stuff. And the whole I I I talked to everyone in that in that lab at University of Pennsylvania. Yeah, Drew Weissman. Yeah. Yes, exactly. He was amazing. He's like he's such a he's sort of like a like a very even-handed guy. He's like, well, it's really important. We could have a vaccine for cancer, for HIV. There's all these amazing things. And then all of a sudden he goes, but RFK is a murderer. I was like, oh, you know, in his most normal tone. But everyone in that lab was thinking of go moving elsewhere. 'Cause our country was way ahead, has been way ahead, but moving to France, moving to Canada, moving to places that they're not getting these ridiculous research cuts because they are on the cusp of doing that, which is really kind of like shooting yourself in the foot. But yeah, no, the idea it was a dream that we could have vaccines that would pr help us prevent cancer. We're gonna get there. Uh now that we have a way to find out who France is gonna get there. Canada or China. Right. No, well he was saying we're gonna rely on China for this. That's what's gonna happen end up happening, which is problematic on every issue, right? Absolutely. So health inequality, as you said, is a huge problem in the US and globally. You note the lack of universal health care in the US is holding us back. Korea has universal health care. They're so healthy in that regard. A lot of preventative stuff. Research shows that rich people not only live longer, they get more healthy years after age 50 than poor people. This should not come as a surprise to anyone. But the lack of universal health care in this country, to me, it's another thing I point to. I'm like, you know when you how you want to screw longevity? Universal health care, basics. And then rich people can pay for more of the bells and fucking whistles if they feel like it. But what would a fair health care system look like in America? Well, it would be where insurance companies are not ruling the roost and only concerned about the one year out comes of big employers or the actual direct uh consumers that cover. So we not only have lack of universal health care, but we have such a perverse incentive that we don't have a country where we'ere health span. Whereas other countries like the UK and just about every other uh you know high income country around the world, their incentive is to reduce the health burden of chronic diseases, age-related specially, and reduce the economic burden. So they go hand in hand. Whereas here, we have a malincentive to do that, that even trans cends the lack of a universal health system because we have no way that preventing these diseases besides the fact that people could benefit, the the financi als don't click, you know. And so we're at a disadvantage. And we could see the prevention story unfold at other high-income countries because they get it, the investment for prevention and detection and forecast ing is so uh easy to see the benefits. Whereas here For people who don't know, our country pays double health care, thirteen thousand dollars a person versus six in most developed countries. Oh, right, right, exactly. No, what we get to be sicker. And we're sicker. Totally. And we're going to keep that up unless we start to get a new mindset of preventing diseases, which starts with prediction and finding high-risk people. But if we don't break through these barriers that are holding us back with our our system of the financial coverage, that is not the last thing is for prolonging health span, which is a multi year story, then we're not gonna make the advances that our others will certainly be able to achieve. What do you imagine has to happen? How do you get there? 'Cause there's been multiple attempts to do it. You know, Hillary Clinton was you know, digging the ditch on that one many years ago. But yeah, I mean I think unfortunately the uh lobbying power of these forces that are holding us back is so strong that we haven't been able to override that . It probably is only going to become achievable when we see whether it's some systems within the US, let's say it's a Kaiser or Veterans Health, or more likely other countries markedly reduce their health care costs from prevention. That will maybe be the stimulus ultimately in the years ahead that we better get on this. But right now, there's no attention being paid to this potential heat. But you know, having been an advisor to the NHS and other countries, I know it's happening elsewhere because they have the the the great interest in keeping their whole population, uh, as healthy as long as possible. Aaron Powell So I want to ask you the last question. You emphasize both the power of evidence-based medicine and the risks of hype and pseudoscience, and at the same time we're seeing a growing skepticism toward modern medicine in the U.S. and distrust of experts and institutions. Now that may be waning down, and it's one of these things we go through, but how do you think we can distinguish between genuinely transformative advances like AI-driven medicine and GLP1 drugs and the kinds of unproven interventions that gain traction in the wellness space. Talk about the distrust of science and what it that might do. How do we regain that? Yeah, well, of course, you know, we had it before COVID, we started to you know have this fabricated data that led to vaccine questions and autism, which was completely bogus. Then it was amplified through COVID. And unfortunately the science community didn't stand up. It it led this orchestrated, financed backed uh minority to make serious holes, and there were missteps of public health agencies and the government. So it just all added during the pandemic to take the questioning of the medical establishment at the highest level. You know, really a disregard, a diss that these people don't know what the hell they're talking about. What do you mean experts? I do my own research. So we got to this height and hopefully we're starting to do that. And the medical establishment has plenty to blame in terms of being high-handed and not being open to open to a number of things. Listening to the the concerns that is uh you know having respect for the doubting folks out there and trying to provide the evidence that their concerns are not real or they should be not they should be balanced by, for example, benefits and risks. But anyway, so we're still, you know, not that long from the COVID pandemic days, where it's at height. And a lot of these people have been now empowered at the highest levels of our government agencies. So that helps perpetuate it. So in the meantime, the medical establishment has still not gotten its voice. You know, the the likelihood of somebody in in um science and medicine to be trying to anti up, beyond social media uh and getting the good information out there. It's a tiny minority. It's so uh uh crowded out by the others. So we haven't put a dent in this. And in order for us to change this, to turn the tide, we got to see a lot more people in the medical community who are credible, who are not selling something, who are going to stand up and get the facts out so that people know. And we also need compelling data. So we're not going to get AI into the mainstream until the data is incontrovertible, powerful, replicated, independently. But when it is, we can't keep having poking holes and questioning it because it's really going to become the standard of care. That's just one example. So, you know, we have unfortunately so many conflicts out there with people who are, you know, all these tests and supplements and peptides and whatnot, and they're getting the audience. They say, Oh, we have the secrets that the doctors won't tell you. You know, and don't wait for this stuff to get approved by the medical establishment because it it works. You know, the rapamycin is kind of the prototype story of that. And um I think hopefully people are going to learn that that's not the answer. The answer is, you know, have the evidence, restore the trust in the medical community, get more of doctors and people in life science to be activists. Talk about it. And and talk about it. Well guess what? I have a two billboards in Times Square and I'm gonna show off people like you. That's what I'm doing. Oh wow. I'm sick of this shit. Yeah, well me too. I I'm so glad you're on it. I mean I can't wait to watch your your series because I think what you've done. I'm sick of it. I'm sick of it. I was like, guess what? I'm gonna play your game and I'm gonna kick your ass just like I always did before. I was right about the tech moguls. Now I'm gonna be right about this. Uh is whether it's Joe Rogan, Elon Musk, uh Uber man, all these people, you know, uh this is a big part of this um you know they they're an underpinning of all it's 100 percent. I would agree with you. And I took ketamine just for you. Just I would not recommend it . I would not recommend it. But I I did did it it and in a medical setting and I say do not do it. It will not help you. Unless you have some and that but there's some promise even there, there's promising stuff. It's just the abuse of it, right? That's right. No, ketamine can help some people. But have ketamine clinic s all over the place we have in California. I mean this is crazy stuff. Yeah. It's crazy stuff. Anyway, Dr. Topel, I really appreciate it. We're gonna be doing a lot more and I'm gonna be doing a lot more because I think it's a huge opportunity to make people healthy, save money, have economic impact, and have everybody live longer instead of just 14 men from Silicon Valley. So I really appreciate it. Oh, thank you. Thank you. Oh, I enjoyed the talk with you. I enjoyed it too. Thank you.