The Truth About "Living Longer" | Dr. Eric Topol

I think that anybody who's selling supplements, who calls himself a longevity, you know, scientist or expert has lost their credibility, 'cause there's no supplements that have been shown to reverse aging, slow aging. It's a totally unregulated, jungle-oid space, and unfortunately, he's one of the people that are doing this now.

Longevity clinics are selling $2,000 lifesaving full-body MRIs; TikTok influencers hawk glucose monitors to people without diabetes; and bestselling authors are pushing supplements to prolong life, all with zero real evidence. To unpack what the data actually shows, I'm joined on this episode by Dr. Eric Topol, world-renowned cardiologist, researcher, and founder of the Scripps Research Translational Institute. He's the author of the new book "Super Agers," which takes an evidence-based look at the science behind living longer. It's not bells and whistles. This is the real science that will help you age gracefully. In this episode, we'll discuss aging, the hucksters capitalizing on your fear of aging, as well as what innovations we can expect to see from AI within our lifetimes. Without further ado, please welcome Dr. Eric Topol to "The Checkup" podcast.

Dr. Topol, I've been following your work for a long time across social media, one of the few doctors on social media that I think is doing an amazing job following the evidence, telling the truth when it comes to complexities in healthcare related to AI, longevity, truly the science behind the research that's going on. How did you get interested in talking about AI healthcare, specifically on the web, where that's not a natural place for a doctor to find themselves?

Right. Well, thanks. It's great to be with you, Mike. So I think the story is kind of a long history of interested in, well, first, it was people's genetics, and then it was digital and then AI. And so they've been kind of sequential ways that we can deal with the data of people to promote health. And so it goes back to that, and I'm really into ingesting lots of reading materials on a daily basis. And so for social media, was really sharing that. And so that's why I got kind of stuck in the COVID years because, you know, I couldn't find, you know, really great reliable sources. And so I said, "Well, I'm not an infectious disease guy, but I can deal with data and evidence," and so that was also the impetus to go back to the healthy aging story, which we had put a big effort in some years ago with the largest and, I think, singular cohort of healthy agers, average almost 90, 1,400 of them where we did whole-genome sequencing. So we've had a longstanding interest in healthy aging because most of the medical world, as you well know, is disease-centric. And so we've always tried to look at the other side of this. And surprisingly, that study, which it was almost a decade of work, it showed very little. The genetics of healthy aging is kind of a small piece. And so that is liberating for people like me who have a terrible family history.

When you got onto social media to talk about the research, was that primarily during COVID the first time that you were on social media?

No, no. I got back in 2009, and then Twitter. I was very reluctant to do it because it seemed like it was about what people were eating for dinner or lunch and whatever. But a friend of mine convinced me that, you know, you have a lot of stuff that's worth sharing. And then so progressively, I would do more of the stuff that I would read on a daily basis. So that's what led to, you know, now 16 years and, you know, into Bluesky and LinkedIn and the others. But the main one that I really concentrate on these days is in Substack because it's a long form and I can really get into the evidence of things and try to point out what's exciting or what's disillusioning or whatever. But yeah, I mean, what I found is communicating like that, if we all did that, we would be able to get this whole field, the medical community, the life science community, it would be much easier to have the real evidence out there. But unfortunately, we're outmanned so much by an organized finance front of a lot of mis- and even disinformation.

Yeah, I remember in 2017, I just finished up my family medicine residency at the time, and I was writing for the New Perspectives blog for the AAFP. And I wrote that the absence or the lack of evidence-based physicians online is gonna create a gray zone for which misinformation can flourish. And just three days later, we had this explosion of misinformation at a very critical time. So I love the fact that you're encouraging other doctors to do the same, 'cause I feel like what happens on social media is misinformation will always be shared. People say it in common tongue when they're hanging out with one another in locker rooms. But if there's a doctor present in that locker room, if there's a medical expert who can share the other side of that equation, usually with evidence behind it, that will convince people to not fall victim to the misinformation. But there's not a lot of us on social media.

Absolutely, you know, you had discovered this at a young age, and you really have a great presence, but we're talking about way less than 1% of physicians and scientists that, you know, take the time to do this because it isn't the way they, kind of, grew up in their careers. Whew, gee whiz, that was not the kind of thing they had their head down to do, whether it's seeing patients or whether it was doing their experiments or whatever. And so this is where we have to change. We have to change the whole biomedical landscape because if we don't, and it's gonna take some time to counter this, we're gonna be subject to this lack of trust and this kind of alt-facts world that we're in right now.

Yeah, I remember back in even my training days, it was labeled unprofessional if you were on social media or perhaps doing television medicine. Did you ever have any hurdles like that?

Yeah, that's a really important point. That's how much the conservative medical establishment is. They didn't get it. The large entities, the societies, I often call them trade guilds, they were against physicians, don't do this. And of course, the institutions were very worried about this because you weren't representing the institution, but your name was associated. And so still today, there's that tension because the ability to express oneself and the ability that somehow that is connected with the profession or your society that you're a member of or your institution, it's a problem still today.

Yeah, I rarely see so eye-to-eye with another guest about the importance of social media and healthcare. Like, I get the notion of where the unprofessionalism grew from, because if you look at medical media 20 years ago and what the major players were on television, it was people promising snake oil, miracle cures, fat-loss remedies, that were not evidence-based. And as a result, they thought if you were going into those fields, ultimately, that's the only path forward. But I think with your work, you've certainly proven that there's a way to get the audience engaged from an evidence-based standpoint. You don't have to approach it with miracle promises or negativity. There's a way to tell the truth, and then there's an appetite for it. Is that true?

Yeah, absolutely, and this is, I think, there's one area, you just nailed it. It's this whole longevity and aging because there is so much out there with these longevity clinics and companies and supplements and true snake oil, lack of evidence. It's rampant, the biohacking world that we are in now. That's what was an impetus that I really need to delve into this because we need to get straight what is the science, where it can take us versus, what is the dominant stuff that's out there right now?

Yeah, I see, and I'm curious what your feelings are on a opinion I've held for probably the last 10 years. I have this firm belief that healthcare is bad on two fronts. One on the tail end of low socioeconomic status. People can't get good healthcare 'cause they don't have insurance, they're underinsured, can't pay for their medications, but also on the flip side, for the VIPs of the world who think they can buy good healthcare, they can buy shortcuts. They can demand antibiotics when they have a viral infection. They can demand propofol to go to sleep and end up having a terrible instance, like with Michael Jackson. Do you see that happening in the world as well? And was that part of your impetus for talking about aging?

You know, in my previous book, I actually pointed exactly what you're talking about because most people just think about, "Oh, it's the lower socioeconomic group that has problems with access and care." But there's the other side of it where it's too much medicine. So for example, going out and getting total-body MRIs with nothing substantiating it, right? And of course, as I go out in the book, a colleague here in New York, Dhruv Khullar, a "New Yorker" journalist as well as a physician, he did this, and now he's got this whole prostate issue he's dealing with. And he's a young guy, and this is the problem when you get a test of thousands of dollars that doesn't have any evidence that's heavily promoted. So what happens in the affluent that want to get more tests and they're somehow getting convinced from entities that this is good to promote their health, they wind up getting these rabbit hole incidentalomas, and they could get biopsies because something was their lung or their liver. They can get pneumothorax or, you know, a bleed into their liver. I mean, this is the problem. We have over-medicine just as much as we have under. And so when we look at the bad outcomes in this country, almost all of it's assigned to the fact of access. And it's not just that. We have, unfortunately, a predatory type problem in the affluent. And it isn't just executive physicals where you can pay thousands of dollars to have every test known to mankind. We have other channels to get a similar type of battery of tests that aren't needed.

Yeah, I actually had the CEO of Prenuvo, Andrew Lacy, sitting right across from me a couple of months ago.

Oh, wow.

And I was very strict and honest about the fact that there is no evidence for benefit. And he said, "Well, not yet, and I don't wanna wait 20 years to see the data." And I'm like, "Well, what if the data shows that there's harm?"

Yeah.

Because I believe one of your tweets recently, you wrote that you believe that there is more harm to getting one of these preventive whole-body MRI scans. Is that true?

That's right. I think until we know more, we should assume that. A total-body MRI in select circumstances might be worthwhile. Like, for example, you found tumor DNA in a blood at the microscopic level, and now you want to see, is there any, you know, macroscopic, is there something to correlate? Or in some cases, you need to find out where is this coming from, but to get-

Or hereditary syndrome.

Yeah, I mean, if you have, I mean-

[Mike] MEN2A or something.

If you have a predisposition gene that is unequivocal, you know, so-called pathogenic gene for cancer, that might be something to consider. But even then, if you have to rely on the total-body MRI to find it, we're talking about billions of cells that are creating a mass. That's pretty late. You wanna prevent it. And if you wanna prevent it, we're gonna eventually be doing a blood test more widely in people who are at high risk. That's one of the strategies that we will eventually prevent cancer, by knowing who is at risk and then getting all over it. Because if you find it on an MRI, that's already pretty advanced. And this is the real problem, is the people that are saying, "My life was saved because I got a total-body MRI," and they found this mass. Well, for every one of those, now there's been hundreds of thousands of people who've had this test, actually, I think maybe even a million-plus, and there are people who have been harmed, and there's no reporting of that data. There's just celebrities, like the Kardashians and others.

It's like you watched our clips from the interview.

You know, this is crazy. And to say, "Oh, we're gonna have the data in 20 years," well, how much harm can be done? And also it's very expensive. So I don't accept that, and I want hard evidence. And some of the doctors that are so-called longevity experts, authors, they are promoting this. There are companies that they call themselves longevity companies. They say part of your being a member is you get a discounted total-body MRI. This is terrible.

How do you feel about those longevity experts promoting these full-body MRIs when, in the past, perhaps, you've praised some of those individuals? I know, like, Peter Attia was someone whose work you've admired. What's your take on him discussing topics like the MRI, rapamycin, et cetera?

Yeah, so I challenged him. I have a much smaller podcast, "Ground Truths," where I write newsletters or interview. And I had done a review of his book where I said there were a lot of good things, but there also were a lot of bad things. And one of them was the total-body MRI, there was rapamycin, there was an overdose for protein that was advocated and many other things. So I invited him, and of course, it's hard to get to Peter through his people. Finally, he agreed to do it because he knew I had some questions for him. And he is, you know, very strong about his views and how, you know, it's good to take rapamycin. When I challenged him that this is an immunosuppressant, it's very potent, it's different for every person, and also, you know, there's this rapamycin leaderboard where all these are taking different doses once a day, once a week. Nobody knows the dose, and there are no data in people that it's either safe or that it promotes healthy aging or slows aging or anything. So he, of course, is kinda like what you got from the Prenuvo CEO. I don't wanna wait 10 years. I kind of have a hunch and I wanna practice medicine, you know, based on my best... Well, I don't buy it. You know, I admire Peter for, like, his sections in his book on metabolic syndrome are excellent. But then there's so many things where he just jumps ahead, which I would challenge. He recommends that people take a gram of protein a day to eat. That's a huge amount.

Per pound of body weight.

Per body weight, I'm sorry, per pound of body weight per day. So a person that weighs, you know, 160, which is lightweight, would be 160 grams of protein a day? No, but the half of that is kind of where we're at for older adults where it's shown to help maybe even some muscle mass. But you know, we go beyond that.

You gotta be careful with kidney disease, et cetera.

Yes, and then, of course, now we know that very high levels of protein intake will promote atherosclerosis, promotes inflammation, particularly if it's animal protein. And then, you know, there are several other things that he kind of goes off the track where there's no data, there's just no evidence. It's his beliefs. Now, he's entitled to his beliefs. And apparently, you know, he has a pretty big following. But now he has a company that he's promoting longevity, and he's selling supplements. And I basically think he wasn't doing that at the time of the book. I think that anybody who's selling supplements, who calls himself a longevity, you know, scientist or expert has lost their credibility 'cause there's no supplements that have been shown to reverse aging, slow aging, promote healthy aging, even though there's lots of claims. It's a totally unregulated, jungle-oid space. And unfortunately, he's one of the people that are doing this now.

Yeah, I see this pattern evolve quite often where you have someone who's very interested in pursuing the future of healthcare, and they jump, hurdle over many of the important steps that you need in order to validate research to understand if it works on a broad scale between interperson variability, between safety with other medications. And all those things are bypassed in the name of trying to get further. But as we've seen historically with healthcare, not even just with the last 20 years, but 100 years, there were things that expert opinion drove us into the direction that was very dangerous.

Oh, yeah. Yeah, well-

And that goes for something as wild as bloodletting or very extreme instances.

No, totally, and I think you have to put the body of evidence together. What do we know? What don't we know? And, you know, what do we need to research to, you know, to find if there's compelling evidence? If you take that hard stance, I think you're on terra firma, and we just need to do more of that. But unfortunately, if you go across the longevity landscape today, there's not enough of what we're talking about here. And hopefully, there's a way to get on track again.

Yeah, I think the way we get on track is by having these conversations and shining a light on the negative ways to speak about longevity. I also had a guest on the podcast, Bryan Johnson.

Oh, my gosh.

Who is famously doing some very extreme things, testing on himself, whether or not it's gonna help him live longer. And I warned my audience to not start trying that for themselves, also not creating anxiety for themselves, thinking that if they don't have that, they're missing out on some miracle cure-all product because it doesn't exist. These things are not just unproven, but proven to be harmful in a lot of instances. What's your take on the entire Bryan Johnson spectacle?

Yeah, I mean, he is the extreme version, don't die. And that's, of course, absurd. But the things he's done, like, having plasmapheresis from his young son and having a penile sensor for monitoring his erections during the night. I mean, these are just, you know, the list goes on and on. There's nothing to substantiate any of his hundreds of supplements and his exact number of calories per day with his whole staff, and it's absurd. And so, yeah, this is the worst example. Zero evidence. He's got a big fan club, you know. And it's really unfortunate because he's really the purveyor of misinformation regarding slowing the aging process. We have nothing that has been shown, at least through objective measures, to slow the aging process with only a singular exception. That's Steve Horvath's clock, the methylation epigenetic clock where exercise, and actually, we wrote together a piece in "The Lancet" about it, but it was his original work, exercise, so far, is all we have. And I don't even know if that's part of his regimen or not.

No, it definitely is. I mean, the things that he does say right is, you know, staying out of the sun to decrease skin cancer risk, exercise, sleeping correct number of hours per night. But then, you know, even sleeping the correct numbers, hours per night is taken to an extreme, where he deems having only a perfect sleep score. And I'm like, that's not living in reality. Your body can withstand one night's less of poor sleep because you have a life, a child, a job, et cetera.

Oh, yeah, no, I think the deep sleep story, and that's where science comes in. And I can't comment, I'm not familiar enough from the details of his stuff, but we've learned that every night during deep sleep is when we clear these toxic chemicals from our brain, right, and these lymphatics that are basically a channel. And what's interesting is, as we get older, of course, our deep sleep is reduced, and so we have to try to counter that. And what was really amazing is these medicines like Ambien, not only, you may feel like you're getting more sleep, but these toxins are going backwards instead of out of your brain. It's amazing, really, how they truly backfire. So deep sleep is really worthwhile. And in fact, tracking that can be helpful. It certainly helped me and sleep regularity, but as you say, Mike, I now try to be pretty tight about when I go to sleep each night, but, you know, do I want to go out on a weekend or do stuff? You have to have a life too, but also there's a misconception about total sleep because people think, oh, you gotta have eight hours. And as I review all the data in "Super Agers," seven hours is actually where it falls out. But that's just, you know, you're asleep in bed seven hours. Much more importantly is what is the quality of the sleep, particularly that slow-wave deep sleep. And people who are not great sleepers might benefit from, at least for a little while, tracking that and getting it to, and as we get older, unlike you, it becomes more important because it is a key determinant of risk for Alzheimer's disease.

Yeah, that's why a lot of my patients who struggle with sleep, I'm quick to order a home sleep study to check for sleep apnea. It's one of the major causes, especially in our overweight population of a way of disturbing sleep without even realizing it, so.

Oh, absolutely. That's step number one - I think that's very, yeah.

Is their sleep apnea. Then after you get that rolled out, because it is common, then of course, you know, start looking at ways, and it's amazing all the interactions with exercise, what you eat,

Caffeine intake, alcohol.

Regularity,

Marijuana.

When you go to bed, all these different factors. You have to learn yourself what it takes to be a better sleeper. And the importance of that, I think, and the mechanism, we've really now become, and that's part of the science of aging. It's about our brain aging, which we now can get through an organ clock, which is amazing. We didn't have that a couple years ago. So there's all these metrics from the science of aging, all these mechanisms that have really blossomed our knowledge base. So you don't have to hack it or reverse it. You can actually use the metrics to figure out the ways to prevent age-related diseases. That's the real premise of the book.

Yeah, for me, hyperoptimization has become a disease. Exercise is good. Not playing sports because you fear an injury and you think that will ruin your athletic score, problem. Sleeping seven to nine hours a night is good. Trying to, from an OCD perspective, keep the same seven to nine hours rigidly, ruining relationships, not good. And I feel like with the biohacking community, they believe more is better. But in healthcare, perfect is the enemy of good, and what's best is actually the balance. And the balance has been missing in this conversation.

No, and it goes to exercise too because these extremists. I mean, we were talking about Peter. At the time when he wrote the book, he exercised four hours a day. Who has time to exercise four hours a day? He told me during our-

Well, his wealthy clientele.

Yeah, he told me during the podcast I did with him, and he brought it down to two hours a day. Okay, but also as I review the data for extreme exercise is uncertain. That is, there's a level of intensity where you get to then maybe it actually is not good for you. And the sleep, you know, people think eight or nine hours. Actually the data, if you look at from the population level, everybody's different, seven hours is kind of the, it's not nine. In fact, that's where you start to see associations with a lack of good outcomes. So a lot of things in extreme, I agree with you. Moderation in everything is a good thing.

Yeah.

Yeah.

Yeah, I think that's smart. So maybe grandma was right with that age-old advice.

There's a lot to that.

Tell me more about this biological clock, because I know Bryan Johnson has frequently said his penis is 27 years old, his brain is 40 years old. I actually just used a a scale that a company sent me, and it told me my biological metabolic age was 26 or something, even though I'm 34, 35. Is this a validated way of measuring age, and is it easier to just look at your cholesterol, get a blood pressure cuff, and check those numbers, figuring out risk through that way as opposed to calculating a biologic age?

Yeah, so I don't think that getting these age metrics, so there's body-wide aging, and the main one that's been validated extensively is through the DNA methylation. It can be done through saliva. Ideally, you don't want to get it through a company because they have interest to make you younger and that you will send all your friends to get these tests and whatnot. But yeah, it's very accurate for your epigenetic age, which many will equate with a biologic age. But there's a lot of other tests that are being sold as giving you your biologic age that don't have a good validation. So that's one test, but the organ clocks, the organ clocks are not out commercially yet. They were initially discovered at Stanford by Tony Wyss-Coray and colleagues. Now they've been validated

By multiple groups and multiple large cohorts. And so they're going to be out there eventually. And that's eight organs and your immune system. And they will be very valuable, when they're available from a reputable, you know, laboratory because they will tell us, in a person at risk, so let's say your concern is Alzheimer's, what about your brain clock? Is it outpacing your chronologic actual age? And how does it stack up against your other organs? So yeah, we're not ready. I don't know what clock, you know, Bryan Johnson's gotten because the ones that are now validated that I mentioned are not available, unless he had some special access, I doubt it.

And then, of course, there's other things, like there's the plasma protein, it's called p-Tau for phosphorylated Tau 217, which, 20 years in advance of Alzheimer's, tells you whether you're at elevated risk. And it adds to other things, like the genetic APOE4 allele or your family history. So getting back to your question, yes, you should have your LDL cholesterol and your blood pressure. Those are standard things, but we will have, and that's what's exciting about preventing. So primary prevention of the big three age-related diseases has been a fantasy for millennia, but we now are approaching a time when you have the ability to get these data in the right people at the right time in their lives and, with multimodal AI, say, "This is the one you're gonna be concerned about, and we're gonna prevent this. Or at the very least, we're gonna put it off for many, many years." And that, I think, is our exciting, unique opportunity right now.

Yeah, how does this work on a practical, actionable sense? So for example, for my patients over the age of 40, I calculate ASCVD risk score, a 10-year score of them having a stroke or heart attack. And then from there, I can decide whether or not they're a good candidate for a statin or other modalities. So I remember vividly an episode of a TV program that I actually went to the premier of with Chris Hemsworth and Peter Attia, where they told Chris Hemsworth that he had an elevated risk for Alzheimer's, and it drastically changed his worldview. I don't know if that's a good test, and I don't know if I would recommend that test for my patients because outside of making healthy lifestyle changes, which I've been preaching to them before getting the results of that test, what changes finding out that you're high risk for a condition like that?

Well, I think for the right person, it can be a world of difference because in general, we know about lifestyle factors. And I call it lifestyle plus because it's not just diet, lots of details there, sleep, exercise, but it's all these other layers of data. You know, it includes things like social isolation and nature, being out in nature and environmental exposures. I mean, there's a long list, and we can get into some of the details, if you like. But the point is, most people don't go after all these things unless they have specificity about them. Then you can see, and I don't know the story about this fellow, but then you can say, "Huh, I am doing everything I can to prevent this condition that I never want to get that I'm at high risk for." But the point is, it's not just that. So firstly, now, used to be you could only, until recently, you could only say you're at risk for Alzheimer's. But guess what? We can't tell you when. It could be when you're age 100, or it could be when you're 60. We can't tell you when. Now we can tell you when. That's very helpful. And now, just like LDL, you can change your lifestyle, get even more into it, and you can see your p-Tau217 come down. And that's like an LDL cholesterol where you should expect, and we have to, again, validate all this, that you would slow the progression because you get that marker 20 years or more before any mild cognitive impairment of Alzheimer's. So we have multiple biomarkers, which this one is the best. And we also, for example, the Ozempic drugs, the GLP-1 drugs, they're in trials now in thin people to prevent Alzheimer's. If one of those hits, which it's certainly possible given all the other data we've seen, then you have a drug, a disease-modifying drug for Alzheimer's. And by the way, they have potent anti-inflammatory effects in the brain. So they really are a good candidate. And there are many other drugs in the pipeline. So if I was this fellow and I was concerned about my family history of Alzheimer's, and I had, let's say, an APOE4 allele, which is a carrier, 25 or so percent of us have that, I didn't have a good lifestyle, I might wanna know, I might wanna get a p-Tau217. A lot of people don't know about that yet. It's in the book. And I wrote a Substack about it recently. It's a breakthrough test, and that would then set me into a plan to prevent the disease and be up on the new treatments added to what we have today 'cause mostly what we have today is lifestyle, but most people are not adopting those changes.

Those lifestyle changes are so valuable for not just the brain. So, like, making one of those adaptations of exercise, diet, sleep, removing social isolation, creating a healthy mental health space, they're valuable not just for Alzheimer's risk, but for so many other risks. And me being a family medicine doctor, I find myself in an unusual space to talk about this because most people who are in this space speak from a longevity standpoint or from a research standpoint. And from those standpoints, all that research is very exciting. To me, when I'm trying to make the patient in front of me as healthy as possible, I'm not just thinking about a disease. I'm not thinking about an organ. I'm thinking about them as a whole, so holistically, and if I'm thinking about them holistically, I want them to institute those changes irrespective of their p-Tau level, right?

Yes. Yes.

So that's why I don't know how much it changes my guidance, versus why I like the ASCVD risk is because that might change my guidance about medication, whereas I would never recommend a healthy low-risk person to take a statin. But if they're at high risk, now I can implement something that would have negative repercussions from someone healthy, but positive repercussions for someone who has potentially high risk for having one of these instances.

Yeah, but it goes deeper than that in a respect because, as a cardiologist, we have seen all the trends of the lower LDL potentially the better. And we have all these new things, like these injectable, PCSK9, monoclonal antibodies, and antisense. And so we could really go get the LDL down to, you know, 20 or 10 instead of getting less than 70, for example. But again, if you knew the person is at very high risk, which we can do now for cardiovascular, so it's taking it to a different level. I wouldn't recommend getting LDL down, as some authors do and people do, to the lowest possible level. But if I knew somebody was at high risk and wanna achieve primary prevention, that's a prototypic example. But you know, I think this whole idea is that you're right, I spend a lot of time with patients, and I suspect you do, because you want to get granular with them. What are they eating? What is their exercise? What time of day? And you basically need to work with them to, how is it gonna work in their life? Like, what time of day do you have to exercise? And how can we change some of these things that you're eating and get rid of the ultra-processed food? And, you know, and so this takes time, and most physicians don't have that time. And so this is a real problem. This is our medical system 'cause the people don't know what they, they don't have that patient-doctor relationship with the gift of time to be able to really get to the nitty gritty of how each person can pull out all the stops. So you're right, if we could do that, it doesn't happen. Meanwhile, what we do know is a person is much more likely to get serious if they have specificity about a condition. So, you know, they may know all these things, but when it comes to them and they are, you know, motivated, that's when you see, like, for example, the randomized study was presented by the neurology association last month in San Diego where I live. They took a group that all had p-Tau elevated, so they all had higher risk of Alzheimer's. And they randomly assigned to pull out all the stops for lifestyle. And these people had their p-Tau and the other markers go drop down 50, 75%. And they felt much better because they were doing things in their lifestyle they would not have done had it not been they were part of a trial. So we tend to think, if we can talk to patients and really try to get them to adopt all the things that we know, it's great, but it just doesn't happen for different reasons.

You're saying as a motivational tool, it could be valuable.

I think it's motivational, but it just doesn't happen in the typical patient-doctor experience today. I mean, so where are they gonna get this information? And I'm talking about all the details of it and all the evidence for it, because some people say, you know, I just recently had a patient come in, and towards the end of the visit, the wife was there. And she said, "Dr. Topol, is it okay if he continues is moderate drinking?" I said, "Well, you know, what is that?" And she says, "Well, he has two tequilas and six beers every night." And I thought you was joking with me, Mike. I really did.

No, of course. Yeah, that sounds...

And I said, you know, my fellow was with me, and I mean, he was also, you know, bug-eyed. And so, no, that's not moderate drinking. You know, but people have a lot of misconceptions out there. But if I hadn't asked, if I'm in a rush, like, a lot of doctors say, "Moderate drinking, that's fine." Okay, so you have to get into the depth of these and people just don't know. You know, moderate to them and what is, you know, they don't even know what actually is ultra-processed foods. And so this requires an education for many people. And like you said, motivation. Most people, frankly, are not motivated until they know that there's a goal, don't get this disease and this will help you not get disease. And we're gonna get other things to help, not just lifestyle.

Sure, are there any things on the horizon in terms of preventive treatments, besides the GLP-1 medications, that are in trial for someone who does have an elevated risk for neurodegenerative condition, that once they find out, it's not just they're making lifestyle changes, but there is some kind of medication or a different approach?

Yeah, there's several drugs that are now being assessed for primary prevention of Alzheimer's. Unlike the drugs we have today, which are not very good, they carry high risk, they're in people who already have Alzheimer's. And we've already seen you can get amyloid out of the brain, but it doesn't get people's status.

Well, that whole hypothesis is kind of shaky as well.

Yeah, yeah, no, this is to prevent not just the accumulation of these proteins that are misfolded, but also to prevent the inflammation in the brain. And so what's amazing is there's this whole revolution of these gut peptides, like the story with the GLP-1 and glucagon, and now there's triple receptors and there's all these other gut hormones because there's a gut-brain axis. They're now going into trials and, of course, pill form, not just injectables. And so we're gonna see many different drugs beyond the current Ozempic and Zepbound for this potential. So it is exciting because the problem we have today is we're trying to come up with cures, but prevention is a lot better. It's relatively easier, and that's where you get the really, not just the best for the patients, but the bang for the buck of investment in the research and in the years of high-quality life lost because of having one of these age-related diseases.

Yeah, I oftentimes want more prevention, but I'm also realizing that if you don't have good validated data behind that, it's easy to go in the wrong direction. In my career, a good example of that is aspirin for primary prevention and how we've walked that back because of what we learned in newer research. So I'm hoping that we can do this in a way where we're not putting the cart before the horse and we're taking a patient-centric approach and not rushing the research in order to put out good data as opposed to rushing and putting out something that perhaps might not be helpful in the long-term.

Yeah, I mean, I think as you well know, you always have to reassess the evidence as it comes in. This is where a lot of people lost trust during the pandemic because we were learning things. And it's always that case. I mean, it's a dynamic thing. And the search for the truth is not so simple. It's not a static thing. So yeah, I mean, we have to reassess the aspirin story, as you point out. It's really important 'cause there are tens of millions of people taking aspirin, low dose.

I just had a resident present the case and said, "Patient's taking aspirin for pre-surgical clearance." I said, "Why?" And they said, "I don't know." And I'm like, well, this is where we investigate and we step in, so.

Yeah, and we get stuck in these things because, and even, you know, our colleagues in medicine, they might not keep up with the literature to tell a person age 70-plus that the bleeding is more of a risk than the benefit of preventing.

Yeah, I actually, Dr. Paul Offit, who's been a multi-guest on this channel, had a great term for it, medical inertia.

Yes.

Where we just continue on with the old medicine without actually seeing what's new. But again, we gotta balance it without not jumping too far ahead. I'm curious, as someone who's looking into tech in healthcare quite often, what's your take on the continuous glucose monitors? Because I have a lot of questions posed to me by patients who don't have either type one diabetes or type two diabetes who are interested in it. I've seen influencers, most popularly the Glucose Goddess, I don't know if you've heard of her.

Yes, I have. She's in the book.

Okay, she recommends everyone gets a glucometer in order to check the velocity or the rise of the spikes.

The spikes, yeah.

And for me, from my understanding, I have no idea what to do with that data because when I look at someone's hemoglobin A1C, I know what to do, I look at someone's fasting blood sugar, I know what to do, when I look at their two-hour postprandial, I know what to do. But when I look at an elevation post-meal, I don't know what to make with that data. Is there something that I'm missing here, or are people, again, putting cart before the horse?

Well, there's a lot there to unpack, Mike. So we've recently did a big study where we got all the layers of data, including the glucose monitor, but the gut microbiome, the genome, everything they ate and drank and their sleep physical activity, because you need all these things to understand, what is this spike from? Some people, they have no spikes, they can eat anything. And then others can get spikes 200-plus that are long in duration. And when you see a spike like that, that would say, hmm, there may be a higher risk of eventually developing type two diabetes. But I don't think these getting healthy people getting continuous glucose has much role except for, you know, a couple weeks or, you know, now that it's consumer-available.

Yeah, just health curiosity.

Yeah, curiosity, we don't know that the spikes, except for perhaps the increased risk of diabetes. We have a paper coming out in "Nature Medicine" about that very soon. But does it have any risk increase for cancer, for Alzheimer's, for cardiovascular disease? We have no clue about that. Those are the studies that need to be done. But one thing that's really, of course, fascinating, the work from Eran Segal in Israel and his colleagues, they did that brought in this whole field, is that if you and I ate the exact same thing, the exact same amount, the exact same time, one of us might have no spike, and the other one could be, you know, the 240. So we each are unique, and the same work was done with lipids by Tim Spector in King's College in the UK. Our metabolism is very unique, and someday we could get a diet that emphasizes the things that avoid unnecessary metabolites or high glucoses. But right now, we're not there. We have a big investment by the NIH to go after that right now. And it's, you know, it's gonna take years to sort it out, but the AI diet, that sort of thing. But right now this is more, you know-

Future than anything.

Yeah, people learn about certain foods, certain people they have really big spikes. And those who have no spikes, it say, oh, I'm, you know, I'm in a very nice place right now. But like you pointed out earlier, as we get older, you know, it may not be the same, so it's not just a one-off thing.

Or the microbiome can change, and then it might not be the same.

There you go, so we have to learn whether having this every five-minute glucose measurement, it takes us beyond the standard measurements that you were alluding to. And it's an unknown now.

Yeah, I think about impacts, like, much like how you said the whole-body MRI can have negative impacts, I remember getting some genetic tests done, and it said that I have low risk for developing type two diabetes. And I said, "Oh, well, should that mean I go out and eat a ton of refined sugar?" Like, what is the actionable, again, I'm family medicine, I'm always actionable, actionable from these tests. And if the action is not guiding me, I'm telling my residents to not order those tests.

Right.

So for example, I had an elderly patient who was having lower GI bleeding, and my resident was about to order a colonoscopy. And I said, "Well, did you ask the patient if they would want surgery if they find something?" And they're like, "No. They went. Patient said, "I don't want surgery under any circumstances. My life is already in a bad position. My quality of life is below where I wanna be. I wouldn't do any surgery." We don't need to do a colonoscopy anymore.

There you go.

So I think we need to get back to that age of understanding why we're getting tests.

We do too many damn tests. It's just ridiculous.

Yeah, and I'm not saying for research, we shouldn't do them. Like, all this research, we need to get to the point where we can individualize someone's diet to their genetics, to their CGM result, but we're just not there.

No.

And then the people that are weaponizing that are weaponizing it usually for some kind of profit motive. I mean, I remember even seeing a documentary where they fed collegiate athletes different varieties of animal-based protein meals, and they saw that there was some fat content in the blood after the meal. And I'm like, well, that's supposed to happen.

Right, right.

And you're painting it out as if they're somehow unhealthy. So it's easy to twist the science when you're taking truth wrapped in a lie and exposing it to the major audiences. So I see that happening a lot. I'm actually curious, what was the reference to Glucose Goddess in your book?

Oh, well, I mentioned that there are influencers like her. I mean, Peter Attia was really keen on them too. You know, I've been involved in this space for almost 15 years that I was on the board of Dexcom, so I could see their value in people who had type one diabetes and in certain people with type two diabetes that are hard to control that take us beyond, you know, a measure that's reflecting a month or months of, but, you know, I really have circumspect about, we need to get the data for consumers before we have the Glucose Goddess and others that are saying, "You should do this."

And after they do this, they then sell a supplement to decrease your spike.

Oh, oh, yeah. You know, exactly. You know, this is the problem we have right now. This is a predatory world without data. And you know, any given person with large social media presence, I think hers is TikTok or something, and they basically, it's replaced in too many circles, you know, where is the evidence? And this person told me, "I'm gonna go do this." It's just, it's anecdotal, and it's even often baseless. For the people that spend their lives actually trying to do the research, it's dispiriting because it's just basically negates the hard effort it takes to get the data.

Yeah, doing quality research is hard. It's demoralizing because oftentimes, you're proving yourself wrong more than you're proving yourself right. In fact, when you're setting out to do good research, you're trying to prove that you're wrong, the null hypothesis. And most people aren't familiar with that. And I think the reason why I went into social media and talking about healthcare is because I saw researchers who were amazing at doing that year in and year out weren't good at doing this social media world

Yes, yes.

And I said, "Well, I'm not a great researcher. I can't do bench work. That's not where my talents lie." So let me take their work and then bring it to the general public, whereas other people who are not good at researching just make up their own research and start pushing it out for these predatory marketing purposes.

You know, it's funny you mention that because some years ago in the "Journal of Science," one of the very top journals, there was a thing called the Kardashian Index.

Okay.

And what they did was they took the number of citations you had in papers and then your presence on then Twitter. And they saw that, you know-

Drastic imbalance.

Yeah, and it was really funny. So it's so true what you're bringing up. And that's why, as we talked about earlier, it's really important for everybody in the research community to have a voice and to stand up for their work and for what is what we know as of truth and facts, because without that, look what's happened. There's this kind of collapse mode. So I am with you. I mean, being on social media on any given day can be very challenging, but like everything else in medicine, there's a net benefit, right? And so I think it's really important to stay with it and to encourage. I try to get all our young faculty and trainees to get on it. And I have variable success because, you know, they say they don't feel like they have enough to contribute or they will just be followers, watchers, but I don't want to actually be people to post things. And they've seen how, you know, people get assaulted, attacked.

Attacked. Yeah, of course.

They don't wanna be part of that. I understand, you have to be callous and you have to be committed that you want to share what you think is worthwhile helpful information.

Yeah, that's gonna be tough for everyone to do. I think that's why you're seeing those variable levels of success. But I think even for those individuals who have tried it and realize it's not for them, that could be okay, but then support your colleagues who are doing that work. Because I look at a post from the CDC, and it has 10 likes on it. I'm like, where are the doctors supporting that post?

Exactly.

So you don't have to be out there shaping and creating content on your own. You could be supporting someone else's content who's doing that work. And ultimately, what the algorithms feed back to us is what we like, what we support. And if the general public only supports the extremist content, the algorithm will just be a mirror of that.

Absolutely, no, we have less than 1% of physicians who are actively engaged in one of the major platforms. And on the other hand, you know what percent of people we have that have no medical back, who have done their own research, whatever? We are so outnumbered, and this is a real problem. So I don't know that we can ever get everyone, but even if we get 10%, that would be-

Yeah, A huge win.

Yeah, yeah.

Yeah, yeah. The second part of why I think it's beneficial to have more medical professionals who are evidence-based online is for public good in the essence of, public health has become political. And in order to impact public health, you have to have a presence. For example, I oftentimes, when I go to medical conferences, I'll tell a story as an example. I was on an airplane once cross-Atlantic, and a young gentleman went into anaphylactic shock. I asked for his EpiPen. He didn't have one. I asked the flight attendant for their kit. There wasn't

One there, but I did see epinephrine for the cardiac ACLS kit. And I said, okay, let's do some rough calculations. We MacGyver-ed it, and we gave it to him. Saved his life. It was a great story. If I did that and didn't have social media, no one would've heard about it. I then told the story on YouTube; it got 10 million views. Senator Chuck Schumer calls me. We're able to do a press conference advocating for airlines to get epinephrine pens on board in order to curb these potential anaphylactic attacks from becoming much worse than they could be. And as a result, we got a net win from that. So public advocacy through social media is also very valuable. And I think it's never been more valuable than in the day and age where we find ourselves with RFK Jr. in the helm of HHS.

What's your take on that?

Yeah, it's more than troubling. You know, we have the misinformation at the highest level imaginable because the people that are now at HHS and these agencies in leadership are ones that, many have taken a contrarian view of the evidence. And they're now seeking to eradicate or suppress the people who are in the mainstream of doing the work and the research and gutting the resources. There are some common threads. I mean, we do wanna see work that's being done to ante up to ultra-processed foods, air pollution, microplastic, nanoplastics, a big issue for pro-inflammatory impact, and with organ damage, like the heart and brain, forever chemicals. So maybe RFK Jr. could help us because in past administrations, we've seen no serious attempt. Now, that's the good part. The bad part is if you keep taking away the people at these agencies, the funding of merit, grants that have gone through peer review and got a meritorious scoring, and you're now saying, "Well, we're not funding that anymore," and you're taking down billions of funding from the crown jewel of biomedical research in the world, which is now 47 billion, which is actually trivial compared to, you know, our national expenditures, and the investment is, of course, extraordinary. You start taking that apart, and now we're talking hearing about a 40% reduction of that beyond what we've already seen. We're talking about gutting and not just at this remarkably opportune time of what we can do to promote healthy aging, but we're gonna just slow that down. We're giving that opportunity away, whether it's other countries, whether it's just put aside for a long time 'cause that's the priority. Make America Healthy Again. If that really was what we're after, we'd be doing these things to prevent the age-related diseases of cancer, cardiovascular, and neurodegenerative. That would be our center stage, but it isn't. What our center right now is, let's just keep taking away, let's get rid of all the leadership, let's put in place some people who have not been supportive of what would be considered ground truths in biomedical work. So we have a really difficult mission right now. And eventually, I am optimistic, we will be fine, but we will lose momentum. We will lose years. And that's really sad because, you know, it's kind of like during COVID, in that first year, we had no vaccine. And what if you could just make it to the point where you could have a vaccine and you were in that advanced age and high-risk group, immunosuppressed, whatever. And we're kind of like, that time is a very important aspect of this, and we're gonna lose this time to get the mission accomplished of preventing the big three diseases that compromise our health span.

So the way I see it is this is all gonna happen. We have the blueprints of how to do this, take advantage of, you know, what we already know and what we will know. But by taking apart our health research system and public health agencies and taking away all the research funding for independent work that was reviewed by Congress and appropriated by Congress, but is then getting negated by being dozed or executive orders, which, at least in my view, would be considered illegal. It certainly isn't the way it's designed. So we have a rough patch, but I don't lose my, kind of, optimistic sense that we will prevail, ultimately. Just that time factor. Is it gonna take one, three years? And then how much do you actually lose, you know, for that unit time? Is it more than a year? Because you gotta kinda reboot stuff. That's the uncertainty that I have.

You think about all those people that will end up suffering unnecessarily, and it's sad. And I appreciate you trying to call balls and strikes in this scenario where, you know, what RFK is recommending about chronic disease is good, and what he's saying about vaccines is bad. I used to be that way too, especially before he came in to HHS as acting secretary. But now I've lost that. I've become a bit more pessimistic and a bit more alarmist than I usually am because the whole notion of Make America Healthy Again, of the idea that we need to focus on chronic health more so than infectious disease, all these premises that he talked about, getting chemicals out of our children's foods and out of our water systems, all of that seemed to be just talking points.

Well, he has recruited the, you know, the MAHA moms, a huge part of our country now, the moms that believe that their kids got autism from vaccines and all these things that you just mentioned. So he's getting to a lot of people. The problem is he makes stuff up.

Exactly.

He says, "Okay, take vitamin A and cod liver oil for measles," and then these poor kids wind up in the hospital with, you know,

Vitamin A toxicity.

Liver problems. I mean, so the hospitalizations that have been for the Texas measles outbreak is not just for measles; it's because of what he's done.

Yeah.

And not promoting the vaccines, and when he does, then he gets the MAHA movement to go against him, and then he backs off. And he just vacillates from making stuff up to please his base, if you will, of people that he made, he created this along with Andrew Wakefield, who propagated fabricated data that ultimately was, you know, had to be-

Retracted.

Retracted from "The Lancet." And that was the most destructive study in the history of vaccines because it was all made up. And so we have fabrication, you know, all over the place. And I do agree with you that this is unacceptable, but I don't know why it's gonna get reigned in because these people are de facto in control now, and they are propagating all sorts of things to do a study now that the vaccines cause autism. That is probably one of the most carefully studied things we've done in history of medicine. And to do a $500 million study, effort to come up with a universal flu vaccine using technology that are decades old when we have such great studies from multiple academic labs that show, here's the path to a universal flu universal COVID vaccine so we don't have to go through variants and boosters, but it's just going backwards. We just keep going backwards, and with miss and conspiracy theorists, and it's really sad, Mike.

Yeah, the amount of misinformation shared is wild because it's happening on major outlets, and I don't know how it's being allowed to happen. He'll say the MMR vaccine has immunity waning at 4.5%, which is just completely wrong. "Lancet" published the results, and it's 0.4%, not 4.5. He'll say, "China has a diabetes population of their children by 50%."

50%, huh.

And it just fully made up.

No, 50% of the population of China has diabetes. That's according to RFK Jr. You just make stuff up.

Yeah, rotavirus vaccine has killed more people than it's saved, just made-up statistics. And then, like, forgetting the infectious front, you would think at least he would focus on the food aspect. And his focus on the food aspect has been to remove, one, oil and replace it with beef tallow.

Oh, yeah. No, the beef tallow thing is completely-

And it's sitting at a fast-food burger joint celebrating that there's beef. Like, it plays like an "SNL" parody.

It does.

And somehow people are not realizing that that's happening. In fact, I did a debate against 20 vaccine-hesitant/anti-vax individuals where I was surrounded by them, and they each had five minutes to sit and talk with me. And we did it for three hours.

Wow.

And one of the individuals said to me something I won't forget. He said, "Now that," well, it was right before RFK actually was confirmed. And he said, "If RFK's to be confirmed as HHS secretary, will he then be the expert, and you're the one sharing misinformation?" And I said, whoa, the take on that. No, and my answer was, and I'm curious what you think of that answer, science doesn't happen by an individual expert. It happens by consensus. And the consensus groups that have been putting in this work, the WHO, Gavi for the Vaccine Alliance, these groups have been doing it for decades. They're the ones who are leading the consensus-driven statements, not RFK Jr., or one person, whoever is the head of HHS.

Yeah, I couldn't agree with you more. That's how we get to the ground truths of, in this case, vaccines and how no public health strategy has been more effective for saving lives, children and adults alike, in history. And so to try to take that down is just egregious. And so, as you say, not just the WHO, not just Gavi, I mean, we're just talking, the problem is if you go back during the pandemic, because the WHO wouldn't say this virus is airborne and they had the lockdowns or light lockdowns, whatever you wanna call them, the schools, and it's all this ammo. All these agencies, they don't know what they're talking about. And so the loss of trust, people were not presenting the data in a straight way or saying, "We don't know." Say we don't know. The whole, you know, six-foot rule and all this stuff. So we are at a nadir of trust because of some of this stuff. It fed into the, you know, and I'm hoping that gradually, it won't happen right away, gradually turn this around and get the trust reestablished.

Yeah, the hypocrisy I wanna highlight for the audience is WHO and CDC had missteps. I talked about them quite often on this channel. I actually interviewed Dr. Fauci a couple of times on the channel and spoke about some of the errors to him. We call those errors. We call them mistakes of judgment. We call them mistakes of communication, mistakes of science, whatever they were in each individual situation. But, hey, how come RFK Jr. doesn't own up to his mistakes?

No, no, no. He doesn't.

Where are these mistakes of making up data, making up statements that HIV doesn't cause AIDS? How in the world can we have someone at the helm of a health agency just take that notion with no evidence? I remember also in this vaccine debate, there was a pediatric oncology nurse who is vaccine-hesitant. And she said to me, "Why do you think that RFK can't be at the helm when you agree with some of the things that he's talking about?" like trying to remove forever chemicals or these things out of our system. They actually edit this part out, so this is kind of a fun fact for the audience as well. And she said, "Why don't you allow him to be HHS secretary? I don't even agree with everything my husband does, and I've chosen to spend my life with him." I said, "Great example. Tell me what's the most important factor that leads you to be confident to stay with your husband for the rest of your life." She says it's his faith. His faith in religion, his faith in our family. Got it. For me, the equivalent of that for who I want as HHS Secretary is scientific rigor.

Right.

And if your husband broke his faith, would you wanna be with your husband? She said no. I said, "Well, if the HHS secretary breaks scientific rigor over and over and over again, I don't want them as head of HHS, even if they have an occasionally good idea." So I thought that was a fair response.

That's perfect. I mean, there's no room for, you know, arrogance, hubris, not willing to fess up that, you know, you're wrong, that you got the wrong read at that time. And, you know, unfortunately, this is how it works. You know, Francis Collins, who was a phenomenal NIH director, he wrote a book after the pandemic, "The Path to Wisdom." And his book is full of telling his mistakes. And that's who you kind of admire is, you know, he really realizes how his communication could have been better. And he learned from people, like you did, sitting and talking with the people that had different beliefs. And that coming together and that realization, that is the humility. We always have to have that, and we are not seeing that right now as you aptly point out. And it's all the way to the top. You know, it's not just at HHS. It's almost like, don't ever fess up to a mistake. You know, it could be tariffs, it could be, you name it. Isn't it something, there's never a mistake.

Yeah.

Yeah.

Because it's become a PR strategy. If you're just very confident, eventually there'll be something else.

Oh, yeah, not only that, but you keep saying the same thing you made up enough times-

It sounds like it's true.

You even believe it, right?

Exactly.

And then everybody believes.

That's the problem.

It's amazing.

Yeah.

Yeah.

It's really a bad situation in that regard. How does the cuts to NIH, probably less so USAID, but how do the cuts to these major research agencies impact our knowledge of aging and longevity?

Oh, I think it will be potentially immeasurable. It's an attack at multiple fronts. I mean, there's a National Institute of Aging, which the NIH across the board, we've seen, you know, we're threatened with not just a 40% cut of all NIH, but also the so-called indirects, which is mostly paying for the space and the utilities and the things that are needed to do the research, not just, you know, tallying up the financial aspects, which is the administrative side. So that's still in suspension. We were talking about 15% versus what is going at normally universities, 60%. We have the universities that are under siege, and so higher education. So all of this impacts high-quality research that goes through the peer-review process, which that itself has been slowed. Grants, I mean, there's now so many grants that have been canceled. I just had to lay off 15 of our people in the weeks, people I've worked with for, you know, more than a decade. And we are definitely doing, and we spent seven years to develop the Wellderly cohort of 1,400 people that some of these research projects-

The Women's Health Initiative.

Yeah, decades. The Diabetes Prevention Project, decade. They're all taken down. And every one of these, like, for example, a lot of things got wrong from the Women's Health Initiative. And all of a sudden, you know, female hormones were condemned. Right, they would cause cancer and blood clots. Now we're learning from the science of aging, one of our objectives should be to prevent early ovarian failure because that advantage that women have, premenopausal, is remarkable protecting from all these age-related diseases, whether it's the rejuvenating the thymus gland or prevention of the ovarian failure, which is, of course, it's gonna happen in all women eventually. So we are learning, in fact, from the work in the organ clocks, that taking hormones is actually good for the immune system and the brain. Now, that's counter to the old work that was done in the Women's Health Initiative. And so much more needs to be done. If we can prevent Alzheimer's in women, which is more common in men, even age-adjusted, and it was tied to that we could be thinking about, in women who are high risk, should they be considering taking the right doses and kinds of hormones? That's the kind of thing we should be doing right now.

And I want to highlight to the audience, research we should be doing, not you should be taking.

Yes.

Because there are people who have created these hormone clinics where they're just slinging hormones left and right.

Oh, I couldn't agree with you more. It's a big unknown, but this provocative data that we should be on it, and again-

Not cutting research for it. Expand.

No, no, and not making premature, selling predatory stuff without the evidence, which is just rampant out there. So, yeah, that's just an example of the science of aging has brought us so much new information that we didn't have. We wouldn't have known what I just said if it wasn't for discovery of organ clocks. And the ability to say, "When you're gonna get this illness, and here's what we're gonna do so," we put that at push that offer, you know, a decade or forever. So I think this is a field which is exciting. I mean, it's never had a more propitious opportunity as right now. And at least in this country, I mean, I doubt that HHS secretary is even aware of this stuff. If he was interested in this Make America Healthy Again, which, you know, I'm not sure it was ever really healthy, but if we wanna get healthy, this would be the work that we would get behind, rather than just-

Cutting everything.

Yeah, yeah.

Yeah, I just had a PhD, Kevin Klatt from UC Berkeley talking about how these cuts are impacting metabolic kitchens where research is being done on ultra-processed food. The things that he's talking about, there is no plan to actually find out this research that he claims to find. Like, the idea that he's gonna create an autism study that he'll find an answer. I remember before-

By September.

Well, no, before he got put into the position he is now, he actually said that he'd get it in two months.

Oh, yeah.

Then he pushed it to September, and now it's 2026.

Yeah, but only under pressure. But you know, what you're saying is a great example. So Kevin Hall, who I look to as one of our top nutrition scientists based at NIH, he resigned in conflict with Kennedy because they wanted him to twist his report. Now, this is another big problem, Mike. So he had a paper coming out about the ultra-processed food. He's been a leader, a pioneer in this work, showing us the problems. And the NIH in the new regime wouldn't allow him to communicate with the public. "The New York Times" communicating directly, and they send the questions. But he had to have them-

Alter them.

They were altered, and it had to be what RFK Jr. wanted on the ultra-processed food, which wasn't what the study showed. So they took his work and they manipulate and they ascribed it to him. They not only altered his answers, but they never said, "Well, we changed, you know, Kevin's Hall's answers." And this is beyond the beyond. You know, one thing is to have misinformation, but then to take a respected researcher who resigned or whatever you want to call it, retired, because of this, this is just, I mean, profoundly unacceptable. And it was called out transiently. We can't have this. Whoever's left to do the work, we can't have them muzzled, and we can't have their work being manipulated to support other hypotheses that are unproven.

Yeah, and this is an administration that supposedly values scientific freedom.

Oh, oh, there's a lot of things, as you know, you know, kind of dressed up, which is not really the truth. And right now, it seems like the predominant mission is to gut the monies that are supporting research and public health agencies. And I don't know, Mike, maybe you know, where is all this money going?

That's a great question. I don't know the answer to that. But I know that the NIH, the HHS, they need to do a better job at retaining researchers, retaining dollars for research. Just understanding how much money it takes to perform a two-week controlled metabolic study is incredible, in order to do it correctly, not just to get the result that you want 'cause it's easy to get the result that you want if you're willing to cheat the science and not are actually after the truth. So very problematic. I'm curious how long until our medical establishment starts asking RFK to resign?

It's a really important question. The problem with that is, if you're a medical researcher and you sound off, then if you have any funding left, it's likely to be eviscerated, and you will be a target. I mean, the problem right now is we are in a culture of fear. So that adds to it. You know, I give Kevin credit 'cause he stood up and told the story and moved on. But, you know, we have a few examples of that. Most people have moved on quietly, and, you know, many are looking for jobs, and it's gonna be hard to find a job in an academic center now because they're all in shrink mode. So the problem of retribution, the problem of organizing a movement, and of course, it's not just HHS, it's part of an administration, which has lots of common threads, which is, basically, we went into a reckless, I couldn't believe more that we could be smarter about our funding. That is, if you're gonna spend $47 billion, maybe you could get more out of that $47 billion.

For sure.

Let's promote more young people. Too many older folks are getting all this funding. And brilliant ideas, hyper-innovation. But that's not what we had here. We had a reckless indiscriminate, we're gonna cut thousands, 10,000 people. Before RFK Jr. even was elected, the administration, he was saying, "Pack your bags," you know, on Twitter, X. "10,000 of you are leaving," or some crazy stuff. So that's the agenda. And in order to take that on, I mean, it's not just at HHS, it's much more challenging. And those who stand up and really are vociferous about it are likely to be facing retaliation.

Yeah, I actually have friends in positions of C-suite execs from major organizations, and they've seen my videos talking about their RFK Jr. Situation, and they say that they wanna be vocal, but their organization is not letting them because a lot of the grants they get are federally funded, and they're concerned about losing those grants. Much like how you say, the fear of retribution is all across the board, even in private institutions.

No, will it go on for years? I don't know. But you know, if it keeps up the velocity of what we've been seeing in the first few months, it's really a serious problem. And eventually, you know, because of it, we're already seeing kids with, you know, hospitalized with vitamin A liver toxicity. Who knows what else. And we haven't even controlled the measles countrywide outbreak. And what's next? No less that. So we're not in a good position right now. You know, Senator Cassidy, who was the deciding vote, who trusted him saying, I believe in vaccines, well-

He was worried about the same retribution about getting funding against this campaign.

Yeah, I mean, this is what we have now. Politics trumping science, yeah.

Pun intended.

Yeah, pun intended.

Yeah, what's interesting is the RFK administration probably gets one thing wrong the most, and it's not HIV, it's not vaccines. It's, they talk about this chronic health epidemic that we're experiencing. That is true. We're more obese than we've ever been. We have higher rates of diabetes, heart disease, et cetera. But they believe that is due to some sort of foreign entity as opposed to just overeating poor-quality foods. And they think they can somehow stop that without a plan. It's very hard to change someone's behavior. It's very hard to change a private organization's marketing behavior. In New York, we tried limiting the size of big sodas, and that got crushed. Michelle Obama tried to do the same on a major scale, crushed. And yet they're talking about as if it's easy to change human behavior without ever actually succeeding in changing human behavior. I think that's where they get things wrong the most, especially when it comes to the chronic health front.

Yeah, no, I agree. We have the worst consumption, highest consumption of ultra-processed foods in the world, here in the US. It has been tied to cancer, neurodegenerative, and cardiovascular diseases, type two diabetes, every bad outcome, right, proportionate to the consumption, and kids is even higher than 70%. Now, what does it take to do something? It needs a plan. It also needs to take on the Department of Agriculture and Big Food, which is basically a few companies that control our whole food intake.

And RFK Jr.'s an environmental lawyer. If you're gonna go after something, do that.

You know, and I talked to Rob Califf who's a very close friend who was a commissioner twice in the past and recent outgoing, and he says, taking on USDA and Big Food is just really, really difficult because they're powerful forces. But, you know, if we wanna see, this would be an opportunity, have a plan where, you know, we're going to have much better warning, education, instead of, you know, a cockamamie food dye additive thing. We get serious about it.

Because there is an opportunity here that some good could be made, but we haven't seen any of that. There is no plan, no alley. It's all been very unknown about some of the things that this MAHA movement has gotten behind him. Where are the deliberate steps that are gonna make a difference? 'Cause that's one that could really be useful. I mean, there are countries that have really gotten serious about this problem. We're not one of them.

And by the way, as you know, regarding the US, because we have such a ridiculous mismatch of our expenditures for our healthy aging, for survival, for maternal mortality, for infant mortality, you know, wherever you look, we do so poorly, and there's an opportunity; it's hard to make it worse. But you gotta have a plan, and it's gotta be logical.

- So you can make it worse if you just cut all the funding.

- Yeah, so how can you possibly make this worse? We are the outlier country of all of the rich countries in the world, and we're going worse, not anywhere better. So you know, here you have an opportunity, unidirectional; you can only make it better. But you gotta do something that is smart.

- Yeah, it reminds me of an analogy, how we just said, if you're in the low socioeconomic space, you get worse health outcomes; high economic space, you could also get worse outcomes. America is that personified in some way, so.

- Yes, it is. It is. You get hurt at both ends.

- So where we're over-testing, yeah, exactly.

- You really do. And people don't understand about that being hurt at the high end.

- Well, we're the perfect example. We're spending tons of money not getting good outcomes. So I think that's a good example of it.

And I also want the listeners and viewers to realize that this isn't, it's political in the sense that it's public health-focused, but it's apolitical in that it's not about Dems or Republicans or moderates, because RFK Jr. was a Democrat not too long ago.

- Yes, yes.

- He's now part of a Republican administration. In 2020, when I was reaching out to Trump's first-term administration, they sent Dr. Fauci to this podcast. So we worked with them then. Then when Biden came into office, we worked with their administration to get the surgeon general and Dr. Fauci on. So we work with every political party. It's just about telling the scientific truth and trying to do the best that you can with the limited information that we do have. So this is not a political attack in that sense. Strictly public health-focused.

- I think that's great that you've had these conversations with folks, and it's without regard to the politics.

- Well, we also have to remember that the COVID vaccine, which for the triumph that it was, is largely creating a lot of divisiveness and distrust in the general public, especially on the conservative side of things. And again, the anti-vaccine movement kind of started on the liberal California, granola side of things, and now it's progressed into the conservative. So again, showing the apolitical nature. But Donald Trump called it his vaccine.

- Yeah, yeah.

- And now the conservatives hate the vaccine. So it's very interesting how the sides flip back and forth, depending on whatever is at stake in a given time.

- Absolutely.

I wanted to talk about and shift the conversation a bit to AI.

- Yeah.

- In your book, in 2019, "Deep Medicine," you said how AI would revolutionize the doctor-patient relationship. It's 2025; my relationship with my patients has not been revolutionized. We have ChatGPT responses creating hallucinations in discharge instructions. And I'm getting really poor-quality notes when I try and use the AI scribes for my patient encounters. Have I been premature in thinking that this was happening now? Or is this a failure on AI's part?

- Well, there's a lot here. It isn't just, you know, the AI scribe of a conversation. I don't know what you may be using, DAX.

- No, a different one.

- A different one, okay. Some health systems, like Emory and many others, and, you know, every doctor says they're saving two to three hours a day they're saving from having to work on a keyboard. That's great. That's a beginning. But that's just one part of this, because that note of the conversation, that synthetic note, not only is the record note, which is better than the notes that are typically made, but it can be used to do all the downstream things like-

- Connecting the EMRs.

- Follow-up appointments, prescriptions, tests, and anything that needs to be done, nudging the patient subsequently for things that were discussed, getting, of course, the audio record and the links to the patient so they're not confused. It can also deal with the pre-authorizations, which is a nightmare for lots of physicians.

- Nightmare.

- So that note, digitizing that encounter has lots of potential. And it has been seen, you know, at least with some of these. And that's exciting, but that's just one part. The big thing, Mike, is that we have, well, on the patient-doctor relationship, we need to get the gift of time. As we talked about earlier, if you only have seven minutes with a patient or 12 minutes for a new patient, this is not time where you're gonna talk about lifestyle. You're gonna listen to a patient's deep concerns where you interrupt them in eight seconds; you know, this is not the way you want a relationship. AI has the potential to get us there. That is, by making the appointments we have, less time on a keyboard, keyboard liberation, more eye-to-eye contact, and more trust and presence. You know, doing the exam that you really show that, you know, the laying of hands, which is fundamental. And also this engagement with the patient, you know, at any time, ideally. So they know you have their back. That isn't gonna happen overnight. But we have an opportunity towards that.

Now, beyond the patient-doctor relationship, which has to go back long before you were born, like, about twice your age, it was a precious, intimate relationship. Patient-doctor, you know, it was almost the relationship in medicine. Of course, that's changed drastically now, eroded, and it has to come back. But we also have other problems that AI is helping us with, like errors. We make serious diagnostic errors at the tune of $12 million a year in this country. And the Johns Hopkins study showed 800,000 people a year are either disabled or dead from these diagnostic errors. AI has tremendous opportunity there. Not only from the scans, which it can see things that humans will never see. Let's go back to the atherosclerotic score you're using, which has been the standard for decades. The chest x-ray was shown to be better with AI than that score for predicting future cardiovascular events, but we are-

- For looking for calcified plaque?

- At everything, things that we can't see.

- Okay.

- Yeah, yeah. I mean, calcified plaque and mediastinal fat pads, and I mean, things that we don't even, we can't see the pixels that the AI is analyzing. It's extraordinary, and we now can look at the retina, and this is part of the AI prevention, and say, "In the next five years, even though you have no symptoms, you're gonna have the beginnings of Alzheimer's or kidney disease." Or how are you controlling your diabetes, your blood pressure, whether you're gonna have a heart attack or a stroke, and 10 other things from the retina. Or the cardiogram, we can say, you know, anemia, what is your hemoglobin? These are things humans can't see, can't possibly. I mean, I've been reading cardiograms for decades. I can't tell you the age, the sex, the ejection fraction, and all these other things, whether you're going to develop atrial fibrillation, which is another reason why you should lose weight, because this is not a good thing. So we have AI as a totally different method for reducing errors and seeing things that we can't see. Digital eyes, machine eyes, whatever you wanna call them. And there's lots of other facets of AI, but to me, the most exciting one is the "Super Agers" story, which is you take all your layers of data, and you're very young, but let's say you were 50 and you wanna know, are you at risk for one of these three age-related diseases? That's gonna really change your health span. And we then get the right layers of data. AI, multimodal AI analyzes it and says, guess what, you're not at risk. Or guess what, it's just this condition that you're at risk for it and when, and this is what we're gonna do. So we couldn't do this without AI. It's large language models, large reasoning models. And that's what makes this time so unique is we'd have all this data dressed up to go nowhere. But with the AI, it makes it possible to be individual-level data to help you, to coach you, to use your images to AI analyze them. It's extraordinary, but it hasn't gotten into the medical practice. It will. I can say-

- What do you think the timeline for that is?

- Well, you know, a couple of the people who got the Nobel Prize in medicine, like Demis Hassabis and Geoffrey Hinton for their work in AI, they've endorsed the book, and they see this proposal imminent. Now, Demis was on "60 Minutes" just a couple of weeks ago and said within a decade or so. I've learned, through my mistakes, three books where I try to predict the future of medicine, creative destruction, democratization, you know, digitization, and then AI, when it's gonna take hope. It's always longer than you think. Medicine is a kind of sclerotic, ossified-

- Medical inertia.

- [Eric] Medical inertia, yeah.

- But sometimes for the good of medicine.

- Yeah, yeah, you don't wanna-

- 'Cause it's easy to flip-flop too quickly.

- Yeah, you don't want to jump. You want to see compelling evidence, and we don't have that for many things that we're talking about. That's why a plea to get that when you have the parts that look like the sum of the parts, which look extraordinary. So let's get that, but it takes longer than you think. And I think that we will get there. In your practice of medicine in a couple of decades, you won't even talk about AI 'cause it'll be completely embedded.

- Omnipresent, everywhere.

- You will see many less patients in person. You know, what did it take to get telemedicine in high gear, which I had written about 14 years ago. It took a pandemic. Hopefully, we don't need a pandemic to get these things moving or some other, you know, major catastrophe. But it takes longer, but it will happen. It's inevitable because we as humans, we as physicians, we're humans, we can't deal with all this data. We're talking about billions of data points for any person, things that we will never see. And we have to say, "We need help." Lean on machines, right? And that's why I would hope to see it, but I won't see it in my practice of medicine, but you will, and it's just a matter of time. Unfortunately, you know, it could be a couple of decades. It could be a little longer. But it's a path that there is no other way to deal with the data to get back, if you know a better way to get back to the patient-doctor relationship, let me know. I mean, you know, so.

- Well, I mean, changing incentive structures for primary care and those things, I think will make an impact as well, because right now primary care is not as celebrated as well as it should be in terms of creating a foundation for one's health. A lot of young folks, especially in the urban areas, are relying for urgent care centers to provide their primary care. And there's no way you're getting a doctor-patient relationship.

- No, no, not at all. But, you know, then the affluent can have concierge medicine.

- Oh, yeah.

- And then you get lots of time with your doctor, and you have their cell phone number and you text them and all. Is that what we want? Is that the medicine we want for people here? So this is a real problem, and that's why we need to decompress. We need to give patients more charge. That's another reason why AI's kicking in, diagnosing all these common skin lesions, urinary tract infections, arrhythmias, you know, ear infections in children. Those will all be done by AI. Okay, so the common reason to go see a family physician, primary care physician, a lot of those that are not life-threatening, they're gonna be done, here's the AI, I have it, you know, validated by the physician for the prescription only, I don't have to go over the visit, you're gonna see a lot more of those things in the next, you know, that's actually moving pretty quickly. Giving patients a virtual health coach, if they want it, if they want it, to help them prevent the disease of interest, of concern, these are things that are happening now that will take a while to, you know, get proven. But I'm convinced with what I have seen so far, they will. And so the physician community doesn't like the idea of patients having more charge. I mean, you as a young physician, you're willing to accept that. But older docs like me, generally, now, I'm in control, control freak, I don't want them coming in with their sensor data and, you know, all this stuff they got from ChatGPT-5, whatever stuff. I want to be the one calling the shots. That has to change. You know, I'm giving the commencement address later this week at Mount Sinai Medical School and, you know, talking about this is that we are in a flux. We're not gonna be picking doctors as brainiacs with their best GPA score, you know, averages and their MCAT scores. We need people-people, you know, that really are empathetic and compassionate. And that I think is gonna be an important part of the next generation along with the AI, along with the patients having more charge.

- Yeah, I'm curious how the general public will land in terms of getting information from AI. And I'll give you one specific example that I find funny and sad at the same time. Elon Musk, head of DOGE, or not head of DOGE.

- Whatever.

- I can't even keep track anymore, is endorsing RFK Jr., to some degree, his notions of asking questions, his medical theories, et cetera, especially on his platform X. I asked Grok, which is the AI of X, what percentage of health claims that RFK Jr. makes are factually inaccurate, and it's at greater than 50%. Why isn't someone who's an industry leader like Elon Musk asking his own AI system about the factual accuracy of the person deciding the nation's healthcare?

- Yeah, it's amazing. Grok is actually pretty good, and it's much greater than 50%, of course. But you're absolutely right. Why?

- So, like, if he's not listening to that on such a huge stage, right, is he gonna listen to it about his cholesterol score?

- It seems pretty unlikely, doesn't it?

- Yeah, so that's why I don't know, how will AI interface with the general public when it comes to the virtual health coach stuff?

- Well, I'm expecting that when that emerges and has proven that it helps people and changes their natural history of these age-related diseases, that it won't be in the current climate.

- Okay. Got it. Okay, good.

- 'Cause it can't be. I mean, you know. We basically upended everything. But we'll get there. I mean, I'm very optimistic that eventually the things, the promise that we see today, the ability to prevent the big three age-related diseases will be actualized, and it won't be at a time when we're at peak misinformation, but it will get back. I mean, too many times in history there's been instability, maybe not as bad as this, where, you know, we will get there. I just hope it's sooner than later.

- Yeah, to leave people with some actionable points. If they wanna be super agers, what can they do?

- Well, they should know all the details of lifestyle. That means, you know, in terms of, we don't have to say exercise. We're talking about not just aerobic, but core, strength training, balance, posture, you know, all the different things that are components of fitness. And it doesn't mean you have to be extreme, as we discussed. You know, my colleague from Stanford, Euan Ashley, said one minute of exercise, like, five minutes of gain of healthy aging. And there's something to that, the data support that in large respect. Now, knowing about the sleep story and tracking it, if you do, I suspect, and as you say, getting a sleep apnea, is it real? Because it's more common than a lot of people realize and it can be easily treated, prevented. So that sleep thing and getting, you know, the details, the regularity, the diet thing couldn't be more important. There's too many people that are, not just the ultra-processed foods, but are this protein craze we're in now, eating lots of red meat, which is pro-inflammatory and knowing what foods are generally anti-inflammatory, or not pro. And then all the other things that we discussed. So everybody could do that. But I just know that that familiarity with the details isn't enough. And I think if you have a family history of one of these three conditions, let's say it's my area, cardiovascular. So you had someone with a heart attack in your family, parents, or something like bypass surgery, something major, and you have your LDL cholesterol checked and you could even have inflammation proteins like CRP checked, whatever, then the question is how aggressive you want to get, not just with the lifestyle factors, but do I just go with statins? Maybe I don't tolerate statins. A lot of people have that problem, particularly as they get older. Do I try to go as low? You know, these are questions that are really important. And remember, when we learned that the determinants are not just your genetics, but largely non-genetics, that gives hope to people that, I have so many patients that come into me say, "My father had a heart attack at 50. I feel like I'm gonna have a heart attack at 50." But we can change that because it's not just the genes here, and we have tools that we didn't have before. We're gonna have pills and treatments to lower LP-little-A, which we never had. We always would say all these years, "Ah, you got a really high LP-little-A, too bad. There's nothing we can do." There's five drugs that are about to, you know, get across the goal line. So our armamentarium has never been better, our ability to block inflammation. So it's just a matter of how aggressive and having those layers of data together. Like, for example, you can get now a CT of the heart and arteries, and you can see, by AI, how much inflammation you have, even without a blockage. And that's the kind of thing, as we get using that more, inexpensive, very low radiation, people at higher risk could find out before they develop a plaque that was significant to use that as a metric. So that's just heart disease. Each of them have that type of edge, and that's why I think it's so exciting. We never had this kinda rich things to work with to prevent the diseases, even though we dreamt about it forever.

- Yeah, it's very exciting. And I'm glad that you're pointing out that there's a duality here, not a false dichotomy. It's not just lifestyle or medication. It's lifestyle for everyone.

- Everyone.

- And for who benefits, high risk, who needs an added layer, medication is definitely an option. And all of these breakthroughs that we have from a technological standpoint will help us better risk stratify who is high-risk, who would benefit from earlier intervention so that we don't have to treat heart attacks. We can prevent those heart attacks, and I think that's very valuable.

- Yeah, and I think it's important, Mike, just to emphasize, there's one big hole in the story. And that is, we don't have an immuno. That is, if we wanna assess an immune system of a patient today, what do we have? It's 2025, and we have-

- CBC, and that's about it.

- CBC, the ratio of the white blood cell neutrophils to lymphocyte. That is a cockamamie way to, I mean, we know so much about antibodies and B and T-cell function, NK cells, all these other components, dendritic cells, and we don't assess any of it in the clinic, any of it. And look, we just went through-

- Well, is that because it's so ever-changing and responsive to the environment that it would be hard to-

- No, it's part of it, but you can do the perturbations to simulate that in the lab. So you can see you, you can give, you know, all sorts of ways to see, how does your T-cell respond to this or that and B cells and autoantibodies. So in the book, I have, in the last chapter, kind of the beginning of the immuno where I had a Johns Hopkins spinout test that every autoantibody, every virus that I've ever been exposed to in my life, and some surprises there. I never had CMV exposure where most adults have had that. And there's links to all these different, like Epstein Barr-

- Yeah, I've heard, yeah.

- With multiple sclerosis, if you have the right genetic predisposition. So we're gonna get there, and it's not that hard. And there are many, beginning to see the shots on goal. That's the thing. The big three age-related diseases are very much dependent on an intact immune system, not too heavy, strong, and not unguarded. We could probably not get metastatic cancer if our immune system really kicked in.

- Right.

- And we have ways to, the beauty of the current day today is that we can rheostat up and down the immune system. We could give, like, shingles vaccines. Today is the fourth study to show shingles vaccine lowers the risk of dementia and Alzheimer's disease. Well, who would've guessed that? Well, it's revving up our immune system. So it's a twofer. A lot of people aren't getting them because of the anti-vaccine movement.

- And they work well against shingles too to 90-plus percent.

- By the way, yeah. 95-some percent. And you know, 20, 25% reduction of dementia, Alzheimer's. And that's nothing to snicker at. So we're learning how to rev up and down the immune system, take control. That's the other part of this. We gotta really get that down so that when we see patients in clinic, we can say, you know, our immune system, you know, it's great.

- Yeah. I would love to get there.

- I am shocked that this day and age, we are not there yet, but I think it's not far around the corner.

- Yeah, I think it's changing. And I think the notion of hygiene hypothesis means something different to my generation, 'cause hygiene hypothesis used to be that you don't challenge your immune system with non-pathological microbes. So therefore, your immune system perhaps overreacts. But I think about that in terms of exercise.

- Yeah.

- If you're hygienic, you're not exercising. And when you're not exercising, you're not creating inflammation, you're not challenging your immune system because inflammation during exercise is modulated by your immune system. So I feel like the immune system plays such a wider role than just the typical protection from bacteria or viruses or fungi in so many variables, whether it's exercise, cancer risk, bone health, et cetera.

- Oh, you nailed it. I mean, exercise across the board, it is how you keep your immune system intact, especially as we age. As we get older, we have this immunosenescence problem and some people, not. I mean the super agers, one of my patients presented in the book, I'm sure her immune system is incredible. But many of us, it really dips, and we need to, you know, get it back up. And it's a little bit of a Goldilocks story. You don't want to get to self-hacking.

- Too fit. Boosting the immune system.

- Yeah, but you also don't want to get it where you have your guard down and then that's when you get in trouble-

- [Mike] With opportunistic.

- Yes, yeah, so this area, it's gonna demand more research. That is the piece. And of course, after the brain, the immune system is the most complex system in our body. And so again, you can't deal with all that data if you don't have AI.

- That's true. That's true. I wanna end on one point that I experience a lot of frustration within my practice. And being a cardiologist, you probably have a very strong stance on this. Young people, 30 years old will come to my office and say their Apple watch dinged that they had five seconds of AFib. I know what to do with AFib in someone who's symptomatic, who has risk factors based on their little calculation scores that we do. What are we supposed to tell the general public with all these trackers that are at play where we don't have definitive data on what to do yet?

- Yeah, that's a great one. So this smartwatch-based diagnosis of atrial fib was the first consumer AI deep learning ever authorized by the FDA. So what you're bringing up is a quandary, because if it's symptomatic, it's easy. But then you have to get, ideally, the PDF of that from the person's watch where you actually look, is this really atrial fib? And five seconds, that's very transient, right? But if it's sustained, then you wanna say, okay, are there structural reasons where if that person is in atrial fib, let's say they have a valve abnormality, let's say their

Left atrium is really enlarged, are they more likely to develop a blood clot that would, you know, go to their brain where they would need blood thinners? 'Cause really, the story is if it's transient, eh, but if it's sustained and if it's in a person who has risk for stroke, then it's a whole different matter. So you have to sort out which it is. Oftentimes, that will require an echocardiogram. I do those, you know, in the clinic with a smartphone.

- POCUS, yeah.

- Yeah, I mean, who needs to send somebody for a formal echocardiogram unless it's something, you know, pretty-

- Severe.

- Severe, but not enough doctors are using smartphone echoes or ultrasounds, but they should. It's the modern stethoscope, and it's much more revealing, yeah. So that would be the thing to do is, you know, get that smartphone ultrasound echo or get a formal echo and then sort it out. But only if it was sustained. Five beats, eh. But you know, if it's gone on for many minutes, even, you know, this could be the person doesn't experience it, but it could be a matter that's worth at least looking into. It's not something to be largely ignored if it's sustained.

- Right, yeah, I've had companies come to me asking to do a sponsorship on the YouTube channel, and they have a new product that is sensing atrial fibrillation in the general population. And they said this is a great breakthrough, but every piece of literature that I've looked at to see if screening the general population for atrial fibrillation was valuable, it was found either insufficient or perhaps not valuable. What's your take on screening the general population for AFib?

- Well, I wouldn't screen the general population, but I think if you were to go, there have been some more recent studies to say if you take people at higher risk over, let's say, 60, obesity, which is a significant risk for atrial fibrillation, heavy alcohol intake-

- Diabetes, well, we have the CHADS score, CHADS-VASc too.

- If those people, you want to look, just like you were saying-

- But that's not screening anymore, I feel like.

- No, no, no.

- That's already targeted.

- Yeah, there's ways that you can put, you know, two fingers on a credit card type thing and get the answer pretty quick if they're in it that moment, right? That's a type of screen that's been used like countrywide in Australia and you get, like, 1% of people that don't even know it and they're in chronic atrial fibrillation. So it is worth knowing if it's sustained, but we don't really have a good approach yet to do that. Again, in every patient I see in clinic, I do a six-lead cardiogram from two fingers on the left leg. I mean, it's just, gets so much information. And sometimes I find people just at that moment. They didn't know it, in atrial, and then we just kinda sort things out. But it's not something that it, once you find out about it that you wanna turn your back on, the question is how deep do you wanna find it? And finding it in young people, eh, it's very unlikely to mean something. Finding it in people of, you know, beyond a certain age where it could, and most people don't realize that weight loss is a great way.

- [Mike] Great way.

- I mean, who would've guessed, right?

- Limiting alcohol intake. There's a lot of valuable-

- The belly reservoir of inflammation is mediating the heart's propensity for this arrhythmia. That was a wake-up call. And of course then, you know, where's the GLP-1 drugs to try to reduce that? I've put several patients on those drugs because they weren't able to lose weight otherwise. And their atrial fibrillation was something that we didn't wanna have to go do an ablation, but we could actually get rid of it just from lifestyle.

- And you've seen remission from those individuals.

- Oh, yeah. Absolutely.

- Wow, that's great, okay.

- Yeah, Yeah.

- I haven't seen data on that, that's cool. But yeah, I couldn't take the sponsorship because I couldn't put out the message that a 30-year-old will need to screen themselves for AFib. So I didn't wanna... Because that's the question. When they want me to market it, they don't want me to say, "Hey, this is only for this specific subgroup." Then I'm eating into their sales. So I would be telling the audience, "Everyone should be taking this," and I don't think that's-

- Well, I admire you for that. There's not enough of that. But look, Apple, when they put this thing out everyone, whatever age, who has an Apple Watch could do this, that's bad. They basically did it.

- Yeah, exactly.

- And that's a problem. I have a lot of worried well because of that.

- You got these people with false alarms or maybe they had the five beats, and this is creating a lot of unnecessary visits because they didn't say, unless you have risk, they wanted everyone to use this app and how-

- Well, 'cause if it saves one life, that's a great press story.

- Yeah, and they've used that.

- Great one.

- They use that one person many times.

- Yeah, exactly.

- Yeah, so.

- Well, I guess that's what the future holds for us. Balance, being honest, transparent, and learning from our mistakes moving forward.

- Yeah. I couldn't agree more. It's really been a joy to discuss all this with you. It's refreshing, actually.

- Yeah, it's very exciting. Thank you for your time, Dr. Topol. The next time you're excited to talk about a subject in this space, happy to have you on once again.

- Oh, thanks. I'll look forward to that chance.

- Where would you like the audience to follow along your journey?

- Well, I'm really happy about the "Supers Agers" book, if they're interested in trying to promote healthy aging. I'm on X and Bluesky, but the main thing I do is the Substack "Ground Truths." And so every week, I try to put out a newsletter and sometimes also podcast to what's hot, what's exciting. And this is where I got into recently, p-Tau217, these longevity companies that don't have really the foundation for their claims. But sometimes, you know, it's like the mechanism of deep sleep and how it's great for brain health. So I try to cover things that most people aren't, they're not covered in the mainstream media, high-quality media, and they're really interesting, often on a science level and hopefully at a level that people understand. I always could do better than that. That is, to use no language that someone would question.

- Well, that's what AI's great for.

- Yeah, yeah, but I try to share, and again, going back to our early discussion, if we all did that, we all would get smarter quicker, and I'll keep doing it 'cause I just think sharing useful information to people. I started when I was, you know, 50 when I was involved with the whole Viox thing. I wish I'd started when I was 30 or whenever you did 'cause the impact you'll have on other young people will be much more profound.

- Yeah, yeah, I remember even reading your work on cardiac cath labs over-stenting people, and it kind of reminds me that it feels like longevity clinics are now the modern-day cath labs.

- Yeah, yeah. They're gouging people. I had the gouging, gauging, and whatever, gorging stents. That analogy is quite apropos.

- Cool. Well, thank you so much for your time, Dr. Topol. Appreciate it.

- Oh, thank you. Call me Eric.

- (laughs) Yeah. One of the worst offenders in this scenario is Gary Brecka. Click here for my video debunking all his claims on how he says to live longer. And as always, stay happy and healthy.