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660. The Wellness Industry Is Gigantic — and Mostly Wrong
01:05:29
Zeke Emanuel (a physician, medical ethicist, and policy wonk) has some different ideas for how to lead a healthy and meaningful life. It starts with ice cream. (Part three of “The Freakonomics Radio Guide to Getting Better.”)
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- [00:01]
Stephen Dubner
Freakonomics Radio is sponsored by nyquil Intense Flu Flu symptoms Don't keep business hours. They like to show up at night interrupting your sleep. Nyquil Intense Flu helps shut them down. Specially formulated to ease flu and cold symptoms, it is the nighttime sniffling, aching, aching fever. Best sleep with the flu medicine delivering fast powerful flu symptom relief for up to 6 hours. NyQuil Intense Flu works overnight so you can sleep. Try NyQuil Intense Flu today. Use as directed. Keep out of reach of children. Freakonomics Radio is sponsored by Mint Mobile this January Quit overspending on Wireless with 50% off unlimited premium wireless@mint mobile.com freak limited time offer upfront payment of $45 for three months, $90 for six months or $180 for 12 month plan required $15 per month equivalent taxes and fees Extra initial plan term only over 50 gigabytes may sl busy capable device required. Availability, speed and coverage varies see mintmobile.com. The global wellness industry is estimated at around $7 trillion and it's growing fast. I guess you could see that as a great thing that so many people have so many resources to devote to their well being. We should say that what the industry counts as wellness can extend pretty far from anything to do with your sleep to home cold plunges from high protein everything to biohacking with untested peptide injections from Chinese labs. Before there was social media or podcasts, books were the primary vehicle for spreading the wellness gospel, and there are still thousands of books published in the space every year. But the book we're talking about today has a title that may seem out of sync with the current wellness trends.
- [02:07]
Zeke Emanuel
Eat yout Ice Cream is the name.
- [02:09]
Stephen Dubner
That is Ezekiel or Zeke Emanuel. He has been on the show before, talking about GLP1s and the dysfunctional American healthcare system. He has been a key player in that system. He is an oncologist, bioethicist, a professor at the University of Pennsylvania, and a policymaker who helped draft the Affordable Care Act. In his book, he argues that most wellness advice today manages to be both too complicated and too simplistic.
- [02:39]
Zeke Emanuel
A lot of the wellness gurus and influencers out there, they have to get on social media daily. They have to write something, and they make things way too complicated because they have to have something quote unquote new to bring people back. They're too simplistic because most of these wellness things are just focused on the physical and sort of downplay other things.
- [03:03]
Stephen Dubner
So how does he see wellness?
- [03:05]
Zeke Emanuel
Wellness is a lifestyle. It's something you're going to have to do for decades. And it should be something that easily becomes habitual and that you actually enjoy.
- [03:15]
Stephen Dubner
Enjoy. But what about the suffering, the deprivation, the never ending search for the perfect collection of self care tools? Today, in the next installment of the Freakonomics Radio Guide to Getting Better, Zika manual offers a different map to the same destination.
- [03:33]
Zeke Emanuel
So last night I had a piece of babka cake for dessert with a scoop of very nice ginger ice cream. It was wonderful.
- [03:42]
Stephen Dubner
Are you ready to get on board the babka train? It's leaving the station now.
- [03:52]
Zeke Emanuel
Foreign.
- [03:58]
Freakonomics Radio Announcer
This is Freakonomics Radio, the podcast that.
- [04:01]
Zeke Emanuel
Explores the hidden side of everything with.
- [04:03]
Freakonomics Radio Announcer
Your host Stephen Dubner.
- [04:14]
Stephen Dubner
Zeke Emanuel as a pair of brothers who have also been on this show before, the politician Rahm Emanuel, who is currently flirting with a 2028 presidential run, and the sports and entertainment mogul Ari Emanuel. The way Ari pursues wellness might fall into what Zeke calls the complicated category. Here's Ari on the show a couple years ago when I asked him to describe his fitness routine.
- [04:38]
Ari Emanuel
How long does this podcast last? I mean, it's so stupid what I do. I'll give you this morning I woke up, I think 4:45. I take either depending on day, Thai helmets or UK helmets, which are live microbes for my gut. I then get a cup of coffee. Today I did bike hypoxia training. I sprint on the bike for a minute at a very high level, take it down to a very low level, put a mask on. That takes me up to 22,000ft for three minutes. I do that for 25 minutes. Then today I did a weight program, chest tri, shoulders, legs and stomach. Then I went in, I did a sauna. I meditated for I think today was 17 minutes. Got an ice bath for four minutes. Steam got out. Take my vitamins. And then usually Fridays I don't eat. I'll have dinner Thursday night, won't eat until Friday night.
- [05:40]
Zeke Emanuel
The wellness craze that we're in says a lot about the social moment that we're also in.
- [05:47]
Stephen Dubner
And that again is older brother zeke Emanuel.
- [05:50]
Zeke Emanuel
About 150 years ago, in 1870, there was this enormous wellspring of interest in wellness. Also with lots of books and new magazines and exercises. And it was the result of rapid urbanization, a lot of immigration, consequent xenophobia and a lot of economic inequality. The Vanderbilts, the Rockefellers, the Carnegies, and a lot of poor people questions about the integrity of food. So Upton Sinclair's the Jungle and we're in exactly the same moment.
- [06:24]
Stephen Dubner
Including the Gilded Age.
- [06:25]
Zeke Emanuel
Yeah, yeah, we've got the Gilded Age. We've got a lot of immigration, consequent xenophobia, people worrying about the food supply in terms of ultra processed foods, and the world feeling topsy turfy, like people can't control their own environment, much less the direction of their lives. And what you have is, I think, people looking inward like, what can I control my wellness? My own life is something I control. Back then we had books like the Manual of Hygiene, which was an exercise book, or the New Science of Healing. We had my system a 15 minute daily workout. And now we have the New York Times, you know, seven minute daily workout.
- [07:02]
Stephen Dubner
Okay. The full title of your book is Eat yout Ice, Six Simple Rules for a Long and Healthy Life. Tell me how this book came into being and why.
- [07:12]
Zeke Emanuel
The reason it came into being is that I began doing work on this book. And one of the things that I became much more convinced of is the importance of dairy. And then several years ago there was this article in the Atlantic about ice cream being actually good for you. And when you uncover and chase that down, you know, dairy has a lot of advantages. If you eat dairy as a young kid, societies that eat a lot of dairy generally taller, you actually get a lot of protein from eating dairy. By the way, dairy is also good at preventing colon cancer. It's good at many other things. Now, there are some downsides to dairy and one shouldn't hide them. It's high in saturated fats, but it does appear that those saturated fats are not used by the body in the same way. There was just a recent report of cream and full fat aged cheeses, actually decreasing risk of dementia. So in general, dairy has, I think, been undersold in American society. Ice cream is a good thing, not only because it's this dairy component, but it also is this joyous component. And we don't have to lead our lives in self denial. I can't have that ice cream. So last night I had a piece of babka cake for dessert with a scoop of very nice ginger ice cream. It was wonderful.
- [08:36]
Stephen Dubner
And you're still alive to speak with me. Amazing.
- [08:39]
Zeke Emanuel
Not only that, I'm thrilled. It was a great evening.
- [08:43]
Stephen Dubner
You just mentioned a few things about dairy preventing colon cancer, perhaps warding off or delaying dementia, also diabetes and diabetes. Okay, I wanna ask you about these concepts generally because you write in this book about a lot of benefits or associations with different foods, behaviors, exercise and so on. But let's just back up for a minute. And address a fundamental question I have, which is in the healthcare realm, especially in the nutrition realm, but even in exercise and even in medicine, I feel like there's a lot of operating on associations. Right. Eating more dairy is associated with a lower rate of colon cancer. Let's say you write that there's an association between loneliness and premature death. And what I want to get at, Zeke, before we get into the particulars of your argument about the book is, is how reliable you feel these associations are. Because, as you know, well, when you hang out with economists, an association or a correlation is a very nice step in the right direction, but it doesn't fill in the entire sentence. So it could be that sicker people, for instance, are lonely because when you're sick, you have a much harder time having social circles and so on. And not that loneliness makes you sick, which I think is the conclusion that a lot of people will come to when they read findings like that. So can you just talk for a moment about, let's say, the strength of evidence throughout your book with associations versus something that might be established as purely causal?
- [10:19]
Zeke Emanuel
Yeah. My daughter is an economist and pounds on me all the time that in economics you do associations and you're not getting into the top five journals, and therefore you're not getting tenure, and you can forget all about it. So I understand it's the economics part of the freakonomics that we're now in. So first of all.
- [10:37]
Stephen Dubner
Well, to be fair, even if I were not a fan of economists and economics, I would say that it's a good thing to establish cause in as airtight a way as possible. Because, look, here's an example. When it rains, you see a lot of people out there with umbrellas. If I came down from Mars and I saw all these umbrellas every time there was rain, I think, oh, if people had only put away their umbrellas, it would stop raining. They must be causing it. That's a very good association, but it's not causal.
- [11:04]
Zeke Emanuel
You're 100% right. Association is not causation, and you need to be careful. And we make mistakes. On the other hand, many of these issues, like diet, you can't do the randomized trial, or you can do a randomized trial for a short amount of time. So you're not gonna be able to do the causal studies. The second thing I would say is if you get multiple studies in multiple different contexts in multiple countries, you begin to believe it. And then if you have a plausible biological mechanism, you begin to. To believe it as well. A Lot of these associations. They've begun to look mainly in the UK Biobank study and see the molecular mechanisms by which, for example, loneliness turns on certain genes. Those genes actually cause chronic inflammation, and you have a mechanism that begins to make sense. So I'm totally with you. If I had one association study, I would say, oh, yeah, you're right. Once you've got a lot going in the same direction and you have a plausible biological mechanism and you're beginning to tease out the genes that are involved, I'm more likely to believe it. Many of the predictions I say turn out not to be right. Yeah, but look, diet is one of those things. Okay? Take butter as an example.
- [12:23]
Stephen Dubner
Butter was evil for about 20 years there, wasn't it?
- [12:25]
Zeke Emanuel
Butter has been very negative. Saturated fats, blah, blah, blah. And my mother cooked only with margarine. Right? And then guess what? Well, if you use butter, it's got the saturated fat, but then if you substitute margarine, it's even worse. And so one of the things about diet that is very important, it's not just the thing you eat. It's also, what is it substituting for? What's the alternative that you might adopt? We often don't think that way. So we only think of one category of food, not the entire diet we're eating.
- [12:57]
Stephen Dubner
Okay, Zeke, the subtitle of your book is Six Simple Rules for long and healthy Life. I'll go through them. Number one, don't be a schmuck. Number two, talk to people. Three, expand your mind. Four, eat your ice cream. Five, move it. And six, sleep like a baby. There's also really. Seven. The conclusion is called be a mensch. So let's start Chapter one, don't be a schmuck. What are some common schmuck behaviors and why do people do them, do you think? Is it that they lack willpower? Is it that they don't know better? Is it peer pressure, et cetera?
- [13:32]
Zeke Emanuel
Well, smoking is a very good case of where it is a schmuck move, as is vaping. And it's not because people don't know. I mean, actually, smokers know the dangers of smoking better than the rest of us. Partially that's an addictive element, and partially it's a social system. Until recently, society was actually pushing people to smoke through advertising, through pricing, and the social acceptability of smoking. We've changed that. What we haven't changed is we really need to increase the taxes on tobacco. We haven't increased them since 2009 at the federal level. And I think that's very important. But we switched to vaping. Now, vaping has some advantages. It appears to be less dangerous than smoking. And I said it appears because we've only had about 20 years of vaping, and who knows what's gonna happen? But there's no free lunch. Vaping still has adverse side effects on people, I think. There's other items I like to mention. Climbing Mount Everest. I can go as a tourist. I can pay $100,000 and do it. And it turns out it's incredibly dangerous. I mean, all comers, including the expert climbers, you know, the chance of dying on Mount Everest is 1 in 100. And if you're over 59, it's 1 in 25. That is a total schmuck move. Who would take a one in a hundred chance for what? Bragging rights? Just seems crazy to me. Also, the actual most dangerous job I've seen is being President. We've had 45 people President, and four of them have been successfully shot and killed, and eight of them have been shot at. They may not have died, but that just seems like a very, very high number of attempts on people, despite great secret service protection.
- [15:11]
Stephen Dubner
Okay, Note to myself.
- [15:12]
Zeke Emanuel
Don't run for president.
- [15:13]
Stephen Dubner
Not going to become president. Yep. Okay. Chapter two is called talk to people. Most of the advice in this chapter, it seems, comes from your father, which I very much enjoyed reading about. Chapter three is called expand your mind. Here's something you wrote. Accumulating a reserve of brain function can protect from the inevitable losses that occur with aging. Is that real? Is there a reserve of brain function? And if so, what's the evidence for that?
- [15:41]
Zeke Emanuel
The evidence is that people who've gotten more education and therefore more brain connections have the same rate of decline. But because they start from a higher plateau, it's noticeable as a cognitive decline and loss of function much later in life. There is very good evidence on that. Just think about how the brain works. The main way that you get cognitive being cognitively intact is you have a lot more connections between your neurons, and it's called brain plasticity, your ability to make more neuronal connections. And then as you age, you lose those neuronal connections and you lose cognitive function. What we're trying to do is push the date at which we lose cognitive function, and it becomes noticeable out as far as possible. There are some people who are remarkable who are productive and creative into their 70s and 80s. Ben Franklin is my quintessential example.
- [16:36]
Stephen Dubner
He's your spirit animal. Can we just say yes?
- [16:38]
Zeke Emanuel
Well, I have A whole course on him.
- [16:40]
Stephen Dubner
I know. Writing a Franklin book as well, Correct or plan to?
- [16:44]
Zeke Emanuel
I plan to, yes.
- [16:46]
Stephen Dubner
Are there not enough Ben Franklin books in the world?
- [16:48]
Zeke Emanuel
They're very long. And I want to target young adults because I think they don't emphasize him as a role model for living the chances he took, the initiative he took, the constant creativity he engaged in, where everything in the world was okay. How does that work? And him spending a lot of time trying to puzzle things way out of his expertise. He once walked through a hospital and noticed a lot of people, and they had these common symptoms. He says, you know what they all have in common? He said to the doctor. They all work with lead. It took us another 150, 200 years to figure that out.
- [17:25]
Stephen Dubner
As doctors, it seems as though you want to hold him up as a role model for a variety of things, but one of them is aging of being productive as you age and also continuing to learn. In chapter three of your new book, you advise against retiring generally. But I wanted to ask you. You know, you, Zeke, plainly, like, maybe love and are plainly energized by your work. I'm happy to say that I am lucky enough to feel the same. But many, many, many people don't like their work, and they don't get that same kind of joy or energy out of it. So for people listening to this and they hear Zeke Emanuel say, don't retire. Don't ever retire. And they say, well, I do want to retire from what I do. How do you think about that next phase? Were you retiring from your vocation or your occupation? But how do you set off on a new chapter that's as energizing and productive as the one that you want?
- [18:24]
Zeke Emanuel
We do have data that countries where retirement is younger people have a faster cognitive decline. There's a sociability with work. There's a schedule and expectations of other people. And you. There's cognitive challenges of how to solve problems at work. And there are new things that you have to do when you think about retiring. You should think about all four of those elements. How are you going to replace them? What are you going to do for the sociability? How are you going to actually interact with people? One of the things I suggest to people is, I understand if you want to retire, if your job isn't fulfilling, all right, then how are you gonna volunteer? And how are you going to do things that give you a schedule, make you interact with other people, make you learn new skills and make you solve problems? One of the things we know from data that a colleague of mine has collected is when people retire, the thing that goes up the most is TV watching. That is not a good place to be. That is not gonna stimulate you cognitively. And so I think if you want to retire from an occupation, you got to figure out the volunteer activities or the social engagement that you're going to have as you age. And unfortunately, not a lot of people spend a lot of time consciously thinking about what that's going to look like.
- [19:43]
Stephen Dubner
When it comes to your advice on expanding your mind, I'm wondering where you stand on drugs. Cannabis is ebbing and flowing in legalization. Seems like in the last month or so, the Trump administration is moving back toward more legalization when there was looking like there might be a little bit less. Mushroom use is up. Ketamine use is up. What's your position generally on mind expanding or mind changing drugs or other methodologies? Maybe you'll tell me about meditation. I don't know.
- [20:17]
Zeke Emanuel
Well, on drugs and in particular on pot legalization. I think this is one of the three great social experiments we've had without a control group, and that is probably, in the end, not going to be good. Cell phones, social media and pot. We know that we have a lot of cannabis use disorder. About a third of people use cannabis. Can't control their use. About 10% of people are actually addicted to cannabis. They can't get off. It has the same kind of pathways as other addictive drugs. I think there might be, and again, I'm not a user. There might be some conditions, it might be better than alcohol, but that still doesn't make it good. Psilocybin is a completely different issue, and I've done some research on it, so I should declare that conflict of interest.
- [21:03]
Stephen Dubner
Did that research include swallowing?
- [21:05]
Zeke Emanuel
No. I've had people advocate, you ought to try it. I said, no, that's not Zeke Emanuel. I don't know that the world could tolerate me.
- [21:12]
Stephen Dubner
Maybe you become more tolerable. Have you considered that possibility?
- [21:16]
Zeke Emanuel
Only if I became more boring.
- [21:18]
Stephen Dubner
Okay. You don't want to remove your edge?
- [21:20]
Zeke Emanuel
No, I like my edge. Actually, there are people who are depressed, people who have ptsd. We've done some research on what happens when you've got depressed cancer patients, give them a dose of psilocybin. First of all, you see the depression go away in very short order within a week, much faster than if they took Prozac or some other drug. And we've done some research to say it can last 18, 24 months. Not for all of them. But for many of them, and that's with one dose. So I think that can be very therapeutic in precisely a very hard problem to handle, which is resistant depression. I think in five years, psilocybin's gonna be standard of care for probably depression and ptsd.
- [22:05]
Stephen Dubner
And how would you describe the plausible biological mechanism of psilocybin and depression? I've heard a variety of things from people who know quite a bit about this. Some say that PTSD is a failure of the forgetting mechanism, that you're ruminating on an experience. Let's call it again and again. I don't know what psilocybin or other drugs may do to interrupt that trajectory or if it's something else. But why do you think it works? If it does work?
- [22:36]
Zeke Emanuel
I'm not an expert on its biological nature, but one of the things we do know is. Look. That it works on the brain suggests that there's a receptor on the brain which is being activated by psilocybin that is supposed to do something in the brain positively. It was conserved through evolution. This rewiring of the brain does seem to be something where people attached to something that happened in their past and can let go of it. And forgetting certain things really important for human beings. We know that people who have these photographic memories and can't forget are actually quite paralyzed. One of the things my kids say to me is that I don't stay mad at people unless they lie to me. They stab me in the back after telling me nice things. Then I get pissed off permanently. But I'm actually one of these people who, you know, if you offend me, you say something nasty to my face. I don't get permanently pissed off at you. And I think it's an important attribute because it allows you to move on with people. It's an important lubricant to social interaction. We're all gonna offend people at some times. I'm a big offender, and I sometimes say things that hurt people even when I don't mean to. We have to learn how to forgive. That's a really important thing to think about.
- [23:53]
Stephen Dubner
I love that you point that out. I agree. I think that's really important. I also, however, find it interesting that while there are some people who offend without even meaning to which you just described yourself as one of those people. There are a lot of other people who work really hard on never offending anyone. And those people I find so boring that I feel I need drugs to be around them.
- [24:17]
Zeke Emanuel
Well, it's not just boring. I find them unreliable because they're not telling you the truth. One of the things I always tell the people who work for me, they're junior and often somewhat intimidated, unfortunately, around me, I say, listen, tell it to me in part because I have two brothers and they have said things to me you can't even approach how severe and painful that can be because they know exactly what pushes my buttons. So don't worry. And by the way, I won't hold it against you. I much prefer when people tell me the truth. Then I learned something. When people are lying to me about how wonderful everything is, I don't know how to fix things. I don't know how to change my behavior. I don't know how to change the world. So I prefer the truth even when it's painful, because it's always something I can learn from. I have a thick skin because of my two brothers.
- [25:02]
Stephen Dubner
We should say your family system is a little anomalous. Your brothers are their edge. If we're gonna use that word, is. On a scale of 1 to 10, it's maybe 30. Rahm Emanuel and Ari Emanuel. Right. I mean, you've been well trained to deal with things like that.
- [25:20]
Zeke Emanuel
Yes. But I do think actually having a thick skin is an important element not to be offended by everything. One of the things my father, I think, taught us is, look, some people may not respond to you positively. Don't take it personally. Just understand they may not be having a good day and move on. I do that a lot. I'm not perfect at it, and I still can be socially awkward about introducing myself to people. But it's a great attribute, I think, because it allows you to actually survive in a lot of circumstances that other people get paralyzed by.
- [25:56]
Stephen Dubner
Coming up after the break, Zeke Emanuel on Trump administration healthcare policy and when to give technology a rest. I'm Stephen Dubner. This is Freakonomics Radio. We'll be right back. Freakonomics Radio is sponsored by Mint Mobile. Mint Mobile is here to help you cut back on overspending on wireless this January with 50% off unlimited premium wireless. All plans come with high speed data and unlimited talk and text delivered on the nation's largest 5G network. You can use your own phone with any Mint Mobile plan and bring your phone number along with all your existing contacts. This January, quit overspending on Wireless with 50% off unlimited premium wireless. Plans start at $15 a month at mintmobile.com freq. That's mintmobile.com freak Limited time offer upfront payment of $45 for three months $90 for six months or $180 for 12 month Plan required $15 per month equivalent taxes and fees Extra initial plan term only over 50 gigabytes may slow when network is busy. Capable device required. Availability, speed and coverage varies. See mintmobile.com. Freakonomics Radio is Sponsored by Intuit QuickBooks Outdoit with Intuit QuickBooks it's the trusted end to end solution that businesses rely on. QuickBooks provides a team of AI agents and trusted experts, so doing it yourself no longer means doing it alone. Their payment agent gets you paid faster, their customer agent secures more sales, and the accounting agent all automates and categorizes transactions. Get your critical business jobs done with QuickBooks on the Intuit platform. Freakonomics Radio is sponsored by LinkedIn Ads when you want to reach the right professionals, use LinkedIn Ads, the platform that has the highest B2B ROAs of all online ad networks. Spend $250 on your first campaign on LinkedIn Ads and get a free $250 commission credit for the next one. Just go to LinkedIn.com Freakonomics Terms and Conditions apply. Last week on the show we spoke with Marty Makary, commissioner of the Food and Drug Administration and part of a Trump administration whose health and wellness policies have inflamed many people, including the vast majority of the political left. Zeke Emanuel has spent a lot of time in and around the political left, including the Obama and Biden administrations, but he has also worked with the Trump administration during Trump's first term. I asked Emanuel what he thinks of the current Trump administration's health policy.
- [28:51]
Zeke Emanuel
Everything is for S in Washington, but the guys running Medicare and Medicaid, as I did not predict it, he has actually done a very good job of attracting the right people and doing the right thing.
- [29:02]
Stephen Dubner
Emmanuel here is talking about Mehmet Oz.
- [29:05]
Zeke Emanuel
He is running cms, the center for Medicare and Medicaid Services, way better than Biden did. Biden's person came and went and I asked everyone, I said, so what did they do? Silence. And these guys, they're actually doing good stuff.
- [29:19]
Stephen Dubner
Why were you so skeptical of Mehmet?
- [29:21]
Zeke Emanuel
Because I thought he was willing to prostitute himself and say stupid stuff to make a lot of money on TV. And I didn't know whether that's why RFK Jr brought him in that he would do his bidding. And he hasn't. He really has said how are we gonna make healthcare better for people? And the other thing, which I greatly actually appreciate, they don't care. And I wrote this about exactly a year ago, I said, you know, these guys are coming in. The best thing that could happen is that they don't give a what the interest groups, what the AMA says, what the hospital association. And that's actually really important. Cause you can't reform it if you, you know, constantly trying to placate everyone. And I'm impressed. I'm very impressed. These guys are actually doing good.
- [30:02]
Stephen Dubner
Name a couple things that they've done.
- [30:04]
Zeke Emanuel
So they've initiated some prior authorization that is gonna tamp down on some abuses. They have initiated new programs aimed at getting better management of chronic illness and using apps and technology that we know work to do it. There's just a recent report about AI getting people who have diabetes on the right dose of insulin in 15 days, as opposed to doctors doing it taking more than 56 days. Okay, that's really valuable. And that also means the doctors can focus on other things and the AI can handle the patient through Alexa. And I'm like, that's fabulous. Let's do more of it. And they are on that path to doing more of it. They've launched a program called Access, which is very likely to go exactly in that direction.
- [30:50]
Stephen Dubner
So if you roll up, let's say Robert F. Kennedy Jr. And Marty Makary at FDA and Mehmet Oz at CMS and roll them up into one class the first year of the second Trump administration's health and science policy. What's a letter grade D? D? Oh, that's still pretty poor because you.
- [31:08]
Zeke Emanuel
Have to average an A at CMS, but an F at everything else. RFK Jr is going to make a lot of people die through just the vaccine thing alone. He hasn't done anything really on the food system. I mean, taking dyes out is not gonna save a single life. He's undercut the entire structure and scientific review process that we have. They have the focus on chronic illness, very good. But they haven't actually done that much on it.
- [31:37]
Stephen Dubner
I wonder whether you try to be apolitical or not really in your book. You give a hard time to Casey Means, Trump's nominee for Surgeon General. You ridicule her health and wellness obsessions, which you seem to think are pretty flaky, and I get that. But a couple elections ago, one of the Democrats running for president was the self help guru, Marianne Williamson. So I wonder, when you are strongly affiliated with one party the way you have been, whether it's just not possible to consider the upsides of your opponents arguments and the downsides of your allies and Whether you become too partisan a thinker, even in the health and wellness.
- [32:22]
Zeke Emanuel
Arena, that's not true for me. My goal is to fix the American healthcare system for the American people. That means five things. Getting universal coverage, making costs reasonable for. For everyone, having consistent, high quality, diminishing disparities, like rural, urban disparities, black, white disparities, and having people fully satisfied. You can't do those things without bipartisanship. That's the first thing. The second thing is, early on, I talked to President Trump in 2016, in November and December 2016, trying to talk to him about how I thought he could improve the American health care system. And I was pushing him to focus, really on drug prices. So we had a number of meetings. I was happy to work with them. Then when Covid hit, I wrote him a memo about how to begin approaching Covid. Joe Biden called me and said, we'd like you to help. And I'm like, anyone who wants to make an improvement in the American healthcare and address this pandemic, I'm open to it. I told Biden I was working with Trump, and he said, fine, we don't care. But Trump, that was not the same attitude, and he got upset and cut off discussions.
- [33:33]
Stephen Dubner
Did you try again with Trump, too, in 2024?
- [33:37]
Zeke Emanuel
We are regularly working with Trump, too, about trying to address American healthcare problems.
- [33:43]
Stephen Dubner
Who's the we, Zeke?
- [33:45]
Zeke Emanuel
Me. Me and my team. So we're trying to work on, you know, focusing on hypertension. We're trying to work on this upcoding problem and getting Medicare to do a better job of risk adjusting. We've actually developed a better risk adjustment model than they use now and trying to get them to adopt it. I am. I don't know whether nonpartisan, bipartisan. There is a big problem, and we need to solve the problem. And this problem isn't gonna be solved by one ideological view. You have to work and keep working at it. There are people on the Republican side who I've learned a lot from. There are people on the Democratic side who I've learned a lot from. There are people on the Republican side who I think have wacky ideas about how to fix the system that aren't gonna work. And the same thing's true on the Democratic side. I am willing to work with anyone to help solve this problem, in part because we are now at 18% of GDP. That's one out of every six dollars that we spend. It's a major cause of the unaffordability problem for every American. If we could bring our Healthcare spending down to 13%. That's a 5 percentage point drop. 5%. In a $30 trillion economy, it's 1.5 trillion. That's $5,000 for every American. Just imagine what would happen if we could bring our spending down to the top of Europe. A family of four would suddenly have $20,000 more to spend on everything else they need in life. It would radically change how Americans live. Now. I don't know that I could, in my lifetime get us down 5 percentage points of GDP, but we should be able to get down 2 or 3 percentage points of GDP. And even that is a huge amount of money for people.
- [35:25]
Stephen Dubner
Last time we spoke, Zeke, we focused on GLP1 drugs. Their efficacy, access to them, affordability, potential downsides. Can you just give me a quick update? What have you Learned about the GLP1 drugs in the last year? I do see, for instance, that Novo Nordisk, the Danish multinational pharma firm, recently won approval to sell WeGovy in pill form in the US that'll be the first GLP one that I'm aware of in pill form. So there's obviously a lot of momentum in that area. What's the state of the union with GLP1s in your mind?
- [35:58]
Zeke Emanuel
In the last year, we have learned more and more about the positive benefits, and we've cleared up suggestions that they don't have certain effects like reducing the risk of dementia. People were very hot on that, at least in the first set of studies. Does not appear to be the case. But one of the biggest home runs, I think, is they have this enormous effect very quickly in terms of reducing cardiac risk factors and cardiac mortality. That's amazing. 20% reduction in a year. That's pretty amazing results.
- [36:32]
Stephen Dubner
What's the plausible biological mechanism for that?
- [36:35]
Zeke Emanuel
You're reducing weight, you're reducing the cardiac risk factors for causing plaque. You end up reducing blood pressure as well. And that also reduces renal disease and kidney failure. I think the second thing that has become quite clear is no one predicted when they began researching GLP1s decades ago that it would cross the blood brain barrier and it would affect the central nervous system and in fact affect the reward system. And now we know that it somehow does all that. So there's less positive reward from food, but also alcohol, tobacco, drugs. That I think is gonna turn out to be an amazing result, that we're only gonna learn a lot more about how you can use it to regulate these other addictions. And it gives more plausibility also to some element that food can be addictive. As well. I'll just tell you, I have a very dear friend from college and I suggested he go on a GLP1. He went on a GLP1, and the next day he called me up and said, you know, my relationship to food is very different. I no longer have this battle with it. And then I talked to him just the other day and he said, well, you know, I've had to go off the GLP1s because we had a change in insurance and I can't afford it. Twelve hundred dollars a month that just can't afford it. And the problem is we have this miracle and people who need it and can benefit from it aren't able to get it because of the cost. We need to be more creative in our society and when we have these really big breakthroughs for a large number of people of getting it at a reduced rate. Me and my group have been advocating for thinking about subscription models of GLP1s because, you know, we can lower the cost. The marginal cost of production is very small and increase the number of people by maybe even an order of magnitude.
- [38:34]
Stephen Dubner
But the pill form I've read, and I would assume anyway, is going to be much, much cheaper. Correct. I'm reading WeGovy monthly pill form will be about $150 a month for what they call the starting dose versus about $1,350 a month.
- [38:47]
Zeke Emanuel
That tenfold difference is not production costs, it's profit. And I think, you know, Novo Nordisk has been losing market share and needs to gain market share. And this is an easy way, but I think that's the kind of, you know, if we had under $100, so we're talking maybe $1,000 per person per year. Kind of, if we got to that level, it would be a home run.
- [39:09]
Stephen Dubner
I mean, it seems like we're heading in that direction.
- [39:11]
Zeke Emanuel
Yes, yes, we're heading in that direction. And I think within 10 years, we're gonna have a lot more options with a lot fewer side effects that are more targeted and the price will come down. And I think that'll be fantastic for American society. But let me just say that's not the way to solve our obesity problem in America.
- [39:30]
Stephen Dubner
So let's talk about that for a moment because all these things you're saying about GLP1s are phenomenally good and or promising. On the other hand, I hate to be the skeptic and I hate to bring the economists into the conversation where they may not be welcome.
- [39:46]
Zeke Emanuel
I don't know.
- [39:46]
Stephen Dubner
But economists, as I'M sure you know, have this phrase, moral hazard, to describe a situation like this, where when you lower the risk or the cost of potentially hazardous behavior, like overeating or eating a lot of unhealthy food, that you maybe, you know, encourage people to do more of the same because you're giving them a kind of safety belt. How do you feel about that? In other words, you've just written a book promoting sensible, good nutrition, diet, sleep, et cetera, et cetera, et cetera. But if there are pharmaceutical solutions that obviate the need to change behaviors, where do you fall on that?
- [40:23]
Zeke Emanuel
Well, I totally agree with the economist. Not on the moral hazard problem, and I'll explain why, but on the idea that GLP1s are not the solution to the obesity epidemic. Although we should acknowledge that in the last year, the percent of adults who have been obese has dropped 2%, and we've not had a drop in decades in the number of American adults who are obese. So something is happening with GLP1s. So here's one important way in which I think actually having the GLP1s are not going to lead to moral hazard, but actually might change the psychology of people. One of the things that happens, I think, when people gain weight is they become despondent about themselves, about life, about the future. And I think if you now recognize, Well, I lost 20% of my body weight, my body image is better. I now see the future differently. I have hope. I have hope that I can control things. I have hope that I can actually change my life. I'm going to invest in my life differently. I might adopt exactly what we want them to do. Exercise, better nutrition, better sleep. You know, the sleep apnea will go down. All of these things suddenly become different, and the valence, My ability to see hope in the future and therefore invest in the future is going to increase. We need to figure out more about how to appropriately use GLP1s. You might be able to get people to drop 20% of their weight inside of a year, then go on a much smaller dose of GLP1s for the long term. We also don't know how giving them simultaneously diet and nutrition advice, as well as exercise coaching how those will intersect. I suspect they're actually gonna be synergistic for all the reasons I say so.
- [42:16]
Stephen Dubner
What's interesting to me, Zeke, is that you write about this age. We're in this wellness age industrial complex. You describe it as a tsunami of information that's coming to us, some of it too complex, some Too simple. But one big point you make is that most of the behaviors that you want people to follow, which is eating sensible food, getting sensible exercise, sleeping well, et cetera, et cetera, you can't make a profit by prescribing that. And that runs up against not just the wellness industrial complex, but really the healthcare system where, as you know better than any of us, many physicians, the way their incentives are laid out is to treat illness and not to encourage wellness. So if you take a step way back, do you see any philosophical or theological adjustments that might be worth making?
- [43:14]
Zeke Emanuel
Oh, absolutely. A lot of people think, well, wellness is an individual thing, but that's wrong. And we all know it. Because the whole issue with ultra processed foods is we've got a whole food system that is incentivizing through food subsidies to corn and soybeans and wheat and rice, as well as many other aspects that make ultra processed foods cheaper. We don't subsidize fruits and vegetables. We don't subsidize other very nutritious elements. That's one area. The other area is we have a whole system now that is making us lonely. We've got cell phones and social media, video games. So people are no longer interacting and they're no longer talking to people. I prohibited cell phones in my classroom as well as computers. And you come into the classroom and it's a lot louder than it used to be because people are actually talking to each other. Apparently in New York, where they've bell to bell prohibited cell phones, what they've noticed is that actually the volume's gone up. And that's a positive because you've got more students talking to each other. I have noticed that the whole cohort of my students, they're sort of socially awkward because they don't know how to talk to each other. They don't know how to navigate conflict or disagreement between themselves. That is a very bad thing. We've created lots of social barriers to actually wellness, not just in the health system. And believe me, I could go on for the next two, three, four days talk about the problems of the healthcare system and the promotion of wellness. But we also have other social systems, like social media, like the way people actually earn their living, as well as the food system, the exercise system that make it hard for people to live a healthy life. There is this age old wisdom and part of our issue is we have to constantly rediscover it, as you point out. And I don't think that's new. You know, what's the renaissance well, they rediscovered the verities of the age. Ancient Greeks and Romans. Okay, Wellness is about biology and the core elements of. We're really social beings. Aristotle knew this, right? Two books of his famous Nicomachean ethics are devoted to friendship and how important friendship is both for virtue but also for a good life. Hippocrates understood diet and exercise.
- [45:38]
Stephen Dubner
It strikes me that one prescription that I'm not hearing from you or anyone is that people need to read again. When you talk to college professors, they say that even at good universities they can't get students to really do any real reading. Even a hundred pages of a book. Forget about the whole book. Have we just given up on that notion, do you think?
- [45:59]
Zeke Emanuel
I hope not. And I was just bitching about that problem of reading yesterday. It's very hard to get students to read and they complain, no matter how short your reading lists are. And I think it's super important. And we've lost that art. And that also means we've lost part of the art of critical thinking. To read something we don't agree with or to follow a detailed argument that's a little more complex. And one of the things I bemoan over and over is how simplistic the lack of nuance in social media posts. How can it be nuanced? And I was terribly against social media for that exact reason. You can't have a prolonged discussion. I have an avocational interest in American history and you think about how long the debates were of the Lincoln Douglas debates, and then you're like, oh, in American presidential debates now there are two minutes on each side and then a 30 second rebuttal. They're not 45 minute speeches that are subtle and have long development of argument.
- [47:01]
Stephen Dubner
I mean, this is maybe Pollyannish and I'm not even sure it's desirable. But do you see a way to get back to. I'm not talking about Lincoln Douglas debates necessarily, but do you see a way to get back to a longer attention span, more attention to detail, more nuance, et cetera, et cetera? Obviously there is a layer of society that still engages in all that stuff. And I would argue that probably many people who listen to this program are part of that layer. But having a thin layer at the top is not very good, I think. Do you have any thoughts for making that layer deeper?
- [47:37]
Zeke Emanuel
Well, I do have thoughts and I think one of the reasons that a electronics Sabbath is a good idea one day a week where you just shut down the computer, you shut down the phones, is good, is that can be a day where you read. For the last two years, I have pledged my New Year's resolutions to have a full electronic Sabbath. I have yet to reach that. I'm about 70% of the way there. I hope 2026 is the year I can actually fully realize it, but I think that's an important step in the right direction for us, a day when we're not distracted. And what this really is, Stephen, is it's about time allocation and it's about prioritizing deeper thinking and deeper reflection, including time with ideas that you don't necessarily share to understand why someone might advocate that and to give them the most charitable reading you can so that you can think through. Well, you know, maybe I'll change my life. Maybe this is a perspective I need to adopt.
- [48:39]
Stephen Dubner
Coming up after the break, has Zeke Emanuel figured out the meaning of life? I'm Stephen Dubner. This is Freakonomics Radio. We'll be right back. Freakonomics radio sponsored by TurboTax. Remember when doing your taxes meant handing over a pile of papers and then just wondering? Now with TurboTax Full Service, it's so much easier. They have local experts near you who do your taxes, getting you every deduction while you go about your day. And they keep you updated in the app so you're never left wondering. Through February 28th, hand off your taxes to an expert in person or online for $150 all in. If a TurboTax expert didn't file for you last year, visit TurboTax.com local to book an appointment. Freeconomics Radio is sponsored by BILT. It's 2026, and if you're still paying rent without BILT, it's time for a change. BILT is the loyalty program for renters that rewards you for your biggest monthly expense. Rent. With bilt, every rent payment earns you points that can be used toward flights, hotels, Lyft rides, Amazon.com purchases, and so much more. And here's something to be excited about. Starting in February, BILT members can earn points on mortgage payments for the first time. Soon, you'll be able to get rewarded wherever you live and unlock exclusive benefits. With more than 45,000 restaurants, fitness studios, pharmacies and other neighborhood partners, it's simple. Paying rent is better with bilt, and soon owning a home will be better with bilt, too. Earn rewards and get something back wherever you live. Join the loyalty program for renters at joinbuilt.com freakonomics that's J-O-I-N B I L T.com freakonomics make sure to use our URL so they know we sent you.
- [50:36]
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- [51:12]
Stephen Dubner
Let's talk about Chapter 4, Eat yout Ice Cream, which is also the title of the book. And I find that chapter four is kind of the meat of this book because it is about what to consume and not consume and how to behave and not behave and so on. You describe a sort of vicious circle where people trying to do better with their nutrition and health, exercise and so on, they often get so stressed out about how to do it that it adds more stress to their lives and that can have a negative impact on their health. So can you just walk us through that vicious circle and how to get out of it?
- [51:50]
Zeke Emanuel
First of all, we have to remember wellness is for decades. It's not for a moment. Wellness is gonna be your lifestyle, how you live, and the habits you adopt on a daily basis. They have to be things that don't require willpower, because if they require willpower, you're gonna exhaust them and you're not gonna follow through. So that's the first thing. The second thing is there are a lot of things we're doing that are anti wellness. And one of the interesting things about human beings that I think doesn't get enough play is we're an additive species. When we confront the problem or a puzzle or something, we tend to solve it by adding things. One of the important things I think about wellness is we have to actually take away the bad stuff we're doing, and we don't do enough of that. Look, there are a lot of negative things in our diet. The top one is sugary beverages, sodas, because they are 140 calories per 12 ounce can, 10 teaspoons of sugar with absolutely no nutritional value, don't do them. They're not good for you. And the good news in America is if we need good news on nutrition is we're actually decreasing our soda consumption. The second is snacking has increased to 500 calories a day over the last 30 years. We've got to bring it way down. I'm not telling you no snacks, but Bring it way down. Those two things alone will actually improve things. And then one positive, which is eat more fermented food, eat more fiber. Those are the two big things we're lacking in our diets on a regular basis. You will be a lot healthier. Just those things. Take away two items and add two items.
- [53:33]
Stephen Dubner
Let's talk for a minute about the gut microbiome, which is something that, for reasons I can't explain, I've been interested in for a long time. And also it's one of those topics that I feel we've been promised a lot more good research over the past 10, 15 years than we've actually gotten. I know there are many, many, many people working on it, but it seems as though the microbiome is a much more important driver of overall health than people a hundred years ago may have imagined. I don't know. For all I know, maybe they were way ahead of us then. Can you just talk for a minute about the state of gut microbiome research and what you think we'll be learning over the next 10 or 15 years that might be really useful?
- [54:19]
Zeke Emanuel
Oh, absolutely. I totally agree with you. For most of the 20th century, the idea is bacteria bad. They cause illness, they kill you, and antibiotics good. And then what we've learned over the last 30 or 40 years is way oversimplified. Those bacteria, they're really there. They're good. We've grown up with them and we've adapted to them. Just think about it from an evolutionary standpoint. We have more bacteria in our gut than we have cells in the rest of our body. They gotta be there for a reason. That's very important. And we also know that the diversity of microbiome is a very important sign. Exactly the function of each species. We're beginning to elucidate this. All of us are impatient. You know, it was 55 years ago that Richard Nixon created the war on cancer. Now we're getting all these treatments and cures. Frankly, it took 55 years because cancer's complicated. The microbiome and its effect on biology, the same thing. It's going to take us probably another 20 or 30 years to really dissect out everything and the circuits and really make a lot of advances. Nonetheless, we do know just basic principles. Diversity is good. The microbiome needs a lot of bacteria, but it also needs a lot of fiber and different kinds of fiber, not just the fiber supplements you get so that the bacteria can grow. They protect the lining. It's probably related. And here I'm going A little out on thin ice. Probably related to the rise in things like colon cancer and other illnesses, especially among young people.
- [55:52]
Stephen Dubner
I remember last time we spoke you were pretty surprised and shaken by the rise in colon cancer among people in their even 20s and 30s. Yeah.
- [56:00]
Zeke Emanuel
Yes. And I've had a lot of friends who've been diagnosed and unfortunately died from colon cancer in their 30s and young 40s.
- [56:08]
Stephen Dubner
When you say that the microbiome is a site of interest there, what do you think is happening? Do you think this has to do with ultra processed foods? Do you think it has to do with antibiotic? I don't know where to lead you, so I'll let you lead.
- [56:21]
Zeke Emanuel
I do think ultra processed foods and the decrease in diversity, I also think probably pesticides that we've consumed and are on everything also decrease the diversity of our microbiome. And the right kind of bacteria that protect the lining of the colon, decreasing.
- [56:38]
Stephen Dubner
And where do those right kind of bacteria primarily come from?
- [56:42]
Zeke Emanuel
Nature. All the things that we are supposed to eat.
- [56:45]
Stephen Dubner
So this is fermented foods, yogurts, et.
- [56:47]
Zeke Emanuel
Cetera, and fiber so that they can grow in the gut and they can out compete the other bacteria that we have. This is where I get nervous. About 60% of calories among adults and children are ultra processed foods. That is not good. We know that decreases the microbiome diversity. Diet sodas decrease the microbiome diversity. Only 7% of the American population consumes enough fiber. That is horrible. We really need more fruits and vegetables as a regular part of our diet. I think this emphasis on protein is overdone and the emphasis on fiber is underdone and we need to shift that. I do think, Stephen, one of the things we are gonna learn is which bacteria are really important and also what the different bacteria do. The impact on our cognitive function, our cardiovascular function. I think we're just at the start of it. We do now know things like fecal transplants can be effective in treating diseases like C. Difficile, which are caused by over antibiotic use, are gonna be really, really important. The other flip side, and I think it's important for the listeners not to forget this is, you know, we unfortunately have in our food system, we treat a lot of animals with antibiotics and that's probably a bad thing because of antibiotic resistance. And also maybe some of those bacteria are not so bad for us to consume. We do know in some cases some of the bacteria are really bad. Raw milk, not a good idea. But in many other cases, I think treating chickens and beef and Other animals with antibiotics is a bad idea and not good for our food system. And this goes back to the issue we were talking about before. Being well and having wellness. It's not just what I do, it's also what the system does. And unfortunately, the American system is focused on more on making profits for this part of the economy and externalizing the costs on the rest of society.
- [58:45]
Stephen Dubner
What you're describing is what some people might call a wicked problem. Not just people from Boston, but researchers like to describe a wicked problem as one that's, you know, entrenched and has a lot of different players in it who have incentives to maintain their incumbency and so on. So any solution that I would think that you would like, whether it's in the healthcare system, in the food system and so on, and is inevitably a political solution, is it not?
- [59:11]
Zeke Emanuel
I agree with you. We have to change the food subsidy system we have in this country. Can we change it overnight? Absolutely not. We've got farmers who have grown up with this food subsidy, who've created their production, and we have to slowly shift. Can we do that? Yes. We've learned we can do that with tobacco, We've learned we can do that with coal. And we have to shift and give them alternatives. I think that is gonna be in every American's interest. There are a lot of societies out there where only 20% of the calories are from ultra processed foods. That's where we need to be.
- [59:43]
Stephen Dubner
Let's talk about chapter five for a moment. Move it. This chapter I liked a lot. We did an episode once called what's the Best Exercise? And the answer was, the best exercise is whichever one you will stick with. I thought of that because when you're writing about exercise and the benefits and so on, you're really writing about habit formation. You mentioned earlier in this conversation willpower and how you can't really rely on that. So just talk about that overlap between exercise and habit formation and how you would advise someone who wants to be more active, wants to be more regular in their activity, but has a hard time getting there.
- [60:26]
Zeke Emanuel
You have to have the attitude, I want to start this. That's the first thing. Initiation. I'm going to start. The second thing is you have to actually set a date, set a time, and make it at least three or four times a week you're going to do something. I often recommend doing it with another person because they keep you honest and they too want to do it and you're sort of playing off each other. The really important thing about Exercise is the repetition. The best data that I have found is four times a week for six weeks really gets you to a stage where it has become a habit and you're more likely to continue it to 12 weeks. We don't have very long term outcomes. The important thing there, I think, is by the time you've gone six weeks, you've built it into a routine. And that is the critical element, the repetition. So the thing I recommend to people is, and this is what I do is vigorous activity. You need 75 minutes, that's 10 minutes a day. Well, I don't do 10 minutes a day. I do 20 minute chunks. So in the winter, I get on a stationary bicycle three times a week for 20 minutes and I do a lot of other activity that.
- [61:39]
Stephen Dubner
What's your degree of difficulty on that bike?
- [61:42]
Zeke Emanuel
I do a peloton exercise and I end up sweating and my heart rate has to go over about 110.
- [61:48]
Stephen Dubner
That's not crazy. 110.
- [61:49]
Zeke Emanuel
It's not crazy. And almost everyone can find 20 minutes or you know, with a shower and whatever else. 30, 35 minutes a day, three times a week. That's not that crazy a time period. You know, some weeks like this week, the holiday week, I am not going to exercise. I'm away from home. I will continue to do my yoga, but I'm not going to get out on the bicycle. All right, then I'll go back home where I have all the set up and I'll continue it. Am I gonna become suddenly unhealthy? No, you know, I'll get back onto it.
- [62:20]
Stephen Dubner
Let's talk about chapter six for a minute. Sleep like a baby. So I'm already a sleep advocate. I love to sleep. I'm like Olympic level sleeper. Everyone in my family's very jealous.
- [62:31]
Zeke Emanuel
What's your secret, Steven? Come on.
- [62:33]
Stephen Dubner
So here's the problem. It's just natural. It comes to me. So I feel a little bit guilty about it because I have a lot of friends and family who really do have a hard time sleeping. And therefore they reach out to what strike me as often absurd aids for sleeping. And you're not a fan of some of the absurd sleep aids as well, or sleep advice? I guess. So why don't you give me the dos and don'ts of the Zeke Emanuel sleeping program?
- [63:00]
Zeke Emanuel
First of all, this is one where everyone has to be forgiving of themselves. Every other wellness behavior you can will yourself to do, you can will yourself to exercise, you can will yourself to eat well, you cannot will yourself to sleep. You get in bed and you're willing yourself to go to sleep. It will not happen. We all know that. Second, we are all prone to quick fixes. That's the American way. We reach for the melatonin or we reach for the magnesium or whatever our pill of choice is. You know, the American Academy of Sleep Medicine. No, they do not work. Do not do them. That's not the approach to take. There are two things we can do. One is we can set the bed and set the room up, make it dark, make it cool, tape over those lights, or get those things out, put the phone in a different room, get in bed, read an actual book, not on a computer screen, and then go to sleep. No guarantees that way, Right? And then if you're still having problems after you've done that for a while, cognitive behavioral therapy for insomnia is the most effective treatment.
- [64:06]
Stephen Dubner
You don't seem to put a lot of stock in apps that track your sleep. Why is that?
- [64:11]
Zeke Emanuel
I get up in the morning. Anyone? You get up in the morning, you feel well or you don't feel well, and let's say the app tells you something different. Well, you're going to believe the app more than your body. No, your body is the ground truth. Are you feeling like you can concentrate, like you've got the energy for the day? If you don't, I don't care what the app says. If it's anxiety provoking, which I think most of the sleep apps are, it's unclear what advantage you're getting. It's not like wearing an aura ring or a apple watch that they're actually gonna make you sleep. They're not solving your problem. They're not therapeutic. They're giving you data. And sometimes that data just makes you more anxious. And that data is not more valuable than what your body is telling you.
- [64:54]
Stephen Dubner
So a lot of the advice out there around health and wellness, or the Wellness Industrial Complex, as we're calling it, has to do with things you shouldn't do. Some you should, but a lot that you shouldn't. And one thing that I just liked about your book was that you focused on some of the do's, beyond just the foods that are good for you and the exercise that is good for you, but also the notion of joy and celebration and setting out to actively celebrate yourself or others and so on. Can you talk about how to make that more of a routine for more people?
- [65:30]
Zeke Emanuel
We're on this Earth for 75, 85, 90 years. That's it. You can practice a lot of self Denial. You can practice a lot of anxiety over getting everything right, or you can live a meaningful life where meaningful is mostly, I find it's about other people. It's about doing good in the world. It's about connecting to people. When I have a dinner party and I have people over and we're having a really good conversation, that's great, my joy is up. It's also good in the long term because, you know, sociability is good. And third, it's virtuous because the other people are gaining that sociability, that good conversation. We're all in it together, and we're all actually making wellness part of our everyday life. It's like a trifecta. It's a wellness trifecta. It's good today, it's good for tomorrow, and it's good for the other people. What could be better in life?
- [66:27]
Stephen Dubner
You quote the late British Chief Rabbi Jonathan Sacks, who wrote, we defeat death not by living forever, which, as we know, is impossible, but by living by values that live forever. Your book, Zeke, is mostly about personal behavior and not values per se, but my sense is that the values are always just underneath the surface. So I'm wondering what you have to say about that. If I asked you to synthesize or summarize Zeke Emanuel's values to live by beyond the eating, the exercise, et cetera, et cetera, what would that be?
- [67:03]
Zeke Emanuel
You're 100% right. And I don't think they're that much beneath the surface. To go back and quote Ben Franklin, his great thing is be useful. And by be useful, he meant, how are you making the world better? One of the things I think my parents instilled in me and my brothers, and now you're going to make me cry when I think about my parents is, look, you are privileged. You came into this great world. You came into it at a great moment, and the real challenge for you is, how are you going to make it better for people who aren't as privileged as you are? And how are you going to make it a better place to going forward? I think I've dedicated my life to trying to make the world better, whether it's by improving the healthcare system, by mentoring kids and putting them on the right way. There are so many ways we can make the world better in our daily life. Cheering people up, just growing things. Ben Franklin challenges us be useful. How are you being useful? How are you? Making the world better is the most important thing we can commit ourselves to. And it'll give us joy, because that's part of having a meaningful life. And if there's anything that makes our life better, it's having meaning in it.
- [68:20]
Stephen Dubner
Zeke, I enjoy every conversation with you, but I think this is my favorite. So thanks.
- [68:26]
Zeke Emanuel
I'm honored, Steve, and you are the best interviewer. Thank you so much.
- [68:34]
Stephen Dubner
Let me just say for the record, I'm pretty sure I am not the best interviewer. So if Zeke Emanuel is going to get that wrong, maybe we should just discount everything he said today. I'll let you be the judge again. His new book is called Eat yout Ice 6 Simple Rules for a Long and Healthy Life. Let us know what you thought. Our email is radio freakonomics.com Coming up next time on the final installment of the Freakonomics Radio Guide to Getting Better, are we about to take a giant leap forward in medicine?
- [69:07]
Zeke Emanuel
It's happening in eight emergency departments in the greater New York area. They're automatically being screened by the AI model for heart disease.
- [69:16]
Stephen Dubner
As we all know, the healthcare system could use some serious disruption. There are a lot of reasons that we are pretty static and we like technology, but we like it in very, very specific ways. So how much and in what ways will AI remake medicine? That's next time on the show. Until then, take care of yourself and if you can, someone else too. Freakonomics Radio is produced by Stitcher and Renbud Radio. You can find our entire archive on any podcast app. Also at Freakino, where we publish transcripts and show notes. This episode was produced by Alina Coleman and edited by Ellen Frankman. It was mixed by Jasmine Klinger with help from Jeremy Johnston. For background research, help. Special thanks to Corby Kummer, David Wendler, Govind Persad, Marion Nestle, Suzanne Rohitter, and Zach Cooper. The Freakonomics Radio Network staff also includes Augusta Chapman, Dalvin Abuaji, Eleanor Osborne, Elsa Hernandez, Gabriel Roth, Hilaria Montenacourt, Teo Jacobs, and Zach Lipinski. Our theme song is Mr. Fortune by the Hitchhikers and our composer is Luis Guerra.
- [70:29]
Zeke Emanuel
I drove in and I had a very nice mocha at Amherst. Coffee I normally do not drink coffee, but because it's Dr. Dubner, I have to be at the top of my game.
- [70:44]
Edward Jones Announcer
The freakonomics race network the hidden side of everything. Stitcher.
- [70:58]
Hidden Brain Podcast Announcer
The start of a new year is a natural moment to set new goals and shake up old habits. But doing so can also feel a little daunting. If you've ever reached the end of January feeling a bit cynical or discouraged about the hopes and resolutions that had seemed achievable just a few weeks earlier. The Hidden Brain Podcast is here to help all. This month we'll bring you the latest installment of Our popular your 2.0 series. The focus will be on the self doubt and anxiety that many of us grapple with when charting a new path. Whether you're struggling with self criticism, a lack of patience, or finding the courage to make a big change, we've got your back. That's U 2.0 from Hidden Brain all through the month of January. Join Us.
- [71:56]
Freakonomics Radio Announcer
Did you know 39% of teen drivers admit to texting while driving? Even scarier, those who text are more likely to speed and run red lights. Shockingly, 94% know it's dangerous, but do it anyway. As a parent, you can't always be in the car, but you can stay connected to their safety with Greenlight Infinity's driving reports. Monitor their driving habits, see if they're using their phone, speeding, and more. These reports provide real data for meaningful conversations about safety. Plus, with weekly updates, you can track their progress over time. Help keep your teens safe. Sign up for Greenlight infinity@greenlight.com podcast hi, I'm Angie Hicks, co founder of Angie. One thing I've learned is that you buy a house, but you make it a home.
- [72:33]
Zeke Emanuel
And for decades, Angie's helped millions of.
- [72:35]
Freakonomics Radio Announcer
Homeowners hire skilled pros for the projects that matter. Get all your jobs done well at Angie. Combination.