B (3:00)

No, no, far from it. I've just been a writer for my whole life. Yeah.

A (3:08)

Hey, everyone, it's Adam Grant. Welcome back to Rethinking my podcast with Ted on the science of what makes us tick. I'm an organizational psychologist and I'm taking you inside the minds of fascinating people to explore new thoughts and new ways of thinking.

A (3:26)

Eric Topol is a cardiologist at Scripps. He's a prolific researcher with over 1,300 publications and one of the 10 most cited living scientists in medicine. In his book Superagers, he shares his surprising findings about the genetics of longevity. And because the longevity movement is full of pseudoscience, he's going to bust some myths about increasing your lifespan and your health span.

A (3:53)

Well, Eric, I thought it would be fun for all of our listeners if we just went through all of your scientific publications one by one.

B (4:03)

It's a new cure for insomnia.

A (4:05)

Yeah, no. I have so many things I want to talk to you about, but I'm going to start with something that I find to be an annoyingly boring question for almost everyone. But given all you know about diet and health span, what did you have for breakfast today?

B (4:22)

I had some non fat Greek yogurt, you know, plain with some blueberries and a little sprinkling of low sugar granola.

A (4:31)

I feel very validated right now. Non fat plain yogurt with blueberries and strawberries this morning. Should I feel good about that?

B (4:39)

Yeah, absolutely. Because you got some good protein, you didn't hit on the sugar. The berries are really healthy. That's as good as you can get for a healthy breakfast.

A (4:51)

Thank you.

B (4:54)

I love it.

A (4:55)

I want to talk about superagers, of course, and I guess the starting point for me at least is the welderly research you did. And I wondered if you could just walk us through the idea behind the study, what you were hoping to find and what surprised you.

B (5:13)

Yeah, well, it was a big surprise, I can say that. So we had to find elderly 85 years plus up to 102 is the range. But they had to be so healthy they never had any medical condition and on no medications and be cognitively intact. So it took us seven years to find 1400 such people who would Participate and give blood for whole genome sequencing. We did the sequencing and to our real surprise, we found nothing different about the elderly as compared to the elderly, which is a control group of people over 65 with the usual chronic age related diseases. So nothing like we had suspected. And it really changed our whole view as to what the determinants of healthspan, particularly extreme healthspan.

A (6:08)

So let me get this straight. You're saying that people who made it into old age with no major age related disease were not genetically different from the people who were aging poorly.

B (6:19)

There were some differences, but most of these people had their parents, their siblings die 20 years younger than them. So that alone gives you a familial pattern that doesn't support genetics.

A (6:35)

And I take it you were stunned by this, given everything we know about genetics and health.

B (6:40)

Right. To have every, you know, 3 billion letters of each of these people's genomes and to see so little difference, it was really a stunner.

A (6:50)

So once you've ruled out major genetic causes, that turns to lifestyle and the choices we make. I think the good news is it's controllable. It suggests to me at least that a lot more of longevity is in our hands than we might believe.

B (7:05)

Yes and no. I would say yes, because lifestyle is a big deal for healthspan, but no, because even though we don't see it in the DNA, I think what we have learned is the immune system, so called immunosenescence, and how that relates to inflammation. So that is likely the explanation and everything supports that. The main endowed feature of these people is they have this remarkably healthy immune system which going back to your point Adam, is so greatly influenced by lifestyle factors.

A (7:39)

Got it. So even if there aren't major genetic influences on healthspan, there are important biological drivers which in turn are affected by lifestyle.

B (7:50)

Exactly. Yes. You got it.

A (7:52)

Okay, good. So let's talk about a healthy lifestyle then. I think it seems to me, you know, as an outsider, that the longevity industry has exploded. And with that the number of people who are peddling snake oil has just, I don't know if whether it's increased exponentially or whether their visibility has increased exponentially or both, but I feel like I'm bombarded with people hawking products, diets, habits that don't pass my non expert sniff test of credibility. This must drive you mad. As an actual expert, it does drive me crazy.

B (8:30)

And it was one of the real reasons, the impetus to write a book, to get the story straight, to get the hard evidence out there, because basically so many people are interested in longevity and extending healthspan and they become the prey, the prey for these longevity companies, longevity clinics, these anti aging supplements, these are being hawked by so called longevity influencers. This is a real problem, is that there's just so much complete pseudoscience not backed up by real data and evidence and claims that are just out there off the rails. So it's a longevity moment in the respect of the interest. And part of that is fueled by there are some really good biotech companies that are trying to pursue reversing aging and they're doing some really elegant science. So that's part of it. And then the other part is this huge investment by the billionaires. When they were young, they wanted to be rich, but now they're rich, they want to get young. So there's so much going into this between the pseudoscience, the investment, some really exciting biotech, maybe someday we'll reverse aging, but we really want to get this straight. And a lot of things that are being promoted out there have no basis at all.

A (9:51)

Okay, so I want to give you your moment in the sun to be a professional debunker. What's on your top 10 list of pseudoscience and snake oil?

B (9:59)

Oh, gosh, there's so much. See, where to start? The supplements are pretty high up. The ones that claim anti aging and health benefits, they haven't had any data, meaningful data to support them. So they're way up on the kind of irritant list of pseudoscience. The longevity clinics that charge up to $250,000 to go and have a plasmapheresis of blood from a young person, or hyperbaric oxygen chamber or stem cells. They're up there, they're all over the place. Next would be the advocates for total body mri. This is absurd because that's supposedly a way to diagnose cancer or prevent cancer. Well, sorry, but if you get a total body MRI and you have a mass that turns out to be after biopsy cancer, that's not catching cancer early. There's already billions of cells. If it's showing up on an mri, the problem is most people who have an abnormality, it's not cancer, but they have to go through a rabbit hole, all sorts of, you know, invasive tests. And I've seen patients who've had, you know, bleeding in their liver that were very serious, or pneumothorax, collapsed lung from a lung biopsy. So you don't want to have a total body MRI if you're healthy. Another one Is rapamycin pushing rapamycin? This is crazy. It works well in mice, but there's no data to support in people. There's this leaderboard of all these longevity influencers that take this dose or that dose. So you could be taking what you think is a low dose because everyone's variable and you could wind up having very marked suppression of your immune system, which. What does that do? Well, you could get cancer. You could just bring it out. You've lost your ability to fight those early cancer cells and all sorts of bad things, no less infections. So I could keep going. I mean there's this protein craze. Many call it bro science. You take these ridiculous amounts of protein.

A (11:59)

Every day to build muscle. Right?

B (12:01)

It's not. Yeah, build muscle. Well, you know what? There are no data to support these crazy recommendations of 1 gram per pound or even more. The data supports, you know, 1 gram per kilogram, which is half and maybe slightly increase if you're older, you're trying to get some extra muscle mass, but when you get to too high a protein, especially when it's animal derived protein, you're going to get body wide inflammation. And the experimental models show you're gonna promote atherosclerosis. You don't wanna do that. So yeah, I guess I could keep going. That's a starter list. There's more, of course.

A (12:40)

I wanna come back to supplements. Can you talk to me a little bit about should the average person be taking vitamins or supplements of any kind?

B (12:47)

Well, I did review that in the book and where are the data? And so for healthy people eating a healthy diet, there usually is no reason to take any vitamin. However, there was one study that showed a very small benefit for multivitamins. And there are people who turn out when they get tested, they might have a very low vitamin D or they might be very low in vitamin B12 for specific. As it turns out, I wouldn't go after these blood tests when there's no symptoms and somebody's healthy and having a normal diet. But when it gets tested and a physician says, you know, you're really, your vitamin D is very low, it's reasonable to supplement it. That's a different story. But for healthy people, they shouldn't worry about taking vitamins. They want to take a multivitamin a day, it's not going to hurt them. But the benefit here is so marginal and there's an expense attached to vitamins. They are generally different than supplements, you know, green powders and all sorts of other herbs and plants and whatnot vitamins are not nearly as incriminated for, you know, the kind of pseudoscience as the supplements, per se.

A (14:02)

Okay. That being said, I have. I have come across some randomized controlled trials suggesting harm from taking too many of certain kinds of vitamins. Where do you come down on that?

B (14:14)

It's hard to be sure of harm. There are many things that have been looked at, you know, like selenium was tested for prostate cancer and looked like it made it worse. And, you know, so there's specific studies in general taking some vitamins that hasn't been as incriminated as taking some of these supplements.

A (14:32)

What about on the supplement side? It seems like there are some that might have small benefits and seem to be relatively harmless, like fish oil, for example.

B (14:41)

You know, fish oil is an interesting one because Omega 3, when you look at the studies from diet, it looks very good, very favorable. When you look at the supplement studies, it looks like you have to take an awful lot of fish oil so much that you'd have to be smelling a fish. But as I tell my patients who ask me about this, they often come in with a list of all supplements they're taking. Said, you know, it's going to enrich your urine, if you like that, but it doesn't really going to do much to help you, your biology and your health. So, you know, if you really want to spend your money on that, it's okay, but we just don't have evidence for the benefit.

A (15:19)

Okay, so it sounds like a lot of people are gonna be scaling back their supplement use and a fair amount of their vitamin consumption, too.

B (15:27)

Well, you'd think so, Adam, but there's a lot of rejection of the medical establishment right now. And that's a lot of reason why people are taking the supplement is because they have kind of given up on the medical community for giving them, you know, good information. So they're doing their own research or they're responding to, you know, the promotion of these things. So I find it hard when I look these patients with their list of supplements to get them to change. And basically we come back with a neutral zone, which is, okay, if you want to take them, go ahead. But they usually don't give them up. It's surprising. They get attached to them. And as you know, there's a lot of placebo effect because you take this thing and you feel better and you attribute it to this thing that you took, and, you know, it's hard to undo this stuff.

A (16:15)

Yeah, that makes sense. Yeah. I was thinking a little bit about Even if there isn't a placebo effect creating a benefit, removing the placebo can carry a cost.

B (16:23)

Exactly. Yeah.

A (16:25)

So we've crossed out a bunch of things that are not that helpful and may even be counterproductive. What are your top recommendations? Evidence based for extending our health span and, or our lifespan.

B (16:38)

Yeah. So, I mean, I think the novel part of the book is about preventing the big three diseases. Alzheimer's, neurodegenerative disease, cancers, and cardiovascular. We've never done that in medicine. We've been talking about it, I think, for a couple of millennia, but we've never done it. And we have a way to do that now. And it does bring in these lifestyle factors, which we'll talk about. But it's not just that. It's identifying the high risk people for each of those diseases. And we have 20 years of Runway. That's what a lot of people don't realize. They think, oh well, this person just had a cancer diagnosis. It must have been brewing for the recent months. No, 20 years. Heart disease, the arteries are getting clogged. Takes 20 years before a person's going to have a heart attack. And the same thing for Alzheimer's, at least 20 years for the brain to get these misfolded proteins and all this brain inflammation and whatnot. So we have not paid enough respect to these two decades or more time. And in medicine, oh my goodness, if you have two decades to be able to get ahead of one of these diseases, that's amazing in itself. But the next thing is we have these new abilities through genes and proteins and markers to find the high risk people. Even an AI of the retina predicts almost most of these diseases, maybe not cancer, but the others. So we have new ways, we have new ways to nail down not just if you have risk when this is going to manifest. If nothing is done, then we bring in the lifestyle factors. But of course, it does rely on the old stuff, the traditional risk factors which have been enhanced in recent times, and a lot of new stuff, which is really understanding the science of aging, the biology of aging, which has made big advances in recent years. And that's kind of why we have this fixation more than ever on longevity and health span.

A (18:36)

It's interesting because if we had stopped where you were earlier on the total body mri, it would be easy for someone to conclude that you're, you're not a big proponent of early detection. And in fact, that's exactly where you're landing to say, let's not wait until 20 years accumulation has happened let's try to head this off as early as possible.

B (18:55)

Yeah, I mean, the total body mri, it's not early detection. If you pick up a mass there, as I mentioned, you've already got a lot of cancer in your body and it may well have spread to other organs. So there's microscopic cancer capability. Pick up now within a tube of blood to pick up tumor DNA in, you know, very small quantities. And what's really exciting there, Adam, is it appears that in a high risk cancer patient who has tumor DNA, you pick up really early. Some of these people, their immune system will squash it so that months later, three months later, six months later, there's no tumor DNA. And there's ways we can also rev up the immune system in that person so that they get rid of the cancer before it ever gets legs. So this is something that I think people just don't know about. And I'd rather have a microscopic diagnosis than an MRI diagnosis if I'm going to prevent cancer. And I want to know if I'm high risk before any of that.

A (19:55)

Yeah, that sounds amazing. So how soon is that technology going to be widely available, do you think?

B (19:59)

Well, you can get the multicancer early detection test now. It can be ordered by any physician. I think the problem with that whole program is it's been mimicking how we screen for cancer using age. So, for example, mammography. 88% of women will never have breast cancer in their lifetime. 11 to 12% will. We put 100% of women recommend to have mammography, you know, every two years beginning age 40 or 45. Well, we can partition the risk. We can define who those 12% are. Why aren't we doing that? But instead we use this age thing. That's when you get the bang for the buck of that test. And we sure want to prevent rather than treat, because prevention, you know, that's the real thing that has been outside of our reach.

A (20:54)

What's the Ben Franklin line? That an ounce of prevention is worth a pound of cure?

B (20:58)

Exactly. I would say hundreds of pounds of cure. Because we rarely get cures. We might get treatments. I mean, you know, our treatments for cancer haven't changed for most types of cancer all that much. That's why it's still the second leading cause of death. So our treatments are bad. Our prevention could be really good.

A (21:19)

So how do you think about identifying high risk then, if you're not factoring age?

B (21:24)

Yeah, so that's where you go to getting these layers of data. So everybody has electronic health records. Everyone has lab tests, may have some scans, and in addition to the usual stuff, then you have a polygenic risk score. And that tells you for the various cancers, heart disease, Alzheimer's, Parkinson's, what are the gene variants that you carry that are associated with, with risk in the top 5 or 10% of risk. So polygenic risk score is 1. A genome sequence or particular gene markers would identify key mutations in cancer genes like BRCA1, BRCA2. So a genome would help. And now in cardiology, where I live for the last three, pushing four decades soon, we have lots of ways to assess with these lipids, new lipids like lipoprotein A, with even drugs to counter that, bringing LDL down really, really low if we need to, looking at inflammation markers that we haven't used. So we have lots of different ways to get on top of prevention of heart disease. And I'm sorry to say that we don't prevent heart disease very well. We react to someone having a heart attack or a stent or a bypass, but before they ever get there, we don't do a good job.

A (22:48)

Okay, so it sounds like there's a lot we could be doing that we're not doing. And I'm wondering, what do I do with this information as an individual patient? Am I supposed to go to my doctor and say I want an apologetic risk score, I want a genome sequence, I want proteomics and I want biomarkers. Get on it, please.

B (23:07)

Yeah. And you know what the response would be of most doctors? What are you talking about? So this is where we need a kind of ground up revolution where the educated, savvy consumer can help drive this. Unfortunately, you know, the medical community takes a long time to change. Look how long these mass screenings for cancer have been going on. Decades of dumb cancer screening. We only pick up 14% of cancers through our current tens of billions of dollars that we invest for cancer screening. And there's resistance to change because the companies that do the cancer screening, you know, they're going to keep lobbying to do the cancer screening and for everyone instead of for people of increased risk.

A (23:55)

So let's, let's come back to the lifestyle factors then we'd love to talk a little bit about exercise, which I think goes, no pun intended, right to the heart of your expertise as a cardiologist. I have heard so many disagreements when it comes to healthspan. Should I be doing lots of zone two exercise? Zone four, Should I be doing zone three? What does the best evidence actually tell us?

B (24:18)

Yeah, the best evidence is just move Physical activity is great and whatever zone you want to be in, if you want to be 3, 4, 5 to go more vigorous. We don't have great data to show that you go, you know, to ultra levels of extreme physical activity that you get ultra benefit that we don't know. In fact, it's possible it's even harmful if you overcook your exercise. What we do know is that the aerobic exercise, that's great, but you also need resistance training. You also need balance training, especially as you get older, you lose your brain perception and proprioception, as it's called. So what you really want to do is have a balance type of exercise. It's not so much the zones, because when you're doing resistance training, you're like in zone two, your heart rate's not that fast, right? But you're getting really important core and upper body strength you won't get from walking or bicycling or treadmill or whatever. So this is, I think, the new thing. Exercises that getting a balanced type of program and trying to get as many days as possible that you're doing it. Mixing it up, of course, and making it pleasant, making it. Nobody, I think, absolutely loves to go do their exercise. But if you make it enjoyable with music or television or, you know, friends that are working out together or whatever, then, you know, you get in a groove and you don't want to get out of it. That's what you want and just make sure it's balanced and you include balanced training, especially as you get older.

A (25:52)

That sounds manageable for most people.

A (25:57)

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A (28:08)

All right, I want to shift gears a little bit. Eric, I know that good scientists have a healthy dose of skepticism, but also are open minded. And I'm wondering how you walk that tightrope. We heard your healthy skepticism around supplements earlier, but you're also somebody who's excited about new possibilities and has published a lot of research around new discoveries. How do you make sure you don't fall off one or the other side of that tightrope?

B (28:33)

Yeah, I mean, you start off by don't trust anything, challenge all dogma and you say, I want definitive proof. You know, as you know, that requires not just one study, you gotta have independent replication. You know, it's gotta be done right. So that old adage of science about proof and replication, transparency, you know, publish it. So demanding for high rigorous work is what we need. That's how we get misled so much and we make big mistakes.

A (29:06)

Well, I think that that speaks to a dynamic that must be affecting you in every part of your life, which is we thought that the Internet was going to give people access to information and empower consumers. And what it's done for a lot of people is give them access to misinformation and disinformation.

B (29:24)

Yeah.

A (29:25)

How do you think about being an informed patient and you know, not over relying on Dr. Google or Dr. Claude or Dr. Chatgpt, but at the same time not entrusting everything to the one or two experts who may primarily be overseeing your health choices.

B (29:43)

Yeah, it's a great question. I think that the gender of AI part is a bonus now just because you can not only go to ChatGPT more than once and go to Cloud or Copilot, whatever you can get multiple opinions, which is healthy, and nobody in anything serious matter in medicine should go with one opinion. And some of the AI work is very encouraging for promoting accuracy, diagnostic accuracy. So it's good or reviewing all the data and not missing things. So to get to your point, it's going to be taking advantage of the AI world we're in right now, which is going to keep getting better and having a doctor who we trust. And obviously, if you want to do research, that's why I did my own research, you could come up with any finding you want to. So that's why you'd like to have the human oversight of an expert, of someone who you trust, someone who you know has your back. That's a problem because most doctors are so busy, they don't have the time to go over things. You know, a patient comes in and they've got seven to 12 minutes, they get interrupted after the first 15 seconds. It's hard. And that's why we hope that we're going to get the gift of time back to physicians and patients to improve that relationship. That's eroded and that's the shortage we have today. That's how we've led to the concierge medicine practice, because we didn't have enough physicians that had enough time to really dedicate and show that they, they really cared about their patients.

A (31:18)

It makes me wonder about you go to a physician for a checkup. Should you then be feeding your health data into an AI tool? Should you be taking your physician's summary and asking, you know, for an AI critique of it? Should you expect that your physician is doing all of that as, you know, sort of a. A check and balance on, on her or his own judgment? Where. Where are we on that?

B (31:42)

Well, you wouldn't anticipate the physicians doing it at this point because most are not. I think it's very reasonable to take your data. Yeah, put that in, see what it says. You have nothing to lose. Now, the problem, as you know, we have some people that are kind of cyberchondriacs to start with, and this could just make things worse. Right. But as long as you're not in that crew where you're just, you know, hyper anxious, it gives you an extra layer of review of your data. And I think that's going to become common. What was missed?

A (32:14)

It does seem like we're rapidly approaching a frontier that looks a little bit like an autonomous car, which is for a long time people said, I wouldn't trust the car. And now the error rate is so much lower that it almost seems unethical to let humans drive.

B (32:30)

Well, what you're bringing up is a really important concept. And the autonomous cars, they function in a low level of autonomy, so called levels one through three. They know their region really well. And they're only in good weather conditions. Right. Everything's kind of ideal. Right. But they can't take you out on the highway or go in zones they're not familiar with, or when it's raining or icy or that kind of snow. No. So that's level four or five. And I think that's what it is like in medicine. You get to a point where your autonomy can work to some degree, but it's never going to be completely covering all aspects of medicine. It's going to be a big augmentative function. Yeah.

A (33:16)

So maybe the better analogy then right now is medicine is going to approach where we are with flying an airplane.

B (33:22)

Yeah, yeah. You have tremendous amount of help and you just are there to kind of oversee that autopilot. We're going to be more efficient. We need it because we can't keep up with the level of the care and the burden that we face.

A (33:38)

Okay. So, Eric, I have to ask you, you mentioned the possibility of reversing aging earlier.

A (33:45)

There's a lot of AI hype right now about these tools getting so sophisticated that we can essentially end disease and therefore not die. Do you think it's possible for humans to live forever?

B (34:00)

No, absolutely not. Aging is not a disease. It's a process. And if we ever are able to reverse it to some extent, which remains to be proven, there'll be some risks for that. There'll be trade offs when we. When we do epigenetic cellular reprogramming in the mouse. We can make a mouse look young inside all their organs look young. Everything's great. But they get tumors. That's not good. So there's going to be some risk involved. I want it to work, but you know, what are we going to get out of this? Three years, five years? You know, it's not going to be immortal. Maybe we'll see a way to get rejuvenated to some degree for a small period. No, but no demos a Sabbath said on 60 Minutes not long ago when prompted, will be able to end all diseases in the next decade or so. Well, of course I don't agree with that, and he's my friend. The issue though is that his strategy is I'm going to use AI for much better drug discovery. Right. And drug discovery is not going to get us to end all diseases. I mean, the number of cures we have in medicine, you can count on two hands really. We have some really good treatments, we're getting better, like the GLP1 drugs, but that's not going to end all diseases. And even with AI discovering new treatments, they're not usually cures. And we can't do genome editing of everybody in the species either. So no, I think realistically that's why I take the path. Let's prevent diseases, let's work that way. Let's deal with the age related process that we all have. Let's find out who are vulnerable to what disease of the big three and prevent it.

A (35:50)

Are you leaving us with the conclusion that even if we fast forward centuries or millennia, that there's no hope for a field like cryonics?

B (36:00)

I don't see that. No. I think that the way cells work, the way organs and tissue in our body work, we're not going to be able to preserve people. And sure, we could put somebody on a life support machine now and we could probably get them to live on a machine for another 50 years. That's possible. What good is it? You're on a life support machine.

B (36:26)

Yeah. So no, I don't see that as a likely scenario. I could be wrong of course, but I just don't. I'm an optimist, but that seems to go well beyond optimism.

A (36:40)

Yeah, I guess hearing you think out loud about that, the only version of it that seems palatable based on the constraints that you're laying out, is some kind of synthesis of organic and inorganic matter that makes the human brain less dependent on cells to begin with.

B (36:56)

That's a possibility, you know, if you could do that.

B (37:02)

The whole idea, you know, is in the nascent phase of, you know, brain implants and that sort of thing.

A (37:09)

So I think we're going to put you in the camp of highly unlikely that humans become more immortal at any point. But if you had to bet on a path, it would be the cyborg path, is that right?

B (37:22)

Well, the cyborg path, you know, I guess what that really means, you know, what does it really mean to be cyborg?

B (37:32)

Because, you know, if we're walking around with, you know, artificial hearts and brains and I don't know if that's human, you know, how much of the original human are we? So I don't even know if I'm all that excited about that prospect either. But it probably has a little bit more of a shot over the long haul.

A (37:52)

Fair.

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Bombas also makes underwear, slippers and tees.

B (38:44)

And for each thing you purchase, they.

A (38:46)

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B (38:48)

So they're cozy, too.

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A (39:39)

All right, let's go to a lightning round. We'll do some quick fire questions. Okay, what is the worst health advice you see dispensed regularly in my field.

B (39:49)

In cardiology, the one that drives me nuts is that people are being told to get a calcium score for their heart with a CT scan. And I cannot tell you how many people I see every week that have got this calcium score and now are getting anxious and staying anxious no matter what you try to tell them because they have some calcium in their arteries, so called cac. It makes me cack calcium artery. You know, that's the one that in my life drives me cuckoo.

A (40:16)

There we go. All right, what's your best health tip that we haven't covered well, we didn't.

B (40:21)

Really talk about sleep. So the vast majority of Americans are not getting good high quality sleep. They're not going to bed on a regular time. And when I found out I was such a terrible deep sleeper in general, I did some tracking and also about, you know, interactions with when I ate, when I exercised, all that stuff, I became a much better deep sleeper. So that is a really important part for all of these age related diseases, notably neurodegenerative. So I think that's the tip I would give is know if you're getting good quality and regular sleep because if you do that, everything's going to be better.

A (41:02)

Noted. What is something you've changed your mind about or rethought lately?

B (41:06)

Well, I mean until I did the research in the book, I wasn't convinced we could prevent these diseases and now I'm totally, I'm confident we're going to do this. The timing of all this that we talked about today is a fuzzy feature but I'm really confident we are going to go to a high power of flipping elderly to elderly over the years ahead and it won't be this rare person that's 85 without these diseases. It'll be much more common.

A (41:36)

Love that. Who are your dream dinner party guests?

B (41:40)

Oh gosh. I find the most stimulating conversations I have these days are people in the AI domain like Geoff Hinton and Demis Asabas because they are really trying to get this right because it has such a two edged sword and I like talking to people that are much more thinking about it in non health medical world to try to exchange views and all that.

A (42:07)

Those are the people we need you hanging out with. So I'm glad it's already happening.

A (42:13)

What's your question for me?

B (42:14)

Oh gosh. Have you ever been roughed up by a doctor?

A (42:19)

Roughed up? No. Thankfully I've certainly encountered my share of arrogant so called experts.

B (42:27)

Okay, but you, you never or your family never had like a, a wrong diagnosis.

A (42:32)

Oh, definitely. I can make a whole list for you.

B (42:34)

Okay. I include that in the roughed up category because you know, arrogance is one thing but another is missing a diagnosis and that's a really big deal. And there's like 12 million major diagnostic errors in this country a year. 800,000 people either disability or die from it. We gotta do better than this. I mean we don't admit to it in the medical community how frequent it is. And so for me this is really impetus that we have to fix get better. It's hard to make it worse.

A (43:06)

You know, Eric, I'm so glad you raised that because I feel like this is maybe the only place I can add value to medicine as an organizational psychologist is to say we know a lot about error prevention. My colleagues Amy Edmondson and Dave Hoffman, among others, have spent their careers trying to figure out what is it that causes an individual expert or a team to make a mistake and then how do we intervene to reduce the likelihood that happens. And it will not surprise you that one of the best interventions that we have to date is building psychological safety in a team where you can speak up without fear, which makes it easier to admit a mistake. It then puts other people in a position to to learn from what went wrong and then rethink their so called best practices and find better practices. And I would love to see more interfacing between your world and mine around those kinds of interventions.

B (43:55)

We need that desperately. Yeah.

A (43:59)

Well, we all know that science funding in America is in jeopardy right now. What's your strongest case? That this is a mistake?

B (44:07)

There's never been a more propitious, exciting time in life science and medicine. And what a time to gut medical research funding and public health agencies. I mean, the mismatch here, and that's a kind word, is incredible. I just hope that it's short lived and who would ever want to wish for time to go faster? So you got back to normality, but in that gap of time, we're going to lose a lot of momentum and precious, you know, improvements in human health.

A (44:42)

Eric, thank you for sharing your wealth of knowledge with us today. It's such a treat to finally meet you and I'm looking forward to the in person version.

B (44:50)

Yeah, so am I.

A (44:54)

Rethinking is hosted by me, Adam Grant. The show is produced by Ted with Cosmic Standard. Our producer is Jessica Glaser. Our editor is Alejandra Salazar. Our engineer is Asia Pilar Simpson. Our technical director is Jacob Winick and our fact checker is Paul Durbin. Our team includes Eliza Smith, Roxanne Hylash, Banbam Cheng, Julia Dickerson, Tansika Sung Manivung and Whitney Pennington Rogers. Original music by Hans Dale Su and Alison Layton Brown.

A (45:25)

From a health span standpoint, it sounds like if you're running or walking or doing active aerobic activity with your legs, you don't need weight training for legs. Is that what you're saying?

B (45:36)

No, it won't hurt you, but you could spend your time better on your core and upper body than keep working on the legs that are getting that. Yeah, yeah.

A (45:46)

Yes. Okay, that was. That was the answer. I was hoping for.

B (45:53)

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