Podcast Summary:

The Human Upgrade: Biohacking for Longevity & Performance
Host: Dave Asprey
Episode: The Tiny Implant Replacing Life-Changing Drugs | Biohacking Tools : 1365
Guest: Kevin Tracey, MD (President, Feinstein Institutes for Medical Research; Co-founder, SetPoint Medical)
Air Date: November 18, 2025

Overview

This episode explores the revolutionary field of bioelectronic medicine, with a focus on vagus nerve stimulation as an alternative to traditional drugs for conditions like rheumatoid arthritis. Dr. Kevin Tracey joins Dave Asprey to discuss scientific breakthroughs involving tiny implants that stimulate nerves to control inflammation, replace expensive and risky medications, and potentially transform treatment for a broad array of diseases. They also debate external versus implanted nerve stimulation, consumer devices, and future implications for longevity, personalized health, and even cybersecurity.

Key Discussion Points & Insights

1. Bioelectronic Medicine: Replacing Drugs with Electricity

• Definition & Rationale: The traditional pharmaceutical model targets diseases with molecules; bioelectronic medicine targets diseases by modulating neural circuits electrically.

  • Clinical Breakthrough: Recent FDA approval for a vagus nerve stimulation implant to treat rheumatoid arthritis (RA). (03:31–06:05)
  • The implant is the size of a multivitamin, inserted in the neck, and delivers a daily minute of electrical pulses.
  • Dr. Tracey: “We have a positive clinical trial where patients… had significant benefit by having a vagus nerve stimulator… implanted in their neck… once it’s implanted, it’s gone, it’s invisible to the outside world.” (00:00)
  • The result: Reduction or elimination of the need for immunosuppressive drugs.

• Why It Matters:

  • RA drugs cost ~$50k-$100k annually; implants could cost the same as a single year’s drug expense but potentially provide long-term relief.
  • Major side effects of RA drugs (immunosuppression, infections, cancer risks) can be bypassed.

2. How Does Nerve Stimulation Work?

• Biology Explained:

  • Electricity in nerves is not like copper wires; it’s propagated by voltage-gated ion channels, slower than light speed, ultimately leading to neurotransmitter release at synapses. (06:05–07:44)
  • Kevin Tracey: “Rather than screen for molecules… we proposed… you might be able to find neurotransmitters… that could control the target in situ and restore the biology in a way that could be very precise.” (03:39)

• Device Specifics:

  • SetPoint Medical Device:
    • Implanted via minor surgery (~1.5-inch incision).
    • Battery-powered, rechargeable transdermally by wearing a collar weekly.
    • Delivers 400 microamps for 1 minute/day, often while the patient sleeps. (08:49–13:59)
    • Programmable; minimal side effects (“a little buzz for one minute”).
    • Removable and MRI-compatible if needed. (50:23)

3. External vs. Implanted Nerve Stimulation

• Implanted Devices:
  • Proven, targeted, with clinical data for specific indications (e.g., epilepsy, depression, RA).
  • “We know the amount of current to be applied… 400 microamps is sufficient to stimulate the anti-inflammatory fibers.” (19:48)
• External Devices (Ear Stimulators, TENS units, Ultrasound, Magnets):
  • Popular in biohacking communities, but lack specificity; many stimulate non-vagus nerves or general skin/sensory nerves.
  • Effects are variable from person to person and not well understood; clinical trial evidence is currently limited and mixed. (25:41–36:53)
  • “We shouldn’t even call the ear units, we shouldn’t call them vagus nerve stimulators… they should be called transauricular through the ear electrical nerve stimulation in keeping with the nomenclature of a TENS unit.” (32:04)

4. Cutting Through the Hype – What is Really Known?

• Cautions:

  • Marketed devices may create “false hope” and can be inaccurate in their claims.
  • True vagus nerve stimulation (VNS) is complex: There are 200,000 fibers in human vagus nerves, each with unique functions—most consumer devices can’t target specific fibers. (58:41)

• Results from Clinical and Self-Experimentation:

  • Small studies show that TENS placed at the cymba concha (certain ear cartilage) can reduce inflammatory markers—promising, but not definitive.
  • Dr. Tracey: “I put a TENS unit in my ear twice a day… we got very interesting results… decreased inflammatory markers in my blood and my colleagues’.” (35:16)

5. Practical & Future Implications

• Patient Impact:

  • In clinical trials, 75% of implant users with RA were able to stop expensive and risky biologic drugs. (48:10, 50:18)
  • “Turn it on and see if it works… in the clinical trial… 75%… were no longer taking biologics or Janus kinase inhibitors.” (48:10)

• Accessibility & Cost:

  • Rollout is starting in select US centers; estimated implant cost ~$50,000 (comparable to one year of RA medication). (43:57)
  • For wider uses or experimental access, need to consult the company or travel internationally—regulatory discussion ongoing.

• Longevity, Cyborg Futures, and Hacking Risks:

  • Dave asks about implications for longevity enthusiasts, cybersecurity (“hackers controlling medical implants?”), and potential for widespread adoption among high-net-worth biohackers. (41:20–46:30)
  • Devices are encrypted, tested, and designed for safety, but user control and digital security are ongoing concerns.

6. Vagus Nerve, Biohacking, and Everyday Tools

• Non-Implant Methods:
  • Practices like cold plunges, certain breath work, heart rate variability training, and lifestyle factors (exercise, meditation) are associated with vagus nerve activation, but through diverse fibers and functions. (54:38–57:10)
  • “When you go in cold water… you often will experience almost an emotional detachment or a feeling of calm… that would be evidence of definite… vagus nerve activity of the fibers that go to your heart.” (55:24–57:10)

Notable Quotes & Memorable Moments

• “Life changing.”
  — (Dave Asprey, 00:27), on patient responses to the implant.

• “The vagus nerve functions like the brakes in your car and it slows down inflammation.”
  — (Kevin Tracey, 08:49), explaining the mechanism of anti-inflammatory effects.

• “There's 200,000 vagus nerves in your body, each with its own specific job description, anatomy and function… And you treat your vagus nerve as if it was a copper wire.”
  — (Kevin Tracey, 58:41), on the complexity of the nerve.

• On consumer devices:
  “You could be stimulating two or three nerves at the same time. Or maybe you are just stimulating the vagus nerve.”
  — (Kevin Tracey, 25:41)

• “The device is… about the size of a multivitamin. It sits in like a silastic pea pod that wraps around the device and holds it on the vagus nerve… you can take it out.”
  — (Kevin Tracey, 50:23)

• When asked if overstimulation is a worry:
  “The answer is you might feel some buzzing around the corner of your mouth… But it didn't cause serious problems. So I'm not worried about side effects of this vagus nerve device.”
  — (Kevin Tracey, 47:25)

• On adopting new therapeutic tech before full understanding:
  “If 25 years ago I could have bought something that would have had a 10% chance of working, I'd have bought it… I like the right to experiment as we figure out the science.”
  — (Dave Asprey, 35:16)

• On longevity & the future:
  “My prediction is that high net worth individuals and people interested in… self-experimentation are going to start looking… to have their own vagus nerve [implants]… It's going to be very interesting times.”
  — (Kevin Tracey, 41:27)

Important Timestamps

• 00:00 – Vagus nerve stimulation implant for RA: what it is, how it works.
• 03:31–06:05 – Can electricity replace drugs? Bioelectronic medicine defined.
• 08:49–13:59 – FDA approval, clinical trial details, cost/benefit for patients.
• 19:48 – Specifics of implanted vs. external nerve stimulation; scientific rigor.
• 25:41–36:53 – Consumer devices, TENS units, their limitations and evidence.
• 41:20 – Future: Self-experimenters, cybernetic implants, security, and market rollout.
• 48:10 – Clinical trial results: percentage of patients able to stop drugs after implantation.
• 50:23–51:37 – Removability, MRI compatibility, entrance into depression/epilepsy treatment.
• 54:38–57:10 – Everyday biohacking: cold exposure, heart rate training, what “stimulates” the vagus nerve.
• 58:41 – Misunderstandings about the vagus nerve’s complexity.

Conclusion

This episode demystifies nerve stimulation as a new frontier in medicine, highlighting both its promise (especially in autoimmune and inflammatory conditions) and the caution required when translating cutting-edge science into consumer products. Dr. Tracey champions a nuanced, evidence-based approach—while Dave Asprey speaks for empowered, informed self-experimenters who push the limits of longevity and health optimization.

As the science and technology of bioelectronic medicine develop, listeners are encouraged to prioritize safety, consult medical professionals, and stay critical about product claims—while remaining hopeful about the profound possibilities to “upgrade” the human body and mind.