« Armchair Expert with Dax Shepard

EXPERTS ON EXPERT: Dr. Eric Topol

2019-04-25

Dr. Eric Topol is an American cardiologist, geneticist, digital medicine researcher and the director and founder of Scripps research institute. The good doctor sits down with the Armchair Expert to discuss the benefits of applying Artificial intelligence to our healthcare system, he talks about the concept of deep leaning and he relays the importance of human to human interaction in medicine. Dax wonders if we are spending too much money on end of life care and Eric debunks the notion that AI will fully replace humans. The two talk about the futile search for pain relief and the doctor gets everyone excited about the advent of a smartphone full body scan. Also, Monica and Dax get a special surprise call in the fact check.

This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Welcome welcome welcomed armchair expert experts on expert in this addition, Monica tax, we have a very interesting human being Doktor S topple. Who is gonna blow your mind about technology where we're going medicine? It's incredible. We talked about it all weekend, Monica our so excited to get all these instruments. He talked about because we want to give ourselves body. Scanners are all the time. Yeah is where little many hypochondria yeah. He has a new book called deep medicine. How artificial intelligence can make health care human again, I loved talking to him sign up. His cue daughter was here. Yeah was so saw. She brought us mines will get into that in fact check, but until then buckle up and enjoy a good doctor Topol to learn or body. I in your health care we are abroad
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see a personalized collection of some of my favorite items, pick your favorite, your apparel peace and run in it for thirty days, love them keep them not convince, and about four already found again on dash running dot com. Slash arm chair to test on shoes or year first hand, experience what running on clouds feels like he's a doctor Eric topple, welcome to armchair expert? I just want to be really clear: is it topple or towards total its toll all right get it. It's rare that I do it right. I'm a dyslexic left hander and I am a butcher. Most names but you are, if This'Ll be maybe my longest introduction of a guess which is exciting. You cardiologists geneticist, a digital
medicine researcher. You started in founded scripts, yes, you're, the founder and the chairman. Do Saint Brecht the director? Ok, that's great! So you I had the pleasure of listening to both a talk of yours, and then some panel you are on at Stanford discussing are future in medicine and I immediately was interested in what a terrible job are currently doing. Can you walk us through just how abysmal is right? Now we can. I just also had I do a lot of work with prostate cancer awareness, so I was a little shocked when I saw some of these. You know the screens aren't as effective as I would have hoped as far as the spokesperson. So I'm sorry, please
you're you're right on about this. So the first thing is, you know what I call shallow medicine. We need to fess up about how bad things are. We make more than twelve million serious diagnostic errors a year in the? U dot, s alone, twelve million right and if you're one of those twelve million people know that doesn't feel good, that you have an error: eater, missed diagnosis or a mistaken diagnosis. Right then you have, you know like four radiologists. When they look at films, they miss, they are false. Negative thirty percent plus rate of missing important things guph do doing now. Is that the I'll, leave the imaging, or is that, like people who watch security cameras for so long, they just it becomes white noise like what what what's happening there? Do? You know, I think it's partly the latter, that is a treaty on this reading, like a hundred study the day, yeah it's hard to stay focused and in even human. These are only so good and that's what we're gonna talk about a course of machine eyes,
yeah train, but everywhere look at it. We have problems. We have very limited time with patient, so the diagnosed doesn't come behind the US and if it isn't come to a doctor's mine within five minutes Anders at least seventy percent error rate in its get increasingly short the times from the doktor as the added computer work. Basically right, I feel like I've observed anecdotally in my life going to doctors. Is I used to go to the kid in the guy? Looked at me for about twenty minutes and we chatted, and now the guy looks at me like for four seconds typing the whole time. Yes, you don't even have I contact the time so limited to squeeze on doctors and nurses. Conditions in general has been profound. It's really detracted in its set up for a lot of these mistakes and problems is shallow medicine, the lack of
being able to get your arms around the data for the person, the lack of their real contact to understand human story of the person and so wet. Wherever way you look at it does have, our screening is so incredibly dumb. We have the mammography for all women ever you're too. Whatever India I like, em mnemonic every thirty days, sorry, I actual arise. My address to eighty eight percent of women will never in their lives, have breast cancer and for their false positive rate for these scans, whether its mammography Europaea sais exceeds sixty per cent. Ok right, so I want to put I wanna make this crystal clear because, as I heard you say it on the panel, I want to say there was a study that followed ten thousand women for ten years and of those ten thousand women there were. Six percent had detected breast cancer from those mammograms, and yet there was that the area
was what was it a six thousand as his hand, ass alarm and out of those you know so many had unnecessary, biopsy tour of chemo could be radiation could be surgery but it, but at the very least, profound anxiety while we're getting further evaluations. So I mean this is the state of the art today, and it's really very shaky. Yeah is just error, Laden there's not enough time with patience, and we really have a broken system, because we keep having more people come into the system and our outcomes in the? U S are among the worst of anywhere in the developed world right in so again distant kind of digging a little bit on that the mammogram think. What would we are true again is that user air is that poor instruments? Is it bad
machine? Is it? Is it a combination of all these things? Well, if it is a combination, but the biggest thing goes back to this Reverend Bays theorem, which is you don't put people into a test, a screen unless they have a risk that increased, so we we are violating this base theorem. As you know, the same Thermo how to pick a horse in a hoarse race by their prior performance, ah ha, and so this is that hold the logic and model. So you don't take every measure, and have a appears, every woman have a mammogram or all these other things we do for people to people when you don't have an established increase risk and we can be much smarter today there so many things that we can do to gauge risk and not retreat every person
right. So in your specialty being cardiology right, I think, as it was explained to me by my cardiologists, there may be five really pertinent factors in your potential to have a heart attack or this kind of issue right. There's your genetics. There's your kind of lifestyle, your diet, walk me through, is exciting smoking. I obedience high blood pressure, obesity and a sedentary lie style riot and family history is your alluded to those of the old traditional risk factors that were established. You know seventy years ago he s over time, but now we can get a genetic risk or for heart disease it so much more precise and add to those traditional risk factor hours, though I could see we're Monica both had twenty three in me there, which we found really fascinating fur, please, yes, it's a tab.
The vote on it in have bracket, then it just became about whether I have drier are or wet year wax and all these other fun things that we like to talk about me Sophronia that they actually have a marker, for which both my mind. Yes, a wicked, take your twenty three me: we have an act that we developed a script. Research call my Jean rank. While you can download on your phone load your twenty three me. I will give you out of a score of a hundred. What's your heart disease risk? Oh my God is added that completely independent and actually, as more as me, such or more meaningful than any of the traditional respect rights. Oh that's! So I guess I didn't even realize so when we, when we do twenty three me, what do we on our dad ideas? We do yes and you can upload it any. I'm! So is all remember your password or get your password again may I was very instructive for me when I did ok yeah. What did you? Well? I have no family history, heart disease. I got a lot other bad baggage of disease.
Now, you're too not all. I can tell you that, right now, just by looking at birth, when I did it when we developed the alley, torture, money or a group of the dead and without the show me history, I figure one gonna be pretty law, gotta ninety two now and I said all mantle recently, I said I'd this can't be and we updated it to put in, although did the genome letters there are associated, don't you even better risk or than it used to be, and I was not He wants it all really do I have a really high risk and it would it changed my whole story about what I do. Cuz, it's actionable. I now I take it. every day out, but I wouldn't, if I had a low risk or because they dont that stand really don't help people unless they already have heart disease for people who are of at very low risk right. So let's get really quick into a kind of a global
Part of your story, which is- and we had this great guy Todd rose, have you ever heard of him he teaches at Harvard, and he wrote a book about the fallacy of the average person how dangerous it is in many applications in the cockpit in a classroom. This notion that we can design a curriculum. We can design medicine based on the average person. In by doing that, you glued way way more people than you actually incorporate rights of ninety nine point: nine percent of people are falling either above or below this, this mythical average and yet our homes, a call system, is based on the same concept. Does it not well, I think most people forget that half of doctors are below average. Now I think, that's why you're here two, I guess we're. I don't want to think that. Well, most does anyone except there, but unfortunately, as is with everything else, that's the way it works, but
you know there are ways we're gonna talk about that weaken of great from their rights. So I'm ok! So you you have a personal story which which again, it's always a guess. Amusing out. The right word, but I'm going to use it anyways its amusing to me. One doctors themselves are perplexed by their own health or or are in the dark of their own health. You know I presume if anyone's can be on top of it, it's you, but you had gotten a diagnosis when you are younger, called OECD, but not of obsessive, compelled disorder, although you may also have that. But what is your unique OECD? Yes, I had a rare congenital disease called after contrivance disciplines, which is a bone disease. It was in my knees, had led to descend between college in midst oh, I had to have a lot of bone sought after it had been basically dead bone and a lot of reconstructive surgery any at that age. You know which I wasn't even twenty at the time they said that my time on forty young and a half
haven't knee replacement, and fortunately, I was able to you know, get to eke out a couple more decades, but then of ultimately, I succumbed at least for one need to have a new placement, so this bone disease, it's just degenerative- dies on its own on the desk to landowners in the Mental Whitworth, o written a distance. So right at the Tipp of the of the feed. You were right in the joint and on the candles. Yes on the epic candles and the candles I do know you know so much about the anatomy. That's good and thank you so much no one is in dress you're, the first person who cares so basically, is it unknown into mysterious disease and just like many other rare diseases, it gets no attention. So it's just. Out here, there's a threshold of what it, how many people it needs to a fact right before its financially viable to dump a bunch of research and that right,
I have already had a Garth rightist which up until may be five years ago, was kind of in that now it seems very popular. I like to think I'm part of that but its aims like more more options are available. But you know, if you have one of these can do is that your maybe one of only a hundred thousand people- you're pretty yearned urine rush shape radio. So you got a knee replacement as a result of this and it was very, very painful and you were told that you would be up and running after forty six weeks or something and then they prescribed you some physical therapy, some in the house and then some out of the house, and it was excellent, creating right. It was. It was making everything worse. They wanted. You discover, I I tried hot laser cold laser. I tried every man every supplement. I I you know. I did things that I knew that could not possibly be any science that back it up right. I was in such bad pay. My my knee was purple and grossly swollen,
and you know I didn't really matter as far as if it had a chance to possibly help me tends in electrical stimulation. I tried chinese toys I know whatever I could get my hands on the up and nothing helped, and when I went to see the orthopedics who did this mercury is a right, orthopedic, surgeon right. You referred many people to him. I had told the coffins in a minute. There was nothing wrong with the surgeon was my very severe response to this joint that was put in which could have been predicted from rare congenital disease. I had OECD out your height the anyway, so I when I went to see him, my wife was with me and you know he said well, you know all this pain your having in your crying spells and can't sleep and everything. You know what you really gotta talk to your internist and get some in depressed and depression. Man medications shower and I'm thinking what you know he doesn't hear me, you know
the sole robotic, but but I wonder if you have the same experience I had were in the past, I had a I had a block of empathy when people would, with chronic pain, would describe. being suicidal. I would think that's absurd, suicidal, but if you're on that path, long enough now you're waking hours are pretty painful to me, it starts to become pretty clear. You're at us the year is getting more more demoralising in. You recognize it in point of this country, He's down the same path, I dont want to do this right now. I think that you know the kind of life. On the one hand, you know you could become an opiate attic gets a pain is so bad in this area. Can you say I've had enough? I want just kill myself remedies such a day. You can understand why we have this horrendous epidemic today, because
once you start unease, pay medicines and you're really in pain, it's very hard to get out of hand, and we don't have the empathy we don't have the time with doctors in conditions that we really need to help deal with this stuff into or go get some more medications that have now thing to do with the problem who yes, so this was for me, this was a really constructive in looking back and got not going through is total torture. But I learn a lot and you found someone who eventually helped you tremendously right was amazing. I didn't want to go to her because I had already had physical therapy a k, physical torture. They want to go near it again here and I was recommended to go see this woman, who was like the guru of physical therapy and she would know what to do and sure right a high, and she really did know what to do. She said you know you had this OECD and you really need a whole different type of therapy. You need to be on high doses of inflammatory, say, Ibuprofen sure now
I can leave presently. I could have been either an sets out an older, yes, actually, and so she having on a whole different plan, very gentle and I started to get better and it was really dramatic different of what I have been going through for for many weeks actually a few months by the time I saw her the other thing taxes which he did was she showed that chick for me, the man she she would text me every day. How is our knee right eye? I never heard once from the orthopedic now sovereignty once how are you I have, but that so it was a combination. She knew what she's doing, but she actually cared for yeah, and it was also at a time when I'm researching about I and I'm thinkin. You know what what what is care and health care? What? Where is the care
yeah and I'm an behind you know it's funny. You'd say that, because, with this area of our right to say it started to my feet and migrated north. I dont understand that, but that's that's the routed staking serves all my feet was then Siena podiatrist, I got you know shoe implants than when you go to my knees I witnessed on orthopedic. I thought long and hard to have surgery on these knees. I'm going through all this for for several years, and I have a dog I told you I just occasionally will tell him like what I'm going through with the feet the knees and everything announced moving to the hips, and he says to me: I think you have sorry attic arthritis. I think you need to go see a room at college. I don't think that you have just these joint pains like you know, and I don't think their injury related. Let's say it was him who got me to go, see a room metalogy. So in it that's just happened. because my term jobs likes me and I like him. We talk about other things, while I'm in there and he actually, we have that time together where he's listening, so I dont think anyone's necessarily to blame, but we're going
into a really really interesting place and that's what you're at the forefront of so that the global problem is really it. It's an attention. Bandwidth problem from the physicians right and it's there's- the bureaucracy involved, there's the that the limits of the the diagnostic tools there's all these things, but All of that is is changing its about to change in your really a captain of that ship. So tell us what's coming for us. What's gonna change? the right as the problem? Is we ve diagnoses? There's really no individual care happening in our system and more pain. What, through its three trailing?
the year is out on every point: six trillion eleven thousand per person, so the exciting part is both for doctors, nurses, clinicians, as well as for patients. Theirs is Paul artificial, intelligent world that is starting now on the patient side that was kind ushered in with a smart watched. It could diagnose your heart rhythm and tell you that it's off track a deep learning algorithm for you and say you know what this heart rate doesn't fit for you, your resting hurry. He should be this year. Activity hurry. Is that something is off track. It I'll tell you to do your heart, cardy dream on your watch and then you get the diagnosis by an algorithm. That's quite accurate! Ok that exists currently, yes, so that was at first it was introduced via startup called alive core and then Apple introduce there
almost a year later in is it what what kind of biometrics are happening? Is it just monitoring your pulse through your wrist? Yes, so it monitors repulse, but it learned for you. What would be those rate nor more s, amateurs and say who something's not right, it picks up, tells you do Deckard examined in that cartography. Reed is actually very accurate. So let's go get low step by step so fascinated. How can the watch do a cardio, Graham, Oh that's proprietary, informing the house! It's actually! This is kind of meeting has been a cardiologist now for thirty five years. I never realized how simple it was organized to have two spots on your skin, which is what you get on the watch on to make a loop and it gets your heart. Electrocardiogram only gets one led and a normal for electrocardiogram is twelve Lee,
but that's all you need is one led to diagnose the heart rhythm. Really, yes, are you get one need and not that basically is take it to get you your heart rhythm diagnosis, that's gonna, probably clear up a big percentage of the risk factor YAP just that detection that what they are, because basically the most common important rhythm, is a tool for relation. It's not common in young people, but certainly in people who, in over fifty to sixty there's at least five percent of people there at this end can be associated with a stroke. So you want to know about it. If you have it, I see what is abbreviated to a very fit so in Am I right in that? So your ear you're out your heart is a muscle. It basically gets an electric signal to pump one side or the other. My Marty office lets it. There's four chain more chamber and two of them are atrium and they can go into this purposeless motion fibula tory as just quivering did quivering instead of Kent
fact h: Q, Monica argue and include the chambers are pumping blood in into our pumping out yes and then so, if the ones quivering it could be put pumping too much blood in and then allowing no basically stagnating Owen. So they can form a clodagh there. Ok and then that clock again to the real pumping chambering, get popped out to the brain were anywhere on the body So now, when you have heart, palpitations is: is that a fib? No that's what typically politicians are just of extra beach. Ok, as I go get that everybody governed by men still my heart's about to blow through energy network hypochondria, yellow, that's actually made out the worrisome part of having is deep learning a high on your risk, because people like you are not gonna have each of relation and we really rare
but will be disappointed. I learn and not just going to have extra beats like everybody else, I entreat you, may get false alarms my gosh, I'm never going to wear this watch again or turn this app off or whatever you do right. But but the reason I bring it up is it's. The first FDA approved deep learning algorithm for consumers and is going to be a lots of them, and so basically people can be generating their own medical gray data with algorithms and so they're gonna get empowered at a level that we ve never seen before. So I think it's important not eat also talk about another building block of all this, which is you see me expression, deep learning, and I guess the analogy I would. I would make to this: is the CIA has been gathering so much information right and the Department of Homeland Security that they had? They have been on a data finding mission and didn't occur to anyone who's gonna
analyze, all this, so they just have mountains in mountains and mountains, a data that no one's analyzing. There is really no outcome to it. It just gathering without any kind of animal Enzo. Similarly, right we have a ton of medical data, but we don't have any whose synthesizing it whose whose doing all that and that an that's your expression, yes, deep learning, dwell. Deep learning is a form of artificial intelligence. Ok, so it's really popped up in the last decade and in full, I've, just in recent weeks, the pioneers from Europe to Toronto, Jeffrey hidden and his colleagues, they got awarded the Turing prize, which is like the Nobel Prize for computer science since
big deal, I hope they gave it to him on a Stanley you from terrain. I think they prefer that you know Canada has been actually a real big part of this whole ay. I movement did I would they ve been the hub for deep learning and so a lot of people like young Laocoon in colleagues you know they work with a hen and unalloyed move to companies like Facebook and all the other tech companies. You can imagine so the the deep learning what that means is that all these inputs of data utilities and image like a medical scan or a picture whatever yeah exam you gave, I think was which was fascinating was some skin lesions? Yes, so there was a task in you that there was thirty one or something dermatologist or twenty three. and they were asked to look at a series of different lesions or marks, and then hey, I was asked to analyze that, in the results were such that a I did, it is good, is the
twenty one or thirty one, twenty one board certified Stanford Gas, eighteen dermatologists and the a I did as well as them and in some cases better yeah, melanoma and skin cancer. Yes right in it and that's been replicated by now many other groups. In fact, almost sixty other d amato I so this week. We know now that a great example, if you put pictures of Askin, lesion or cancer, an algorithm can do as well or better than even export. That is incredible. in in, as I see that through I constantly, am seen him wife, Come in here. Does this thing on my back? Look it's growing by the way who can keep track of what's growing, if you don't does her best. But Sheikh I don't know I guess it was a millimeter. It's time you know they would be so awesome if she could take a photograph of it in and then a an app could tell me if I need to be panicked or not, is that in the year
saying that exists. Well, it isn't yet none of the commercial budget heading that way. Ok, there will be old, eventually, multiple of these acts, for algorithms, like we're saying for heart rhythm, but first skin lesion, and for so many other things now Monica you wait for that. Can I say I actually think this is helpful for a hypothetical hypochondriac, because she Monica since I've known her and were best friends she has had a brain aneurysm she's had been allotted tumors. I had one this week of this week. I grab the legitimacy to do my kind of think I might be achieved being a her liver was gonna explode a few days ago now her kidneys, we're gonna, exploded, yeah happening that yeah. As these beers she's had many many
terminal disease. Since I've known her- and yet here is its shining like a bright sorrowfully out of kilter picture, Hell see, I don't eat an algorithm for that now, so I actually think you know you could see where you you're mine would go like. Oh, this is going to be a bad thing for people with hypochondria, but actually eventually it has run out of shit to look at you, you couldn't you can scan your whole body. Well, you know, like a really good example. Is a urinary track infection? Yes, she had many of the original language. Not ever I mean no one had wandered back our ears. So now not in the U S, but in the UK they have a kid. Were you? Basically they the machine, learn from a dipstick. Then you take a picture of that on your phone and you get the diagnosis very accurately whether you have a duty I or not, and so you even need to go to a doctor to find out. If you have a? U t I because now
ah there's gonna be a I to do that for you. This is just so many examples. It over the next few years will be seeing that are going to help to reduce the need to see a doctor, because these are not serious diagnoses either their important, but there now, like life threatening type things worry ivory melanoma, certainly dwell here. Well, that's true, the point being is at a screening: oh, ok, ok! Is it once you have a milliner within its important to get it to a doctor to deal with a bright, but so the point by point being that we can get accurate screening, ear, infections of children, all sorts of things that are common without having to that of decompress. But doctors have to do that. One big piece of ass. The other thing is this way to make what doktor do out source it out sorted. Today's machine were yet our train like what we're talking about first scans for radiologists for slide for pathologists Emmi across the board. So I give you go for a colony asked:
you probably two young ever now, I've had a bunch of them and I need to go again. it's not a fun. When I rode era keeps you sent me males with, like top rated Nina Practical case right well, the problem with communist copies is it small. Polyps are very frequently mist and you know want to go through that procedure and miss things especially pieces of small ones. Can be just as dangerous as the big one So what would they would the output, the digital video that the camera took to an eye exactly? Why in the small ones, are no longer need to be missed now and it can? I imagine it would do it real time because often their cutting them out as they detect them real time, real time, machine vision, deep learning of the of the video. Oh, my interest eradicate internists, no, not at all
are they afraid of them you're bringing up the kind of thing I worry about? The most is if we take all this efficiency yeah and we turn it back to patients and and restore the patient, Doktor released the gift of time, which is what this bring back right. We can actually take medicine backed away used to be decades ago when it was a precious intimate relationship with it was trust and presence in real care, but if we let the administrators do what they would normally do, which is just squeeze more yes, then you, like you say, then this thing will be a horrible bust. It could actually get worse. Gives you
right now. We have peak burn out depression. Even suicide. Now can ass good, a global question about this reduced time with the doktor. So it sounds like ideally Monica it would just it would get rid of fifty percent of the low level stuff that are wasting a doctor's time here your face, you t I my figure, and I can only a lot of it. I'm sure I and then give them that the same amount of time to focus on some higher level stuff. Now my question it is, but I guess that's out, but that's what I'm that's what I mean a second take away a lot of what a general price Titian or does it more specialised doctor. I dont see ever see that going away, but it's just like you t eyes and ear infections and holds and stuff like that. If something else can detect it, that's normally why you go see your general practitioner
well, but they are also in my wrong there, the gateway to everything, so I asked my liberal Knowed looks or I don't know it's a limp. No, but I seem to have swallowed a golf ball that was my dad's taking likewise my net and he goes in these- that's not great. So then he prefers stay too. If you dare, we are supported by Kiwi CO, Monaco and I was a kid. If I wanted to do a project I had to get hammer and nails in some would out anyway dangerous and can I didn't learn too much? That is all behind us key. We co is the coolest way for kids to learn about steam subjects. Science technology engineering are in math and kids like to learn by having fun in with play. They focus on creativity
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So back to why were even in this situation is: it is a result of the population explosion. Has there been a reduction in the amount of doctors? Is it just that more people now see the doctor? Why? What? What caused this to begin with? Well, the biggest thing was that there was medicine became such a big business, and so over the time there was the squeeze to see more patients a more quickly. At the same time,
each person was curetting more more data and, in fact, that one of our problems as we as doctors can't get arms around all this data for each person, you can't even get the data in one place, no less in a review it all. You can do a good job in trying to sort things out. So, at the same time, when does big business was occurring and we had this whole since the nineties, electronic medical records, like epic concern, are all these other companies on top of all the other movements like relative value units and health maintenance organizations, all these things about the business, a medicine they were done to make money not to help the patient or even more of our relation, knowing it S. Actually, what is done is that what you mentioned earlier directives, or you-
I see a doctor- you might not even make eye contact the actors are on a keyboard which we can liberate that because of taking voice to make notes and but but basically, what we have now is the outgrowth of decades of progressively detour reading, because medicine became such enormous business, a number one employer of all jobs in the United States. Now these are the number one it raised over retail back in May two thousand seventeen, so we just keep put more more people into is quickly getting to one out of five. Every dollar or health care in this country, which has no, there isn't even another place in the world that close to eighteen plus percent GDP. Dear points, I just want to point out what you just said like with a real example, which is I would have had an analogy to a beating at eight my whole face swelled up. I had seven asthma attacks over the course of
these. Whatever years I had blank blank blank blank blank when I go see my room it'll, just all I can kind of Tom about, as one might joint swelled up last right or if I've had a surgery. Nine years ago, there's no hey, he's gonna spend the next week in a half going through everything that aid doesn't exist. To your point, it's not centralize. There's no record of every stop I've ever made at the doktor, but whether a record there might be something glaringly obvious that it is time all this shit together, rye actually exist. They got it in a. I has the ability to do that in a narrow, second bright, and so does go back to that point as well as molecules with no time currently to think you ve got average of seven minutes yeah. I know less to get this data to two so to synthesize it and that's what I can do really well. In fact, we as humans have early society with data and in our current them
we were talking. I d learning has insatiable hunger. Just can't get enough data in the more now to better works right. Exactly so a better and more. We have the worst. We work right, reducing lose it yeah. I saw taken on new data about five years ago when I kid rice. So this is why we need this and we need to embrace it, and I think that your point regarding, if we are biggest problem, today's particularly in the U S is data- are so far when no one can get all their data right, yeah. So what's the immediate solution for that, so I have a four year old in a six year old, a night, and when I hear you talk, I think, while they have a real shot at being at the forefront of this. What do I need to be?
Do we? How do I you know is? Is there an app? Is there some kind of anything that I could be already compiling every trip that they have to the doktor so that they have a sense of what's really going on what kind of patterns a merger we're just starting to see those sorts of acts develop? But I mean, I think, you're right. Your kids are ideal because if they have every medical encounter, anything related their health from even when you were in the womb to no less to the current monsieur, went away where borne out in that kind of staff can be very telling exactly it's big and we we don't even take that into account. So what we wanted to have all it did in one secure place, and it's a much safer thing to keep it in units of a family or an individual in to have it in these massive servers they get hacked and held hostage and and are dated that are sold and brokered, and he also
Cyber thievery, that's going on usage. You foresee a day where I will go to the pediatrician I'll, take my kids. They do all their staff to enter in the computer, and I will just am mean tat. My phone on somethin that'll get transferred to some kind of data bank. I now hold onto no question about that. That's where it's gone you should own it Yazzi. The reason why it is so important in the ear of a. I is all about the inputs if you're missing a lotta, your inputs, whatever you get at the other end on the output side, is gonna, be compromise. He also it is essential that we move, and they already are places in the world that have done this. Like example, in Estonia of all places, everyone who owns their own all their medical data, whatever regenerating their genome of they have it they're all their data from the time of birth, on a blockchain platform, so secure lay own it and if you see a particular doc like with two you're going to your room autologous, you just
the relevant parts of that right now, my empty by Austria, but if you want to be a medical researchers share, whatever is irrelevant to that so you'd point you make the call rather than having all your day being going all these places, I don't even know I dont even love it by the way. When I call- and I want to make an appointment- they say: what's it about I've had moments. Where am I bet you call to make an appointment, he here doktor air and they go. What regarding, and I sometimes when we like you, you worry about their arson and alone. Let me in the doktor talk about what I need to see him about. You know, I'm saying I would you say: Yoke is you're, so honest and open parts of wages, I'll play, though you have Harrison numbering brimming high local centred high, are worn, we're gonna play with Doktor Wechsler, oh great. We have wanted to what is this? I want to make love to my wife. Last night I couldn't become erect. Ok,
how long you tried to those linear about I'm busy. Please give you up what we should be wary. Did you think he's adjusts? You ever see a picture on Zan like no one can say that. Certainly many many men are making appointments. Were that exact thing where there are no more they lie at my hip, hurts just get me in the room with him or her whatever it is. Can I two things that annoy me about our system? One of the things that annoys me as we have some really emotional attachment to some concepts in this country, and often I find that in practice it great one of them being our privacy, which in general I agree with. We should have privacy, no one should build enter our house without a warrant all that stuff. But I am very frustrated that we had a stupid, fucking debate about whether vaccines are causing autism in this country for
four years and then he's going over to Denmark or Sweden or whatever the hell it was, and they do an epidemiological study in five seconds because they have the dad of every citizen Ryan and they go conclusively in a minute. Now, there's no correlation. I think it's preposterous. We don't do that in a country with three hundred million people were. We could really be answering some huge questions, so is there anything on the table to to basically allow our info to enter a pool without any kind of identity attached to it? It's just info on six foot to male, whose forty four the need to say Dac Shepherd, but why can't? We have a pool of of data like that, so we can do these huge studies and five second arm with you, but you are therefore we want to have an right now, the? U S is really lag behind countries in Scandinavia. I guess what I'm gonna do China is doing yeah yeah, so we are behind
We are just that. What happened here is that the government cave to these health information companies and they just like the Tower of Babel talk to each other and we never had any teeth here to say we're gonna do this together, you know we have trained thirty million people and we can learn. From each other and do so much better than we just never have had this type of uniform front more and that was gonna be part. Two of my other irritation with our system. Again for the record, I am a capitalist. I believe that capitalism and decentralized market places the best system for a country with that said, I'm not shocked at the folks in Toronto. Just did this, of course, the folks in Toronto did it because that no one's profiting from healthcare there? The government is the big burden that they want of you'll, make us cheap and affordable and as effective as possible. There hugely incentivize to do that. Our system is, you really does incentivize, for you, too
Allow me to stop going to the doktor for sixty percent stuff. I need to or get diagnosed by, my phone right that you're talking about this three point. Seven trillion is going to peoples bank accounts in their so incentivize to prevent this from happening and so entrenched and so difficult to break up this cartel. Or wherever you want to call it. The amazing I spent the last year and a half commissioned by the UK to review the National Health service and to plan the next twenty years here, and it's so different because in the UK, which is amazing, just the opposite of what you are just relating the end, each as is viewed above the royal family or the BBC as the most revered institution in the country. Yes, and they everyone is a gallop tearing. The data are shared the way they should be. It isn't perfect by any means are, but what the will to change that
well to adopt the ally and these things that we're talking about to make things more efficient may at their on. They were the first country in the world to have this. This whole planning exercise issues. It is it's it's the apex of stubborn, in my opinion, to actually be able to see with our own eyes systems that are working better and then just Bull headed Lee. Just refusing to adapt them yes in, and that was the sorry part about this- is that our come when you look at life expectancy? I don't know if you knew this, but the last three years, the? U S is declining, it's the only place ever in the world. This is happy where's every other country, including China, but every other country that day life expectancies is increase. Ok, I just wanna be a cynic about that number, because it's getting touted a lot lately, and indeed I did just had the cynical fuck. You tell me if I'm wrong about this:
it's not dissimilar to ranking California for schools, it's a bit misleading because we have a huge first generation population, English as a second language. That is a huge impact on our school members. Right tests numbers we taking on a bunch of foot by the way, I'm pro immigration sought. There's none hands on this, but does that reflect just we ve taken on a bunch of folks that have lower life expectancies is that is it is that it is at factored into this number everything's factored in this. As you know, the this always c d of all the countries have the same ground rules of the house, data's analyze. I think what you what we have here is we have horrible inequities saw the people of lower socio economic status are really their suffering, but it isn't just
life expectancy. It's every major outcome like maternal mortality, childhood mortality, infant mortality, real a yes or a no, yet that stuff, it's just a taxi, just horrendous. So what has become so problematic with respect to how much resources we put in and outcomes entered? we should be ashamed of, while you not, I found to be very telling. Have you ve taken a ride around the suburbs of Nashville? Not recently, Oh buddy doctor I did it to goes, I wanted to go to some restaurant. There was pretty far out the city. I have never now I'm fine an area Michigan, that's pretty close to Bloomfield Hills, which for years and years and years was always number two or three in the highest earning suburb in the country, s sure at best, you can drive for three miles and see
actions the I was driving in Nashville for eleven miles. Looking at twelve thousand square foot houses. I couldn't believe what I was seen in my friend who live there. Huey Estes shout Huey a will. What is all this money? Who I've never seen this? In my life? It's the biggest MC mansion, it's incredible things: ozone represent healthcare. Three, the biggest. There are all these are. This is all healthcare. Asia is yeah and I was like. Oh, this is pretty too This is this. Is it visible indicator of where the monkeys, or at least some of the money? Ok? Now? Why are we saying that? The reason this new trend is happening is because of this sort of lack of care work and just two things: a marker first, its inequities, the lack of care, the other one is the over care.
So about a third of that three point: six trillion plus is waste and unnecessary stuff, so the people who can afford care they get tested. You know they just get so many things done to them, and this is something that we can do better, and a lot of that is that I don't have time to think I'm just gonna order. All these tests cover my ass to just get done, because I only have I got to see the next patient, so I can just order all these tests, no click, click, click and you're off to get all these things that you don't need done, so we have a problem both over an under. I also wheat mood who we just talk and do I Sunday, GPS Angie grouped around no. While and I asked this- I said you know what I mean, don't I lost a dad and stepped out in the last five years, and I
just watch the amount of resources in money that that last year of their life sucked up- and I thought I with I wonder if there is a study of what percentage of your total lifetime care you use in that last year- is it ten percent is fifty percent? Is it forty just in dollars and in resources, and I thought again, this is a very dicey question, but due EAST Ben way too much money t pain the last year life. That's yes, the engine who can bring that up. I mean, of course, when it's your loved one, you want it, but I mean if you're, just looking at this huge system, we got to make some realistic, genes and in our we are we goblin up way too big of the the pie with well
end of lifestyle, I'd I there is no question about that, but I think it goes back again to this time. We don't sit down with families and really explain everything exude the empathy and we know do you really want to have this person go through the suffering, and you know this takes a lot of dwell time with a family to really so you you, their story, the purse patient story, and we don't do that- does no reward. For that. You know it's like this. A our view, Co. yeah. I spent an hour and a half or two hours reviewing the situation. Right is just if only if you care and if you have the time and we don't have them yet in fact on J- was saying that that part of the thing that they then labelled death panels was exactly that. Just setting aside an hour to tell people, ok, you're, sixty five or your seven year, whatever it is here, is some things, It happened here, the outcomes here, the statistics of you use this. This is what it really changes. The course it just. The knowledge is mostly
just find themselves in a terrible situation where they ve got the diagnosis, that's terminal in their terrified, their families, terrified them and now they're gonna. Do that? thinking in their decision making, they're gonna be reacting and not acting, whereas if you have some awareness of all this- and you kind of can enter that with a game plan, he can probably make some better decisions. I would imagine yes- and this is one of those many serious things that where we want to emphasise this human you in bond that has been largely lost over decades, if we bring it back than this is something that can be addressed. If, if, if we use this gift of time right, we can do so much better, and this is a perfect example of where it can be that time and that that bond can be deployed
Ok, great now so training of my left anything out of here you yourself, ass in aiding I'm really. This stuff is really exciting. Like oh, I just have a really quick kind of technical question. How can a device do aging selling for mobile device? Yet so I use a smartphone ultra sound so that, instead of that the scope- and here I am- I mean a cardiologist- and maybe I should be disbarred, because I haven't used stethoscope further last almost ten years now. Why would I do that when I just pop uproar on my smartphone and I can do high resolution imaging of any part of the body, especially for me, the heart and
wanna do my lunch, so my journeys is all I did that Monica three years ago I got this device and I and I couldn't believe the resolution we actually are published. It is good as the three and a half day, thousands are alter sound machine, it sits in the hospitals and clinics so I'd. I decided I do at home body medical selfie, and when I was doing this as a kind of I could do the heart easily guys I've been doing for years, but I said well, how do I do a gallbladder had a google it and I gave a how that's how you do a kidney? How do you do live? I did all this stuff. I did total body from my my carotid artery scientists and all the way down to my left foot everything in minute really quick and asked what what is that device cause it cost a hundred ninety nine dollars a month as many doctors at work together. Can you? Oh it's really not that expensive. So what is it
gripped him based model or you can buy it outright? I think is some six or seven thousand, but I don't know she had we gonna do that yeah, yeah, L, a few those lefthanded blogs and wondered. Why won't forget donated charity at fair, chair donating ass will do nothing but Skinner bodies. For the rest, that's all rescuing weren't rain, with the only thing you can skull, but what's amazing you saw a few months after I did. This is funny how use it's almost like. You had the same reaction. If I had this idea the total body. A few months later, I start Heaven abdominal pay. I didn't know what was so. I got the thing I should like to find out what this is, and I see I have is diluted, left kidney, so hygiene must have kidneys, don't so I go to the emergency room and I tell the emerged from doctor. I've got this dilated kitty am I
mark for when you want to see it here, and he thought I was a freak, an ailing shares Erika back there, and so he says he didn't believe it. You didn't believe I its image, my my So he sends me for a cat scan and it was exactly if I showed the two images Nude Saint, which one is the calves, in which one is the smartphone real interest anyways that cause like twenty five. A hundred dollars that cat scan and that's the point is you can get the stuff so cheap through your phone now, but you were you able to upload your your your own scant anywhere to have a look at it? That's not all will yet is it got there workin on their work and yet so there's five of these ultra sound probes and have said you can get today, better FDA cleared a couple of them, are really into I, so that not only will teach you how to get the image say yet a moving up of an age to the left, and it also wool interpreted automatically for you, oh my, so that were not there yet, but that's what deciding in the future. You are able to look at your lungs. Are we
That's my obsession. I really want to look at my mom. I should have brought it will meet at all where I would allow you wouldn't believe you alive show we do alive show and he D stands. You won't let you do that. I, whether a great issue, but what have we find out? I have lung cancer on stay, Molly's a whole catch up on the way we certainly don't under certain days. I feel like I'm late stage. I do ask we could do bring that's where I feel like most prior businesses. More, I'm sure it'll be out fry it just currently there's this. Do we don't have an mri through the phone? Yet you know it, but if I would have told you if I wanted to hold you sell fifteen years ago that you're following a meal, the dew was its. Currently, I am in no way I knew. It also is amazing about this. You would think it every doctor would want to uses because it
they'll powerful the insult, maybe you'd say while some valued have been trained in the stuff it doesn't take. You could get trained in this in no time. For the point is there's no reimbursement, oh ok and it and they say, was too expensive worth really not that expensive renews each test it you do. I ve been ultrasound is between eight hundred thousand dollars in the lobby that they walk and no one wants to give that up to that of the problem, because if we started doing these left and right in the hospitals, health system would say all know your cut into the revenue here. Ok, I want some fun questions now, based on assuming that this is all going where it obvious. Is, and I'm really glad that just tell me in a nut shell scripts Research Institute and you you also got that a huge grant from the Nationalists health right right for torrents of nine dollars in it's called the precision medical initiative.
Let's get a minor one million. People is that ours is gonna, be using these kinds of the ices eggs yeah. That's what we're doing so it this precision. Medicine initiative is an an all of us and curly. A hundred and eighty three People, Americans of a million, have enrolled more than half are under represented minorities are we rarely employ ass and they are going to have all these things they're going to have genomics they're going to have sensors all the central, even talk about their gut microbiome. I mean the whole works because they're going to have like big data per each of them get back to their if they don't go to them and that's going to be at the hopefully the beginning of a large
population. Participants who will usher in a new form of medicine over the years ahead can ask I'm because I'm very, very interested microbe. I am. I weirdly think that my arthritis, as a result of not having the right biome so hot. How is that monitored? Well, that's really improve in question because was just changed in the last few weeks: yeah the our understanding of it so used to be. You could just Stana a stool sample, ok and you can send to many different coming he's right. You know you biome American got, does a long list of them and for NGO similar to twenty three me type hundred dollar, something whatever like that. You would get an output hat. You have this bet back towards citizens that this different bacteria, how much per cent density turns out? That's,
only scratching the surface. What we really want to do is sequence, each bacteria, because you may have deletions and changes of the genome of that by terror that are predictors of things like Sorry attic I tried out so turns out it's much more complicated than a lot of people thought. The micro bias is far more important than anyone had ever estimated will look at the results. So, as you would know better than anyone, but but people get see deaf right and see. Death is really hard to tree because a blast it with antibiotics. But then they antibiotics often kill a bunch of great bacteria in your stomach that could help fight the sea. Deaf and people are doing these fecal, transplants, in getting like ninety plus per cent results, which is what you triple of what any other approaches at again. It's a product of this fund health system, because in Canada you can do it everywhere in theirs clinics. Here, I think in California, can only do it three places and in it has to only be foreseen.
If so, if you have any other condition, they will not allow it, and it's just. I don't know why. I think, there's so much in introducing the right got bacteria to treat a different, yeah you're. Bringing up a really important point to this fecal transplant thing is, is had shockingly good result. Almost a hundred percent curative for the sea difficile each can be a lethal problem, Thea, the so called pseudo membranous politeness. So loud people want to say, ok what why can't we do a fecal transplant for other conditions where they get microbe. I M has been implicated as causative and if we just take a healthy persons get meagre by and we could come up with a far better way than all the other approaches we have, the problem is it this field transplant from donors is, is tricky and people wanted
develop. These move, like poop pills or crap souls Gerald Rhapsody, saw where it has a cleaner way. Yeah, because what you gonna do you gonna have like donors, healthy donors that keeps in India. Don't samples and not a hug arises because I literally considered it because I'm not here to fuck it if I can go to a clinic, which I would far prefer, I dont want to handle any this stuff, but If they do, I dont want to be on an amused at present for my zadig arthritis. Much rather do three fecal transplants and be done with it, so I'm open to do it happening I think it's really telling this. Even if you go and proceed if they don't want you to take the stew. Full of anyone with mental health issues. They don't want anyone with obesity and just just by knowing that they don't want you to take that person still tells me. Oh most, people have Micro biome problems which are causing that eighteen diffused air. We all support by tourists Monica this is the coolest.
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we have here, is a lack of cause and effect. So there is the all these associations about what they all these various condition to get microbe. I'm associate like with everything and so no one really knows. But when you, when you manipulate the microbial whether it with a fecal transplants, are ultimately with her with a poor, EL thing then will start to learn. Only at all surprising to me that certain autoimmune conditions are markedly ameliorated by manipulating them goodbye. I wouldn't be at all surprised, based on everything we know, because the GUT Micro Biome is so critical to our immune system. In fact, even this week it was reported in nature, which is number one biomedical journal that they, the gut, has its own compartmentalized live system. We never knew about why, because it's basically for dealing with this, a Micro, biome story.
But to make so much for me to know that the only thing that's ever really helped was being on a specific diet right. So what it tells me is that my body has an allergy, do a lot of things I'm eating and if I get rid of those things in the algae goes way, but it would. It tells me further is something to my stomach snap processing that stuff or there's something you know This is a lot coming out of that got the Anna fight about it because he doesn't want to take. My poop were deciding yo. Who was going to give you a transplant. I was not an option. Well,
Why is it so? First and foremost, Amy Handsome on the card is a friend of ours? Basically, we all decided. We wanted her poop for any number of problems that people have. We just decided sees. The healthiest. Happy is the best person between now, and I am sure we all wanted to improve awareness singular rid. She could become are afraid you become a hypochondria here. Maybe it was. It was related that won't Monica how to spell of anxiety and only one another kind of falls into the little I dont. Certainly no one anxiety and other Amy Hansen is in the air, but at any rate, Monica was very heard that anyone her poor, but but you were like second on the less that's a pretty high, already lagging furthest equipping. No one wanted my group so ass. His and my feelings were hurt. Ok, here's a couple questions I have assuming that this really takes off in that year. Average American on their phone is getting all this information
ok! So, let's say that there is three hundred million Americans. They have this tech. It now we potentially have three hundred million people that no about elements which, in theory is great. Everyone should know if they have something but Can our system handle that? Well, what we want to do is to fulfil the dream of prevention, which remain. Been able to do before manoeuvring ways we had to approach a prevention were like a mass strategy, stopped smoking. Kenneth right. We didn't have prevent the illicit you otherwise get which we are quickly moving into that era, so like, for example, we talked about the polished in Greece, go for heart disease. If you really are at high risk that you would try to prevent them from ever occurring and there are actionable things you could do, whether it's a healthy lifestyle that specific for you or taking stands at just one example. The aim would be for die bees for asthma sufferers,
most all the common conditions, where there is a strategy, if you knew you are really at risk right, so, instead of what we have today, which is why we base the all people the same. We don't really prevent anything there. We are going to move into a time when this is gonna by having the data for each person and having predictive algorithms having a virtual coach, and so instead of your phone telling you how to get from here on your gps, it will be constantly uploading your data, if you want something its optional court. Your whole corpus of the medical literature, everything that's relevant to you of the massive literature, to the moment, with every layer of your medical data coming into you and coaching, you saying you know who you are at risk for asthma,
how we gonna near you'll, never wheezing your life, we're gonna do this for you right and I'm gonna get you in the book. I do many examples of what is gonna look like in it. It's not that far away, because this is basically that enormous data set is constantly seamlessly being processed, for you and then also being looked at in large numbers of people to make that better and better over time. Ok, so great, so you can just touch and something have you read you ve all Harare book, either sapiens or homo day. As I read them both and I know, are you quoted in Normandy as its in I would be? I was quoted in I think in homer. Deus, yes kind. I I know him. We looked up in Israel, we run the same panel in a programme in Haifa and what was really interesting is he is mother which, with him and he was born in the hospital and had been back there in decades. Anyway, I got to know two Norman. He and I have corresponded since,
and you know he's a really interesting foul. Oh, he is now you what I said to him. He I interviewed him and I had a bad experience with time like this. In my life, I thought we ve been talking for like eleven minutes in an hour, and a half ago by me, he's is in his unique a bit he's like ay, I because he has all these. Interdisciplinary kind of focus in he. There doesn't seem too, your scholar, that's really synthesizing, all these vastly different fields, anthropology in psychology in all the stuff, so he's kind of putting some things together in asking some really pointing so one of that he brings up in homer days pertains directly to this, which is setting a goal for yourself right. So what he's explain very simply, we think of ourselves. The self is one thing the self, but in fact there are two distinct selves minimally, one of the mean your experiential self, so that you- and I sitting here experiencing this moment, if I'm on Instagram my experience yourself self loves it in two hours- could go buy in the east.
your annual self enjoys every minute of it. Now, when I go to bed at night, the narrative self evaluates my day its readiness story of my life. It's very disappointed. I spent two hours looking at Instagram right, so these two things are often diametrically opposed. So when you set a goal for yourself on this at the sing, that's gonna help you, who is the aim, this was the service only your narrative self, or is it supposed to service your experimental self? Should it have the should it have the authority to trick the experience yourself to service the narrative selves goals? I mean he's a real. There are very broad philosophical questions, but they're they're they're becoming a reality. Was a they'll be in your settings. It has
the thing between exert Priscilla, I've done without narrative, I'm cold, savareen, yeah yeah, but rose, is really really interesting. I agree because the example uses in the book is that you with all these devices you could be walking into a meaning in your phone. I'll tell you don't talk in this meeting your blood, sugars low. You slept like shit last night intercourse. All levels are high. The last time you spoke up in a meeting. You got trouble your boss right here, but you know he also got care. The way, oh, you tie, debated him about the ok. Please because held me in Harmodius, where he's projecting the future
He says you know we're not any doctors, algorithms are taking over men, he just doesn't get it because you have a medical grounding right. We are going to need doctors but dick and be reconfigured as to what they do. So he gave too much credit I think for like in or in the book on IBM Watson, health, which has really done anything yet, and the projected much too strongly how, though the entire medical profession is gonna, be guided. I dont he and I really disagree about that, but you touch on adapts, though, that you know what, when the self driving car thing got really hot, it's still is, but did the people were talking about, have totally autonomous, cart
and these levels were level. Five is no possibility of backup, no human back level. By how it turns out. We will never get the level five because level five is affected by a weather, road conditions. You need to have a potential for backup, and so just as we now blown through the possibility of total autonomous cars will never happen. People that the top people in this field, which is the pinnacle of ay, I all agreeable what we'll get to level for, but never to absolute and no back up under any given the same thing in medicine, we'll never gonna get to a point where all things in health care are gonna be done without human backup rights. There are certain things work we talked about, so this, I think, is what you're getting at. Is you know that initially does exuberant about automation? Yet then we can
reset in their certain things. This is gonna work where you can just automate everything under all conditions. Ok, so great, so you can so in this future world, where the device is potentially diagnosing you with things at a rate that on power or better than other doctors will ay, I be licence to prescribe medicine. It can be in fact, for example, in the event that duty I thing I gave the algorithm gives a prescription based on the patients information about they are about to take their go straight to the farmers is or has to go through. It got no right to the pharmacist, really are no doctor That might have overwhelmed the? U S, because you know where that that's what happening, and you can see that with children with your infections, a lot of things where it's you know you check for allergies. You know what the common first line drug would be. Why would you have to bother a doctor exile right? I guess it will. Just
be categories, because I'm a I'm fourteen year sober my attic brain go straight to this is awesome. I'll, have a device of a friend with a broken bones, I'll fuckin scam, his bone I'll get oxy cotton prescribed to me. So that's immediately, where my mind we're, probably not that one ok so, though, probably be categories of year exit are abuse, it does bigamy me sometimes things I have to get prescriptions for where I'm like. This can't be a blue it's not here, no life is rightly know would take this in most countries around the world. Those sorts of things are over the counter. Again, it's all honey. I want a man, I know because I remember being even on a Europe trip when I was nineteen in Europe and I had not to get you to excited but pretty bad diet, and I went into the pharmacists in Paris and I'd like to unlike explore, reacting out what I'm going to say, Fraid Squad crime and holding my study, and yet the pharmacist gave me a priest.
Friction, Laval, Anti dire, Ria pale that work like gangbusters out drink any. You know french food hours later, and I just thought this crazy that the EU can have that here. Are there and not here it's a little bit disheartening. Well, I'm so excited about your work and I really hope that your project yields great results with the million folks getting monitored and in implementing that night I I I do see. This is a hugely democratizing bit of technology. That's going to benefit a lot of people. I just hope people don't get assessed This is a lot of money at risk. There is that, and there is this potential that we can make things so much better than today, but also has reviewed. I mean it's early, but it could go to make things worse, so we have to really a plan this
have to seize this opportunity. We may not ever see anything like this again for generations if ever because the impact of potential impact of ai with this torrent of data for each person could really be a great way to take us back. You know what to bring back restore the way CARE Healthcare used to be yeah. Well, I wish you a tunnel luck, I'm so glad. There's folks, like you out there that haven't ok, they're livestock road racing like me, and you have a book right. Your book, deep medicine that came out this year and a half dozen ain't just a month ago, a month ago, great so check out deep medicine is all very, very fascinating. Thank you. So much for coming, I really hope we get to do again. Excellent thinking and now my favorite part of the show the fact check, with my soul maiden Monica bad men
Monica I dont have a song, unfortunately, because we had we have an exciting morning here. There's someone observing us right now and try to not let that affect our honesty and what not, by Adam now nothing can effect honesty. We have Ella Times reporter here, make sure crow. And our teasing dot area Eric Total brought daughter, Sarah, so sweet we're very flattered to find out that she was a hard core arm chair in she brought do gives one of them incredible. Gifts really thought for well thought out. Monica what'd, you get a mug that has a picture of my boyfriend of my boyfriend benefit from goodwill hunting. He picked the right picture and on the back it says, what's incorrect, but that, but but it doesn't matter because we know what it was supposed to say. Yes, she knows what it supposed to say
he's not going to react and drank some coffee out of it. It says what about then facts, but it's supposed to say how do you like yeah, like as a reference to how do you, like them apple, harassed? It's beautiful mine is a pitcher. It's got a pitcher of my boyfriend. Brad Pitt share my boyfriend J C, and then it says don't trigger me. Am I now really thought Oliver boyfriends? I represent it yeah there we both got guys says they do. I have to correct something from last week: Sanjay Gupta, ok, of course my father listened. He measure, listen the shock Potman pad men now, and you say my last name all weird. I said a short Patman now you said it an act. No. I didn't levelled at a higher level where just cause of these. Well, that's interesting because the first name through you off
it was an pad want me to say I was unintentional. I now hear how did I say your mom's and even the car Mamma and you said her name- is normally boggled it better and then he said, maybe that's acute, nickname, IKEA five or let's get her permission for here, but Mamma Mamma is a fun team. It's also a mouthful next time you guys are at the shopping. So in Georgia people go oh Mamma Mamma, Mme reality kill. Can I suggest something share your worship that says murmur with an arrow poignant to your mom and then your Mama whereon says Mama with an arrow point: intelligence classy. You always have to be position correctly for it to make sense, I bet will get no fight about that spread of Lee, but a shock Meda. Yes, he doesn't listen the pod cast, but healing God, thank God, dad
listening turn it off you're not allowed to listen. He don't have permission. No, he he be he's, probably thrilled to hear you talking about him and all that positive light in that he might be getting a little bit. I hope so it deserves to be big. I wonder if he's heard that I want the basically there's a job offer on the table for him to do our political, especially as we ramp up for this election, and I think we definitely need to show its point of view. I certainly a point of view. It's just the fact is that all he has quite a player sure dies. It's really fun because in general I'm outnumbered disagree with this assessment, but you wouldn't you and mom yeah are always tat. It may not be ganging up on me. Well when you're done admire together were ganging up on you get your dad pretty lock step with our political views, shrill by my add up
had is so vague p. I dont to be honest and well, and I feel this way about you too, if I'm being truthful, I dont know what he actually believes. Ah because he is just very good at arguing in Hell. Just argue wars order here. Are you the opposite side of what ever you are saying the same thing, so I dont. We know we used to think about anything up I'll. Have it engraved on my headstone what you think finally get to know. They don't say it I'll say Reagan. Was my favorite display my head, so you, while I didn't see that that will only who work out for me if you pass verse, witches, statistically, very probable? Well, we don't now be cool headed humor. This week will, thank goodness, duck
Eric Toper was on because it seems that we have a solution to your ipod. Andrea am, I would give yours I return and mine on a term settled, think they're the same well. I know you don't think they're the same. Laugh, you wouldn't think they're the same cause when you see it in another person. It's highlighted big time. That's true! When it's? U? It feels more rash right right totally I've seen you do it many times, so I would you give us ok, I would get well what's a tent like whose it can, I would suppose TAT is someone who is absolutely arrested by their fear of the core element in their lives. I mean, I guess there, like in their house wearing aluminum foil over their head in all the doors and windows. Are sealed re yeah? That's it the ten! Then I am a one remark. Zero just to give the Addis Euro zero. Your arm is cut off lying on the floor and you don't think savings wrong there.
We need to go to the hospital. You know I'm probably a seven Ok, why I'm proud of you may now I was, I was gonna, say five, that's what you really feel but you're like you know- and I gotta I guess, Counterbalance well my own bias, yeah yeah, but some feels a little high. Like new radioactive. If, if ten is somewhat the window seal, then yeah like oh, I didn't get a neurological scan this week, even though I thought I had a tumor and if you can I've done it without a lot of inconvenience. You were of yeah yeah. I think I'm. So I must say a half seven vulgar and you are a five day. Disagree I'd like to see like three points between
to be honest. I would like to be of now and I'll. Even let you go to a six as long as I got out of the three year. Not three ok can remember. Thinking is that I had a brain tumor tat about using, I buy you about that. You I'd like seven other things. Now you can you had a brain tumor you some elms forget I forget, but I do I does. I notice that when it's happening with you- and I like that, it happens, to you, because I don't feel so alone, the right road- and we both admit it's- it's kind of a failing in some way. As we know have these things that we think we also now have were wrong just general me wrong. Ok, I don't feel a hundred percent certain that I didn't have robbed dough and then I Did you have to think you from remembering you thought you had wrapped ice at this so extreme? I still feel like I could
I told my relied already know by bodies really good at recovering from things. You'd have to be doing exercise I known or not around. I guess you'd have to be doing cross. Why, but seven days a week now, no, no! No, it happens it happens in a week. in one shot. It does over use in an instant nata habitual over nelse. Ok, this one- and now here So, what's I couldn't fury like as if you ve, never high journey thing and then you're like and then a walk up to the observatory, Rapto well, you cause our your sign, but now is the extreme does not, and if you ever like climbed a flight of stairs and adapt our extreme, then yeah you Polly, shouldn't start off hiking Griffith Park. If you ve never claimed the flight of stairs. That's right! Oh yeah, should I tell people what happened last week? It was what to me were your ailment. Oh god, yes capsule,
yeah? How embarrassing, I think it's adorable! So last week I had a horrible and said aunt that that cause me to feel like I had a brain tumor them. I stole my. Have you come to you, wake up in the wake up in the middle of the night ash and I had felt somewhat mess near my underpants area closure, and then I thought maybe I just had a really intense night. Sweat sometimes I get those you didn't make any pointing out. I started my period in the middle and are now very regimented on my period right right right. Ok, But then, when I started doing some investigation, it was Europe my arm, he was p p their regime a guy a mountebank, let one in my bed, thirty one you're home! What woman this has never happened before this isn't like. I have
incontinence, nor even Sarah Silverman Bat. Now. I have been a light bed wetter, exactly no history. I haven't peed in the bed, since I was barely five years older earlier than that yeah. I also don't pay very often at all. So the fact that its uncontrolled, all aboard. In my sleep was a rare. I Gary yes, then accompanied with severe back by severe lower back pain. So, of course I was like ok something's wrong with my kidneys. I probably have a kidney infection right which I've had before Boca the next day. I I text my through the greatest the text might have for an hour then thousand curtsey shout out. Yes, if you need P d in LOS Angeles, please go see out and courtesy she is the, but only if you really need it my life is because you want to meet Allison well if she they're gonna payer. I'm sure I'm sorry! I guess you could just hang yeah, it's better data, yet ending up she's yields,
I want to say for the record. She feels a lot of your your car, poor girl yeah. She gets a lot of text. For me this is happening. What do you say by the way? She's? Very good, but she never makes me feel stupid. Me always listened to what I have to say and then says: ok, yeah, that's all this, but it's probably this I can tell she is just being really nice and telling me that I'm over reacting Europe sees all. Again, you super knowledgeable, also not an internet snow, but then things that I'm asking her normally are like muscles skeletal, yeah, ok and she can tell based on like seemed comes a basin what's happening if it is muscular or she's like this doesn't does an organ at issue here. Our this, you need to go said the doktor, but she never never says reproach you not. One said except us all on one
day. She I all, I said: ok, do how have I haven't really really bad back paying jobs was a one year old, she's dealing with right like when you call yeah and about have not like she's pregnant saw tat. She was gonna deliver any day now Reich I'm out here has also I did. I was taxing her and she was like in ideas like are you. We know K and she's like riding in us and shows like Germany from the darkness. Like I mean no cause, you might need to be going to the doktor at any moment. Anyhow, she said yeah. This is strange and aid. It's definitely not consistent with acute muscle pay great. So she was like. I do think you should go to the doktor about the Essen and she never says it. So then I was like oh boy, ok great, so you were so I went they did Your analysis, even though I had no p p laughed all car and venture is brought your shoes.
he cut off like a corner of it in and stuck it networks under lasting hell. That's my favorite jokes. I tell a really which shares in old couple go to the doktor on old man and a woman and the man is needs a get his physical. He's gonna hard of hearing, so they sit down in the doctor, says: okay well before you leave, I'm gonna need a blood sample, a urine sample and fecal sample, and the man says to his wife what Jake worries I, and she goes she made your underwear. That's a good. Your underwear. Ok, so anyway, I to do your analysis. There is nothing on men, kidneys, drawing blog now maiden check my brain, and I so had a big abscess. All my foot worldwide
hold on hold on hold on. No, I did you stubbed your top here. For now it was stub. It I would have remembered stabbing added appeared out of. Nowhere is clearly a scrape described it on something. Listen now. It was very deep times have gaps that has observed here on my foot and I had to Brazil my head right and it's weird yeah you're not dig in ambient or anything. Can you not walk and run a bang and ensure that I love that you know I'm here, I think you fell out of bed lay like a baby hit your head and then, when you got up, you scrape your foot on the bottom of your bad and then you got back in bed and you were confused and thought you would made it to the bathroom and then you just squirted and then that's everything we know about brain tumor about the back pain, totally outwardly extraneous information like on as a key test throw that right. I want unrelated on Coralie unrelated middle of the night, the outgoing out, your back up
or maybe sustained during this fall. Ok, we are half asleep. I just I but Aunt Polly woken up by this that crashing onto the ground right, but you knew straight to brain tumor, well or aneurysm. The I would do delineated little difference between your my hypochondria cash is. I have these thoughts and then I just never go to the doctor. I know that I was in hey. Are you I'm you you you your more prone to go investigate or, as I like, I whip up some crazy theory and then two weeks later, just forgotten about normal. I guess that's true, and I mean if there's, if there's physical symptoms that need addressing yes ago, the doktor I didn't go to the neurologist like I want Arroyo. It was rough anyway that led us to have a conversation about wearing two adult divers, all right, so I'm leaning towards this. So I wake up in the middle of the night to pee minimally wants always that's guaranteed,
sometimes twice a night and on a bad night three can I have a very hard time falling back asleep. It takes me fifteen to thirty minutes each time, so I'm losing an hour and a half on a bad night of sleep, and it's only going to get worse. I have older friends and for males it just gets worse and worse and worse in an in this group. We are talking about it all the males there were experiencing nighttime p b that we're over thirty five. Yes, so my my thought was why don't I just start wearing depend undergarments in training in my body to pee at night, which I do think we'll take a few weeks. I think it'll. Basically, I wake up in the middle of the night I gotta pee go. I've got my diaper on I'll, just p and then maybe the next time I wake up. I can do it more half asleep and then eventually I'll, just train myself to pee at night in my diapers and then I'll give way more sleep and I was posing the question. Why not do that? What's wrong with right?
You are opposed to dwell for a couple reasons: wine. If, then, you are in a situation where you can't your mama's calling me let's try under sure hello. This is Monica. I gotta yeah did you? Oh I'm sorry, I got your text and I thought I responded, but I probably did not respond she's in the middle of a vat jack, we are recording yeah we'd, be wit, pause to answer an important call. It's ok! Oh my god. Thank you. I will tell him that ok by well the first
legal rate at a whole flow going about my diaper well now is my arm to talk only which also appropriate that I'm talking about returning, diapers and mother would call last person who dealt with my diapers yeah. She said. Is it like? I think I feel like he's about to try to be a baby. I got break out of this. I put a lot of energy dick getting him to not be I'll, be ok so which are an injection. I had a couple wine. What if you are in a situation where you are in a group setting- and you can't p, but now you're bodies train to pm while the nights are definitely being the bad and there's gonna be a stranger, their hold on handling all think camping, ok, so I'm camping MA, but I'm campaign in a town with strangers yeah. Why am I doing upon
collapse? But there are plenty of reasons I can't really get into, but will Ogden concede that if there is an apocalypse, this was about ok, but also its assume note for this for ships and giggles that its and there's not a park. What, if you want, if you just had to share bed, would like I'm now bed hopping, let's say what view Darlingtonia yeah. You had to do so I just tell her look. I'm older appeal out in the middle of the night it was. It was cutting into my room and now got the solution. It's an adult diaper and I wear it kid big work has said, but the nest this lead to another conversation. That's it wouldn't be able to I'll, tell you why I think our goals are more than our undermine children, unheard nobody's, gonna, her skin and no virus scan and she doesn't like it. They're not made of burlap, these are going to be a nice Ella bellowed. I first, why might have just make an adult one, but I dont. Why not?
hey here's. My other, why? I think this is like a Jonathan high kind of moral moral act, paddling experiment about morals, there's no morals being in a diapers and adult. There is no more I'm taking up practicality, why you wanna get frisky in the middle of the night. That was my other thing, and you said now that you're not interested not at all, and no doubt before we're married, there's, no way we're going rescue. What about our johannsen this scenario? I will make an exception I'll, give risk overnight. Now this our move, my diaper now in a very sexy now she doesn't now I'll, take Adela Doo, doo doo, Doo, Doo, L, she's, peel, gaining doo, doo doo Doo brought about this email. It smells like p or new where water bomber- ok. So let's get into that. Am I drink fluid compulsively, as you guys can all attest to theirs and seven drinks on my desk right now, so much fluid that my urine never smells. It smells like water. What is wire smell? I grab you think you're going,
I got them all my puking as you smell water, now, you're gonna. Wake up Thurston has its merits. The scarlet Johannsen Ami far still the hours you files that clean water. In my it's all you gonna want to smuggle your wet body will ever impede. I hope we interviewer. We ask as I gotta hunches sheet she can kick out on when you said that you would like wild right so that lead to another commerce because this is how it started. God bless. Delta she's for cheese is still in it. It brought. My two lincoln was out of a deeper at two and a half at night. Yes, this gale this bit. She loves her diaper right and I started thinking. I gotta get around this deeper and then other or what get her out of diaper. What does she wears a deeper the rest of her life at night, and then I just thought: what have I met a super cute growth and amazing personality. When I was in my twenties, everything was perfect and their them right through into bed. She goes oh by the way where diapers, when I go to sleep at me, like that,
she's, so Q and adorable I'm an you're so unique and authentic you're still wearing diapers? It would not be a barrier for me. I would love it and then we pose that questions are different guys at the party. I was relieved you see that right, Anson said, might even like or more Charlie a little less but could get through every ten tralee said he could manage thrill. They wasn't thrilled about the idea of rain and I were actually excited about it because I'm like this person, they really thought about the rules of life that they just got put on our shoulders they ve questioned them and they realize now this rule silly that added adult key word diaper at night. They are so that's it that's a critical thing. They answered her some enough control or our commitment to bettering themselves in that they just decided to just where diaper their whole life ass. He used to working through an issue was an adjournment. Rob judgment laid mere com. Now was the date that day there there failing, but there
failure. Now I think if you have an issue, you should work through that issue. Minority goes judge men, others know a good thing to want out of a partner. You want that out of all the people in your life, there's no working through for an old man, peace in the middle, and I there's no solution. If they're working about twenty euro ok twenty year old girl should have by then tried to figure out. How do I do this, as opposed to suggest who cares what I'll? Just what's now your servant, anyways I am I would I wouldn't be off putting me. In fact, it might even be like appealing tax hurt yourself. Ok, so he mentioned the Turing prize touring pride and that's the Turing award often refer
two as the Nobel Prize of Computing carries a one million dollar prize. All I want to win it now. I know I didn't care at all until you just said there. I now it's named for Alan entering the british mathematician to articulate the mathematical foundation and limits of computing. He is also that movie the imitate then game with Benedict Cumber Botch- oh, oh god, for their movies about him. Now cover all really he's the one who decoded the german messages in world war. Two. Yes and he was gay right. He was highly his his almost actuality yeah. They are breaking, and now, when I now such an elegant movie, really was yeah. I lie what I said to him: here's what I would have done about. Ok out a cracked, the code-
and I said I wanna call a press conference and I would say I have cracked the code. I could save everyone's life, but I want tomorrow morning, legislation decriminalizing homosexual behaviour. You want the solution, you'll have to take it from this gay and you're gonna decriminalize gay yeah. I mean, I think, there's a lot more emotional hardship to overcome than just then just he's already. Here are not second guessing his bravery, I'm just saying in retrospect: wouldn't it be great if he held that info hostage until people gather shit together back then I mean that hard for someone to do now back then he would just they wouldn't. Have they probably what killed it. Also, let's do, as I thought, experiment something we don't agree with. So let's say that I'm worn Jeff's, he cares cancer says I got the cure yeah, but you have to legalise this form of s
and whatever the hell, yeah, yeah, torture, polygamy, What are we deal? Yeah? I guess a utilitarian Kantian to bear. I guess we we therefore we now don't do I know exactly what we do. Ok, we say: yes, we legalise it. We get that cure for cancer and then we'll fuck, you we just double cross. You knew deserve to be double cross. Sworn jumps out. I mean I guess the odds are now come. I guess it doesn't. Just like a week of polygamy was legal, that's not really. We can do it right. We condemn browser in our man. Could then you're just not answering the question then you're just doing now, I'm taking the adult who peason diapers, I'm not third rail. No one considered. I think we don't do it. Oh any
have to hope that their mother says and your father, whose about to die of cancer. You now put it we're. I guess the hope is that somebody else's close and is about to do it. He's not gonna hold this information hostage. Fourth option: Wally's. At the press conference we send some operatives in to his home. We steal you I'll, be ok with Amtrak. Ok, you said you ve had a lot of corn. Ask a piece in the EU need to get another one, but according to the world, you really only need to start getting them at age fifty year, but I have a familiar helpers. I'm saying that wrong. I remember you don't have it but right. So I to a practical just the last time I got one and he's
at night explained he's a what're you. Why have you got in so many? You mingott nonsense. You re teenage! Oh my uncle on my mom side. You know had calling cancer in my cousin had a really young and he said that's not what side of the family familiar. It runs in re, so I stopped giving them. I said that out loud on Jimmy Camel- and I got all these tweets going- that's not true that guy is not telling you the true doktor said it. They may have saved my life to talk about that. I'm Kimmel but anyways I need to go in, they have you ever had and there was a little off our Paul. No I'm all pollack free so far, so there you pal, I don't mean to, and it's not great to just keep getting them says who says Eric Toto. Well, I mean there's no downside other than me whose bands, in the time I wasted colleges array and to Europe,
I simply do not get one is. I want to be ironed out while that of really risky position that take a spurt of high in a few years, you're not going to be you're a seven at age. Fifty sure can just around the corner. I just made a milk milk lemonade round. The corner. Fudging is made at a colonoscopy, vs yeah! Well, yours, Still you do there really thorough allows the day before, which is by the way, the only really bad part of the corn ass could be as the prep yeah cause I get knocked out, For that, I'm not around. For that error, sad and then I get proper, follow up everything killed. My Jackson was and then you're out and then you wake up and you have a ton of gas and then you get over that and you're on your way, but the prep the day before drinking that crazy fleet and
stop yeah yeah yeah no eating my the whole day yeah. Then I told you I always get cravings by the end of the day for the weirdest things so the last time I got it. I got this insatiable craving for Mcdonald Chicken Mcnerney. And so on my way home from the corn asked me, I gotta twenty peace one he up and I had all twenty of was this before or after the pink sledge video. Oh, I know her watch that things will allow the idea, I'm smart enough, not to why I watched you did you have you had another sense. I don't think so. A real is up in debunked or was actually a legit good question here. I think it is legit. Ok, but I don't know for sure. Ok, so I was looking at what most people go: the doktor for grey top ten things came, who form one skin disorders, oh sure, too,
slightly rashes, yell, a grass was the acme was on their like we're. Molly, probably obsesses on fee ensure an ode to joy, pain and asked the arthritis yapping living thing. They mean three back problems. That's me for cholesterol problem once that's you, five! Oh, what are even further the story about my dad. I didn't care prefers this list all available circle back five upper respiratory problems, not including asthma, on her cat six anxiety, bipolar and depression, seven, chronic neurology disorders. Also me a high blood pressure, nine headaches and migraines ten diabetics.
A cold is not number one. I know that's what I thought this is like a very specific list. It was alleged soccer it. It was a little cloven, kissing Lou. I would just have to imagines number. I don't know. Maybe people don't go to the doctor that money for that year? Who knows? Because you don't really cause why you just have to take hold medicine? I feel like a lot of people go. Maybe it's an hour, I think well call Mabel, I greatly shared or you could die. I mean sure people died, fever fever for six days or something here, sorry, it's back to my dad had listened good pronunciation might listen to the Sunday grouped episode and I was wrong in the fact check. I told a story about him and I said that he went to this array the doctor
and they gave him this pill. Blah blah blah turned out. That was a homeopathic doktor knocked and I are basic doktor Clyde. Not that was the same thing, but it's not the same thing. Homeopathic medicine is western ochre. So he corrected me on mass grave. I'm sure you near for you dead, and he set also said. The man was seventy years old at the time, and that was forty years ago. Ogre stories on internal yeah, ok grow exactly okay, so back to backs Bloomfield Hills, for two or three years in a row was the highest earning suburb. According to you know, I could be. I couldn't find information about that can substantiate there, but it's not even in the top twenty or currently twenty four war suburbs highest earning suburbs,
while the top three high as earning suburbs. In the: U S, sure you won't gas correctly, Ongoloo say the top two or in Connecticut FUCK. You were on the less their online in Connecticut ones, and all I guess now we have the whole Silicon Valley. Thing. Ok, go ahead. Ross, California is number one where you go right: Scatterbrain, medium household income, two hundred and fifty thousand plus during the staring at second short hills. New Jersey, also to fifty plus Glenview Kentucky, is number three. What YAP Vat is a shock to me? The land, I'm delighted, yeah, what's happening, Glenview, I wonder and are now about to fifty Haines Underwear Factory- maybe thank you saying all right. That's actually a great gas we
on time had a corvette, show down and bowling Green Kentucky, and then we had this big of van and we went to some of these like where the Kentucky Derby horses are bred in this guy who, on this compound a horse, stables were nicer than a four seasons. Like eight. Would they had they hosted a dinner in there, and I thought this is big bucks yap? Attaining? I love your guess. It's equestrian real related bunker, so you said that you are a Nashville and that you draw for eleven miles and there were twelve thousand foot houses for eleven miles. So then I texted Houston Estes friend of ours, of labour, you claim to be in the car with during this eleven mile drive my asked if this was true. This is what he says. I asked him a few questions and then he responded. I saw you and acts on some ridiculous calmer
so the other day I immediately cancel my cable subscript saw nobody ever. I double down on my question is an eleven miles of rich houses. Yes and mine is right in them. The latter were why privilege, and then he said to be more specific. There are two or three main secondary roads where the homes are very large, and this continues for mile after mile it's kind of weird. When you see it is not being from here like Dax Uncle you, finally, God to them kind of leading hidden, clarify eleven miles, which is what I needed hated him to drive the, but he didn't do that for me any so. That's gonna, be here. That's gonna, rap things. Ok, I love you. I love you.