Ask Dr. Drew - Charlie Sheen Shouldn’t Be Alive: His Unfiltered Story of Fame, Addiction & Recovery + Dr. Aaron Kheriaty on Canada’s Plan To Euthanize 12-Year-Olds – Ask Dr. Drew – Ep 556

Episode Date: November 17, 2025

Charlie Sheen rose fast in Hollywood, starring in hit films and becoming TV’s highest-paid actor in 2010: reportedly making $1.8 million per episode of Two And A Half Men. But fame fueled a collapse captured by the tabloids: cocaine, arrests, explosive relationships, and headline-grabbing meltdowns that pushed him to the brink as he struggled with a growing addiction. After a stroke*, overdose, and HIV diagnosis forced a reckoning, today Charlie says he is now eight years sober and rebuilding his life. In his new memoir The Book Of Sheen, Charlie looks back on the costs of fame, addiction, and his inspiring journey back to reality. Dr. Drew learned about gold, silver & retirement with Augusta – now it’s your turn: https://drdrew.com/gold Charlie Sheen is an actor known for Platoon, Wall Street, Major League, and Two and a Half Men. He was born Carlos Estevez and grew up in Malibu. He has appeared in films and TV shows since the 1980s and has written a new memoir The Book Of Sheen available at https://amzn.to/3XrRdtL. Follow at https://x.com/charliesheen Dr. Aaron Kheriaty is a physician specializing in psychiatry and the author of five books including Making the Cut: How to Heal Modern Medicine available at https://amzn.to/4pt6yXh. He is a Fellow and Director at the Ethics and Public Policy Center and serves in advisory roles at multiple institutes. Learn more at https://aaronkheriaty.com *CORRECTION: After publication, Charlie Sheen clarified on the show that he does NOT recall having a stroke. Media reports and info on his IMDB page are likely inaccurate.  「 SUPPORT OUR SPONSORS 」 Find out more about the brands that make this show possible and get special discounts on Dr. Drew's favorite products at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drdrew.com/sponsors⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  • AUGUSTA PRECIOUS METALS – Thousands of Americans are moving portions of their retirement into physical gold & silver. Learn more in this 3-minute report from our friends at Augusta Precious Metals: ⁠https://drdrew.com/gold⁠ or text DREW to 35052 ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠• FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. Get 15% off a 90-day Starter Kit Subscription at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drdrew.com/fatty15⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get 15% off your first order at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drdrew.com/paleovalley⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ • VSHREDMD – Formulated by Dr. Drew: The Science of Cellular Health + World-Class Training Programs, Premium Content, and 1-1 Training with Certified V Shred Coaches! More at https://drdrew.com/vshredmd • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twc.health/drew⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ 「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://kalebnation.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠) and Susan Pinsky (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/firstladyoflov⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠e⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. Executive Producers • Kaleb Nation - ⁠⁠⁠⁠⁠https://kalebnation.com⁠⁠⁠⁠⁠ • Susan Pinsky - ⁠⁠⁠⁠⁠https://x.com/firstladyoflove⁠⁠⁠⁠⁠ Content Producer & Booking • Emily Barsh - ⁠⁠⁠⁠⁠https://x.com/emilytvproducer⁠⁠⁠⁠⁠ Hosted By • Dr. Drew Pinsky - ⁠⁠⁠⁠⁠https://x.com/drdrew⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Well, in a few minutes, Dr. Aaron Carriotti will join us. He has a new book, Making the Cut now available. You've seen him here before. He, of course, was the bioethicist, psychiatrist, who is summarily dismissed for daring to stand up and say, I have a bioethical obligation to at least question what's going on here during COVID and with these new vaccines. But first, the one and only Charlie Sheen, he really needs though introduction. But I want to say this, you must go get his book.

The Book of Sheen. You must go see the documentary. It is a, amongst other things, the sweep, there's the book. He has said on the record now, he'd rather tell the stories, rather other people tell the stories for him, which I think is a wonderful way to approach this. But his life has head across the sweep of the last 40 years. And his experience, frankly, was representative of many people's experiences around the same time. But his was very public. So let's get to it, right after this. Our laws, as it pertain to substances, are draconian and bizarre. The psychopaths start this, he was an alcoholic because of social media and pornography, PTSD, love addiction. Fentanyl and heroin, ridiculous. I'm a doctor for, I say, where the hell you think I learned that? I'm just saying, you go to treatment before you kill people.

I am a clinician. I observe things about these chemicals. Let's just deal with what's real. We used to get these calls on Love Line all the time, educate adolescents, and to prevent and to treat. You have trouble. You can't stop, and you want to help stop it.

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augusta can do for you order the book now the book of sheen uh you can follow charlie on guess what charlie sheen on x and wild a f brewing charlie thank you and welcome to the program Thank you. Thank you. It's an honor to be here. It's enjoyed you with Corolla. Thank you for some of the comments there, too. We'll get into all that stuff. You guys had a good time, right? Yeah, yes, we did. Yes, we did. Now, you've been on his show several times, obviously, right? Well, I've been on that show, but he and I do a podcast four days a week. And he calls me every day, too. And he actually calls me every day. So he had a lot of, a lot of, back, and forth, he and I. Do you agree that he could lower the table? Not symbolically, like the actual

freaking table where you sit. Like, don't you think it could be like a regular table? Oh, yeah. Did he tell you where that table came from? He didn't know. He didn't talk about the table. I just surrendered to it and its position. Yeah. So, so it's this gigantic block of wood that is, to Charlie's point, it's way too high. And then you have to climb. up into these chairs to kind of get near the microphone, right? And the chairs are uncomfortable. Yeah. And that was sent to him by a listener right at the beginning of the whole outset of the

Corolla Studio. So he's just gone with it. Ah. I mean, but, you know, it's a lot easier to make a table shorter than it is to raise it, right? Evidently. Yeah. I'll see what he says. I will, I promise you, I'm going to write you a.

I'm going to write you a little note that addresses that issue. See, there it is. No, no, no, that's just, I think that's the old one. No, no, I think there's a new new one since that. Okay. Because that one you just showed looks manageable. Looks reasonable. Yeah, that's not the one now.

Yeah. That one is reasonable. That's when they used to be lower. Yeah, the now is just the gigantic block of wood that goes on forever. It's a lot. It's a lot. Anyway, but I have a lovely time with him. Let's talk about him.

Yes. Let's talk about the doc and the book straight out here. So tell people why they should read the book. Why do they need to do both the book and the doc? So why should they read the book? They should read the book because it's highly entertaining, first of all, I think. And it gave me an opportunity to tell these stories in a way that they'd never been told before. or, you know, weren't some version of them that had already traveled through somebody else's filter or intentions or whatever. And so it is, I guess, as they say, straight from the horse's mouth, as it were. And then it's different because telling a story in a documentary has to be

a bit of a performance because you want to keep an audience engaged, you want the story to have a beginning, middle, and end, and you know, you know, add some humor, obviously. And so there's a different kind of pressure in that, in that environment, as opposed to having a couple of weeks or five days or three days to, to write that story in, in a book. Yeah. And the thing that jumped, a couple things jumped out of me. And this now is the first thing for both the doc and the book. was the level of personal detail you wove in. I'm just take, I'm just take one quick example that just is in my head,

which is you at a party, you're getting loaded, and you hear Nick Cage talking about his watch across the room. And that's like so specific and so personal. I'm like, oh my God, what a moment. And it led to a lot of shenanigans, of course. But the book and the doc are filled with moments like that. oh thank you thank you yeah it just and it wasn't just that it was his watch it was a it was the his voice yeah and it was it was one person on planet earth uh in that in that dark alcove

and i walked over and tapped him on the shoulder and was tapping the shoulder of destiny and the unknown at the same time you know yeah and yet you guys sort of and you went on to sell stories I don't want to divulge all of it because they need to watch it because some of them and talk and read it because the story on the plane is beyond and all that stuff needs to be watched. Pretty crazy. But do you think, I mean, you guys both came from such a similar background.

That was the other thing that jumped out of me about the dock in particular was you were a bunch of Malibu kids. I didn't know that. That you guys were all kind of, and the way you described Malibu in the 70s, I know exactly what that was. I was, Susan is from Newport. I spent a lot of time in Orange County beaches. Orange County beaches were very similar to Malibu beaches at that time.

It's not what it is now at all, neither of them. And I thought, oh, I know these kids. I used to hang out with these guys like this. I know who that is, but I didn't realize that's where many of you, Sean Penn and Nick and you all kind of came from that same area. Yeah, early on, especially the timeline that were a lot of those super eights came from. That was mostly the Penns and other neighborhood pals. And then Rob and Chad Lowe joined a little bit later.

And I didn't really begin any type of a friendship with Nick until I had already decided to become an actor. And so he wasn't at ground zero with us, but he was certainly very close to it, very much on standby, you know. But I wonder, you know, the level of attraction you had for whatever it was you heard in his voice, I wonder if that was, and I'm going to, I'm going to, we haven't gotten to this material yet, but I'm going to frame this this way and you tell me if it's out of line. Your disease, his disease talking to your disease, you know what I mean? It's like, oh, must go there. You know what I mean? Or other things, other, you know, different parts of, you know, perhaps. a mutual attraction to the things that we both were excited about or inspired by. I don't frame everything in the disease model, you know. It was just out on the town and there's that accidental, you know,

or not so accidental cosmic collision course with Nicholas that just opened the door to a whole different universe, you know. Yeah. And another thing that caught my attention, we just recently watched the Scorsese documentary too. And the similarity between what he was doing, where he was writing storyboards and then filming stuff. And same thing I've heard with what's, I'm blanking on the guy, the director of E.T. Help me. Everybody. Spielberg. Spielberg. He also did films when he was a kid. And here you guys are doing films when you're kids. I don't know that that happens anymore.

That was kind of a unique thing that multiple people of that generation seemed to suddenly tap into, no? Yeah, yeah, absolutely. Ron Howard as well did Super 8s. And I think it might be difficult for today's younger generation to wrap their minds around the fact that technology, there was no technology. It was so.

It was so bare bones that you were shooting on film. You relied on a local photomat to develop that film. You had to wait. And then you were editing literally with scissors and scotch tape into the wee hours of the night to try to build a sequence or make something make sense on film. But I think a lot of it was that, you know, I had grown up adjacent to it. I had grown up on dad's sets all over the world. And so I really got to see the process in real time and how much went into it.

And that I was always sort of mystified by the fact that almost every job on the set comes to a halt when the actor's job begins. If you think about that, right? That's interesting. Yeah. There's 100 people putting it all together. You know, they're all your teammates, obviously. But then it's, you know, director, cinematographer, a key grip, an electrician. It gets really small for who has to stay active when they're actually, you know, those precious moments between action and cut.

So that, I always gravitated towards that because I knew that's where the, that's where something special was going on, you know. Well, was it Jack Lemon would always mutter under. his breath at the beginning at exactly that moment like i forget it whether it's showtime or it's magic time or he had some phrase he would say every take interesting interesting wow and and how that wouldn't disturb like what his first line of dialogue was because the only thing i'm muttering under my breath before action is that first line of dialogue at least the first couple words So you can attach it to something that you really hope you remember when it matters. And as you were making those films, did you want to be an actor?

Is that part of the appeal that what you were doing in those moments? Yes and no. It was more of a hobby. It was a lot of fun. It was a chance to bond with friends on a different. level with a different goal um because i you know i wasn't a surfer i'm not a big beach guy not a you know i saw jaws in a movie theater a hundred times as a 10-year-old so that cured that thing um but um yeah but i was also playing baseball at the same time so i really discovered a

real love for film but also was so drawn to this game that that i just i i couldn't get enough of you know so i i had that i had that dream that that so many red-blooded kids have when they first put on the mitt and they were swing a bat you know yeah yeah i uh and i i my i had a son those way into baseball and he um we went we were on in did you ever do those hollywood dodger night games i did i did a couple of those yeah they never really felt like real games. And when I pitched in a couple of them, they kept telling me, hey, you know, pull it back a little bit. Slow it down. Yeah. I think I was at one of those. I remember Tony Danza would pitch, too, and they would tell him the same thing. Like, like, then stop throwing the heat,

will you? Right, right, right. Right. So wait, so, so were you there? Were you there when Kareem was our first baseman? Does that, does that line out? I feel like I might have, I might have been. I might have been. Yeah, okay. Yeah, because I couldn't imagine having a better first baseman than somebody who's, you know, seven, three, right? Nothing. My wife remembers it. Yeah, nothing's going in the front row, right? But that's for sure. But I bring this story up because my son seemed, he came with me, a couple of my sons, two of my sons came with me, but the one was like, oh my God, it was so exciting. I love being in the dugout. I love, love, love, love, love. And the next, and the next, couple of days later, I went, God, you seem like you really loved going to the Dodger game.

Hey, you should really think, you know, you could think about what it would, you know, what you could do to maybe be in that day, God, on a regular basis. You could be a sports, you know, castor or a journalist or maybe a coach or something. And he became immediately, like, sort of kicking the sand, got really angry with me. And he just got silent. I was like, I had no idea what I just said. And so the next day at breakfast, I go, look, I noticed I seemed to upset you with. the Dodge thing and go, I go, what was that?

And he goes, he goes, if I'm playing for the Dodgers, I'll be in the dugout for the games. And I was like, oh, boy. I'm really, wow. Wow. So you just, there's a lot of, you know. You sent him up to the press box.

You just said that's where it's going to begin for you. Wow. Wow. I mean, not a bad career. He was going to, not a bad career. And would last, would last longer than the average length of a player, right? I mean, so. Well, I was thinking like an adult and he was thinking like a nine-year-old. And I really felt like, oh, that was a swing and a miss on my part.

Very quickly, I try to pay attention to these super chats that comes through here. Somebody asked if you have any, I don't remember these in the book or the doc, even, any Knesson stories. Kenneson stories. He's mentioned briefly, there's a section in the book where I talk. about the transition from it was really a thing that I called BP and AP as far as fame goes it was before platoon and after platoon and it was it was literally I mean it was overnight and there's a line where I'd say something like I I went to bed in a in a game of horse and woke up in the NBA finals you know right right

Not to mix up all these sports analogies. But yeah, Kenison, I didn't talk about him too much in the book only in passing during sort of that chrysalis phase where I was really suddenly had backstage access to everything. And it was really exciting. But there were a couple moments that he and I had that was just he and I. there was a cafe on sunset a thousand years ago and that was like his spot and and he he said something that that always stuck with me um we were talking about family we were talking about you know our parents and relationships and that whole dynamic and he said that uh he says you're so you're the third you're the third child and third son and i said yeah and he said well just remember

that the third son is always mom's favorite And I like, I don't know what he based that on, who told him that, who fooled him with that fact. But I kind of, you know, I tucked that one away and just sort of just rode with it for a while. I don't even know if I ever told my mom that. But that was a, that was a Kenneson Nugget that I've, that I've carried since. I will keep an eye out to see if there's any truth to that. I mean, to be a third son, to have that many kids, that there is a third son is already kind of a rarity these days. Right.

But yeah, yeah, how about that, right? But then, sorry, I forgot to add that he also added that the third son reminds the mom the most of her husband. This is from the book of Kenneson. So, again, I'm just, you know, I'm not claiming this to be the gospel. Just sharing, yes. I hear you. But I'm going to, hey, those of you on the stream are in the Rumble Rants. If you agree or disagree, if you've seen this, ring in.

Well, I'll share that with Charlie. Go ahead. I interrupted you. We're finishing a thought. Oh, and the thought is gone. It happens like that. Good. That's what my brain works.

The thought was this, that it's pretty cool to have a go-to-Kennyson story that isn't us like, you know, scoring dope in a back alley or like, you know, in some kind of other situation, you know, that's the thing that stayed with me, you know. Because he was really, he was really soulful and really engaged in a lot of cool stuff.

And he was, it's such a human quality to him, you know? Yeah, I met him once. No, no, no, that was Bobcat. I met him once with his, he had two, girlfriend simultaneously or wives or something and they were in the car when he crashed even i think yeah why not and um and uh and he was he was great i mean he was really interesting dude but so let's set some record straight here um we promoted today Caleb do you want to maybe explain what you were doing there so charlie can talk about his uh actual stroke his stroke of luck that we actually got him to

be here today yes there were there were multiple sources that i found that said that you had had a stroke. I forget when it said it was sometime in the late 90s, I believe, and multiple sources, including AI, told me that. And then we posted about it on Instagram, and then you went and left a comment and said, I didn't have a stroke, maybe a stroke of luck, but no medical stroke.

So let's fix this now so that we stop perpetuating this rumor and we can get chat GPT fixed and your IMDB page fixed. Talk about if you ever had a stroke. I mean, to the best of my knowledge, I have never had a stroke. So, I mean, could I have said it as a joke? It's just like stroke isn't really something that kind of sits in my, in my satchel of joakness.

There's not, you can't like pull a lot of humor out of stroke, you know? Yeah. So I don't think I would have just flippantly added that somewhere, right? And I don't think so. And to sort of pile on, I don't. see it. Strokes have residual. I, you know, I'm trying to see the residual and you don't have that. So that's... Okay, good.

Good. Good. All right. I'll take it. Yeah. Good. God. Okay. Well, I mean, there was a story years ago that that I, on a jet ski, that I saved a bunch of swimmers from a hammerhead shark

by using, steering the jet ski on both sides of its head to guide it to shore and get it away from the swimmers. And I'm like, I mean, that's like really cool. I wish that was true. But it's just funny how these things try to find their way into the cultural fabric, you know. So funny. Well, as long as that's a superhero shit, so good, that's fine.

Pretty cool. Yeah, pretty cool. So one of the things that came out during your interview with Carollo, was something that I had pissed you off about back in the day when you were in your winning phase. And I want to set the record straight on that as much as we can. I certainly meant no harm to you by that. And if it did do you any distress, I absolutely apologize. But I was actually worried about you. I know you were. I know. And this is what I keep saying about it. I did this And we had just lost Anna Nicole Smith

and sometime before that. And I kept saying, you people are watching this woman die and you're not doing a damn thing. And I said, and now you're going to do this with Charlie? Is that what's going to happen here? What are we doing?

Are we going to help or not help? You know, and all they did was massage all your stuff. It seemed like at the time, right? I know, yeah. Go on tour. Let's go. You're winning. Yeah, let's take this mess,

this like in real time disaster. Let's take that on the road. What? Perfect. No, but no apology needed because what was interesting, because I think I was bitching at people like, I've never met this dude and he's just, he's diagnosing me from afar and all this stuff. And then like over time, I was like, huh, he was right.

He was on to something, you know, but you did give me a great piece of material. It just kind of happened in the moment where you said this is, you know, clearly exhibiting very telltale signs of a bipolar situation, right? A man, and I was saying, go ahead, finish. No, and then so when Andrea Canning hits me with the middle of that interview, I was already kind of right teetering close to the edge just with how I was, you know, I was starting to boil. and from that came by winning and that turned into another folk song or whatever

adventure adventure thank you thank you for the material yeah well done by pleasure my pleasure uh oh and there's another how what how did you and i never save for that dodger game but how did we never crossed paths how did we not ever wind up at the same rehab or the same freaking hospital or lecture or something you know i know it is weird because that that world it's kind of it crosses in many many different ways and just today before the mics heated up we talked about a mutual friend and his sobriety and you know and we we could have passed easily through him but we didn't and so i don't know i don't have explained for it but i knew we would meet one day and and and And we still haven't shaken hands, which I would like to do one day.

And so that's still one of my goals. Yeah, awesome. Likewise. Yeah, it's super weird, isn't it, the way the world works? And by the way, gosh, damn it, I'm blaying it on your co-star and two and a half men. John Cryer. John. Cryer used to come on Lovelland all the time back in the day.

I knew John pretty well. And then he sort of, you know, two and a half friend took him also to his. next level and he sort of left us behind at that point. But I always felt like John was great guy and really nice and knew him very well. And it was, again, we've been swimming in the same waters with the same people and just haven't crossed. It's weird. Let me, let me ask another question here about that whole era. Here's somebody asking, did you, did the Howard, I didn't hear this interview, but they're wondering how you felt at the Howard Stern interview when you were in that phase.

I felt like there was a real opportunity for Howard and I to take it out of the gutter and discuss something that we both had in common was being fired by CBS, by ICOM, right? And so I thought that we could sort of bond on that. And he like, and I remember I woke up at like 3 a.m., did a quick work out. took a shower i had to be you know on the west coast had to be on the phone with him at like 445 or something on godly and um and and and he opens with uh hey it's nice to meet you whatever um how does it feel to see uh one of your girlfriends in a in a in a in a bukaki uh orgy um doing anal with a bunch of black guys that's like that's how it that's what he opened with

So how do you get that back to, yeah, I don't worry about that stuff, but let's talk about what you and I have in common. It was just so, and so I kind of didn't, I knew there was no, there wasn't going to be a connection beyond that, the gutter stuff I just mentioned, you know, like that. I bet he would apologize for that now, too. I bet he would really apologize for that, I think. I've known in recent years, yeah. Yeah, and I've never met him. And then I never did his show for real, like in studio or at least, you know, the long version over the phone. Yeah, we didn't have Zoom at the time, you know.

Yeah, do you think so? You should go in there. You should, yeah, he's a great interviewer, at least these days, really, he just sits and he just tunes in very intensely to what's going on in the person he's interviewing. It feels like a therapist office when you're in there. That's what that feels like. Because he's so tuned up. Good to know. Good to know.

Right on. Yeah. But when you were fired, this is what bothered me. Did anybody offer you help? I mean, this always drives me crazy when people go, yeah, you're misbehaving. You're fired. Not like, hey, man, let's see if we can get this taken care of. Let's help you.

Let's do something here. Or you're going to be fired. Because then you have the leverage, right? You have leverage to get people to do something. But if you just fire them. That's it. You haven't done anything for them. And then they, sometimes men, particularly really spiral at that point.

Right. Interesting. Yeah. They did present an opportunity, but with the headspace I was in, because I didn't have any control over it. I couldn't influence, like, the parameters of what they were offering or the boundaries or just the details, right? You are right?

And, yeah, no, but they, you know, less moon vests came to my house. And I talk about this in the book. And he was there with the head of legal. And he said, look, there's a jet on the runway, like ready. It was the first time, actually, I was ever offered the Warner Jet just for the record. And so, I said, I really appreciate it. But no, I'm going to do it here. I'm going to do it.

I'm going to get clean here at my house. And of course, we all know how that went. went. But yeah, no. But I think that was right before the official firing took place. Yeah, because why would they have flown me anywhere if I was, if I'd been sent to the cornfield, you know? Well, yeah, but I don't know. I just don't think people, I'm glad to hear that there was a real effort. I missed that. I forgot that. But that when you're an employee and a part of a community of stuff. There should be heroic efforts taken to help somebody who's suffering who's in trouble. I mean, but that's just me. Maybe I'm, but so let me talk for a second about

what I pissed you off about because what I was seeing, you know, people, there are certain things that you can see through a video. In fact, when we teach, when we train medical students, we show them videos. We show videos of Parkinson's disease. We show videos of manias. We show videos of, you know, psychotic and you learn and think about it whether a psychiatrist is making an assessment across the room it's it's what they're seeing is what they're with the symptoms that are manifesting in front of them and and a mania for instance is not a psychological event i don't i don't know your psychology we've never sought down to talk deeply about your personal psychology but i i could see if you had a rash i could see what the rash was and i could see if you had a stroke what the

neurological features were and i could see if you had a manic episode These things are just, they manifest. They're just, they're visually manifest. And so it was, you know, I think it was the cigarettes in the nose that tip me off. That's all I'm saying. Do we have a shot of that? Is the screen going to reveal? I saw it come by.

I saw it come by a few minutes ago. I think Caleb was playing something from the documentary. Is that what you were airing there? Yeah, I'm trying to find that segment right now. Of course. Okay. That's from the spoof version that I did of that interview, which was really, which was largely inspired by the hot shots and airplane type humor and actually having worked with

those people, you know, and it was inspired by some early, you know, Woody Allen stuff. And yeah, we just kind of put that out as a, just as my response to that. that old thing well i would just say that that's a there should be that's another teaser for the doc because in the doc you talk about where these ideas were coming from and what they were inspired by and you know that that that comes out quite clearly yeah yeah so two things i have to take a little break here before oh there it is there it was freaking funny those were all real and they were all lit i i remember because you were inhaling through your nose and out of your mouth Yeah, good times.

Any event, well done. Thank you. So I take a little break, but before we go to break, you have a non-alcoholic beer, which is fast. We, you know, we have, I have lots of family members that drink non-alcoholic beer, so I want to hear all about this. Nice. Nice. Yeah, I'm actually, I'm actually drinking one during this, this episode. Oh, my God, how exciting. How do I get it in a shot? No, I can't see it. Get in for your face. There we go.

Up high. There it is. Yeah, it's wild A.F. Right. Wild A.F. And the A.F, of course, stands for alcohol-free. Yeah, one of my co-founders, a gentleman named Todd Christopher, brought the idea to me a couple years ago and said, how do you feel about NA beer? And I said, truthfully, I never really had a reason to drink it, you know? So that turned into, you know, a longer conversation.

And then a week later, we're on a flame. to Boston, meeting with Harpoon Brewery, and then talking about, you know, what, what it takes to build a recipe. And it's really cool because I'm not like a, you know, I'm not like a spokesperson for a brand that's like somebody else's dream. I've been in the mix and as a founder with this product. And I really enjoy it, and I think others are going to as well. well let me let me just say generally for alcoholic beers because again i have family members

that drink alcoholic beers and i've had the chance to i that's what i reach for now myself too what did i say oh non-alcoholic beers and i am stunned how good they are you cannot tell them from a taste standpoint difference from an alcoholic beer and and the range of taste are the same as in alcoholic beers too exactly no i was i was blown away as well um Because my only experience with it back in the day was like an O'Doole's or something, right? And those were not, those didn't do it. But yeah, because it's unlike the mock tales that I think are terrible, it's, it's real beer. They just suck out the fun, the fun juice, you know?

Yeah. But you know what the only problem is when you're, when you're, put your mic on, is your mic on? Yeah. And the only problem with that is you feel guilty. for having one before noon. You know what I mean? It's like, oh, my God, I want one of those and you're like, oh, is it too early?

But it, yeah, it's okay. Yeah. No, I parked that guilt because I start my day in a sauna blanket in a company called Higher Dose. And so that's how I start my day. And they recommend like a ton of hydration during and I've been drinking wild AF

in my, my portable sauna sleeve. And I would drink it after a workout. So, yeah, but I get the morning thing if you're not doing those other things. It kind of makes sense, yeah. Yes, if you're not, yes. I love them.

I drink them all the time. It's an old, sort of a triggered emotion by previous experiences. But it's interesting, I'm looking at one screen on my re-stream chat here, and I told you, it says, good to see charlie looking so well charlie looks fantastic i i told you that i noticed that too so good for you yeah thank you i thank those people yes that's very sweet it's it's it's just they're just

it's just it's just something that jumps out so good for you um so take a little break here i'm gonna stay you're gonna stay with me another 20 minutes or so um i got i guess a bunch of other stuff i want to talk about so we'll get right to it after this my career dealing with illnesses that shorten life. And now we have ways to extend it and extend wellness. I've been working with the team over at B Shred to develop a product that has everything I want in a longevity supplement. NR boost has nicotinamide riboside. You know how metal can rust. Well, your body behaves in a similar way. It's mediated through something called NAD. NAD falls as we age, so we're less able to fight off that oxidative process. We oxidize much like that metal.

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Dr. Drew called me unfixable. Charlie Sheen's still with us. Dr. Aaron Kariati in a few minutes will join me as well. So Charlie, if you're comfortable with this question, how would you just, and I've sort of two versions of this. One, if you would feel comfortable describing your sort of bottom, when did you have some moment, what was your moment of clarity? And has that moment changed or your sense of what that moment was changed as a result of doing the book and the documentary? has the moment changed as far as did I discover something else in telling those stories that was it was a lower bottom or was there something else or did you see the setup for it or something did it change so I'm wondering whether you're going through this experience for you

has clarified stuff for you so it's just it's interesting to me because you're doing your whole life you're laying it all out there you know 40 years essentially you put it out and And that's not a small thing. And you've had, you know, some moments in your life and you're very open about it. So let's start with the bottom. What was the bottom? The bottom. A moment of clarity.

Yeah. The moment, well, the bottom was kind of multifaceted. It was a whole string of events that were just one after another after another. And it was really just biologically really starting to, I, I, It was the one place I couldn't live in denial about how my body was literally speaking to me, yelling at me, when it starts trying to turn itself inside out, you know, when things on the inside that are supposed to stay there wind up on the outside. And so that's, and then there is one, it wasn't connected to, and it's not in the book, but there was a thing where I had a condo in Westwood for years. And it was a really, it was like a central hub for most of the partying for a while. And I remember one day I had done, I'd smoked too much Coke and I was getting, you're starting to feel, you know, super anxious.

And I downed a water glass full in like one gulp of absolute papar, pepper, right? You know, the red label one. And I waited what I could usually rely on as that 30 second window to finally get blissful, you know, and it didn't show up. It didn't arrive. And I remember feeling completely stuck and hopeless. And I thought, because that's that, that was the solution. And I remember thinking, oh, man, now what? You know, because this, this friend had had abandoned me in that moment.

But the moment I do talk about that happened later on was that story I talk about in the car with my daughter Sam and my, you know, my dear friend Tony when it was such a simple thing that she needed a ride to an appointment. And I was a morning drinker, you know, and she reminded me, she called and said, hey, we have to be leaving in a few minutes. And I'm like, to go where? and so I called Tony and I said I don't want to let her down get here we got her to the thing and it went fine and but it was the drive home it was that drive home where I could see her in the mirror in the back seat and I just whether she was thinking it or not I just felt that that um she was wondering why it's not just the two of us in the car like it used to be why why dad just doesn't doesn't drive anymore dad's a really good driver you know um and it was just a

something as people could call it God people could call it just the greater consciousness whatever it just something hit me in that moment that this had to change and it had to had to change quickly and I knew exactly what had to be done it wasn't like I had to consult with a bunch of experts or I had the I had the solution and it was to stop yeah it was to quit and and just to be just to be noble again and to be available and to be engaged and and and to be reliable and the fact that i you know i i to to disappoint or to let down one of your children nothing feels worse um and so that was that was that moment um that and and and the moment matters even more because it didn't

involve like uh you know a shoot out with the cops or i didn't like hijack a blimp i didn't like do stupid crazy big news stuff it was a very personal experience um but it was as clear as anything i i did that it was that that was the turning point and you know like i write in the book um a couple of beers the next day maybe two volume and then the day after that just said and i'm done uh and that day happened to be my oldest daughter cassandra's birthday december 20 And it was just like, yeah, I can't plan that. You know, in that headspace, you don't plan shit. Just how to like get to the next thing.

Even if the next thing is just your kitchen, you know? And so, so yeah, I think it was a bottom that didn't need all of the special effects and chaos for it to be crystal clear. yeah and the clarity is so key and and i've heard many many stories like that it's it's often these very simple moments that just get through they just they're just there it's it's just in and once it's in to your to your toes you can't you can't deny anymore you're you just see it you feel it and you it's that moment of clarity i what whatever step that just made me tear up yeah oh wait on yeah it made me a little bit too i'm just trying to keep it together you know because were live um but uh but yeah no it's it's that great line from apocalypse when when kurt's is telling

that great story to to dad or to willard and he talks about and it hit me like a like a like a diamond bullet you know and and just that then he realized you know why we're going to lose this war and and i always hung on to diamond bullet it's just so specific and and so final you know I like that the diamond bullet of clarity that's amazing yeah yeah yeah

so let me I have a couple of really only two other topics I wanted to get into one was I want to know what happened to that doctor from Mexico that was injecting your blood

into him that was the strangest chapter in this way that was like Bill Maher puts him on the show and so I'm like what is going on here well come on man

what the hell right that guy was that guy was a disaster um that thing about him injecting my blood it took me a couple days because sometimes you see something that you kind of have to convince yourself that you really saw because your mind wants to tell you that it was fake or it was you imagined it or it just wasn't but then when i came to grips with the fact that okay that's exactly what happened is when he took my blood and then said i'm so convinced that that that that that you're uh you know that you can't contaminate anybody or transfer whatever um i'm going to inject your blood into me but he turned away from me and like a like a like a like a dime store magician like a like a hack illusionist he was doing something with the needle he was doing something with

his wrist and then he barely so he switched needles or he did something that was like that was clunky but I was, you know, pretty, pretty loaded, you know, it was just booze at that point. So, but that's why I, I knew I saw it a certain way, but wanted to believe that it was real, that this guy had brought something that just was a, was basically a miracle, you know? Yeah.

But now, then all the other stuff showed up where his kids were in a band, and is there any way that I could help, you know, because he's helping me so much that I could, you know, get them in front of some, some, some, you know, record type. Yeah, some producers. So it was just, it was gross. It was gross. Yeah.

He also claimed that they were trying to kill him because, you know, the stuff he had was so valuable that, but they wanted to eliminate him and like that. And I mean, when we do hang out, I'll tell you other stories about this guy, make your skin crawl. I can't wait. Yeah.

yeah now you really really motivated me now with that one okay absolutely oh my god i knew i when i saw that guy come on board i was like oh my god you didn't even have to ask him that question he handed it over to you what's that what was the who's the craziest thing or whatever oh yeah yeah and and then the other thing i i wanted i want to kind of i don't know quite a to bring this up without i want to defend you on this one point and people are going to sort of i want to make sure we present this in the right way that there's there's there's all this oh my god charlie with men charlie with men i'm like oh that's stimulants and sex addiction that's just how that goes that's just what that is it's tried to describe it you've tried to describe it as just this where it goes but i don't

think people understand what you were talking about can i help you sort of frame that because i've seen that a million times and it's and it has nothing to do with with your sexual orientation or anything has everything to do with the the state you were in the addiction you were into sure and men are sort of just more of more as some of my uh you know who's talked about very publicly is jason ellis he had this exact same story and um and he says the men were just more available and more compliant for him and that's was that was that was interesting yeah that was it so that was his reasoning but is there anything else i can do to help you sort of frame it for people so they don't get sort of i don't know they they don't know how to talk about it interesting um no oh

because I presented it metaphorically as the other side of the menu, right? Is that what's confusing people? Yeah, that I had just been ordering from one side. I think people then they go, yeah, of course, you're gay, Charlie, that's that. I was like, no, no, no, that's not what this is. This is, this is just, this is just him

rolling through the menu. Right, and it was in a specific, you know, time pocket and tons of crack. And so, and also it had to do with the company I was keeping was mostly adult, adult actresses, porn stars, you know, and so they'd spend all day at work, and then they'd come home and, like, share some of those stories, and then, you know, in that, in that brain space, a guy gets curious and just

like, well, let's just, you know, why, why does that only have to happen at work? Can't that happen here? Yeah. And they were like, sure. Right. And I'm like, cool. And so. Well, it's like you need higher, it's needing more and more and more intensity. It's the same thing with everything you were doing. You just, you know, it's just, it's, you're not getting the same relief, as you call it, from what you were doing before. You need. Exactly.

It goes, progressive. And the progressive part of the illness, I'm going to use the word illness. I don't know if you object to that about, it's just, I'm a doctor, shall use the words. But, but the progressive part is what people miss. They don't understand how progressive it is, always, it's always progressive. And they just assume that, well, if, you know, if Charlie had just slowed it down a little bit, you know, everything would have been fine. It's like, no, no, this thing, even when you try, it progresses, it has a way of breaking through. Yeah, no, I was just, I was wide open to just new experiences because it's, you know, everything on one side of the menu had been reordered thousands of times.

and, you know, just needed to just some different level of variety, you know. I understand. Yeah. I hope that gets, if they, it's just more intensity. It's more intensity is really what it is. Yeah. But I also, I also. Right.

I'm sorry, but I also included it in the chronology, how I presented it was if, if you read the book and you'll see exactly where it's placed because that's where it happened, how close then the HIV diagnosis is to that, to that time. And so, and I don't, I don't know if that's specifically related, but, you know, I'm a retired gambler. And yeah, that's, that's what I, that's what I would bet on, you know. Yeah, that makes sense. But, but for the grace of God. My understanding is you infected no one. No one. No one.

Yeah. As we sit here today, yeah. I'm still the only person with it that was anywhere near any, any of the party and any of the, any of the get-togethers, you know. Yeah. But, I mean, thank God. I mean, right? I mean, this would be a very different conversation. Oh, yeah.

Yeah, I know. Yeah. but yeah and it's um it's not it's not like you know i don't um i'm i don't look at myself as a victim you know i think people need to i think people get that from me that i'm not running around with a big woe was me story no it's part of my story and if i'm going to tell it all then how could that not be included also if i didn't talk about it people that you know are savvy they'd be like, well, hold on, buddy. You basically got accused by a cartel for dealing

because of the amounts you were doing and you're going to tell us that at that level that like they're like one dude didn't like stroll into the room at some point, you know? So. Right, right. Yeah. Makes perfect sense to me.

Thank you. Thank you. But something I don't think I've seen you talk about I didn't remember seeing is, did you have any difficulty with the antivirals or anything? Is that always been easy for your bodies tolerated all that and responding well and that sort of thing? Finally, yeah, yeah. The first combo pack didn't really sit well. And it wasn't just physical stuff.

I started to feel like kind of disconnected. It's strange to saying like, yeah, from the actual room I was in. And you don't read that in any of the side effects. They don't say like it's going to affect you psychosomatically or whatever, right? And so that finally kind of just went away. But it was more just, more just stomach stuff. But then I would kind of take a step back and just like bigger picture, right? Dude, you're alive, you know?

Shut it. You're alive. You have nothing to complain about. And then when I finally, you know, you're, you know, you know, got the combo that was, that was the one for me, I just stayed there. And it's, and like I write in the book, you know, I only, I only think about it really for 20 seconds in the morning. And, and I don't feel like it's, it's really taken a big bite out of, out of, you know, just my, my daily existence, you know.

viral load zero essentially absolutely yeah just had blood work like a week ago yeah yeah great so and who knows who knows what's going to happen with it as far as like people are like well where's the cure i'm like hey whatever if that happens great if it doesn't um what the you know i am so grateful but the level that the technology of the medicine available today is i have no complaints Yeah. You know, and Charlie, something I, you know, one of the reasons I was at the beginning of COVID supporting Dr. Fauci so thoroughly was I was there when we first, I took a lot of AIDS patients back in the 80s, like a lot.

And I was there when we opened the boxes of AZT. And it was the first time we had something. We could do something. It was so excited. You know, it wasn't great. It wasn't a great medicine, but we could do something, you know, for these men. Right. And we got off of that one, thankfully, very, very quickly into other better medicines.

But it just was extraordinary that we were able to turn this into a chronic, non-infectious illness that people are going to live decades and decades with. So congratulations being part of that breakthrough. And also, if I could just add, there was an off-label benefit with it, especially at the onset of COVID. And then when the vaccine showed up, I never had to take it. it because um oh right but you know because i kept saying show me one study that says it's safe for people with HIV and they were like well i'm sure they're getting to that but you should probably take it anyway just in case for the thing you know and i'm like well um and then i got covid and survived and um and then i felt like i had i felt like i had better protection than an experimental vaccine

was it's going to deliver you know yeah yes yes so i so i so i so i so i I could use my HIV legitimately to reject that whole thing, you know. But not only that, you were asking a very important question that they, if the doctors were actually honest with you, they would go, we don't know. Maybe we're uncomfortable with you not taking the vaccine because somebody on it, but maybe the antivirals would help you that you're on. We don't know. We don't know.

Instead of saying we don't know, we'd always go, take the vaccine. That was a bad chapter. That was not good. Yeah, yeah. And I think we're continuing to keep finding out more about how bad that chapter was. Yeah, it's really unfortunate. Really unfortunate. Yep. Well, listen, what is not unfortunate is the time I've spent with you here and the stroke of luck that you've not had a stroke and that you've been willing to come join time with me here. And I look forward to shaking your hand and hearing about the Mexican physician and his rock band son. This is like, there's some good stuff. There's some good stuff. Yeah. Yeah.

I hate that stuff when people behave like that, but there you go. Yeah. Taking advantage of people when they're super vulnerable, you know, and leading with fake medical, you know, authority. It's like, what the hell, man? But no, it's been. There's so many layers. So many layers.

One is, you know, physicians not maintaining boundaries and doing their job. It is taking advantage of you and you're vulnerable. But then to me, there's also this weird thing about fame generally. People get weird if somebody has fame. They just treat them differently and then they can't help themselves. They start asking for stuff. It's like it's very, it's really a problem. It's really not good.

People should really examine themselves when they get like that. I agree. But no, it's been an honor to be here. And thank you for providing this forum for us to almost. meet, to almost meet. But no, this was overdue. This was overdue. Yes, I agree.

I agree. And I look forward to taking your hand in person. I will go out of my way, even if it's just for a quick visit, I will go out of my way to find that opportunity. So, and everyone, if you enjoyed this conversation, get the book, watch the doc. Do both. Don't do one of the other. Do both.

They're both worth your time. And I think, I don't, I haven't heard anybody say they didn't enjoy the time. with you in the book of Sheen or with the doc. So thank you for those. Oh, right on. Thank you for sharing all this. Can I say something? Oh, wait, wait, go ahead.

Charlie, I'd really like to thank you for your experience, strength, and hope. Thank you. That's lovely. It's so nice to hear. Cool. Good stuff. Ooh, yeah, cool. All right, my friend.

See you soon, I hope, and otherwise, enjoy the rest of your day. Right on. Okay. Thank you. Take care. Charlie Sheen, everybody. Well done. Let me look at what you guys were thinking about this.

I'm going to look at the restream. Wow, he looks good. He looks good. He looks healthy. He looks bright and happy. I want to know who his cameraman is. I think it's him. I think it's just him.

Well, he's had a lot of experience with films and stuff. No, he does look good. Let's buy his beer also. His non-alcoholic beer, I think. Yeah, I want to try it. Let's see. Okay. All right, let's, we're going to switch gears.

We have another guest. coming on in is one of my favorite guests here he also has a book and trust me whether you follow dr. Aaron Kariotti on Twitter or his substack it is time well spent he is a psychiatrist you can get his is Aaron Kariati watch the spelling A-A-A-R-N is the first name. K-H-E-R-I-A-T-Y-A-T-Y-Y-Y-S-S-T-Y-E-R-I-E-R-A-A-T-Y-I-E-R-E-T-Y-E-R-E-E-A-R-E-E-A-E-R-E-E-R-E-E-E-E-E-E-E-L-E-E-E-L-E-E-E-E-R-E-R-E-E-E-E-R-E-E-E-E-E-R-E-E-E-W-E-E-E-R-E-E-E-E-R-E-E-E-E-E-1. It's interesting, this book is 22 years in the making. So it's a medical narrative of my time in medical school. So it's a memoir of medical training at Georgetown again 22 years ago. And I wrote those patient stories

shortly after I finished medical school. So they're very fresh, they're very vivid. And they're written at a level of detail that if I were to try to reconstruct them today, you know, a quarter century later, I wouldn't have been able to remember all those details. But those are Those are combined with a kind of more mature, hopefully a philosophy of medicine and also a critique of contemporary health care. So the book does three things. It puts you sort of at the bedside or in the operating room and shows you what it would be like basically to start learning this profession of medicine. And it's a profession that I love, that I fell in love with. But it's also a critique.

You know, it's sort of my lover has sadly turned prostitute of late. And so that sort of breaks my heart because I see, I've seen medicine done at its finest, as I'm sure you have many experiences, you know, in your training and with colleagues and over the years, practicing medicine, seeing it done in some cases really well and beautifully, and it's an extraordinary thing to be able to watch that and learn from that and sometimes occasionally even be a part of that. And then you've, like me, probably seen it, especially in maybe more recent years, done not so well.

And so the book is an attempt to understand, look, where have we gone wrong in contemporary health care? How have we lost our way? And it's probably more diagnostic than therapeutic, but the closing chapters do have some ideas about what might be done, given the state of contemporary health care and what's wrong with it. And based on what I try to present in the book

is a sort of sound, grounded view of what medicine is and what medicine should be, where do we go from here? And how can we try to address some of the things that are making patients unhappy, that are making physicians unhappy, causing doctors to retire early and leave the profession in droves, which is major concern right now.

The physician shortage, I think, is potentially in the next few years, if you look at data from the AMA and elsewhere, the people that are monitoring this, I think this is potentially a serious problem. And it's not that, I mean, part of it's we need to train more physicians. But if all the physicians that we have trained stay in the game until retirement and continue to practice medicine, we're probably going to be okay. But a lot of folks are leaving medicine.

So what can we do about that? so so one of the things that's always jumped out of me and i i i wonder what you have to say about this that has been lost it seems uh there's several things that sort of are big in my mind as it pertains to diagnostically exactly what you're talking about one is that when we were in training we thought this was such an important job that there was no more important job than this and your job was to put the patient first in all settings no matter how tired you were and how miserable you were no matter what you'd been doing put the patient first

and you learn to do that in incredible circumstances of high stress and high fatigue and you did it and it worked and you didn't make mistakes because it was so important and that seems completely gone at least on the sort of general medicine side of it for sure yeah unfortunately that's my impression as well there's much more of a clock in, clock out. When I'm off the clock, I'm no longer responsible for patient care.

That mentality has crept in. And granted, there were work hour requirement problems that had to be addressed. So I trained just prior to Congress passing the 80-hour work week. So I had 110-hour weeks, 36-hour shifts, you know, in medical school, which, you know, when the surgical intern is falling asleep in the operating room, you know, his head is not. into the operating theater. It's not a good thing. So there were problems with the old system as well. But one thing that the old system did was ingrained in you, the idea that your

pageer goes off at 3 in the morning, you jump out of bed and you go take care of the patient because as you set a moment ago, their needs come first. And in fact, while it is a burden to do this at times, you know, when you've been up for 36 hours straight, it's also an enormous, not only of responsibility, but an enormous privilege, Like, we were allowed to do things, Drew, in medical school that in any other context would be considered felonies, like carving up a dead body in gross anatomy lab or practicing unperfected procedural skills on unsuspecting patients. I still remember and I describe in making the cut my first lumbar puncture on this poor lady curled up with her back to me and I'm trying to navigate the needle through her spinal column into the, you know, through the Dura into that precious space where you can get a little bit of a cerebral spinal fluid. And I'm not doing a very good job and my hands are sweaty.

They're probably shaking a little bit. And the resident finally had to sort of take over for me. And, you know, I caused this person to some degree of discomfort. Well, the adage, the adage was literally what we did, which was C1, do one, teach one. Teach one. And that's actually what we did. That's right. That's right.

In fact, I don't know if I left that as a chapter title, but at some point, that was a chapter title in making the cut. It was all about that, see one do and teach one, philosophy. And so, you know, on the one hand, the sort of jump in and swim was, you know, you could see problems associated with that. But on the other hand, the upside of that was you very quickly had to sort of grow up. You very quickly had to feel the weight of responsibility for the patients. prepared you to be an attending physician where you're... And to be fair, Aaron, to be fair, it was graduated. You know what I mean?

There were times during third and fourth year medical school where you're thrown into things where you're like, I can't believe that's throwing me into this. But, you know, there's somebody watching you. There's an intern right there. And then when you're an intern, there's residence right there. And I remember the biggest change in what you're describing, going from the day, I went from internship to residency. I thought, oh, I'm making the decisions now.

That day was a big change because you were asked to do stuff that where you weren't uncomfortable, you were uncomfortable with before that, but after that, it's like, oh, no, you're calling the shots. Yeah, suddenly you look down and you're wearing the long white coat, which signals that I'm no longer a medical student. I'm a resident or an intern or an attorney position or I'm an intern. And yeah, I'm actually writing the orders. And I'm under supervision still, but I'm still calling the shots. I remember my first week as an attending physician on an inpatient psych ward. There was this bizarre situation where a patient became very agitated, big 250-pound guy.

And he starts rearing back and kicking the locked psych unit door as hard as he could. Never in my wildness imagination did I imagine that he would be able to do this. But after a dozen or so of these kicks from this enormous 250-pound man, The door gave way and opened on this lack psych unit. And he walked from there to the acute rehabilitation unit, the place where the frail, elderly post-stroke patients are trying to do rehab and shuffling along with the walkers and sort of recovering. And I looked around the unit.

And, of course, the nurses had called security, but it was going to be another minute or two at least until they arrived. And I said, I'm the attending now. So I'm responsible for this guy. have to go retrieve him. And so I had to walk through the tour and find this guy. And fortunately, I think he was so confused by what had happened and almost as shocked as we were that when I took him by the elbow and walked him back to the psych ward, he came, he came with me. But it was that moment of goodness, you know, there's no one else here that I can look to. This one is on,

this one is on me. And that's the, the physician works in a team. But you're the final locus of responsibility. You're the point through which help or harm ultimately comes to the patient. And so that's something we need to cultivate starting on day one of medical school. And I'm not sure we're doing a great job of that. Not that the system 20 years ago was perfect either and had its own set of issues. But maybe the pendulum has swung so far in the direction of, you know, let's worry about wellness and lifestyle and, you know, not push the young trainees too hard that we've lost something that's essential to medicine. Yeah, I absolutely agree.

I just think about another quick story. Manic patient, lock site unit. When a manic patient started yelling, I figured it out. I know you're in big trouble. They always got the guy, figured it out. I figured it out. And he took, he had, he was, he walked out of his room with one cowboy boot on in his underwear, big, huge dude, and walked to the nursing station and threw a chair through one of those

wire reinforced glass windows. Yeah, yeah, yeah. You like, you can't break those windows. He broke and it was only about, what, three by one foot. And then he dove through the window. It was like, oh my God. And, you know, we had to assemble a team. And he was not to be led by the elbow, but show of force did get him to calm down.

And he came along with us after a while. But yeah, that stuff, that's some of the extraordinary experience. Again, I wish we used more of those same techniques out in the world, frankly, because people are just coddled or encouraged and behaviors are just not okay. I got chased by a homeless person last week ago, and she was just like that. She was going to kill me. She figured it out. Susan needs to kill.

I figured it out. You didn't turn around and try to talk her down, Susan? You know, deploy a little bit of psychotherapeutic rapport. No, I tried to videotape her. No, I tried to videotape her because I wanted them to know why I died. And I didn't push the button until I got away from her and then I only taped myself tripping on the sidewalk. So it was okay, though. I made it out a lot.

No, that's scary. One of the stories we hung our interview on today and promotionally was on Canada's youth of end of life, youth in Asia, this sort of thing. And now they're going to, apparently they want to start offering it to young adolescents. And I've seen personally situations where they offer it, they start talking about it so early in people's course of care

where like when you are miserable and you don't know what your progress is going to be and it is going to be expensive and it is going to take a long time. And if you start talking to somebody like that about end of life, they might do it. I'm very concerned about this. What are your thoughts?

I'm extremely concerned about Canada. So Canada, through a judicial court decision, but by basically the highest court in the land, their equivalent of the Supreme Court in 2016, legalized doctor-assisted suicide and euthanasia. And the distinction between those two things is, assisted suicide, I write you a prescription for a dose of a deadly drug,

You take it, you fill the prescription, and then at home, on your own, you ingest the poison, essentially that will end your life. Versus euthanasia, which is you're in a hospital or a clinic, and I as the physician, am directly injecting, usually an intravenous injection of a deadly drug. So both of those things have been legalized in Canada. The latter, the euthanasia,

where the physician more directly actually administers the deadly drug is much more common, in Canada. I think most people want a doctor to do it rather than to self-administer this because I think it allows them to be a little bit more detached from the process. And it sort of legitimizes it. If the physician is involved, then it must be ethically okay, I think, is the way many people reason about it. But Canada has really gone off the rails when it comes to their euthanasia regime. So assisted suicide has been legalized in a handful of states in the U.S., including my home state in California, around the same time. It was 2015 when

it was legalized in California. But California has had far, far fewer of these cases than Canada, you know, even comparing and scaling to the size of our population. So the latest numbers that we have from Canada are from two years ago from 2023. We don't have last year's numbers yet, But in 2023, 15,000 people in Canada died by euthanasia. That's approximately one in 20 of the total deaths that year. So 5% of the total deaths in Canada two years ago were done by euthanasia or assisted suicide, which is just an astonishing number when you stop and think about it. It's one of the leading causes of death now in Canada.

Wow. What happens when these things are put up for debate is that advocates of euthanasia or doctor-assisted suicide always try to reassure the public that this is only going to be for a narrowly defined set of people. People, let's say, with only six months or less to live, people with the terminal illness, okay, easy to feel compassion for someone like that and you don't want them to experience pain and suffering at the end. You want them to maybe exercise a little bit more autonomy than they would otherwise have. So that those arguments can feel very compelling, especially when they're applied to someone who foreseeably is going to die pretty soon anyways. And so that's what happened in California, for example. It was legalized precisely for people who had been diagnosed with a terminal illness.

And that's how it started in Canada. It started in Canada with people that were diagnosed with a terminal illness. And then in 2021, that was expanded to people that had chronic, they called it irremediable. conditions, which is a very vague, sort of nonspecific legal term, right? And so we've seen cases, well-documented cases of people who don't have a chronic, even a chronic medical illness. They simply have a psychiatric illness. There was a case of a 27-year-old patient who is euthanized in Canada, whose only diagnosis was ADHD and autism. And the parents were not informed. Granted, it was an adult child,

but the parents of this arguably potentially disabled child because of the nature of the autism were not informed and they're suing the state for having killed their child without their knowledge, much less their consent. And this person did not have a term illness. Clearly, they had something that was chronic and at least partially disabling and impacting their life. But it was something that we care for and treat and manage routinely. So the expansion, to psychiatric categories has not officially been done, but it's scheduled to happen in two years in 2027. But even in advance of that, there have now been multiple well-documented cases like the one I just mentioned of people that don't have, don't have a terminal illness,

don't even have a chronic medical illness or a medically disabling condition, but simply have a psychiatric disorder. And to me, that's very troubling because I treat psych patients all the time they want to take their life. And I don't hand them the gun. I don't hand them the news. That's not the job of the physician. The job of the physician is to say, I'm going to continue to care for you.

And maybe your depression has proven to be treatment refractory so far, but that's what I do in psychiatry. I'm a specialist. We're going to find something for you that works. We're going to look at, you know, if nothing that's FDA approved does work, we're going to look at the possibility of experimental therapies. We're going to keep going.

I'm not going to abandon. you. And so one of the, one of the things that tends to happen, once you cross that bright line and you say, number one, some lives are not worth living. And number two, doctors should be empowered and legally permitted to help people end their lives. Once you cross that bright line, then the safeguard, the so-called safeguards you try to erect around that become sort of arbitrary, right? People naturally would want to know, well, Well, why do I only have to have six months or less to live? Because the arguments that you're using to advance your position on euthanasia have to do

with pain and suffering on the one hand or autonomy and choice on the other hand. And if I have chronic depression, my pain and suffering is arguably worse than my grandmother who has terminal cancer because she's going to be dead in three months, whereas I'm going to have to live with the burden of this illness potentially for years. So if she should qualify under the law, what's the reason that I don't qualify under the law? If she's allowed to exercise her autonomy and choice or to diminish her pain and suffering, those arguments would seem to apply to me as well. And it's really hard to know how to respond to those arguments once you've crossed that

bright line. And that's why I think you tend to see what's happening in Canada. You tend to see things start out narrowly defined when it comes to euthanasia or assisted suicide. And then inevitably, every couple of years, they start expanding the scope of the people that this applies to to the point where eventually you end up with what you might call death on demand. I'm tired of living. I just don't want to go on anymore for whatever reason that, you know, the physician is really not even supposed to inquire about or ask about. And so this is what I want you technically are capable of providing it therefore you have to give it to me and that's that's the

direction that canada sadly seems to be moving in and the other thing we know why it's it's it's why ethics and philosophy have a role you they they help us where these sort of pragmatic guidelines fail right it's like yes we don't want people to suffer however there needs to be guidelines in terms of how we make decisions yeah that's right this has been a perennial temptation for medicine and it goes all the way back to the days of of hypocrite some people think well the only arguments against euthanasia or assisted suicide are based on people's religious convictions and certainly many people have objections to these practices that are grounded in a religious ethics or religious doctrines about the sanctity of human life but the fact remains that

Hippocrates in the fourth century before Christ was a pagan, and he wrote this thing called the Hippocratic Oath, or arguably his followers wrote the Hippocratic Oath, depending on which scholars you're looking at. But in any case, the Hippocratic physicians and the oath that they took in the 4th century BC said, we're not going to practice euthanasia or assisted suicide. We're not going to give women a passery for an abortion. Those provisions were in the original oath of Hippocrates and the reason is that doctoring is dangerous right the tools that we have as physicians are very powerful and physicians sometimes wound in order to heal right I get out my scalpel to lance the abscess and I tell you this is going to hurt a little bit and that's true

it is going to hurt a little bit but the surgeon is justified in using his scalpel that the internist is justified in giving a drug that has some degree of risks as long as the potential benefits outweigh those risks, right? But the risks are there. So medicine has always been dangerous and it's always been very powerful and there's always lurked that possibility that these tools can be used not only for healing,

but for other purposes as well, including killing the patient. And in order to avoid a kind of role confusion, in order to help the public trust that physicians always have, had patients' best interests in mind. In the ancient world, physicians publicly professed promises to use their knowledge and skills

always and only for the purpose of healing, to minimize harms, to not exploit the patient by divulging things that were disclosed confidentiality. And also not to use our powerful tools to do things other than heal, to do things like kill the patient. This is why, for example, the American Medical Association forbids its members and its code of ethics. from participating in capital punishment.

It's interesting. The AMA doesn't take a political or ethical position on capital punishment itself. It doesn't say if you're a member of the AMA and you sign our code of ethics, you can't vote for a candidate who believes in capital punishment. It says, as a physician, there's an internal morality of medicine. The doctors should use their knowledge and skills always and only for health and healing. And so as a physician, you should not participate in this practice, regardless of what you think of it politically or as a social practice or what have you.

It's the same reason they take the position that doctors should not participate in enhanced interrogation, right? If you're if you're torturing political prisoners at Guantanamo and using your knowledge of pharmacology or your knowledge of physiology to do that, that can potentially undermine the trust that patients have in physicians. Physicians have these powerful tools and the public needs to know, that these tools are going to be used for health and healing and not for other things. Even if you happen to think those other things might in some circumstances be ethically or politically legitimate for the state to conduct. As doctors, we have to maintain the trust of our individual patients, but the trust of the public as a whole.

Tell us more, we got to wrap up here at the last couple of minutes. But tell me more about what people are going to get from reading the book. So one of the things I do toward the end of the book, I haven't talked yet about the sort of critique of contemporary health care, but just to boil that down and maybe give you a little taste of what you would find there, I argue toward the end of making the cut that medicine today has been compromised by managerialism, which is an ideology that infects many of our institutions and not just medicine. It's the ideology that basically says through expert scientific knowledge, we can and should manage and control everything from the top down. The so-called expert should be in charge of all our healthcare systems, and we should dictate sort of what happens at the ground level.

And it actually matters very little whether that managerialist control is coming top down from government agencies like Medicare and Medicaid or a single health. payer health care system like many other countries have, or whether it's coming from corporate conglomerates that are swallowing up all the local hospitals and dictating the terms of care to physicians. So I argue that the pendulum has swung too far in the direction of top-down centralized control such that physicians' appropriate judgment, what I call discretionary latitude, their ability to tailor recommendations to the needs of specific patients, have become overly constrained right i'm sitting and staring at a screen and checking a bunch of boxes that were dictated by external managers forces outside of my control yeah and meanwhile the patient's

sitting over there not being examined and not feeling heard and many of the things that i'm forced to do as a glorified data entry clerk for this electronic medical record system have nothing to do with the patient's chief complaint. So patients feel like they're being processed through a bureaucratic system of what I call turnstile medicine. Which they are. People moving machinery, right? Compared to Disneyland, Disneyland is an exquisite form of human engineering where the whole point

is to get as many people through, as many turnciles, as many rides, as many food lines, as many toilet lines as possible in the course of a day. And they're very good at that. Well, hospitals have become people moving machines as well. And so people feel sort of processed, but very often unhelped. And so what I argue, and just as a teaser in the closing chapters, I argue that there's, there needs to be more models of decentralized control. We need to learn how to cut out the bureaucratic middleman.

I give some examples from direct primary care to cooperative methods of payment for health care needs and so forth. I don't claim to have all the answers in that regard. I do sort of gesture and illustrate this with a few contemporary examples. But really the general thrust of, I think, what needs to happen is pushing back against this managerialist regime, decentralized. Control that allows physicians to be physicians again. And so I think there are some things that can be done at the state level, the federal level to loosen up the regulatory machinery, that it would allow some of these experiments to occur.

And then doctors and patients who hate the contemporary system will do the rest. There's a lot of creative minds out there that will come up with workable solutions. And if you want, just to put a little quota on that, if you want to know why COVID happened the way it did, it's because of this managerialism that ran completely amok. We have a huge problem with public health as well. We have a problem with people's willingness to take away our privilege. and freedoms in the name of, I don't know what. But anyway, yes, there's a lot there.

The book is Making the Cut, How to Fix Modern Medicine. Aaron, it's always a pleasure to talk to you and look forward to speaking to you again soon. Likewise, Drew, thanks. Thanks, Aaron. Dr. Aaron Carriotti, everybody, follow him on X. Aaron Carriotta, K-H-E-R-A-T-Y-M-D. And coming up for us, I think I have Tuesday.

We think we have Xia Ying Summers coming in. Let me get my list up so I can be accurate with you guys. with Terence Hartnett, who's a comedian, cancer-free documentary. Then we have Elaine Kulotti, voter psychology. That should be really interesting, particularly in California. November 20th, Susan Krabbe to you, a book warning USA about Californication, so to speak, and Danny Sulekowski, who is an Australian, essentially evolutionary biologist who says that everything that you see in terms of the kinds of progressive ideas that are being forced

on people are the result of elites, particularly females, manifesting their evolutionary strategies to gain access to more privileged reproductive opportunities. Let's put it that way. It's a lot there. A lot coming up. Rob Henderson. Chloe Carmich goes a lot here. Check it all out. We'll be with you again next Tuesday, beginning at 2 p.m. We will see you. then. Ask Dr. Drew is produced by Caleb Nation and Susan Pinsky. Emily Barsh is our content producer. As a reminder, the discussions here are not a substitute for medical care, diagnosis, or

treatment. This show is intended for educational and informational purposes only. I am a licensed physician, but I am not a replacement for your personal doctor and I am not practicing medicine here. Always remember that our understanding of medicine and science is constantly evolving, though my opinion is based on the information that is available to me today. some of the contents of this show could be outdated in the future. Be sure to check with trusted resources in case any of the information has been updated since this was published.

If you or someone you know is in an immediate danger, don't call me. Call 911. If you're feeling hopeless or suicidal, call the National Suicide Prevention Lifeline at 800 273-8255. You can find more of my recommended organizations and helpful resources at doctordrew.com slash help. Okay, only 10 more presents to wrap. You're almost at the finish line. But first? There, the last one.

Enjoy a Coca-Cola for a pause that refreshes.