On with Kara Swisher - The Problem with Wellness Culture, According to Dr. Zeke Emanuel

Episode Date: January 19, 2026

Dr. Zeke Emanuel is one of the country’s foremost healthcare experts. An oncologist and the former chair of the Department of Bioethics at the National Institutes of Health, he was one of the architects of the Affordable Care Act and now teaches at the University of Pennsylvania. Emanuel’s new book, “Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life,” offers practical advice on eating and living well at a time when Americans are bombarded with dubious “wellness” content everywhere they look. Kara and Zeke talk about how nutrition advice has gotten overly complicated; why it’s OK to indulge in the occasional serving of ice cream or glass of wine; and why he mostly dismisses wearable technology as a means of measuring a healthy lifestyle. Emanuel also shares his thoughts on the Trump administration’s latest updates to the food pyramid, and his fears over the distrust the government is sowing around vaccines.  Special thanks to Politics and Prose Bookstore for hosting this live conversation.  Questions? Comments? Email us at [e-mail] or find us on YouTube, Instagram, TikTok, Threads, and Bluesky @onwithkaraswisher. Learn more about your ad choices. Visit podcastchoices.com/adchoices

This is my favorite Emanuel, just so you know, I know all the fucking Emanuals. I tell my brother's at all the time. Yes, exactly. Hi, everyone from New York Magazine and the Vox Media Podcast Network. This is on with Kara Swisher, and I'm Kara Swisher. On today's show, I'm speaking with Dr. Zeke Emanuel. He was one of the architects of the Affordable Care Act. He now teaches health care management, medical ethics, and health policy at the University of Pennsylvania.

He's also an oncologist. Emmanuel has a new book. out this month. It's called Eat Your Ice Cream, Six Simple Rules for a Long and Healthy Life. He offers some practical advice on eating and living well at a time when all of us are bombarded with dubious wellness content everywhere we look. The Trump administration isn't helping matters right now either. Spoiler alert, Emmanuel doesn't think eating more beef tallow is the solution to a healthier life, and he is 100% right. Do not get your nutrition advice from RFK Jr. All right, let's get into my conversation with Dr.

Zika Manuel, this interview was recorded in front of a live audience at Politics and Prose Bookstore in Washington, D.C. Don't go anywhere. At MedCan, we know that life's greatest moments are built on a foundation of good health, from the big milestones to the quiet winds. That's why our annual health assessment offers a physician-led, full-body check-up that provides a clear picture of your health today, and may uncover early signs of conditions like heart disease and cancer. The healthier you means more moments to cherish. Take control of your well-being and book and assessment today. Medcan, live well for life. Visit medcan.com slash moments to get started. Zeke, it's great to be with you here at politics

and pros in Washington, D.C. to talk about your new book, eat your ice cream, six simple rules for a long and happy life. Yes. So that is my rules. Yes. Yes. I agree. All right. So let's get started. One of the main the thesis of your book is that life is not a competition to live the longest, although that is the obsession with much of the tech industry, which is news to these Silicon Valley CEOs, a lot of them are obsessed with achieving immortality, whether through lots of different means, including downloading the brains to various things. Clearly, a lot of people want to live the longest. So, in a world full of wellness advice, what is your point? Why should people listen to you? Well, first of all, it's common sense.

But here's the problem with all of that stuff. There are multiple problems. One is it makes wellness and living a long time an obsession. And it's the wrong obsession. Just living a long time isn't a fulfilling life. The question is, why do you want to live a long time? What's in it for you? And about, I don't know, six months ago, I was at a dinner.

And, yes, one of those brothers sat me next to Brian Johnson, who some of you will know is a guy who wants to live to 150. And I said, why do you want to live to 150? What's the point of your living to 150? Silence. And then he turned to someone and says, you know, I'm the most monitored human. ever. Well, that's not an answer to the question of why, right? The whole point of living a long and healthy life is because we have other things to do. We have a why to our lives. And living a long time is not about, it's not a fulfilling part. And so it struck me that they were replacing,

right, the means to a good life and making that the end. And that's always a mistake as my ethics. professors, you know, you don't need a lot of fancy logic to know that's the wrong thing to do. I mean, what do you think the motivation? Because they think they're the finest people in the land, I believe. They can't imagine the world without themselves in it. And I, look, I got the lowest passing score in psychiatry rotation at Harvard Med School my year. Okay, so don't listen to me when it comes to Harvard Med School, but go ahead. Didn't come to psychiatry, right? But here's my, that's a hypothesis, unproven. there's something deeply unfulfilling to them.

You know, maybe it's they have imposter syndrome. They got rich because they just happened to be lucky. They were at the right place at the right time. Whatever it is, right? And living, they're trying to find fulfillment and living a long time is the substitute for finding why they're doing what they're doing and what it is. And, you know, I think that there are many of them who are doing great things. but I think if you want to live a long time, right, and there's a title of a book, I'm sure it's here.

That's, you know, something like you have to know why you'll die to live a long time. Which was Steve Jobs' ideas. By one of, you know, one of the civil rights people. And it seems to me that's the right end. That's really important. You know, what are you willing to die for? That is so important to your life that you're willing to die for it. that'll give your life meaning.

And I have a feeling there's nothing that these guys would die for. Anyway, that's a hypothesis. I have no idea. And as I say, I'm just a terrible at psychology and psychiatry. But it has sort of infected the society at large. It's idea of wellness. It's been driven by these platforms. There's influencers everywhere.

Talk a little bit about that because there's so much nonsense, like in gobbledygook and just codswall up. So if you, you know, we're all inundated, whether we read the paper, get newsletters, whatever. And it turns out that even if you're on any of these platforms, right, you get this stuff, whether you want it or not. It's something like 90% of people have gotten wellness or longevity stuff, even when they don't actually look for it. But, you know, one of the things that struck me in doing this is there's both too much and, you know, Too little. It's simplistic. Now, the too much you know. And almost all these books pick them up, and they make things so complicated. You have to do this routine in this way, or this is the number of minutes,

or, you know, exactly this number of grams of protein you have to eat. You know, I had a little tweeting battle with the HHS yesterday, and they listed. I objected to one of their recommendations. and they listed in ground beef, all the micronutrients that you get from ground beef, the selenium, the magnesium, you know, it's like, yeah, you don't have to really worry about that if you eat a healthy diet. You don't have to count on each one of those things.

So it's way too complicated. Since we've talked about Peter Rite, I can say. Page 269, I believe, of his book, grilled into my head. He has himself squatting and talking about the bad form of his squat. Now, do you think if he got the right form, it will make Heller Beans worth a difference to the longevity, the wellness, or the meaning of his life? I can assure you, no. No squatting.

Well, no squatting's good. But, you know, if you've got the form a little long, it's not really going to make a difference to get it exactly right unless you happen to be going for the Olympics of squats. Right. And then, my friend. The other thing is it's a little too simplistic. So if you pick up these books, they're either mainly about exercise with a little sleep and nutrition, mainly about nutrition with a little exercise and sleep. But that's it. It's sleep, nutrition, and exercise. And that's just way too simplistic. And one of the important things of my book, I think, is, you know, saying, look, it's what we're doing here. It's social relationship.

interacting with other people that is the single most important thing you can do for wellness, longevity, and happiness. And all the rest of this stuff is secondary. And they totally, I mean, the wellness industrial complex, totally under. It flips the script. One of the things since I've been doing this reporting for so long, it is actually, everyone's like, what is the secret then? I go, I have to tell you, there's, you know, eating is good, not eating badly,

sleeping well, exercise, fine. And I said, but not living near a cancer collection, you know, like a Elon Musk data center, which look that up. But one of the things, I said the two things, if I have to say after all this year of reporting is don't be poor, because the longevity numbers are coming down rather significantly for people below a certain, in poverty, and have friends and family. All the scientific statistical stuff is all around. And you always want causation, not just correlation. There really are study after study showing that. So let's get to the book, because it's organized around six rules, essentially.

The first is don't be a schmuck, which you avoid self-destructive risks. You list smoking, alcohol, tanning, avoiding vaccines, avoiding cancer screenings, and owning a gun as the six-top schmuck moves. interestingly, I don't know which one to go first. Interesting enough, you'll include weed under smoking. The country's been moving towards marijuana legalization for many years now. Explain the various schmucketudes. Stack rank.

Stack rank them. Well, smoking we don't have to explain. And yes, vaping may be better, but it is no, as someone says, no free lunch. There's lots of issues with getting addicted to nicotine and whether you actually then go on to smoke cigarettes. It does help some people quit, but there are plenty of other issues with it. You know, from my standpoint, there are a lot of things we should avoid. The gun one is interesting.

It was based upon following 18 million people in California and looking, you know, wanting a gun, if there's some violence in your neighborhood, very, very understandable. I think. But it turns out having a gun in your house dramatically increases your risk of dying by gun violence. And it also dramatically increases the risk of any child dying by gun violence because about half of the guns are stored loaded and stored accessible in the, you know, night table drawer in the dresser drawer where kids can get a hold of them. And then it just turns out that you're much more prone to violence, right? You don't get killed by the stranger coming into the neighborhood a lot, but a relative or a friend. That's actually a lot. So that's sort of the

check-offs gone. Yeah, exactly. And so if you take neighbors, one who owns a gun and one who doesn't, the one who owns the gun, twice as likely to die. But my real, the sort of discovery here, I was thinking, as I was writing this chapter, what the smuckiest thing? out there. And I thought, got to be base jumping. You know, where you put the Michelin squirrel suit on, you jump off a mountain, there's wind, and you don't control anything, there's no parachute, no nothing, right? That's got to be really the stupidest thing you can do. Turns out not true. That chance of dying from, you know, squirrel jumping is 1 in 2,700. Getting injured is about 1 in 250, but dying is 1,2,700. Turns out,

Spending $100,000 to be a tourist and climb Mount Everest is schmuckier than face jumping, right? It turns out that the risks for all comers, including expert climbers, shirpahs and all the rest, one in a hundred chance of dying. Right. And by the way, your body doesn't come down. It's frozen up there. And no one is going to spend any oxygen bringing you down. Yeah. Also, it turns out if you're over 59, I'm just scanning the audience here.

Our chances, one in 25. Now, what could be stupider than to make a lot of money, be 65 and say, I'm going to celebrate go up Mount Everest? Well, you know, it's so funny to say that because there's so many checks thatios who always tell me their Everest stories. And by the 50th one, I was like, and they were trying to relate Everest to life. I said, there's nothing relatable about going up a mountain you shouldn't be up and telling me what it means to run a company. I said, so if you mention it one more time, I'm going to hit you. So it's like, I think you're stupid if you tell me. Right.

I've been up Mount Kiliman Jarrow. Those people are not, well, good for you. It was dead boring. I would not recommend it. Okay. So what, most people aren't going to Everest. So of these tanning, you know, Dr. Oz today said everybody should have a drink or toe. So, well, yeah, alcohol.

So alcohol is one of these complex issues because not too long ago, we were all told red wine. It's the French paradox. You drink red wine. You'll live forever. Flaws, increasingly, the data are pretty clear. From a physical standpoint, what it does for the body, it's bad. There are seven cancers associated with it, esophageal cancer, breast cancer, not. a good thing. It's also associated obviously with liver problems and cirrhosis. It's also

disrupts your sleep cycle. So if you drink wine at dinner, you might go to sleep. You might be sleepy, go to sleep, but then it disrupts the cycle so you don't get full night's sleep. So why did the government today recommend more drunken? I don't know. But so you increasingly, you've got like the WHO, you've got various officials saying zero is the safest. But look, there's, you know, birds like fermented food with fermented fruit with alcohol. Monkeys like fermented fruit with alcohol. People have been drinking forever. It does a lot of things. You know, people get relaxed. They talk to other people. They like the taste. Plus, we know that 65 to 70 percent of the American population,

I won't survey this group, drink. You're not taking 65 percent of the population, who are drinking alcohol and going to zero, just not happening. And actually, when the Surgeon General report came up under Vivek Murty, I wrote him and I said, you know, I think it's a little too extreme. I don't think people are. People are going to tune that report out when you say zero. So be responsible. What's responsible?

Okay. Here are the no bins drinking, right? No drinking alone and no drinking to drown out your sorrows. Here's the positives. Use it to facilitate social. interaction with other people, drinking over dinner. Or, you know, I was in Chicago. I went out with my brother and my wife to a jazz club, and Ram was regaling us with stories about this is where El Capone was. And by the way, the passageways where he got away from the cops when they raided the joint,

there are four, and they go to different theaters and blah, blah, blah. You know, that's, first of all, it's interesting. And second of all, you know, facilitated by alcohol. And then we had great jazz. Right. That's the reason to do it. And I think under those circumstances, you've got the positives of social interaction and, you know, being with other people. And, you know, that's a tradeoff. But let's face it, you know, we all know. Life is a tradeoff, right? You do some things which are. And you pay the price, right. All right. Speaking of which. Obviously, the most controversial and you worked for NIH vaccines. I don't think that's controversial. Well, I don't either. I mean, there. I mean, There are some people in this town who don't like the data.

But I have a table in the book where I talk about the mortality of vaccine preventable diseases. And when you look at the mortality of all these diseases, you know, they're undetectable. We don't even, there's no mortality for many of them. You know, and one of the problems, I think, is that we have gotten to a situation where the vaccine, have made so much of childhood safe that people now have become, why give my kid vaccine? It's so safe out there. Yeah, the reason it's safe is because there are vaccines, right? Parents and our grandparents, right, in the 50s, were nervous every summer because their

kids might get polio. They might end up paralyzed. They might end up in an eye along. You know, when I was at the Dana Farber in Boston, and they exiled me to this outbuilding across the parking lot, little brick building. You know, I was doing something they didn't think was all that important, like, bioethics. Anyway, they put me there, and I was on the second floor, and then one day I walked downstairs, and I walked into the basement. All these iron lungs lined up.

There's a storage of iron lungs. This was like 1995. And it was like, these were all the iron lungs for the polio patients from Boston Children's. hospital, which was the other way across the parking lot. And once you see them, you realize, you know, it was really bad. And once that vaccine, the salt vaccine and then the Sabin vaccine became available, parents were winding up their kids. They could get their kids vaccinated fast enough. Right. So where are we now then? Well, I'm most, the vaccine situation is most concerning about little kids because, you know, we're getting rid of the hepatitis B vaccine

right around. But, you know, they're going to. be some kids who get liver failure, get hepatitis B, have liver failure, and are going to die from it. Unquestionably the case. Last year, 288 kids died because of flu. We're going to have probably more this year because of flu. Obviously measles. Rodevirus, diarrhea. You know, same thing. This is a, it's a terrible thing. Vaccines have made our lives so much better and the data are uncontrovertible that they're safe. does every medical procedure has some risks right just taking blood has some risk you might get infected you might right there are there are some risks to vaccines we have a compensation system for that and by the way you want to know how frequently that compensation system is used for every

million people who get a vaccine one gets a claim now i don't know anything in life where the chances of you know getting harmed are less than one in a million It's pretty obvious that this is a very good thing for all of us. Agreed. We'll be back in a minute. Hey, it's Olivia from Ollie. Is it just me? Or are these wellness trends getting ridiculous?

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These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Allie! Hey, it's Olivia from Ollie. Getting better sleep this year is totally doable. But skip the lettuce tea in the mouth tape. These sleep trends are getting unhinged. Ollie's sleep gummies help you fall asleep, stay asleep, and wake up refreshed.

Just melatonin, L-thian, and botanical extracts. No weird wet salad aftertaste. Better sleep. start tonight. Go to OLLLY.com to choose your snooze. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. So rule number two, talk to people, as you noted, just a second ago, maybe not drinking as much, including strangers. We're living at a time when young people are habituated to living on the phone, so we're adults, let's be clear, that talking to a stranger feels rude. College students say

that trying to start a conversation with a fellow student that's sitting next to them before class notes, for example, would be weird. Many of them are scared of being rejected. Talk about this social awkwardness and how to get over it. There's more substantive ways to do it. I, for example, walk behind people in San Francisco who are looking at them when I'm ever there.

And I go, look up! And someday, you're going to hear of me murdered in the streets of San Francisco. I have to tell you, every person looks up and goes, oh, I'm such an idiot. Like, they do not blame me for being extraordinarily rude. They feel like they're in the grips of this. But young people, in particular, the isolation.

There's been a movement across the world, including in this country more of isolating kids from both social media and phones themselves. I think the problem is adults, 25 to 45 myself. But talk a little bit about that, the meeting of people and what the phone environment does to that. Well, so last year in the fall of 2024, I banned all phones from my classroom. I also banned computers and taking notes by computers from my classroom.

And two remarkable things happened. One was I came in and the classroom was a lot louder when I walked into the room. People were actually talking to each other. And it was pretty amazing. They, you know, began to be before they were just looking at their phone. And the second is I actually got way better evaluations. And the reason isn't because I was doing anything different. The reason is they were paying attention and makes all the difference.

Every time you talk to a professor who's banned phones in their classroom, suddenly the classrooms get way better because people are not on the phone. They're not worrying about what's on the phone. They're actually worrying about what is the... Talk about socialization because it does feel social in some ways, right? Of course, these things feel social. But talk about the importance of socialization for living longevity. It's very clear that we're in a problematic situation.

Absolutely. So people will say, well, look, I can connect with my friends, you know, who are living in Australia or living in California via the phone. A hundred percent true. The problem is you made those friends face to face. You did not make them over the phone, over social media. you can continue the conversation once it's made. Now, the data on making friends and interacting, very, very interesting. So many of you will know the Dunbar number.

This is an English anthropologist at Oxford, and he looked at the brains of various animals, including people, and it's like, you know, we can have about 150 friends. That's all our brain can handle. Now, most of them are acquaintances. They're casual. You might have them over for dinner. You would recognize them.

you'd have coffee with them. But five or so of them are five to ten, are close friends who you're very intimate with. Many of them are, you know, family. Many of them are people you got to know in college where you were talking deeply at midnight with them. And then we have about 15 or 20 more who are people we have over to dinner.

We see regularly we talk to about once a month. And those are really important for our psychology. So if you look at the data, people who have more close friends versus people who have one or two or zero increasingly, we have a huge number of people. About 20% of the population now have zero to one close friends. That's it. It's very, very clear that the more close friends you have, right, the more, the longer you live. As a matter of fact, the difference between people who are lonely and have fewer social connections and people who don't is, increase the mortality rate if you have fewer social friends between 22 and 33%.

I just recently for this series in Sherry Turkle about the increase in the chatbot relationships. And she said it was an outlier. She's at MIT. It was an outlier before and now it's regular, that people are consulting their chatbot date. Google just settled with the parents. I've done a lot on the parents. The kids are committing suicide with this relationship. In general, these chatbot relationships are seen. They're no substitute. There's no substitute. So look, my father was extreme extrovert.

I relate in the book. We used to take road trips. He loved driving, and we took road trips out to, we lived in Chicago and go out west to Montana and Wyoming and Colorado. And every time we stopped in a diner, right? He would start talking to the next table. Or if there was no next table, he talked to the waitress. And he would ask them all sorts of questions. Like, you know, why are you here?

You know, how did you come here? What do you do here? All those kind of questions. And he didn't do it like that, you know, this is an FBI interrogation. I want to know, name, rank and seal. He would, you know, he's just curious. And he was endlessly curious. He did the same thing in parks.

Now, his kids, right, we were always embarrassed by this. So he's off again, you know. Can we crawl under the table? But it turned out people loved it. And I learned from him several really important things. First of all, initiate the conversation. The other person probably wants to talk and is embarrassed or shy. We're all like that.

I'm still like that. But initiate. Ask the other people questions and they'll talk about themselves. And what happens if you get rejected? Happens all the time, right? Nothing will happen to you. There's no big issue, right? Absolutely nothing. So I have a practice here. All of you, you're Washingtonians, you know, right, all the cab drivers, the Uber drivers, they're from Ethiopia, right? So I get into a cab. You recognize people that they're from Ethiopia, but I ask them, where are you from? And they tell me Ethiopia. I said, you know, I've been to Ethiopia five times. Suddenly they light up. They love it, right? Someone's been to their country. And so they asked me, where have I been? And I said, well, you know, I've been to

to Gundar and I hiked mountains there. I've been to Addis Ababa. I've been to Lalibella to see the churches carved out of the rock. And then I say, so where are you from? And they tell me, I said, how much family do you still have back there? And we're in a conversation already. And it makes their day and it makes my day. And this is, this is one message from my dad, right? I'm being virtuous, right? Not only am I having a good conversation, right? I'm having them have a good social interaction. It's good for their health, too. Especially these ones that aren't friends. Like, they're actually, the health benefits are rather like just speaking to people you don't know.

Totally. It's really interesting. Now, you also, another way to stay sharp mentally, because a lot of it is about mental sharpness. Explain the difference between crystallized intelligence and fluid intelligence and how people can maintain what you want is fluid intelligence. Yeah. So crystallized intelligence is all you crossword puzzle people who know all these words are your scrabble people, you got crystallized intelligence.

You know a lot of words, and they're going to stay with you for a long time. I was just talking to an 85-year-old wife of my former dissertation, of my former, my dissertation advisor for my PhD, who unfortunately passed away. And she said to me that she has, you know, gone back to playing ping pong. And I was curious, well, is ping pong kind of like bicycling that, you know, you never forget it. You know how to ride a bicycle as a kid? You don't ride it for a long time.

You get back on the bicycle. You know how to ride it. She says absolutely yes. And my serve is killer. Right? So, you know, that's crystallized intelligence, knowing the muscle movement or knowing, you know, your old telephone number, your old home address, where an event happened a long time ago. Crystallized intelligence, the last thing to leave. Fluid intelligence, on the other hand, is, you know, being able to keep something in your head.

and concentrate on something else, come back to remember it. It's decision-making or fixing a pattern that you see or solving puzzles. That is fluid intelligence. And it's really important in new circumstances that you haven't seen before to bring all your information back together. So doing new things. The reason I have honey here is this is Zeke's honey. This guy's a famous scientist, but he decided to make honey.

And by the way, it is the most delicious honey you've ever seen. But he learned how to... 20 bucks for you after this. Okay. He learned to make honey because it was hard for him, right? Anything that's hard, whether it's you learn to make chocolate. Correct. He and I, in the video, he made me put on colonial garb in March.

I had never marched in a colonial parade and never will again. As a minute man. As a minute man, which was fun. It was actually fun and interesting. So doing things different. Yes. It's part of fluid intelligence. Yeah.

And it, you know, declines. beginning in the late 30s, early 40s, our fluid intelligence declines. And it's the thing that is really, really important. That allows us to be creative, allows us to continue with it. Anything, it can be physical, mental. Exactly. Totally. And there are things you can do to keep it going. And the first thing is, you know, get a lot of education. Turns out raising your baseline, really, really important. And this movement that really had, university professor has me shuddering is, you know, university's not worth it.

Well, may not be worth it to you from money standpoint, but it's worth it to you from a brain standpoint. Why is that? Well, getting a lot of education makes more neural connections, bringing together, you know, learning Dostoevsky and connecting him to other writers, other messages, right? really, really important. Because once you start high, the decline seems to be pretty similar for people. And you start from a higher baseline. It can be anything.

It doesn't have to be dusty. You can learn how to do a carburet. Right? It could be a fantastic trumpet player, whatever. And then as you grow trying new things, trying to establish those connections and trying to do things that challenge your mind and force you to make new connections. Well, beyond crossword puzzles and things like that. Yeah.

Just whatever it has. Something is hard for you. Well, crossword puzzles are probably the same thing. They're relying on the same store of knowledge. Knowledge rather than like. Yeah. I was talking to Walter Isaacson the other day. And he was interviewing me.

And he said that he's been learning French for the last four years because he's writing a book about Marie Curie. He is. He's moved on to better people, dead ones. And then he's learning French so that he can report on her. And that. is, and he spent a lot of time. No, you don't do these things passively, or like transiently, I mean, not passively,

transiently. You've got to actually stick to it to make those connections. But those are what keep your brain young. Now, one of my big heroes who appears in this book several times is Ben Franklin. He is the model of this. He was endlessly curious about everything, always thinking. And, you know, what is he famous for? If I ask you, you'll say, bifocals, right?

Almost everyone, that's the immediate... I was not going to say that at all. What were we going to say? The lightning rod? Drinking. Oh, conservation of electricity. No, he was not a big drinker, not a big drink. I'm teasing you.

And when did he invent the bifocals? He was 79 years old. Yeah, wow. And he had two more inventions after that. He invented them just before he left France to come back to the United States the last time. And then he built an addition to his house, a massive library for. his 4,000 books so he could stay curious looking at books. And he had to get the books high up on the shelf. So he's the guy who invented that arm. Do you have any of those, Brad?

That gets the books from high shelves. And then he invented a chair where you fold down the seat and there are steps there so you can climb up three or four steps to get a high book. All of this after 79. Because he had neuroconnects. Go ahead. He had plasticity in his brain like no one. Brain plasticity is a word a lot of neuroscientists use. I played a lot of games. We did a lot of games, which is another poker and different things like that. I just,

we just, my wife and I took a mahjong lesson just recently. It's the trend thing so everybody get on it in 2026. We'll be back in a minute. The next chapter should be everyone's favorite. It's titled Eat Your Ice Cream, which is the title of the book. In it, you give advice on food that mirrors, in some cases, the newly

inverted food pyramid that was published by the FD and or RFK. sometimes a broken clock is right. There may be a surprise to some people. Tell us why he should eat our ice cream, but he does not think, well, maybe he does because of whole milk. But compare and contrast your advice on food

and RFK juniors. Yeah, so I would say I was, there are positives in yesterday's, yesterday's announcement, okay? And I was very pleasantly surprised. The positives are mostly, on the what not to do. Don't eat ultra-processed, so much ultra-processed foods.

58% of the American caloric intake is ultra-processed foods. It's horrid. Don't drink sodas. Cut down on your sugar. All of that's in his recommendations. It's also the top couple of Zeke Emanuel's recommended. He's also against package cakes and cookies and things like that. All of that, I agree with.

Okay? he doesn't emphasize fermented foods, which is my big, the positive thing to do, eat fermented foods, good for the microbiome. In the case of, you know, probably the thing I pushed the most in the book if I had to, with no financial conflicts of interest, by the way, yogurt, good dairy associated with a drop-in, type 2 diabetes, great for the microbiome because it's fermented, key, key, is the same, kimchi, sourcrow, really, really good. The thing I vehemently disagree with in that book is they're pushing more red meat.

We know we've got tons of studies about red meat, high and saturated fats, heavily associated with cancer, heart disease, stroke, diabetes. We could go down the list. There's a much longer list. You know, you like that? I like it every so often, you know, maybe once every two months. I'll have some red meat. I like a hamburger too.

Not way too much emphasis on that. You know, don't use seed oils. Use beef tallow. Wrong. Seed oils are actually quite good. You know, canola, sunflower oils. You know, the best oil, if you want is olive oil. It's very expensive these days.

But, you know, so there are many good things. Beef tallow is a no. Yeah, definitely. Definite no. Yes. So I, that's the recommendation. Now, of course, I deal with a lot of other things. If there's one other big positive thing you have to do that Americans are terrible at, fiber, more than 90% of Americans do not eat enough fiber every day.

We don't eat fruits and vegetables, which is main source or nuts, main source of fiber. And that is bad because the fiber is basically the prebiotic. So we spend a lot of money on those stupid prebiotics. Just eat your fruits and vegetables. Right. Really fresh. The surprising one, avocados. Yes.

One avocado will give you almost all the fruit. That's right. Absolutely. So my big breakfast recommendation is a bowl of berries, some granola with oats in them, yogurt and kefir on there and throw in some hemp hearts for additional protein. Nothing could be better. All right. Last chapter is on sleeping well. I don't sleep a lot. None of us do. But I wear this and I now are very much tracking it. This is the aura ring.

Does it help? I have to say, I used to call all of them unwearables. They're called wearables. But this one actually gives me some interesting information, especially around sleep. More information than, say, getting up and feeling good? Yes. No, correct you are. But it's just interesting to me. And we're doing this thing. So I wanted to find out. But I did interview a bunch of sleep experts. And, of course, you don't quite in as much sleep as they say, too, at the same. Like, it's more like seven hours. It's the time that you wind down. Yeah.

Sleeping on cold, having a cold room. And so there's some typical things. But talk about sleep because there's a lot of people who don't sleep a lot. High achievers, Martha Stewart, Tom Ford, Bill Clinton. And I hate to say it, Donald Trump, doesn't sleep very much. Well, wait, wait, wait, wait, wait, wait. You talked about high achievers. All right, okay.

Okay. I said, let, let, let, let, let's achieved a lot. So, so let, let me first talk about the wearables, because I am in general against the wearables and especially for sleep. I should note very carefully, in my household, I'm the minority opinion. My wife who has a PhD from MIT, very quantitative. She loves the numbers that really motivates her. Now, if the numbers motivate you, good. but I've never understood the wearables, especially for sleep.

Sleep, you get up in the morning, you feel like shit, you know. You didn't have a good night's sleep. You know, you had a good night's sleep. I don't need a little, you know, Orra ring to tell me that. And that's what I told the CEO of ORA, I was giving a talk somewhere, and he was sitting right next to me. And I said, you know, I think that thing you're selling is like, anyway. You Larry David and him, you Larry Dave, you went, eh.

Anyway, I don't quite understand that. But sleep is a huge problem, mainly because of what you said, is that we have this sort of Protestant ethic, ethic in America, and we think, you know, less sleep is better. I had my debate partner when I was, you know, 15 years old. He had this idea. I'm wasting a third of my life. Sleeping, it's got to, no, sleeping is really important for you.

How do we know that? because we do sleep. Sleep is really, just think about it, really dangerous. You're not out for eight hours. You are the most vulnerable you could possibly be to, you know, the Cheetah next door, right? And yet it's preserved. It must be important, right? Nothing would have been conserved through evolution like that that made you so vulnerable

unless it were really, really important. It also cleans out your brain. It's very important to clean out your brain. REM sleep. It's just like a workout. you to restore your muscles and lots of other things. It moves the memories from short-term memory to a long-term memory that the short-term memories have campus long-term.

That's why I'm pointing to. This is a biology lesson by including everything else. Anyway, really, really important. And we do a terrible job because we think less is better. No, less is not better. And we have to change our attitude. Now, we Americans like to quick fix it. So we reach for the pills.

Terrible idea. They don't work. And this is in Zika Manuel talking. The American Academy of Sleep Medicine is like negative on all of them. You go to like the Cleveland Clinic, web page. You go to Mayo Clinic. They all say the same thing. The only thing proven to work besides setting the bed is cognitive behavioral therapy for insomnia,

which is to figure out what's going on. You know, so. There are some new classes of drugs that they're looking at, correct? Lots of, yeah, yeah. I would not. If, Kara, you can invest, I would be skeptical. I'm not investing. So very last, and then we're going to get to questions in a second, but exercise.

And then I have two newsy questions. Exercise. The answer is, yes, you've got to do all the kinds of exercise. There are three kinds of exercise. Aerobic, right, for your heart, lungs, vasculature, reduces cardiac problems, and stroke risk and things like that. You've got to get your heart rate up. Strength training, really important.

So you're not, the fragility is, you're not fragile. And really, really important. And then balance in flexibility, yoga. So, you know, I start my day. My wife and I start our day, 20 minutes of yoga in the morning, followed by about five minutes of core exercise. And then we go off and... So it's not a lot.

You don't have to do a lot. Like, obsessive. That's the yoga. I ride a bike in the winter. You do. Four, three or four times, the inside bike three or four times a week for 20 minutes. Just 20 minutes.

Get it in and get... You can fit 20 minutes into any days. The obsessive exercise is proven not to be that much beneficial unless you like it. Correct? Yeah, right. So one of the interesting things is we all have 75 vigorous exercise, 75 minutes a week of vigorous exercise, 150 weeks of moderate exercise. And if you push that up, you do more and more, there's a plateau. And you don't get any more. And then you just increase your risk of getting repetitive motion injury, you know, tennis elbow, whatever, you know, problems with your knees, doesn't decrease your mortality.

at all. And the other problem I find is, you know, just think about it. Ten hours a week, what is the opportunity cost there? What aren't you doing in that time that you could be doing? Now, sometimes there's a good excuse. You know, when I'm writing, I usually come to some problem. I can't say it right. I don't know exactly what I want to say. And then when I go out, I go out for a run, you know, and I think about it. And it usually solves my problem. But there is a plateau, and I think we don't recognize that enough. Don't overdo it because you're either wasting time or you're risking serious injury. Right.

And don't tell everyone about your exercise routine because it's exhausting. We're going to end very quickly on quickly on some newsy question. The CDC recently dropped childhood vaccine recommendations for six diseases. Seems schmucky to me. But the CDC said we're now more in line with other developed nations that recommend fewer vaccines and have similar better outcomes. where do you come down on the schedule? Look at your face. Wrong.

Okay. I mean, you know, Denmark, just think about Denmark, right? A country of six million. Denmark does not want us to think about them right now. That is very true. A country of six million people, universal health care coverage, where when you go to a point of service, you go to get care, copay zero, right? And they've got nurses that pay attention to kids to make sure they get all their vaccines.

They actually are doing well. And they actually follow a little more paternalistic, you might say, than America. That contrast, right, they're down at 11. By the way, they're the outlier. They are very short on the vaccine. That is a bad mistake. And I can tell you the most difficult or the worst thing about it is the call I got from my three daughters, right, which is, Dad, what should we do about vaccines for the kids?

Right? Now, they have, you know, a doctor they can consult. But most people don't have that. I said, you just tell your pediatrician you want the old vaccine schedule and no screwing around, okay? But I think it's going to sell a lot of uncertainty. Your own daughters. And we've already seen this, the vaccination rate, not just for MMR, but for diphtheria

and tetanus is down. 65% of the counties in the United States now have the herd immunity level, which is 95% for MMR. They're below the herd immunity level. We're going to see lots of outbreaks, lots of kids hospitalized, and lots of deaths. That is not a good thing for the next generation, the wrong direction. The wrong direction. Okay. Last question.

Republicans in Congress refused to reauthorize Affordable Care Act subsidies, but now they did tonight. They voted. They went against Trump and the others. Yeah, but the Congress. It didn't pass. It passed, but it passed in the House of Representatives. It might pass in the Senate. You were instrumental in creating the ACA.

If you could go back to those negotiations knowing what you know now, what would you have done differently to make the law harder to undermine? How long do you have, Kara? So let me, it's a complicated story. One of the things, look, the Affordable Care Act has been a tremendous success. 25 million people or so got health insurance, and we know that giving people health insurance actually decreases their mortality. We actually plateaued on health care costs as a percent of GDP for 15 years, unprecedented

in American history. I unfortunately can't say that our quality has gone up, and I also can't say that our satisfaction has gone up in that time. One of the problems, the biggest problem is you put in place a bill. and there was no mechanism to make moderate changes without going back to Congress. No company, no company would put in a strategic plan, operationalize it, and then not reexamine it for 15 years. You just wouldn't do it. And that's basically what we did with the affordable care.

There are many modifications that need to happen and couldn't happen because of the political polarization. Republicans just uninterested in trying to make it better. There are many things to make it better. If I had to go back, go back, there are two big changes, sort of themes of changes that I would make. I'm not going to talk about the particular details except for one. We made health care more complicated. We added the exchanges and we added a bunch of stuff that made healthcare more complicated. I think one of our mantras going forth has to be simplification.

We have to simplify things, not make them more complicated. We have to mean, all right, either you get insurance through your employer or you get insurance. Everyone else gets insurance this other way, which I think ought to be a small exchange. Only six plans on it, reduce the number so that people can make rational choices. The other thing we needed to do was to make much more standardization, standardization of medical treatments, standardization of electronic health records. So, you know, you go to two different hospitals, you can actually get them move back and forth, standardization in what we pay. You know, there's no price for anything in health care. There are a million

prices for, you know, go to the hospital, you know, there's a Medicare price, there's a Medicaid price, and then every private insurance company and individual plans in those companies has a different price. It's nonsense. It's one of the reasons we have so much, it's so costly, and we have so much administrative costs. 20% of all health care spending is administration. And one of the reasons is we haven't standardized things. So simplification and standardization is where I would go. Now, my plan, okay, I'm running. My plan is, you know, we need to do something about affordability now.

Right now, everyone, when insured people are afraid to go to the doctor or to the emergency room, you know you have a serious problem. When deductibles are $5,000 and most people can't afford that, serious problem. So we have to do things and everyone has to be. taxed. Hospitals, insurance companies, drug companies all have to suffer something to get the cost out. But that's not comprehensive reform. We have to move to more comprehensive reform and get a plan. And the problem is, you know, and just as much a problem for us liberals who've been working on health care, we haven't got a lot of plans out there. And, you know, there's a lot of depression among, I think, most health policy people. It's like,

You know, we're not going to get anything. So why think about anything? No, we have to work now. And I like to remind people, you know, Medicare was first proposed 1957, enacted 1965. You have to develop an idea, vet and idea, socialize it with people. And health care is particularly hard because no one knows how the hell it works. It's just so complicated. And so it takes a lot of time to socialize people and you have to talk to them.

My first action, by the way, on the road to affordability is cap deductibles and out-of-pocket payment. They should be no higher than $1,700, which is 2% of the median income of American households. And that should be it. That's what they do in Germany. That's what civilized countries do. Okay. If your brother runs for president and wins, we'll see. If he may do HHS thing, what's the first thing you would do?

You say buy RFK and your beef tallow. No, along. What's the first thing I would do? That's a really good question. There's so much that needs to be done there. I don't know. Actually, you've got me stumped. Oh, I think this issue of health care reform.

And the reason I keep coming back to it is fixing the health care system is because we're spending $5 trillion a year. You know, the American health care system is the third largest. economy in the world. Only the United States and China are bigger. Our healthcare system is bigger than Japan, bigger than Germany, total economy. So why would I focus on? We need to take money out of that system so we can do two things.

One is spend it on other things, education, you know, fixing our grid, lots of priorities in America. The second thing we have to do is give some of that money. back to families. If we took the American healthcare spending from 17 and a half percent of GDP down to 15 percent of GDP, two and a half percent drop, that's $3,000 per family. Just imagine what most Americans could do with $3,000 extra dollars. I now know what I would. My very first action, thank you for giving me time to bullshit, filibuster while I was thinking. All right. Okay, excellent. My very first thing is,

I would mandate through Medicaid that all newborns, right, get nurse family partnership so they have early childhood interventions for the first two years of life. If there's any higher return for a dollar spent, right, it's the highest return for the government spending a dollar. It's a university economist estimate between $7 return or to $15 return. Because what we do early on is the most important thing for brain development, for socialization, for all sorts of things. So you got to work with parents. You got to make sure kids have a strong, healthy start. That would be my first thing. Because that's what it takes to live long. It's an investment in the future. Sure. Yeah. All right. All right. Well, the book is called Eat Your Ice Cream. And by the way,

there's ice cream all around this area. Six simple rules for a long and healthy life. What is your favorite ice cream? I've got two favorite. I've got two favorite. ice cream places in Washington, D.C., Dulceza, where Rob Duncan is a very dear friend and makes a special ice cream for me, the chocolate hazelnut, and I'm trying to get him to make a leadna, honey, pistachio ice cream, just heavenly. And happy ice cream has a wonderful chocolate as well, and I eat them all. All right. On that note, Zika Manuel, everyone. Thank you so much. show was produced by Christian Castro

Roussel, Michelle Alloy, Megan Bernie, and Kalyn Lynch. Nishot Kerw is Vox Media's executive producer of podcasts. Special thanks to Rosemary Ho. Alia Jackson Perez engineered this episode, and our theme music is by Tracademics. Thanks again to politics and pros

for hosting this event. If you're already following the show, you're eating ice cream. If not, you're drowning in beef tallow. Go wherever you listen to podcast, search for On with Caraswisher and hit follow. Thanks for listening to On with Kara Swisher from Podium Media, New York Magazine, the Vox Media Podcast Network, and us. We'll be back on Thursday with more.