Ten Percent Happier with Dan Harris - What's Worth Living For? | Dr. Atul Gawande

Episode Date: September 14, 2026

A surprisingly uplifting conversation on aging, sickness, and death. Plus: why you get happier as you get older, hard-earned tips for handling tough diagnoses, and how to think about AI in your health care. Atul Gawande, MD, MPH, is a surgeon, author, and public health innovator. He holds the Fish Chair in Surgery at Brigham and Women's Hospital. He is the Samuel O. Thier Professor of the Practice of Surgery at Harvard Medical School and Professor of the Practice at Harvard T.H. Chan School of Public Health.  Dr. Gawande was Assistant Administrator for Global Health at USAID from 2022-2025. He is a longtime writer for The New Yorker and has written four books: Complications, Better, The Checklist Manifesto, and Being Mortal. In this episode we talk about: Why the best doctors ask patients what matters before choosing treatment The simple question that reveals what makes life worth living Why patients who get less aggressive care sometimes live longer His father's answer to "what's worth living for" changed three times Why staying independent and staying safe often pull in different directions Research showing people get emotionally calmer, not sadder, as they age What happened when the U.S. shut down its global health aid programs Why he sees AI as a helpful second opinion, not a replacement, for doctors Get the 10% with Dan Harris app here Sign up for Dan's free newsletter here Follow Dan on social: Instagram, TikTok Subscribe to our YouTube Channel Additional Resources:  Being Mortal, the book Being Mortal, the documentary This episode is sponsored by: Warby Parker: Buy one pair of glasses and get 20% off any additional pairs at WarbyParker.com/HAPPIER — and using our link helps support the show. #WarbyParker #ad BetterHelp: Sign up and get 10% off at BetterHelp.com/HAPPIER. Notion: Learn more about how Notion can support your business, at notion.com/happier To advertise on the show, contact [e-mail] or visit https://advertising.libsyn.com/10HappierwithDanHarris

Hey, everybody. Welcome to the 10% Happier Podcast. I am your host, Dan Harris. As a Buddhist, I am simultaneously galvanized by and terrified by the unavoidable fact of death. Galvanized because being aware of your mortality can make life more vivid and vibrant in the present moment and terrified because like who's not afraid of dying. Today, though, I'm talking to a very famous doctor who argues that we can make this process, which again is coming for all of us, much more humane. Dr. Atul Gawande is a renowned surgeon, a Harvard professor, a writer for the New Yorker, and the bestselling author of many, many books, including the one we're going to focus on today, which is called Being Mortal. Now, you might be thinking, didn't Being Mortal come out in 2014? Yes, it did. But that was before I had a podcast, and I've been meaning to have Dr. Gwande on the show for a long time. And then I found an excuse because just a few months ago, the New York Times listed Being mortal as one of the top five books that will lift you up in hard times, which reminded me that I wanted to have Dr. Gawande on. So here he is. Dr. Ratole Gawande. Welcome to the show. Thanks for having me, Dan. When my dad was still working, he was the head of radiation oncology at the Brighamon Women's Hospital in Boston. And he used to rave about this brilliant young surgeon who was

writing articles for the New Yorker. And I should read those articles. And he was talking about you. So it's very nice. to finally meet you. What's your dad's name? Jay Harris. Oh my God. Yes. I've shared patience with him.

That's amazing. That's your dad. He's in a very different situation than when you knew him. He's had a lot of health problems. He had a stroke and has a form of Parkinson's. So he's sometimes walking a case study in impermanence. Tell him hello, but also you're going through what everybody goes through, dealing with a family member who's got significant challenges now.

Yes. So that brings us to your book. Again, being mortal, just one of many, many books you've written. One of the big through lines in the book was your experience with your father. Maybe let's start there. Yeah, my father was a surgeon who's also. I'm a surgical oncologist at Brigham and Dana Farber in Boston. My father was a urologist.

My mother was a pediatrician. I grew up in Athens, Ohio, and he developed a tumor in his brainstem and spinal cord that started causing him to have pain in his neck, and a scan revealed a tumor that was too large to actually remove. And that began our three and a half year, almost four-year journey with a struggling through the condition he had and the life he would be facing with it. There were things that could be done. There was operations, biopsies that could be offered, chemotherapy, radiation.

He would take some of those choices. He would decide not to take other those choices. But what struck me was we had over 100 years of medical training between the three of us and my sister are coming in as well as a non-medical person. And we were no better equipped than anybody else to navigate it. And I started writing the book really because I had reached a point in my career when I was confident that if you had a problem I could fix, I could give you a great chance at fixing it.

But come to me with a problem, like the kind of problem, my father had. And I didn't even, I was uncomfortable and I didn't know even what it meant to be good at taking care of people, let alone actually being good at it. And getting to write was an excuse to start talking to people. It's strange to go as a doctor up to people and say things like, hey, can I come watch you a geriatrician in your office today? Or, you know, can I go follow you a patient as you navigate things at home. But when you're writing an article or then writing a book, you're allowed to do those things. And it was an amazing opportunity ultimately interviewed over 200 people, practitioners, patients, family members, as they all coped with

these kinds of problems. You talk about this in the book. Very few of us like to talk about death or to think about it. And yet, as I mentioned in the introduction, the New York Times listed being mortal as one of the top five books to read when you need to be lifted up in hard times. Why? What is it about thinking about death in the right way that can be uplifting? So the surprise to me was the people who were best at managing these situations understood that it was not about death. It was about living to the very end. and what it meant to have a life worth living to the very end, or to help people, your family member, a patient, navigate coming to that space. It's shocking to me that it took me all

of that time, 200 interviews, et cetera, to figure out the ultimate lessons. At the core of it is the fact that people have priorities besides just living longer. They have goals and purposes that are very meaningful to them, and they aren't just to control the disease. The most effective way to learn what people's priorities are is to ask them. But we don't ask. When we don't ask, the result is the care we provide as a family member, as a clinician, anybody trying to offer help ends up being out of alignment with what matters most in their life. And the result of that is suffering.

And I saw that now, grasping that, interviewing lots of folks, saw that through the lens of people living in senior retirement communities and nursing homes, people navigating tough conditions like your father is with Parkinson's disease and other things. My own father with his brain tumor. And it also gave clarity about how to approach, how to be good at taking care of folks. One of the people who I spoke to a woman named Susan Block, who's a esteem national expert, palliative care clinician, she described to me taking care of her father, who had become ill with something very similar to my father, facing a spinal cord problem. And she was the one who helped distilled for me that the goal of a clinician is to identify what are your priorities. And there are questions that you can ask. Like, what's your understanding of where you are with your health? What are your fears and hopes

for the future if things worsen? What are you willing to endure and not willing to endure? what's the minimum quality of life you find acceptable? And when she asked her father this question, he said, hmm, minimum quality of life. Well, if I can eat chocolate ice cream and watch football on television, that'll be good enough for me. If I can't, let me go. And it was the best living will ever.

He was telling you, not do I want chest compressions, do I want to be in an ICU? He was telling you, here's what's worth living for me. And if you can help provide it, you know, let me do it. If I can't, let me go. And then, you know, it became my favorite question to people. You know, I asked my dad. And his response was first in the early days with the tumor.

What matters to me is I want to stay a surgeon. I want to keep being able to go to the operating room. And so the goals were could he keep working? later as he started to get paralyzed and have numbness and pain shooting down his hand and he couldn't operate anymore, then he was despondent. It's like, I don't know what's worth living for. And then he realized what he missed most was not operating. It was helping people. And he ended up running for district governor of his Rotary Club in Ohio. And getting to do good through a service organization kept him going and motivated and happy and fulfilled for the next couple years.

And then when he became quadriplegic with it, it became food and family around the table. The answer changed over time. How can we get better at having these conversations? And I think it's not just about having conversations with your loved ones, but also like having the conversation with yourself. Yeah, part of it is it's more of a skill than I'd understood it to be. You can't simply ask someone, what matters to you? What's your priority? Like, what are you talking about? That understanding was distilled by Susan Block into something that we actually took in our research center and turned into a set of questions that people could ask and started training clinicians and using them. And those became the questions I mentioned. and asking things like, well, what's your understanding of where you are with your health? And then being able to progress through questions like, what are your hopes and fears? What are you willing to endure and not willing to endure?

What are you willing to? What's a minimum quality of life you find acceptable? And those answers help, first of all, that help the other person articulate for themselves what matters. They don't always come to those answers with clarity at the first time. But it opens the door, and I found it changed, it almost physically changed my position with patience as I'm talking in the office, because it suddenly felt like, you know, I'd face someone who has a terminal condition, they're deteriorating,

and they want something that's going to save them. They want to know that they're fighting and what they're fighting for. And a lot of times in these discussions, you can feel like you're in conflict. Same thing with a parent who's starting to have issues. You know, my mother, when she got older, started to have issues where we feared she was going to have a fall. And I care about, is she safe? She wants to know, can I live? And her answer is, well, what I want is to be able to remain independent in my apartment.

And what I want is for her to not to fall. And those turn out to be the same things from a different perspective. And so now we could say, here's what we want. How do we pursue that? How do we give her her best chance to remain safe and doing well? We eventually navigated. It took time, not driving anymore, but she learned to use Uber and Lyft, learned how to even, she started teaching people in her retirement.

community, how to navigate Uber and Lyft and find the cheapest ride and also talk the delivery driver, the driver into carrying your groceries, you know, up into your apartment for you and things like that. And then I found I'd call to go see her and, oh, she's gone into town. She's doing her thing. I found myself not in conflict with patients because we were having a discussion that was different in medical school. I was taught you lay out the options for people, the pros, the cons, the risks, the benefits of option A, B, C, D. But what I found in practice was people would always then follow up with a question.

What would you do, doctor? And what I was taught in medical school and residency training is you answer that by saying, no, no, no, that's not for me to answer. only you know what matters to you. So you tell me what your choice is. And they feel abandoned in that moment. And what this was teaching me was there's another way of being, and that's being a counselor. And a counselor understands your goals.

So now if I understand your goal is to be independent in your apartment or to gather people around your dinner table and be able to enjoy that, I can then say, here's within the range of capability what we have to offer. And here's what I would recommend, based on my experience at getting you, that goal you're looking at, or whether it's realistic to expect it at all. And we have to think about a change in goals. You're talking about this, about having these conversations largely from the perspective of being a physician, although you have, of course, referenced your parents.

For the rest of us, do you have any guidelines? that you think we should follow when we're, you know, inevitably thrust into these scenarios? Well, I'm imagining your conversation with your father. We have had it. Well, and, you know, that conversation can start with a story. This guy we were talking to talked about a man who said, chalked that ice cream and football on television, and that's what really matters to him. What matters to you?

Or you started by saying, dad, what are you willing to... go through in order to achieve or to live the way you want to live. And that is a conversation I think any of us can have. And then the trick is honoring that. There are periods in time, whether it's my mom, my wife's parents, where I didn't love the choices they were making. And, you know, and sometimes you just know, they're ultimately the one that take risks, not you, sometimes you're paying for it. Sometimes there were periods in time when I thought I'm just waiting for that crisis call to come when there's a fall down the stairs that she shouldn't have been navigating in the first place. Or when my father continued to go to do

surgery, even when as his hand became paralyzed, and the nurses would actually help him. they helped get his glove on and he learned how to tie knots with one hand kind of stiff and unable to do it like that that was a source of conflict saying like you know we this is this is just going to be end in disaster this is not good and needing to have that but that's you know a counselor can do that a counselor when you're in that function can advocate for and say yeah here's why you quit cigarettes. Here's why you shouldn't be in the operating room and navigate it. It takes a few conversations, but we got there. Mostly it felt like a burden was off my back that's that they're living their life and trying things and going to navigate and give them some of that

chance to do that. There are so many times in my life, and I suspect this is true for you, where you just need a little reset, some little hack to get you out of a thought spiral or to help you fall back to sleep when you wake up at 3 in the morning or help you recover from some sort of temper tantrum. You know what I'm talking about. Which brings me to a little meditation challenge we're launching over on my app, 10% with Dan Harris. Starting on Monday, September 21st, we're kicking off a five-day meditation challenge. It's called reset, and it's all about getting back on solid ground when life throws you for a little. which is inevitable in all of our lives.

This challenge is guided by the amazing Diana Winston, who's a really legendary and fascinating and very nice meditation teacher. And crucially, she has crafted each daily practice to be something you can actually do in a moment of suffering when you're struggling in some way, large or small. These practices can literally help you reset. September 21st through the 25th, Reset with Diana and Friends and me over on the 10% with Dan Harris app. You can sign up now at danharris.com. You know this, but a lot of patients and, and perhaps this is even more true for the family members,

want folks in medicine to do everything. You know, like, let's do everything we can. And yet there's, and you talk about this in the book, there's interesting data around moving into hospice or palliative care where you're just trying to treat the symptoms and keep people comfortable. I have a friend just by this is anecdotal. I had a friend who was put into hospice and lived there for six years. I was told he had three days to live.

Three days and he lived there for six years. And so, yeah, just be curious about your view on this. So one thing I'll start with before I get to the research is just saying we talk about this as, you know, I want to do everything. And the debate is not, do we want to do everything or not? The question is, everything for what? Everything that we can do to accomplish what? Is it control of the disease at all costs? Is there anything you would not want to sacrifice in the course of your care?

You know, my mother, she died just this past year. No, I'm sorry. Yeah, well, she was 89, though, and she had six years with stage four ovarian cancer. And she, you know, we had a clinician who asked her these questions. I knew which clinicians to go to, who'd gotten the training. And I went to one who did. She was great. And so, you know, my mother, as I said, wanted to keep her independence in her living facility,

but enjoyed her life and wanted to be able to do the things she did from ping pong to taking walks at sunset. And so she did take the chemotherapy, but the oncologists also identified that one of the drugs caused a neuropathy, a loss of sensation in her feet that could cause a fall. And when she started to get that numbness would stop that treatment. And that's what she did. that she got surgery to remove the tumor partially and that she navigated a colostomy, understanding that that was something she was willing to navigate, all of those kinds of things. But then as the treatment started to take away things that were important to her,

that after six years, she finally halted it. She got much longer with state four ovarian cancer than anybody would have predicted. Now, one thing I'll say is that, so the research study was one that randomized people with incurable lung cancer, stage four incurable lung cancer, and randomize them to have their usual oncology care or also see a palliative care clinician from the very beginning of their care. often people would say, used to say, hey, you know, it's not time to see the palliative care clinician. We still have options. It was thought of as like a last thing you do when you run out of medical options. And instead, they said, let's have people getting palliative care consultation right from the very beginning. And they found that the group who got those early palliative care discussions and plans focused on things like,

how do I maximize your quality of life as well as your quantity of life? Those people end up choosing to stop chemotherapy two months earlier than the group who were in the regular arm, just continue care as normal. They had much better control of symptoms and quality of life. They had lower costs. They were less likely to spend time in the hospital. And they lived 25% longer. Because when you're answer to every question is, well, let me just find another treatment to give. Let's get another operation, put you on the table. You're getting all the complications and none of the benefits and losing the things that matter to your life when it's not planned in a way that's aligned with your goals. So it isn't a question of, do you get everything or do you not get everything?

It's do you get to choose the assets and the options and the treatments and the capabilities that accomplish what's most important to you and your goals. And at a certain point, your quality of life starts to become more important than your quantity of life. And ironically, caring for that quality of life helps you live better and longer. Another main focus for many of us, especially as we get older, is staying independent. But you have a whole chapter in the book that compares to grandparents, one of yours and I think a grandparent in law, one who insisted on living on our own and the other who

just lived surrounded by his family. Yeah, can you tell the story and also what does it say about our thirst for independence? And they're both complicated cases, right? So one was my grandfather, who was in India, a farmer, in a rural village, and living the way, you know, farming societies of lived for thousands of years, that you have an extended family, you know, your children would inherit the farm and they'd become farmers. And that extended family would end up taking care of you into your old age. He continued, he died at the age of 108. He continued to be, you know, sit at the head of the table at dinner and be the first one served. He was still continued to be largely with it. He would still walk his fields. He, um, uh, you know, he died falling off of a bus

when he was still wanting to do his thing. He, he was headed to the court to contest someone who'd failed to, um, pay back alone and hit his head. Um, and, you know, that kind of society where family takes care with you, of you and right to the end and you remain the, the, the, the patriarch or the matriarch of the family, succeeded, but at the cost of the freedom of your child, in India in this case, it's particularly the daughter-in-law, the one who marries your eldest son becomes the person to take care of you. And then in this case, when they died, because he lives so long, you know, it would be the next oldest daughter or daughter-in-law. And people as economies improved, sought freedom for themselves. Young people wanted freedom. And we became,

you know, nuclear atomized families. And you had the rise that you see in India now, even, of nursing homes and senior retirement communities and all of those things. The other story was of the life and ultimate death of my wife's grandmother, Alice Hobson. And Alice lived for years in a home on her own valued that independence, but gradually became more and more isolated, started having some cognitive issues. Someone working as a landscaper took advantage of that and had her write multiple checks to him for the same services over and over again. And she had a car crash that went into the yard of her neighbor across the street. And that ultimately landed her in a assisted living facility in a place that was more like a hospital than a home.

Whenever we'd come to see her, she'd always say, when am I getting to go home? And you'd say, you are home. This isn't home. And understanding what does it mean to enable freedom for young people, lives that everybody want to live, and the fact that even when adults even have their choices, older adults, they often prefer not to be in the home of a child because now I'm under their rules. I'm living the way that they insist that I live. And so, you know, sociologists call it that people prefer an intimate distance, that you live nearby,

but just far away that I also have my independence and community and education and goals and activities that go beyond bingo and watching television, those kinds of places exist more and more. My parents are in a place like that, and it's been very interesting to, you know, my mother has her cat with her and is very, was not particularly social as a, as a, you know, in her, prime, but she's like the mayor of this assisted living facility. And, um, yes, she's really thriving at one point said, you know, this was the happiest period of her life. If you get it right, I mean, so many people, I know, so many parents of my friends who, you know, if I bring up assisted living, you know, it strikes terror in their, in, in their soul. But, but, if you get it

right, an assisted living can be fantastic. Yes. The, um, there's these, distinctions between senior living communities that have in assisted living and nursing homes. And the best way to understand it is that the places that many people end up plugging into are ones where you can live in independent apartments. You can get services there. Some end up needing assisted living where you are at a higher level of services. And then some need full 24-hour-a-day nursing home assistance. And enabling those in environments that don't feel like you're in a hospital, you know, I interviewed people being admitted for the first time to a desisted living or a nursing home level facility. And they react, their experience was that it was like jail. They couldn't have their own furniture. They, you woke up and went to bed at the same time every day. You know, you'd wake up, you'd get changed by an orderly.

You'd get in the pill line. You'd go eat, you know, what you're told to eat. And that has evolved considerably, but not consistently. Many, many places are quite different from one another. My mother, for example, was in a senior retirement community located on a college campus, and she could take courses in the college with the students. And she was a former pediatrician, so she loved the connection to young people. The young people worked at their center.

Sometimes, you know, some of them were learning physical therapy students. Some of them were staffing the cafeteria. Some of them were involved in activities and vice versa. And she started a ping pong club every day. And I remember walking in one day to pick her up for lunch. And the group was all bursting out into tears laughing. Three of the four were at very, very, stages of dementia, some cognitive, significant cognitive impairment. My mother had mild

cognitive impairment, nothing near dementia. And she, I finally got to said, you know, what are you guys laughing about? My mom said, none of us can keep the score. I'm the only one who can keep the score, but I can only keep the score if I call out the score every time at the end of every point. And I forgot to call out the score at the end of the last point. and now we're lost. And what it brought home to me, I, you know, if I answer the question, what, what, what are my priorities, you know, what, what's a minimum quality of life I'd find acceptable. I would have said, anything that would give me dementia is not an acceptable life. And here we're, here, one of her best friends had significant dementia, but she was having joy in her life. She could enjoy and play ping pong, you know, enough to have fun, turned up every day, and had lots to talk about with my mom, didn't necessarily remember everything. And my mom loved her, and she loved my mom. And that was a extraordinary lesson to me. And she wasn't, you know, imprisoned. She was in a place she actually felt was her

home. It's now been more than 12 years since you wrote your book being mortal. Where are in terms of processing your own mortality? I'm now past 60, so that was a different place than when I'd written the book in my mid-40s. And I would say, you know, when we looked for, we moved to D.C. for work in the last administration, and we actually decided that we would look for a place that's on one floor. just in case we're staying long enough that we should age and want to, you know, make it convenient. But I would say I'm still, you know, at age 60, the average American who has access to health care, access to good public health as well, will live 90 years on average. So I'm

aware on the one hand that I'm on the back end of the age curve. but living my life still as the way you do when you think you have an infinite amount of time. I have plenty of things I'm ambitious about, trying for, et cetera. But Laura Carson, since the Stanford researcher that I wrote about, has followed people as they age or as they became ill. She started her study in 1980s as the AIDS crisis hit, and it included people who suddenly became ill with HIV AIDS at a time when there was no treatment. available and they had a death sentence. And what she saw was people who are older or facing their

mortality behave differently than younger people who have a long time ahead of them. Younger people will prioritize spending time with going to a nightclub on a Friday night and hoping to meet new people will focus on their job opportunities, acquisition of contacts, income, homes, you know, your status in the world. And as we get older, you think you're going to become unhappier, you're going to become depressed. In fact, as you get older, anxiety and depression decline. You develop capacity for a wider range of emotion. Like there's a, the bitter sweet, feeling of nostalgia, being able to live with, you know, a contradictory sense of things being bitter and sweet at the same time. And you tend to close your circles more. You focus more on

family, the closer friends you have, relationships, and less on those other things. And the interesting thing was during this study, that's the pattern you saw even when young people became sick. It wasn't a brain development thing. It was a perspective. It's whether you had a perspective that you had a shorter amount of time or essentially an infinite amount of time. And if you had less than 10 years, then you felt you had a shorter amount of time. If you had more than 20 years, you basically acted as if life was infinitely long. And you really fell into these two categories. But there would be moments that came. During the study, 9-11 happened. And they were doing the study in Hong Kong and the SARS epidemic happened. And at that moment, everybody

reverted to a life-as-fragile approach. They wanted to go home instead of hanging out in the nightclub. They wanted to see family. They cared about pulling together and what really matters. And they were actually relieved of some of the anxiety, depression, things like that. And then six months later, they were back to how we live. And so I'm still in the stage of trying to do stuff going on a podcast with you. You know, I still have things that I'm excited about and interested in solving in the world and trying to address and new things I want to try and new people I want to meet. But I am, you know, transitioning to also nurturing these friendships that have gone on now for 40, 50 years of my life and make time for staying close with them.

Just came back from a week summer holiday that we take with five other families where we've been gathering together for four. 40 years and those things start to matter more and more where I was kind of, you know, liable to blow it off a couple decades ago. It's so interesting that you can write a whole book about mortality and still kind of in the back of your mind, even though you know it's irrational, feel like you're going to live forever. Because I don't have evidence every day of my mortality. I have things that you know, they're different from my 40s. I'm aware that I'm having losses, that I'm not gaining things back. I'm not as fast as I used to be. I don't think as fast as I used to think. And finding ways to compensate for those things, I'm an avid tennis player. And I'm now having to

change my game considerably at 60, where, you know, I was power and to some extent speed that And now I have to be much smarter. And I think I actually play better than I used to. And I'm holding my game up, at least, by playing smarter. It's such an interesting kind of bug in the human operating system that, like, we know intellectually we're going to die, but we don't live like it. You know, I think there's a great line in the Indian epic, the Mahabharata, I think that's how you pronounce it. And the line is one character asks the other, what's the most wondrous thing in the world? And the other person says that we're surrounded by aging, illness, and death.

And yet we don't think it's going to happen to us. What do you think that's about? Well, I mean, the average lifespan of human beings right into the beginning of the 20th century was to your mid-40s. And the fact that we doubled the human lifespan worked against. nature and now we're living beyond our nature. And in that period, we have an extended range of being able to live with fragility. And our management systems, our internal biological management systems are made for expecting demise to occur fairly rapidly once you start having aches and pains and limitations and, you know, a cardiac condition.

or a lung condition, whereas now you can live decades with all of those things and live a much higher quality of life than ever in history. And so we adjust our perspective based. You know, what really Laura Carsonson's work showed is that we tune our perspective based on the evidence of whether we're actually mortal and fragile. And when we don't have immediate evidence of our own mortality, when you're not waking up and every few weeks realizing your cancer is progressing or your heart disease is bringing you to an end stage, then you have purpose and things that you do live for. And that's why those questions matter. One of the things I argue in the book is everybody has a loyalty, something that they're willing to sacrifice themselves for, even die for, that matters to them. And that might be your kids. It might be an idea. It might be a project, an accomplishment.

It might be beauty, religion. Getting to serve, figure out those things and then serve them is what, you know, is what, matters and can matter all the way to the very end. And I think in our, as we get older and get to live these long, much longer lives than human beings had, we get to serve purposes like that for much longer periods of time. What are your purposes? You know, what would I really sacrifice myself for? My family, for one, my children, my wife, my sibling, my sister. Number two, I would say is I've found purpose in trying to make the systems around health better. I've been fascinated for my whole career around the idea that we have learned how to double

the human lifespan, but don't know how to deliver it affordably, effectively, give people these opportunities to achieve their loyalties. I'm interested both in the human experience and how we make our systems more. effective at addressing those kinds of problems. And a lot of my work and jobs is sort of at that public level of making our systems better and more effective over time for solving these problems along the way. Those are my two big ones. For whatever reason, I get a lot of pleasure and joy out of whacking a little yellow tennis ball around a square box. And that also goes right in there as one of my priorities. I can't figure it out. But I'll do that for hours.

I buy it. I get tennis elbow, so I can't really do it, but when I get a chance to do it, it's very fun. And you're doing it with other people, you're moving the body, all those things feel good. I've been talking with my friends that there's ball people and non-ball people I've decided. The ball people can't make any sense of people who want to go biking three hours up a mountain or, you know, endurance running or any of those things like runners. Put me 10 minutes down a road. I'm like, what the hell am I doing? Why am I doing this? This seems crazy. But then they say, the non-ball people say, why are you chasing a little yellow tennis ball around? Like, what keeps you going for two and a half hours doing that? And the ball people just like throwing a ball in a basket

or hitting one over a net. Talk about strange wiring. Both of those are bizarre. I'm non-binary in this regard. I like both. You do both. So there are people who are both, huh? Yeah, I mean, I do much more the non-ball stuff because I have so many injuries that prevent me from like playing tennis or doing other things. But I would, if left in my own devices, I would liberally do both. Speaking of aging. After the book, you moved to Washington, as you mentioned, and you were running USAID, which is for people who don't know it. One of the soft power wings of the of the U.S. government where we spend

money to help people in other countries. And we've just lived through a time where the Trump administration gutted it. One study from the Lancet, I believe, said that this conservatively has probably led to or will lead to tens, if not hundreds of thousands of unnecessary deaths. I'd just be curious what your, yeah, how you're processing all this, what your thoughts are, how you think we should think about it. Yeah, and my role there wasn't leading the whole thing. I led the global health work of USAID, which is one of its biggest areas. My observations all stem from why I even took the job in the first place. Much of my work that I'm excited by including this work around aging and the end of life is around making making it possible for people to get the benefits of everything we have discovered to enable a longer, better life. And one of those gaps comes from simply poverty in the world. The lowest

income places in the world have half the survival rate of other places. And getting to USAID and again to lead its global health work turned out to be the best job in medicine I've ever had and likely the best job in medicine you've never heard of. I had 3,000 people in 65 countries and Washington, D.C. deploying on the one hand, what seemed like a lot of money, $8 billion a year. On the other hand, was about half of my hospital budget in Boston, $22 per American taxpayer out of $15,000 in the American tax bill. But with that, we were reaching hundreds of millions of people by strengthening systems for vaccination, for reducing deaths in childbirth, for addressing HIV, malaria, TB, for fighting outbreaks and preventing those outbreaks from reaching home. And the result of that has been documented

to be, over the last 20 years, 90 million lives saved. In the countries where we worked, we cut the child mortality rate 32 percent and the overall mortality rate by 15 percent. It was great for the people we were serving and supporting. It strengthened countries to get onto their own feet. And I saw this from India, in India, where my parents grew up and where I would visit as a kid. Not only did we give food aid, but we provided the technology, scientific training, and so on, for what's called the Green Revolution, where India went from a food recipient country to the fourth largest exporter of food in the world, feeding the rest of the world and not only itself.

And those kinds of accomplishments I got to build on. It was incredible as an experience. So to come out the day that I left, noon on inauguration day as the great American tradition, the election changed the president and we peacefully handed over power and responsibility to the Trump administration. And then within hours, Trump had signed an order to freeze and halt all of the work of USAID. like overnight, a complete dead stop. Food, aid, left to rot in warehouses, medicines on the shelf not allowed to be used, staff pulled out and sent home. I've been bearing witness to what has happened. It was on an argument that USAID was a criminal enterprise, was corrupt, didn't accomplish anything.

And what's difficult is that was just a lie. The work immediately had consequences. And there have been now two different estimates that have put it in the ballpark of about 700,000 lives lost in 2025 from the shutdown of everything from HIV drug distribution to TB programs, to outbreak prevention and surveillance. So we are still in the bomb blast radius. There is more ongoing damage. There's some of the work that has come back. Then there's been a strong backlash.

Not only from liberals, this has been a longstanding bipartisan supported effort over 60 years since John F. Kennedy formed U.S.Aid. And I don't think it's for nothing that, on the one hand, there's been a cut of $40 billion for overall assistance to countries, but a rise of half a trillion dollars in the war costs that we have because we've walked away from the idea that we offer a helping hand first before we show a fist of domination to how we approach the world. And it's not only unpopular abroad, it's unpopular at home. We see America as being a force for good in the world. USAID was one of the ways that did that, and people want to have those kinds of efforts

continued. So the Republicans and Democrats came together to vote a budget that restored funds for foreign assistance and keeping the shell of USAID intact. The administration is not necessarily kind of spend. that. They have held that funding back, but we'll see what happens. One last question for me before we get to our final segment. What's your take on AI in medicine and how we as patients should be interacting with AI, if at all, when it comes to our help? The best description I've heard is to say that AI is not going to replace your doctor,

but doctors who use AI are going to replace doctors who don't use AI. And as an intelligence at our side, I already see the ways that it can be dramatically useful. You know, most of many clinicians have adopted AI. They call them ambient scribes that will record and do your note-taking for you. and it's reduced the time that doctors require to write their medical notes and spend more time with patients. You'll see patients getting more, you know, people turning to AI can get better information and more clarity. Taking it as gospel is a bad idea. I often, when I'm asking questions of an AI bot, will ask multiple ones so that I,

I'm triangulating among different sources. It might be Claude. It might be Gemini. It might be open AI. So I think there's important value that AI is bringing. I'm not seeing the signs that AI is different from other technology breakthroughs that have come before. We have had technology breakthroughs that gave us the GLP1 drugs, for example, for controlling obesity that have replaced surgery for ulcers with a pill. And AI is going to be another one of those things. know, it might be very soon the best reader of your mammogram. It may be the best initial diagnostic for some dermatologic conditions. But as a, but knowing which ones it's going to be the best for, which ones it's not, and what to do now based on what it's advising,

how to deal with the risk of being wrong, et cetera. Those are still things that you, want to have a co-pilot with. And I'd want a clinician who uses these capabilities alongside. And if I, and as a patient, I want to use this kind of information with people I trust as clinicians. A lot of promise, a lot of peril, a lot to be figured out. Let's do this. We've been doing this closing segment. We're just a couple weeks into trying this. It's called What's Good. And we just ask the guest, you know, what are you excited about? It could be a book, movie, record. Don't say anything in tennis. You've already used up all of your tennis chits here. Could be just some little practice or habit you've formed in your life. And then I'll give you one for mine. The first thing I thought of was the lunch I had today where my wife has showed me that if you put chimmy churry on a ham and cheese sandwich, it's amazing. And it is amazing. So there's that.

That sounds disgusting. What are you talking about? It's absolutely delicious. But, you know, life is good right now because I've finished my first draft of my next book. I've got a cool project we're working on to find new ways of addressing our shortage of mental health beds for people. Like this, you know, I just get excited by, I still get excited. by things like that. And a little chummy-turi. What's the next book?

The next book, and I haven't learned how to describe it really adequately, but the topic is how minds change. So how do people change their minds about things? We've, at a time when we feel kind of hopeless that anybody is going to change their minds, it is mining and understanding how did we do things like, we got cigarettes out of bars and restaurants and airplanes. We have solved many problems and are in fact solving, continuing to solve many problems. And so, you know, it's understanding how people actually get things done in the face of resistance, including things that I've tried to get done. There's many failures I talk about along the way as well, but that's the next book.

That's fascinating. Will you come back on when the book comes out? Yes. I'm going to hold you to that. It's not till probably till the end of next year. But I do have the first draft done. Great. Congratulations.

I'll give you one from my side. It's a TV show that I just started watching with my wife called Furious. It's on Hulu. It's incredibly well done. All of the performances are just incredibly powerful. But the writing and the subject matter are very powerful. It's really about female rage. It's about female rage.

about a female serial killer and the female cop who chases her down. And when I first heard the conceit, I was like, I don't know, but actually, it's extremely well done. Again, not only just on the level of the performances, but on the issues it explores. Elizabeth Maryweather is the woman who created and wrote it. She also wrote and created a show called The Dropout, which was about, what's the name of that woman who had that bullshit blood testing company? Oh, Elizabeth Holmes? Yes, yes.

So she did that when that won like all the awards a couple years ago. And now she's back with Furious. And I'm annoying my wife because as we watch it, I just keep saying this is so good. This is so good. That's amazing. Well, that's a great recommendation. I always end up watching these, you know, mainly cop shows, especially British cop shows. I'm watching this Irish, well, northern Irish cop show called Blue Knights now, which is...

Blue Knights or Blue Lights? Blue Lights, you're right, blue lights. I've been meaning to check that out. It's harrowing, but it is, I'm completely absorbed. I might use that on a future, what's a good segment after watching it. Such a pleasure to finally meet you again. You heard about you decades ago and have read you in The New Yorker, and it's great to meet you, and I really appreciate your time. Thanks for AFMI On. Look forward to it again.

One last thing before I let you go. If you want to listen to this show without ads, check out 10% Happier Plus, which is a subscription that is available right inside Apple Podcasts. If you become a subscriber, you'll get every episode ad-free. That's new episodes and all the episodes from our vast 10-year podcast. Plus archive. Look for 10% Happier Plus in Apple Podcasts and just hit subscribe. And a quick heads up. If you're already a subscriber to my app, 10% with Dan Harris, you've already got access to ad-free podcasts. Ad-free listening is baked right into your app subscription along with everything else, so please don't pay twice. You can check out the app at Dan Harris.com and you can check out 10%

happier plus inside Apple Podcasts. Thank you very much for listening to the show. I deeply appreciate it. soon. Give us. Thank you so much to everybody who worked so hard to make this show. 10% Happier is produced by Tara Anderson, Marissa Schneiderman, DJ Kashmir, David Hart, and Hayden Broome. Our recording and engineering is handled by the great folks over at Pod People. And Nick Thorburn of the indie rock band Islands wrote our theme. Thanks for listening. Peace.