The Checkup with Doctor Mike - Debating The Value Of Eastern Medicine (Ayurveda) | Healthy Gamer Dr. K

Episode Date: April 11, 2024

Buy Dr. K's new book "How To Raise A Heathy Gamer" here: https://www.healthygamer.gg/how-to-ra... Follow Dr. K and the rest of @HealthyGamerGG here: Twitter/X:   / dr_alokkanojia   IG: https://www.instagram.com/healthygame... 00:00 Intro 01:30 Risks Of YouTube Medicine / Mental Health Stigma 27:25 Mindfulness and Enlightenment 32:30 Ayurvedic Medical Tests 54:45 The Weaknesses Of Ayurveda 01:11:10 Why Ayurveda Is So Popular 01:21:26 Why I Don’t Like Ayurveda 1:39:00 The Advantage of Ayurveda / Placebos 1:56:32 How Much Time Matters 2:07:26 How Do We Know “Thought” Exists?

What frustrates you so much about Ayurvedic medicine? It leads to a fundamental misunderstanding of health care. It opens room for health gurus and hucksters to take advantage of people. Now I'm understanding this conversation a lot better. So I noticed that this was becoming very antagonistic, which was really weird because I actually agree with the majority of what you're saying. I'm not talking to someone who has an open mind. If you presented some data or information here that showed Ayurvetic medicine, is way more accurate than you think it is.

I would have changed my mind today. Dr. Kay, more commonly known by his channel tag, Healthy Gamer, is a popular psychiatrist who has found success online educating on the intersection of mental health and gaming. He has a viral Twitch stream where he interviews creators about their spiritual and mental health, myself included. Today we were planning to dive in and speak about his new book, How to Raise a Healthy Gamer, which is available now,

who we actually found ourselves in a somewhat contentious discussion about Ayurvedic medicine. Ayurveda is an ancient Indian medical system based on ancient writings that rely on a natural and holistic approach to physical and mental health. For what it's worth, I think as an expert, Dr. K is one of the most honest,

if not the most honest voice when discussing the benefits and harms of Ayurvedic practice. So as ecstatic to speak and learn about what's valuable versus what's not about the Eastern practice, I actually learned a lot in this conversation and I hope you will too. Dr. Kay.

Dr. Mike. It's very rare that I sit in front of someone who has significantly more experience discussing health to a huge audience online because there's not many people doing it, period, but to do it for the amount of time that you've done it, not just years that you've been online, but also when you stream, you spend a lot more hours in front of the audience. For me, when I make content online, you know, we hyper-edit a fast-paced moving video, 10, 15 minutes. Now I'm entering a little bit more into the podcast space. How do you do it and not get in trouble?

So, you know, it's a great question. So we'll see how much trouble I get into. Well, let's get into troubles today. That'll be fun. And so I think a couple of things to keep in mind, right? I think just being super careful about what you say, what you don't say, I think steering clear of like medical advice. So I think what I, the way that I kind of frame things is when I make content online, I almost

think about my target audience is like residents. So if if I'm talking about, let's say, a clinical condition like borderline personality disorder, I frame it in the way of, okay, if I was teaching a group of residents or medical students or even premeds, how would I explain this condition? So that's really what I usually think about. And then I'll prepare lectures and just keeping it more educational. What about when you're having conversations with a guest, and I've struggled with this myself a lot. I've had difficult conversations on this podcast where someone brings up either a past trauma

or you could see that they want to talk about a past trauma. And I get uncomfortable, and I'll explain what I mean by uncomfortable, that I don't want to become their doctor on camera, right? So I know what next question my doctor mind wants to ask, but I also need to be hyper aware that I don't ask that question and become their doctor. So how do you kind of ride that line and make sure you're doing this ethically? Yeah, so it's a great question. So I think we have a pretty rigorous informed consent process that not many people are aware of. So, you know, most people will see like the final product, but we go through a rigorous informed consent process. We also have like a boundary

setting call before we meet someone or we offer a boundary setting call for anyone who wants to take advantage of it. And that usually is a chance for people to say, we don't want to talk about this or I do want to talk about this. And I think the main thing to keep in mind is that if you think about your job as a physician, you know, the process of a diagnostic interview is very different. So you're usually thinking about what are these, the alternate diagnoses, you exclude certain kinds of things, you assess every patient. So for example, like for psychiatric intakes, we assess for suicidality, homicidality, psychotic symptoms. So if you really look at the process of diagnosis, it's not just talking to someone about their life. It's literally

assessing for any number of conditions. And I think that's where it gets a little bit tricky because talking to someone about their life, which is usually what we do, and then sometimes we'll also educate about conditions. So there's absolutely like a concern there. I think we try to get through it by using a rigorous informed consent process, really taking a more educational approach. And it seems to have worked pretty well so far. Yeah, I, there's many times where I know that there's a question to be asked that will be very powerful and would create some emotions, but it feels manipulative to ask it, if you will. Yes. So I'm like, oh, I don't think I should do it because I don't think this is, now I'm crossing that boundary. And I can even talk

about a specific episode where that happened, I was interviewing Steveo, and he was talking about his childhood, and he was talking about how it's impacted him and his decision-making to be a daredevil on jackass. And there was probing that I wanted to do to figure out how he got to this place where he's at. But I felt like if I did that, I would be putting my doctor hat on. Do you agree with that notion, or do you think I, that's a safe space? I think we have a challenge, right? So like everyone says, so we have a mental health crisis. Suicide rates are increasing, depression, anxiety. We're seeing an evening out of body dysmorphia between men and women. We're seeing an evening out of ADHD, equality in all things. So we've got this mental health crisis. And the

question is why, right? And this is where we have, you know, organizations that will advocate for destigmatization of mental illness. So the question becomes, how do we do that? Right. So now, because mental illness is a little bit different because we've been so. careful about talking about, which I'm all for, right? So I don't conduct clinical interviews. I never have my patients on stream or anything like that. And at the same time, like, what is destigmatizing mental illness literally look like? Like, how do we do that? So people can have awareness campaigns, which is like fine, but I don't think that that's worked because that's what we've been doing. And this mental health crisis has happened on the watch of everyone who is

focused on public health medicine or whatever, right? We've got advances in neuroscience. We've got all this kind of stuff. And it's not working quite the way it's supposed to. So part of what I think is really important is that if we sort of think about it and we think about the concept of mental health like equity, right? So physical illness and mental illness should not be treated differently. So a lot of people like, would you be thinking that question if you were talking to someone about their experience of being a cancer survivor, right?

So we don't have those same hesitations if someone has a heart attack or if someone, you know, has a complication with labor or is raising a special needs child. We're not like very, very touchy-feely about that. We're open to discussing some of our struggles if people feel comfortable. Of course. And the whole point is I think that's the way we should be around mental illness, is that people should be able to discuss, hey, I struggled with this, I struggled with anxiety, I struggled with trauma, here's my story.

And then to also recognize that the practice of medicine is different from talking about your experience of life. And so the North Star that we try to use is people should be able to come on and talk about whatever they feel comfortable talking about, that we don't want to say, oh, we don't want to put guardrails that, okay, you can talk about your difficulties at work, but the moment that you mention something that touches mental illness, we're actually going to muzzle you, because that's sort of what goes on right now, and like, no wonder we have a stigma on mental illness when literally no one talks about it.

I guess I have two follow-ups on that. One for the mental health stigma of it all. I definitely think that if you look back 30, 40 years, it was viewed as a weakness. If you talked about mental health, if you said you had a mental health issue, you were labeled certain adjectives that were not nice. Is that the sole reason that we have, or the major reason, that we have this spike in mental health conditions and diagnoses right now? Not at all. I mean, I don't think, nothing is sole reason. Well, majority, like the heaviest reason, if you want.

So I think it's a big reason, right? So if we sort of think about, let's look at like men, for instance. So men are very reluctant to engage in psychotherapy, like historically 70% of patients have been women. And so the question is why. So we absolutely have a stigma against mental illness, especially when it comes to sort of like some masculine identity things. So men are expected to be independent.

They're expected to be self-sufficient. So the concept of getting help is almost we're conditioned to not get help. And then the other problem is that we tend to have very poor understanding of mental illness. So on the one hand, you know, we'll have people who will not really understand what it's like to truly be in a depressive episode. So from the outside, the best that they can do is relate it to their struggles, which is that when it's hard for me to get out of bed, what I need to do is just give myself a swift kick in the ass and get out of bed. And that works for you unless you're struggling with something like a real mood disorder. So a lot of people don't understand that. And that's part of the reason that we have the conversations that we have is because

when you have a full conversation with someone about their experience of whatever it is that they want to talk about in life, whether that's spirituality or career or mental health, whatever, then we start to, I think what we've seen in our communities, people are like, wow, this is like a very humanizing experience, this isn't bad. I never realized, holy crap, I am this way. This is something I've been struggling with. I thought I was always alone, because the two or three people that I tried to talk to seem to have no experience of this.

Okay. And by the way, I don't disagree with the notion of that it's important to break the stigma. I'm kind of just playing devil's advocate or creating the conversation. Push, bro. For the idea of talking about, let's say, cancer or heart attack in comparison to talking about mental health, on one hand, I see the value of that, right, that we should treat mental health like a physical symptom. Like you have a broken bone, you need to go get it fixed, the same way that if you have a mental health issue, you can get it fixed and talk about it.

But on the other hand, there's really subtle differences that are super important. For example, if a primary care doctor who saw a patient in urging care for a sore throat ends up dating that patient, there's less of an ethical dilemma than if a psychologist or psychiatrist ends up dating their patient, do you agree with that? I don't know on a technical sense if I agree with that, but on a practical sense, sure. I think there's a very different level of clinical relationship if you're evaluating a sore throat, which in a one-time clinical scenario, versus generally speaking, if you look at a psychiatrist who are therapists who has a long-term relationship with a patient, I think there's a big difference there. Right. Like you would, like, I guess one would check for conflicts before taking a patient on, whereas, like, I would never do that as a primary care doctor seeing someone for a sore throat. So I feel like there are some intimate differences between the two. Oh, absolutely. So I don't think that they're one to one by any means. Yeah. I mean, so I think that oftentimes, especially with psychotherapy, psychiatry, psychology, you're discussing more intimate and vulnerable things that. have to do with more, they're more intimate and vulnerable. Yeah. So, but I would sort of say that a better analogy would be like, do you think that, let's say

I'm your oncologist for two years and I help you overcome cancer and in that process, I get to know your family and things like that versus I'm your therapist for two years, do you think that those are ethically comparable or do you think there's still a difference there? I think they're more comparable, but still with mental health, I think in knowing the influence one can have with the power of words in an intimate setting, the mental health situation is still different. Do you feel like that's fair?

Yeah, I think it's very fair. No, no, no. I think it's very fair. Yeah, that's why, like, I don't know, like, when I watch your interview that you did with Graham, Stefan and Jack, and I'm watching it, and there was like a section where you were doing some psychoanalysis of them, and I'm like, how do you do that? because, like, I wouldn't even feel comfortable discussing a sore throat on a topic. Where is that line for you, basically, is my question.

Yeah, so if we look at what I did with Graham and Jack, so I wouldn't call that psychoanalysis. So, like, I think this is where a lot of people don't know what psychoanalysis is. So people will sort of, so I specifically, I was pointing out certain dynamics that they have, and I was talking about Ayurveda and a couple of these other, like, things. And I was educating about that using them as examples. But if you look at that, you know, I'm not assessing them. If you kind of think about that, let me put it this way. Let's say that that is the interaction that I have with someone who is presumably a patient.

Would you consider that medical care? Like did I, would you say that that is, so if someone comes to you and that's the kind of interaction that you have, right? Does that qualify as diagnosis or treatment in your book? I think it partially is, yeah. I think when you're getting a history of present illness from a mental health condition and as a trained individual in that area, asking questions about mental health and then giving your read on it is partially a history assessment, et cetera. What would be the condition that you would say I was assessing for in that situation?

personality disorder potentially um mood asking those questions and then giving your read of it again i think when you're interpreting what someone is saying from your state and they're looking for you to have the answers i i feel like is that potentially making a diagnosis and maybe i'm wrong and no so so no i think this is this is this is a fantastic conversation something i've thought about a lot and i really appreciate your perspective so let's just think through that right so here's the way that I think through it. The first is that I, like, if I was precepting a medical student or resident and they did what I did and they said, I have assessed this person for a personality disorder, I would fail them. Well, of course, that's why it's not complete. Right. So, but I think

there's a difference because if that is, if you're saying that this is not sufficient for a personality assessment, then it is also not sufficient for a personality assessment. So if someone did that and they said, I assess this person for a mood disorder, I was like, no, you didn't. You didn't assess their sleep, you didn't assess their anhedonia, you didn't assess their guilt, you didn't assess their energy levels, you didn't assess their concentration, psychomotor, suicidality. I didn't assess any of those things. So if we really look at the, there's my read on it, the technicality of what it means to do a diagnostic interview, right? We have a, we literally have textbooks that say these are the questions that you should ask. So the DSM-5 has sample, you know, algorithms for assessing

diagnostic interviews. And I think the big difference is if we sort of say, okay, what constitutes the practice of medicine, assessing someone for a mood disorder, if you do what I did, and I bill an insurance company and I say, I assessed you for a mood disorder, I could be sued for malpractice because I didn't actually assess for a mood disorder, right? And so that's kind of the way that I think about it is if we say assessing for a mood disorder or a personality disorder, and I'll get to your point because I think there's validity there, if we say that this is what it is, did I do that and the answer is, in my opinion, no, therefore I didn't do that. Is that kind of make sense? Yeah, that you're saying it's not complete so that therefore it's not actually

happening. I would even say that it not only is it not complete. It's not like I did assess eight out of the nine criteria. Usually speaking, I'll assess zero to one out of the nine criteria because I still won't do a clinical assessment. I may ask them, you know, I won't assess for anahedonia, for example, or things like that. And that's where I think there is a very valid concern about, so if I'm a mental health professional and I talk to people about their mind or their mental health, does that qualify as clinical care? That's your concern, right? It's not a concern. I'm just curious how you tow the line. Yeah. Like when do you decide that you will talk about an adonia or you've talked about one now you don't want to stray into the two,

three, four, or five? Yeah. So it's a good question. So a couple of other mental things that I do is if there's a conversation that I would have with my kids or a loved one, that's something that I would consider okay in a weird way, right? So like, for example, when I'm teaching someone about their personality and the way that they react to things, I have those conversations with my kids. I think it is a part of my parental duty to teach people, like my kids, like how their mind works and how they respond to situations. Now, if we say that that qualifies as the practice of medicine, that means that I'm committing a ethical problem every single time. I try to teach my kids about their mind.

So I think that this is where you're spot on, that mental health is different because the lines are blurrier, right? Where do you draw the line between teaching someone about their mind? Another good example of this is like, if we look at people who are like spiritual counselors or coaches, and they're in the profession of teaching people about how they work and asking them questions and helping them understand themselves, are all of these people practicing medicine? And I think the answer is we actually have a clear idea of this, that the answer is no. We don't consider that practice of medicine. So then the question becomes, okay, so if I'm a

psychiatrist, can I do something like spiritual counseling or something like coaching and it be separate from the practice of psychiatry? And there the answer is yes. So as part of how do I get okay with this. So we had conversations with the American Medical Association, the American Psychiatric Association, the Massachusetts Medical Board, where we basically asked them these kinds of questions. And the answers that we generally get are that, yes, you can do this. And there are many psychologists that will also be executive coaches and stuff like that. So it's possible. I think the main thing to consider, though, is that even as a physician, we are held to a ethical standard, even in the non, how can I say this, we're held to the ethical standard of a physician, even in a non-medical

space. Yeah. Like the same way when I read an ad, I have to be very careful because I'm putting that ad not as just an influencer, but it's someone with a license. Yeah. So same principle there. Absolutely. So I think that's the standard and we basically checked with people about that. And the reason I'm so curious about this, just to give you some background is for me, A, doing this podcast, I run into the same dilemma of like, when should I pull back? When should I keep going? Two, as you mentioned with your kids, I've had people in my personal life, friends, loved ones, etc. That we would either get into an argument or they would come to see me for advice. And I'm like, I don't know where the line is here of should I be doing this because there's such

a clear conflict of, you know, you might be my girlfriend, you might be my close childhood friend, and you might be my brother. How far can I go without saying that I'm practicing medicine? Yeah. So let's ask that question, right? So let's say that you're dating someone and they just had a bad day at work. Are you allowed to use reflective listening and empathic statements when you're talking to this person that you're in relationship with?

What do you think? I think empathic listening would be fine. I think when you cross into the line of them asking, well, you're trained. Why do you think this is happening? do you think this is related to episode X that happened 10 years ago? And now it's starting to cross into more medical questions I would ask my patients. Yeah. So I think that's where the line that I use is we have clear, very clear diagnostic questions.

Right. So in that diagnostic process, that is what the practice of medicine is. So if you also look at like, you know, medical boards, they will define the, so the American Medical Association. defines the practice of medicine as like diagnosis and treatment. And then diagnosis is not just talking to someone about their mental health. Otherwise, we wouldn't be able to do that. You know, does that make sense?

We can... Yeah, I mean, like, if we look at the evidence of who has success with patients, whether it's a counselor, whether it's a social worker, a psychiatrist, a psychologist, a family medicine doctor, a friend, a priest, the results are not that far different. you agree? I think it depends on what you're looking at, but sure. Yeah. I just mean in terms of, like, success of what the patient deems success or satisfaction. Well, so satisfaction of a person, sure. Satisfaction of a patient, I don't know. I don't know that a patient with a mental illness gets the comparable outcomes from speaking to a priest compared to a therapist. And so I think the other

thing is that, you know, once you do therapy, I think there's a big difference between talking to someone about their problems in the practice of psychotherapy. And you think that's because of the specific, defined guidelines that you have to hit within the conversation? Not just the guidelines. It's also things like if we think about like a, so when I'm doing psychotherapy, I have to put together a formulation. So this is usually a biopsychosocial formulation of what's going on with a patient.

And this kind of is like a map. This is really like analyzing everything from their upbringing to biological genetic factors. and we kind of put that together. So there's a lot more formal robustness to it because we have guidelines kind of like you said, right? So the practice of psychotherapy is like you spend usually a long amount of time with someone. You do an intake with them. You spend like two hours running through all kinds of different questions.

Then you put together a formulation. Then you put together a treatment plan. And as part of that treatment plan, you do like A, B, C, D, and E. I think having conversations about mental health does not touch that. Like, what I do with my patients and my practice is very different from what I do on stream. And when you talk about, like, the spiritual aspect of it or the coaching aspect of it, where you would take on consultations online, not as a doctor, how is that different? I mean, so I spent seven years studying to become a monk, and I learned a lot about the nature of happiness and suffering. And so I think we're starting to see that blend into clinical practice.

So we'll see things like dialectical behavioral therapy or psychotherapists will teach mindfulness. So let me kind of ask you. So do you think mindfulness is a treatment? Of course. Okay. So if mindfulness is a treatment, do you need a license to practice medicine to deliver treatments? no and if you have a license you delivering the treatment carries different weight so you don't you think that it is okay for people to give treatments without a license to practice medicine correct so how do

you decide so for example like if i'm a random person on the street i can give iv fentanyl to people and that's okay in your book i think that there's a difference between medications that are supplement form it's basically based on the regulation what do you mean by that so prescription medications are not going to be given by someone on the side of the road but can someone give you a Tylenol which is a treatment yeah they can and I don't think that's not ethical mindfulness is like Tylenol it's I see what you mean yeah so it's like an over the case you would qualify it as treatment correct so do you think that mindfulness should be regulated as a treatment because when you say regulated you mean should be treated

as a controlled substance? No, so like if we look at Tylenol, right? Sure, it's over the counter and you can give someone a Tylenol, but there is still a regulation of Tylenol because it's a medical treatment. I think it should be regulated as much as the supplement industry's regulated. Okay, but so would you consider supplements as treatment? Yeah, of course. Okay, interesting. Well, vitamin D deficiency and you're giving someone vitamin D, anemia, you're giving them iron. Diet is a treatment, then you could recommend someone. Yeah, so you'd consider exercise a treatment as well. Sure, yeah. Okay. But I also, like, for example, Sam has a friend and he wants to become more fit. Sam will tell his friend, you should exercise this exercise I do. It's wonderful.

That's a treatment. His friend didn't get checked by a doctor beforehand has a heart attack dies. Is Sam liable? No. I tell a patient, go exercise, go high intensity, do this, didn't check them for cardiac disease. They have a terrible blockage. I am liable. that's very interesting yeah so i i think it makes sense i think we're basically we would agree i would use different terminology but i think your terminology i like better in what regard what do you so i would not so i think just because something has therapeutic value i think we're basically saying the same thing so i think that just because something has therapeutic value does not make it a treatment in my mind so i think that what makes something a treatment is whether you you're using it to

treat a medical condition, right? So exercise, mindfulness in that way, I think, is a evidence-based treatment for mental illness, but I do not consider it a medicine at its root. Interesting. How come? Because it's not designed to treat a medical condition. That's not why it was ever developed. But if DBT uses mindfulness as a tool, you consider DBT a form of treatment. Yes, absolutely. So how do you draw that distinction? Because DBT is not meditation. So DBT is literally dialectical behavioral therapy. So it is a protocolized treatment that includes something that is from a spiritual tradition, like meditation. Sure.

So what we're doing is we're taking this tradition of spiritual development. We are distilling it down into a certain set of practices, which are then tested and used for a clinical improvement. So is like a life coaching session or a spirituality session? a diluted medical treatment? I think medical treatment is oftentimes a diluted spiritual pursuit. Oh, tell me more. So if you look at meditation, right? So we use mindfulness for, you know, clinical treatment.

But if you really look at the development of meditation, the meditation was designed to help people attain moksha, enlightenment, nirvana. This is why we developed it. So they were not interested in treating depression or anxiety. That's not why they did it. They did it to attain a state of superhuman bliss, let's say. Can I ask you a question about that? Yeah.

I don't want to lose your track, though. So we'll come back to that. Isn't, like, it's hard to judge why things were created in the past. It's hard to even look back at history 100 years ago and try and gauge, like, for example, why I did something yesterday is hard for me to judge. Yeah. So I'm wondering how much more difficult there is to judge why someone. created something thousands of years ago. So I'm going to pose a question to you to be more specific.

Is it possible that the reason meditation was created was to ease symptoms of anxiety, depression, even though they didn't have these diagnoses, and they called it enlightenment? It's possible. I mean, isn't it reasonable to say that? Well, it depends. I mean, do you trust the people who made it? And if they give you a reason, so if I invent. something and I say I invented this bottle and this bottle is to drink water from would you how much

faith would you put that the reason I invented this bottle is to drink water from if I tell you this is why I made it as opposed to this is a bottle for my piss if I can't find a toilet yeah I think that applies in the present or in the recent past I think when you look back so far that time-wise, their definitions and understanding is going to be greatly different. So they would never have said mindfulness is a treatment for anxiety depression because they didn't have those terminologies. I hard disagree there. Really?

So you think that existed, like the idea of major depressive disorder, generalizing anxiety disorder. Oh, absolutely, right? So we have, for example, like Ayurvedic medicine, which diagnoses mental health conditions. Right? So you have systems. familiar with that. Tell me about those systems. Yeah, so you have medical systems. So this is the big thing, is that medical systems would diagnose things like depression, bipolar disorder, stuff like that. And the reason that I say that meditation was not developed to treat a mental illness is because they say that it's, they're like, I invented this thing to help people attain enlightenment, get rid of suffering. And then along the way, you will treat your mental illnesses. But that's not the goal. So the way that I understand it, and the reason I trusted is because that's what they say. So they were very clear about, and then who are we to say, oh, they didn't understand these terms and things like that? I think that's actually sort of judgmental.

I'm not calling you that, but I'm just saying to look back at them and say they didn't know better, they didn't use this language, and we are interpreting what they said based on our understanding, I think is not a good idea. So what I would say is they're very clear, right? So if you read something like Patanjali's Yoga Sutras, so this is sort of like the seminal text on yoga. and he kind of says, like, okay, here's how we're going to talk about enlightenment. And here are the different ways to attain liberation. Here's like some of the challenges from attaining liberation. Here are the malfunctions of the mind, not malfunctions, but the ways in which the mind can operate poorly. And then on the flip side, we have a comparable text of Ayurveda or something like traditional Chinese medicine.

Well, they'll talk about mental illnesses. So they'll talk about things like even things like cerebral palsy or malfunctions of the brain or things like bipolar disorder and they'll have treatments like usually herbal treatments and other kinds of things where they separate these two. One is a rogue or an illness. And the way that I kind of understand it is the use of medicine is to get you from negative 100 to zero to remove something that is malfunctioning. Meditation is a process to go from zero to 100.

So you can still increase your number. So if you start meditating at negative 100, you can get to zero. But the practice was not designed as a treatment. It was not designed to bring people to baseline. It was designed to bring people at baseline to above baseline. They had diagnoses that many years ago of cerebral palsy? Absolutely. How did they describe cerebral palsy a thousand years ago?

And by the way, I'm saying a thousand years completely uneducated. Five thousand years. Yeah. So I don't know specifically. Let me just think about what examples to use. Because I just, the reason why I'm so skeptical about this is I look at how mental health was discussed in the 1900s of like histrionic personality disorder versus hysteria in women. Like very judgmental, very culturally based at that time.

You're saying that didn't exist 5,000 years ago? No, no, no. So, dude, the east and west are completely different, man. Like, it's like, it's like night and day. Okay. So let me just give you a couple of examples. Like, if you look at an Ayurvedic textbook, they had a super cool diagnosis for diabetes. Okay.

They had, they say, go pee next to an ant-hill. If the ants drink your urine, then you're diabetic. Okay. Right? So they had a lot of understanding of physiology. What did diabetes mean to them? Um. Because to me, it means checking someone to hemoglobin A1C and seeing it fall in a specific range.

But if I'm trying to put myself in their shoes, I have no measurements of that. I have no, I'm not even aware of bacteria, right? Antibiotics don't exist. I don't know. I think they have certain herbs that have antimicrobial properties. They understand the process of sterilization. So I think they have... They do? Oh, yeah.

I mean, we just did a video on the history of the first gentleman who recommended washing hands in between treating morgue patients and delivering babies in the 1800s. What was that? That was 1850. 1850s, yeah. I mean, so I may have a rose-tinted glasses when I look at Eastern medicine. I don't think Eastern medicine is perfect by any means, but they absolutely, like, do, like, so even if you look at an Indian culture, this is how well they understood microbiology.

So in Indian culture, we eat with our hands, right? Mm-hmm. Okay. So, you know, we also don't have toilet paper. So anytime... I don't know that, actually. So, like, if you look at, like, ancient India, like, not, I'm just, you know, toilet paper is a relatively recent invention. Of course.

So how did people in India clean themselves after having a bowel movement? They would wash with their hands. So you, and then this is how well they understood microbiology. You never eat with your left hand. You always eat with your right hand and you always wash with your left hand. That's funny to me because you view that as like them practicing microbiology. I view that as them stereotyping and being rude to people who are left hand. No, I'm just saying.

Yeah. No, I mean, but there's a reason. They were aware of the bacteria, but they weren't aware that some people preferred to use. No, they were absolutely aware that they were left-handed people. What they realized is, I don't care if you're left-handed. There needs to be a convention where bacteria that come out of your ass should not be put in your mouth. Sure. And that is more important than the handedness because they literally lived in a society where there were endemic diseases like cholera and stuff like that.

So for the sake of sanitation, they would always have you eat with one hand and you never use this hand. and this is your washing hand, and these are completely separate. So one hand touches the back of the GI tract, and one hand touches the front. So they had an understanding of microbiology in that way. I don't know. Was it microbiology, or did they just see cause and effect? Probably more of cause and effect than microbiology, because this is where they also develop something very similar to the theory of humors.

So they have like these concepts of elements. But the really interesting thing is that what they basically, I think, what they did is notice all kinds of correlations. and then developed a heuristic system to explain those correlations. My question is now, is this a radical form of survivorship bias where we're remembering the ones that turned out to be right and are not pointing out the hundreds of correlations that they deemed as cause and effect, and they were magically wrong? Could be, could be. So now let's get into that.

This is great. Okay, so let's look at that in a couple of different ways. So it's absolutely a possibility of survivorship bias. So let's also remember that there are a lot of things in Ayurvedic medicine that are not correct, right? So this is where – and what tends to happen is we don't propagate those. And then what ends up happening is a survivorship bias where the stuff from Ayurvedic medicine, like let's say Ashwaganda or Brahmi or meditation, these are the things that we now associate because we remove things like heavy metals in the usage of medicine. So there's something called Rasa Shastra in which they'll use things like arsenic, mercury, things like that as treatment. But that is not nearly as popular, but that's absolutely a part of Ayurvedic medicine.

So to say that Ayurvedic medicine is right, I think is a gross overgeneralization because there are eight branches of Ayurvedic medicine. Some of them have scientific support. Some of them have scientific evidence that they're actually harmful. Now, there's even a counter argument to that, which is that they may have known something. about the usage of these chemicals that we don't. So a good example of this is if you go back 60 years ago and someone shows up and says, hey, you don't need to take an SSRI for your mental illness,

you can sit there and meditate. And what would science have said 60 years ago about meditation? That it's useless. Absolutely, right? And that's what we did say. And so they figured something out that based on our modern understanding of biology at the time was literally useless, was so antithetical to everything that there was a revolution in biological

psychiatry, we're like, this is complete BS. And we were so confident. And today it turns out that we're grossly wrong about meditation. Yes. But again, are we just pointing out the one time we were wrong? And we were actually right the huge majority of the time? That is what I think makes Western medicine the best. So what makes Western medicine the best is we are the best at pointing out when we're wrong. That's what makes... But that's a scientific method, is it not? Sure.

That's why people were mad during COVID that guidelines changed. And it's like, well, because we're pointing out when we were wrong. So, yeah, that's the scientific method. So I think this is the weakness. I was, I helped to organize a conference at Harvard a couple years ago.

And one of my mentors was on the panel. And so this was a conference on integrated medicine. So there were a bunch of like Eastern medical practitioners there. And they kind of asked this question. They said, like, what do you think needs to happen for Eastern medicine to be more widely accepted? And my mentor, brilliant guy named John Daniels, said, you guys need to let your treatments fail.

The problem is there's such a pissing contest between Western medicine and Eastern medical practitioners that no one on the East is willing to say, yeah, this treatment sucks. So the way, the one thing that we do really, really well, which is I think why allopathic medicine, talking about selection biases, but let's talk about, not selection biases in a the reason that Western medicine is dominated so much is because we are so good at pointing out when our medicine is wrong. So if you look at things like thalidomide or, you know, like that's such a great example of, oh my God, revolutionary medicine solves nausea. And by the way, we're never going to use it ever again, right? And so we're really good at that. And the biggest

problem in Eastern medicine is they are so hung up on getting widespread acceptance. There's this ego battle going on between Eastern medical practices and Western medical practitioners that Eastern medical practitioners are not willing to say, oh, hey, by the way, this treatment actually sucks. Is that because a lot of those treatments are less based on the scientific method and are more culturally based? So I think they're based on the scientific method, but they don't look at the mechanism in the same way that we do.

So if we look at scientific method, what is scientific method? It is having a hypothesis, testing that hypothesis, observing results. So I think they did that. That's not how meditation was developed, which is a whole different conversation about sources of transcendental knowledge and all this good stuff. But they absolutely applied the scientific method. So I don't think that you can develop as robust of a system of medicine. The big difference, though, is that we're really good at instrumentation. So in the West are a big – it's not even technically a part of the scientific method.

You can just, you know, a child can make observations, test hypotheses, and come up with conclusions. I mean, every time a child learning to walk, that's what they're doing. Absolutely, right? But they don't use a microscope. They don't understand anything about anatomy. So one of the things that I think we've actually mistaken is that in the East, they use the scientific method quite robustly. They just don't use instrumentation.

So what they did is figured out all of these correlations and causations and developed these kind of heuristic systems, even something like the concept of an organ is actually an abstract concept, right? It's not, you can make an argument that there's no such thing as an organ, there's just, everything is just cells. You can just say that about anything, about a cell. Yeah, right? That's like, I think Deepak Chopra's main thing is, like, what is HIV? That's a concept that you've created in your mind. It's like, well, wait, hold on a second. Yeah, so I'm not quite there. I think it's very easy to go. So I think they applied the scientific method, but what they didn't have was good instrumentation to elucidate the mechanisms. Right? So they, they didn't have.

microscopes. They didn't have, but they were still able to make observations that when you have a diabetic, they're going to have sugar in the urine. And if you have sugar in the urine, you can test for that by if ants drink your urine. Right. I think a lot of their scientific method approach is more so finding correlations and things that happen, which can be a form of scientific method and an introductory form of scientific method. But then in order to see, if your correlation is valuable. Can you affect it? Can you reproduce it? Can you generalize it? That is always missing. In Eastern medicine? Yeah. I disagree. Really? So tell me more about that. So like, I mean, that's how they came up with these things like Ashwaganda and Brahmi and some of these

things that we use in psychiatry, turmeric. So for example, the usage of bitter herbs in the treatment of diabetes. So what they did is I think, right? So I wasn't there. You just have these texts where they'll say, okay, if you've got someone who's a diabetic, they need to eat bitter medicine. So I think what they discovered is that when you feed someone of food that has an impact on their insulin metabolism, has an impact on their blood sugar, once this person eats bitter melon twice a day or drinks the juice of a bitter melon on a daily basis, the amount of sugar in the urine that the ants get attracted to goes down. They'll even taste urine to detect the sugar content using their tongue. And then I think they see that this leads to better outcomes over time. So I would not call that a correlation. I think at some point in the system of medicine, what you always have is an intervention

and then you measure that outcome in some way. I guess to me, unless you randomize it and control for biases, it's not that. That's a huge problem, but in the opposite way. So here's the key thing. So when you randomize, so we view the RCT as the hallmark, right? There's a huge problem with the RCT. So let's say I show you an RCT that says that cholesterol, let's say like cholesterol, lowering medication. What is the outcome for an individual patient when you prospectively give

them a cholesterol med? You're talking about number needed to treat? No, I'm not talking. Sure, but so if I come to you today. That like 99% of the time for the individual, it's not going to have an impact. But for the general population, you will see. So this is really important to understand. So our system of medicine does not make predictions about individuals. It makes predictions about populations. So Ayurvedic system of medicine is completely different because they don't care about populations. They care about individuals. So their whole system, so if you think about randomized controlled trials, what we're literally

doing in that trial is removing the individuality from our system of medicine, which then creates a problem of external validity. So the basic problem of our studies is that we can do a study on 10,000 people, but you know this is a clinician. This is why we need clinicians. because your human brain needs to take all of this data and then translate it to apply it to an individual. So in the Ayurvedic system of medicine, they think that randomized controlled trials are the antithesis of practicing medicine. Can I explain why I heavily disagree?

Yeah. Well, I agree with, first of all, the notion of why we need clinicians of taking generalized concepts and individualizing it to the person in front of us, a thousand percent. And I think that's what my residents get wrong, the majority of it. the time. I just did a video on this because the idea of number needed to treat just why I brought that up is because it's a topic where, for example, lowering blood pressure, we see population-based controlling it to a certain number will prevent 30% of heart attacks and strokes. But for the person sitting in front of you, 98, 99% of the time, it's not going to do anything. So the question of why I still, the reason why I think randomized controlled methods are still the best

for the individual is because we're throwing out the baby with the bathwater. What does that mean? We're throwing away randomized controlled studies because they're imperfect to the individual. I think we need to look at it deeper and say, right now, this is the best knowledge we have for the general public, which will ultimately be the best for you because this is the best information we have. In the future, as algorithms, as information gets better, I think we can, we can, better individualize randomized controlled studies so that we can run simultaneously thousands,

millions of experiments to know instead of 80 patients I need to give this blood pressure medicine to prevent the heart attack, only 10. So now I'm targeting the therapy more towards the individual and less towards the general public. But so then ideally what you would want is not even a randomized controlled trial, you would want trials on an individual, right? Because that's when you produce perfect correlation between your scientific methodology. Explain that to me. Too much bias when you're treating a single person. But isn't that what you're looking for?

You want an amount of bias that is specific to the person. So let me give you an example. I think bias works both ways. So let me ask you a question. So let's say like, so we now have some of these services in psychiatry where you can do genetic testing on a person. Correct to see which medication is going to have the best. So do you think that those kinds of these are not recommended by the American and psychiatric association.

I just had a patient bring this in last week. Yeah. So I don't use them usually in clinical practice because the data does not show that using these services and randomized control clauses is the fact of which is hilarious. Okay. Right. So I'm with you there. But let's say like theoretically, you know, if we could get to a point where that did work

and we can recognize that, okay, this person has this kind of serotonin transporter gene and this kind of medication is effective, do you think that, is that the kind of goal of personalized medicine is to create a, a system of understanding this person is an individual, not worrying about the population. It's what are your polymorphisms so we can figure out the perfect medicine for you. Yes, but the only way we can get there is with randomized controlled trials. How so? In order for us to know that this works on this person.

Oh, we have to say a randomized control trial that this is effective for lots of people. Yeah, so the methodology is personalized. And then we are doing a randomized control. trial on personalized methodologies to see that personalized. That I'm with you 100%. Okay. So when I look at the Ayurvedic system, I think they're closer to that personalized methodology. Don't you feel like there's so much bias in that approach, though, when they try, like for example, I had Dr. Gundry on my podcast who makes a lot of claims that disagree with a lot of the big institutions, the American Academy Family Physicians, United States, Preventant

Task Force, the American College of Cardiology, et cetera. And when someone presents information that disagrees with large bodies of evidence or large bodies of medical groups, you need to show me amazing evidence to show why you know, but the rest of the people don't. Like, you need to show me corruption on their side. You need to show me why you believe what you believe, what evidence you're looking at, et cetera. But when you're treating one person to make your treatment successful,

doesn't require a lot of evidence. How are you defining evidence? In the statement that I made, evidence that I need to know that they're telling the truth is randomized controlled data. So how can you have randomized controlled data on an individual? By scaling it.

But then it's not on an individual, then it's not a population. It's individual population. medicine. Because that's what an algorithm would do. So you're talking about doing an RCT on individualized medicine versus population-based medicine. Correct. Yeah, but I mean, I think, I don't think we're disagreeing here, but what I'm kind of pointing out is, so let's talk about clinical practice, right? So when you know what works for this person, you have a pile of RCTs, but then you as a clinician individualize your treatment. Of course. Deviate for protocols to get the best

clinical outcome. Correct. And this is a practice. It's an art. Two doctors may recommend two different treatments and both be acceptable. So in this situation, how would you describe what you're doing? Would you call this individual practice of medicine? Would you call this? The art of medicine. Okay. So I think Ayurveda leans more into that. So Ayurveda basically says, okay, if we look at individuals, there is no such thing as an independent disease process that exists outside of an individual. that every disease process gets personalized when you stick it in a person. And so their approach, so I personally think that if we want to see proper outcomes from Ayurveda, we can never do an RCT because their whole system of medicine is that depression in me and

depression in you is different, which, by the way, it's really fascinating that we're moving in that direction. I'll get to that in a second. But what I think we really need to see for Eastern medicine, the right kind of study is actually a cohort study. So what we really need to do is take a cohort of people, give them Eastern medicine, cohort of people give them allopathic medicine, and see who has better outcomes. Well, that's not a cohort.

What do you mean? In a situation where you'd randomize people and you'd say some of your, oh, you mean it's a, you want to do a comparison cohort, as opposed to give someone true Ayurvedic treatment versus a sham. No, no, yeah, I'm talking about cohort studies. So a non-inferiority trial between. traditional allopathic treatment and Ayurvedic treatment. Because the whole point is that when we, their system of diagnosis presumes that there is not a treatment for depression.

And then what we do is we take that thing, we remove all the individuality, which is a core part of their system of medicine. So their whole system of medicine is that, so there's even like, so for example, they believe that, you know, the man, I'm extrapolating here based on my expertise, but if you look at like depression, there are three subtypes of depression. So there is neurovegetative depression, right? So difficulty getting out of bed, things like that. Then we have anxious depression.

We recognize these as two clinical entities. There is a really interesting third subtype of depression called depression with anger attacks. Where the primary manifestation is frustration and anger as opposed to feelings of sadness. Now, the really interesting thing is if you look in Ayurvedic medicine, they say that there are three dominant elements. There's like the earth element. There is the wind element. And then there is the fire element.

So if you take this depressive pathophysiology and you stick it in someone who is a predominant earth type, you will end up with a neurovegetative depression. If you stick it in a person who's a wind type, you will end up with an anxious depression. And if you stick it in a fire type, these are like Pokemon, you will end up with a depression with anger attacks. So even in their literature, they have these three subtypes of depression built out. and they say that it correlates with something about your alleles and how they manifest, your phenotype.

I think we're talking about two different things. I think Ayurvedic medicine does fantastic observation. Yeah. Like what you're describing is they've observed different subs. And I think that's, you're going to get amazing validation even when you check individuals when you do good observation. I think when you say we should do a cohort study to say, see if it is non-inferior, to me, that's the same thing as an RCT. Like, it's not the gold.

Like, for us, an RCT is the gold standard, right? But we have levels, a hierarchy of evidence. And cohorts are still up there. It's not just mechanistic, right? Like, if you do a cohort study. But a cohort study in RCT are two completely different study designs. I agree. But in terms of weight of evidence, they're high levels. No, no, but a weight of evidence is fine. What I'm saying is that the RCT as a study, design is antithetical to this system of medicine. Sure. And I'm just using RCT because it happens to be the gold standard.

Let's take cohort. Let's take RCT, all the higher levels of evidence. They're not done for Ayurvedic medicine, at least the majority of it. So granted, we can't do RCT, but we can do cohort. Those things aren't done. So I feel like we are taking. what they're doing and you're seeing it as a leaning towards story towards observation away from the evidence-based model.

And I see it as full one-sided. I don't follow you. You said earlier a statement that it leans towards the story-based, the individual-based versus the group randomized controlled. I think it doesn't just lean in that direction. I think it's fully in that direction. Absolutely. Right. So I think Ayurvedic medicine is not about populations. It's very different. So I think that that's fair. Well, for example, you were talking about the art of medicine. I think that there needs to be a cautious balance between taking good quality evidence, whether that's RCT cohort, et cetera, and then balancing that with the individual in front of you. But I think in Ayurvedic medicine, we're just having full on art.

100%. So there are. That's not 100% because they are taking into observations and all that. So, I mean, I'm sort of addressing the questions you're asking, but I am not a proponent of Ayurvedic medicine, even as it stands today. I know it sounds kind of weird because I'm talking about it. So before this whole healthy gamer thing, my actual area of interest was evidence-based complementing alternative medicine. So there are all kinds of problems that we haven't even touched on.

I mean, here you are saying, what about this, what about this? I can dismantle Ayurvedic medicine because there are fundamental weaknesses. The first fundamental weakness of Ayurvedic medicine is that you have no way to gauge practitioner reliability. The good thing about allopathic medicine is that at least in the United States, if you finish a medicine program, there are standards that people can expect. If you go, you're a family physician, I'm a psychiatrist, but two people have a heart attack on an airplane, they're going to get some comparable care, right? even I can handle that some. So the biggest problem with Ayurbethic medicine is when you have this individuality, how do you judge the quality of a practitioner?

How do you know ahead of time whether this person is good or bad, whether there's biases in their patient population? If their patient population has high socioeconomic status and this practitioner is very charismatic so they're engaging the placebo effect, how do you even know that their treatments are working at all? This is a fundamental problem with Ayurbetic medicine, which is that, the good thing that we get, this is why I think allopathic medicine is grown so well, is because it is reliable. Irobedic medicine, I do not know that it is even 10% as reliable is the practice

of Western medicine. So if you think that, why do you discuss Ayurvatic medicine principles often? Because I think there is a huge amount of utility to it. And just because the, so if we can improve reliability on the Ayurvedic side, then I think we have something very potent. right? So, and the other reason is because I think that, like, what is the thing that you think that's potent? What do you mean? You said that if we approve reliability, we'll have something on the Ayurvedic side that's potent. What would be potent? So I think that they take this individualized approach. So in my clinical practice, the more that I, so I think we get taught in Western medicine or in medical school, we tend to get taught the population-based medicine

way more. And like you said, we call it the art. Why do we call it? Why do we call it? it the art because we don't have explicit systems. So the whole point is in... There's subjectivity to it. That's what art means, right? Well, the reason we call it art is because we haven't made it scientific. Does that make sense? We haven't conceived of a way to make the art of medicine scientific, which is why we call

it the art of medicine. But there is absolutely a logical scientific. scientific method going on in your head. I think it's an art not because it's not scientific. I think it's an art because it's not standardized. And maybe I'm just mixing words. No, no, no. But that's exactly my point is we have not developed a standardization.

We have not scientifically broken apart the art side of medicine. I don't think that that can happen. Yeah. Well, so there's a system of medicine that's done it. Which is what I remember. That's what I'm saying is that they've taken the individuality. Do you believe that, though? Yeah, absolutely.

there's lots of flaws but i think that that there there is they've done it yeah you mentioned we need to bring some of western medicine into irovedic practice to improve iervedic practice i view that as not an optimal use of time is probably the wrong word um i would view based on how you describe irovedic medicine that there's a lot of problems 90% of it has issues etc etc why not take what works of Ayurvedic medicine, the art aspect of it, and bring it to Western medicine, as opposed to bringing Western medicine and trying to fix something that is really very problematic already so far gone. It's a great question.

So the first thing is that I think the question is sort of moot because I think both are happening simultaneously. So I think as we progress in our scientific understanding of medicine, we are moving closer to Ayurveda. So that's happening automatically because I think that as we're discovering more of truth, we're just moving in a particular direction of individualized medicine, which is the whole backdrop. So if you look at our Western system of medicine, the idea is that a disease process is independent of an individual and has a treatment. So the whole point of an RCT is let's remove all of the individuality, all of the specificity from an individual patient, because

if we take an individual patient, we treat cholesterol in this individual patient. We have no idea how that's going to apply to the other 9,000 people we treat because this person is an individual. So let's remove individuality from the equation. Let's look at high blood pressure and let's try to isolate this disease process. Then we run into a problem in Western medicine because you can isolate this disease process in a laboratory, but the moment that you have a real person in front of you, things get complicated. Agreed? 100%. So Ayurvedic medicine, just looks at it from the opposite direction. They kind of say, okay, let's start with an individual and let's understand what works for this person. And then they also generalize. They sort of

also have, you know, diagnoses, right, which obviously means that it's not, it's not, there's diagnoses that are shared amongst individuals, but they start from a more individual lens. We are starting at a population level and we are trying to narrow down to personalized medicine. They start at personalized medicine and they sort of extrapolate out to a more general way. Isn't that flawed by design? No. It's only flawed by design if you presume that the population base and the system, the

existence of a disease process that is independent of people exists. Wait, to say that again? So do you think that hypercholestrolemia can exist outside of a person? Like exist in what way? Like, on the definition of a text, in a textbook, it can. Okay. So, like, can you have hyper cholesterolemia outside of a person? Yes, in a petri dish.

Okay, right? So when you translate that to a person, it becomes individualized, right? And then our core pathophysiology, completely agree that you can say, okay, whatever, there's something that can exist in a petri dish. When you translate it into a person, you are adding individuality to it. Maybe the word bias is good here. I don't know the way that you're using it. I'm not 100% sure.

So all I'm saying is that the whole art of medicine is we have these general principles that are scientifically true and we apply them to an individual and then things get muddy and we have to include the art of medicine, right? All Ayurveda does is they start with the presumption that a disease process and an individual that every disease process is going to manifest in a unique way and that that is the foundation of how we are we are going to approach treatment. so if you say is that biased in the sense that every treatment is individualized yes i'm going to make a comparison you're familiar with bro science no so when you go to the gym and you hang out in the gym environment there's a lot of guys that walk around to claim that they have the right way of exercising the right yeah and it might be the right way for them but if i in medicine try and take what worked for one person and try and scale it, I'm going to run into a disaster. Yeah.

That's why I think it's better to look at population and then try and narrow it. That's why I think the principle of starting with one and going up and generalizing is way more problematic. No, no, yeah, but so this is a fundamental misunderstanding. The whole point of Ayurveda is you don't generalize one to the broader population. You develop a system that works for each person ideally. That's what their approach is. There's no generalization.

I mean, there's some generalization, some necessary generalization. But their whole point is that you, when someone comes to you and this guy is a bro-science and he says, this works for you, the Ayurvedic doctor says, this worked for you. Let me try to figure out, the next person comes along, and they try to figure out what will work for you specifically, what will work for you specifically. They don't care about populations. They care about individuals. And you don't think that's fraught with forever reliability issues.

What do you mean by reliability? Again, like the practitioner reliability issues. Oh, no, no, it's fraud with reliability. Like, that will never get solved. I don't know that. How can you have reliability when cults can lead people to do the most ridiculous things, feel certain ways, because of the power of the mind to be manipulated? How can we ever measure what one individual is doing, whether or not that's valuable? because I feel like it's so easily corruptible when we're just treating everyone as one, one, one, one.

So I think maybe I'm foolish, maybe I'm optimistic. So here's where I'm coming from. Here's why I don't think it is an unsolvable problem. So if you look at the history of humanity, we've been faced with unsolvable problems that get solved. So I have faith that if we were to leverage even 10% of the brain power in scientific weight that we have in alopathic medicine towards Ayurveda, I think we could, it'd be amazing. what we would accomplish. That's my gut instinct. I don't know that that's true. Is it potentially an unsolvable problem? Absolutely. So what I think, though, is that what I've seen already is that it doesn't take a whole lot. So, like, I think that if we were to put, let's say, like, put together

like cohort treatments and we were to start to measure outcomes. So I do think we need to add some of this population-based stuff and evidence-based medicine. So let's compare Rasa Shastra, where someone gives arsenic and all this kind of stuff, to, for example, like Ayurvedic herbs, or or the inclusion of yoga and Tai Chi, let's actually take cohorts of these people and study and see what's better and what is it. And then I think what we'll discover is there can be a methodology

because they still teach general methodologies but the focus of the general methodology is not on a disease. It is on a person. So in Western medicine, what we do is we make a diagnosis and then we treat the diagnosis. We don't treat a person.

We don't ask, and then clinically we end up doing this, which is that we start to treat a diagnosis, but then as we actually treat a human being, this treatment of a diagnosis doesn't work like that. The person doesn't take their blood pressure medication. So now you have to have this conversation with them or they have this kind of side effect.

You have to change to this medication. So we end up individualizing. That's what makes a good doctor. All I'm saying is if you think about it, the actual theoretical, if you read a pathology textbook, which has all of our understanding of medicine, you will not find any art of medicine in there. You'll find it in other textbooks,

but not in a pathology textbook. Then in the practice of medicine, we are adding what you call the art. And all I'm saying is there is a whole system of medicine where we take the RCTs and the population-based stuff and the pathology textbook. We add the art. But this is not the bulk of our approach to medicine. This is the bulk of our approach. Does that make sense?

Ayurbetic medicine says this is the bulk of our approach. That's the big difference. Yeah, I'm just viewing starting points. Western medicine, we have the starting point. point of randomized control data, population-based data, that we can then tailor an art and improve our art. We definitely need to improve our art. I will never not support that. Ayurvedic medicine has such a fraught foundation. And we're like, let's bring randomized controlled and evidence and all that to this fraught concept already. Why? I don't think that the

fundamental concept is fraught. In fact, I said there's like 90, like 10% of it is only valuable. Yeah, but I don't think the fundamentals are fraud. I think the fundamentals are actually, I think the reason we practice is the more we practice the art of medicine, the closer we are to the Ayurvedic system, because that's what their system is. It's an individual treatment. But we end up there versus starting from there. I think that's a drastic distinction.

Yeah, it is a drastic distinction. But I don't think that one is necessarily worse than the other. I mean, I don't think that they're worse. I just think if you're trying to start, like if I was creating a civilization and I was like, okay, let me find the most effective way to bring the best medical care. If I'm making a Sims game out of this, I would create randomized population data, and then I would bring in Ayurvedic principles, individualizing it later. So let me, that's fine.

So that's your prerogative, and I would encourage you to. But I'm curious what you think about that. So let me ask you this. Do you think, what do you think is a better system of medicine, a system that is population-based, or a system that gets outcomes that are tailored to the. individual. Let's say that I could perfectly diagnose you. I did all the genetic stuff.

I could analyze all of your phenotypes. I could analyze even things like your digestion, you're absorbed, hold on, digestion, your absorption of nutrients, what kind of absorption difficulties you have. And I understood all of this information about you. Which one do you think would be better? Of course. You created a perfect example, but that doesn't exist. So the foundation of Ayurveda starts with that.

yeah but it's nowhere near it it's not even close oh this is that that's where that's where you got to be careful right so i think that it's way closer than what we give it credit for you're saying they have a perfect understanding of each they do not they do not have a perfect understanding what i'm saying is that the direction that they are moving in is to focus on the individual so we don't even focus on the individual we focus on a population so we have let's say we'll use a video game analogy. So we've leveled up to level 100 on population-based medicine. And then the reason that we have good clinicians and bad clinicians is that the good

clinicians are the ones who've leveled up to level 50 on individualized medicine. In Ayurveda, they've leveled up individualized medicine to level 100. But their population-based medicine is level 10. I think when you use that example, when you level up to 100 on the individual level, your data is fraught with error and bias and subjectivity because you're not studying it en masse and there's so many mistakes that you could make when you're just treating an end of one. Very true, right? So, but you're thinking from a population-based standpoint.

But when you kind of think about it, and when you treat an individual, you can make so many mistakes. Because that's what you do in your practice, right? You don't treat populations. You treat individuals. So how do you figure out what is best for your? individual patient who's sitting in front of you. It's fraught with errors.

It's fraught with bias. All of health care will always be fraught with error. Our job is to take the best worst approach. And to me, the best worst approach is seeing what works that's generalizable, continually fine-tuning it as opposed, if I was building a pencil or I was building a house, it's much better to have the foundation of randomized control. generalized data, and then building upwards to get the subjectivity of how you want the house to look, whether it's pretty, but without a good foundation, that house is going to

crumble. And I feel like Ayurvedic principles are built on a weak foundation. So I think that's very, very, it's a very reasonable view, right? So, and I think that there's like good data to support that view because there's a reason why allopathic medicine has spread all over the world, and Ayurvetic medicine is not. Well, that's a good question here to be had. Why do you think in Eastern culture we never got, well, not we, but why hasn't it moved to a labeling system, a randomized controls? Why has there been so much disconnect between randomized controlled stuff happening in Western medicine, but that is firmly pushed against in Eastern medicine? Why do Eastern people not like randomized control trials?

Yeah, like why didn't throughout time? Like, the way Eastern medicine is talked about now is more similar to how Eastern medicine was talked about 500 years ago. Okay, yeah. Then Western medicine talked about now than how Western medicine was talking about. Why is that? Why is it seemingly stuck in the past? So there's a lack of a better word.

What do you think are, what's the differential diagnosis? for why something doesn't change over 500 years. My skewed, skeptical belief is that it's based on culture, religion. Okay, so culture is part of it, religions. What else is on the differential? Lack of refinement. Okay. That is also on the differential.

I'm not saying it's the cause. Yeah. That it works. absolutely right so that's what's really well hold that we have that it fully doesn't work lack of refinement and that it can work those are possibilities yes so so we can't give them equal weight here and say so it's good right so now now you ask a question right that's on the differential yeah maybe the reason comes in with two days of cough cancer is on the differential but we don't talk about it because that's not valuable sure but i think in the case of let's say like let's look

at these eastern traditions so these are the traditions that gave us medicine meditation, right? So this is where, I think, part of the reason, and, like, I don't... When you say a statement like that, you know what I hear? What? When a patient comes in with two days of cough, if I say that it's cancer, I'm going to be wrong so often, but I will be right sometimes. Ayurvedic medicine, you're showing me came up with meditation.

That's that one time they called cough cancer. Fair enough. And it turned out to be cancer. So I don't even disagree with you there. So this is exactly where, like, I think that's why, I mean, I gave this example where Dr. Jeninger was like the biggest problem with Ayurvedic medicine. I'll be the first one to say this, right? So I'm sort of, I feel like I'm adopting a pro-Irovedic stance because of the way you're asking questions. But I don't use Ayurvedic medicine with the majority of my patients.

I use evidence-based techniques with the majority of my patients because they are reliable. Right. And at the same time, I'm with you that I don't know. So if you look at this text called Jarak Samita, there's like time. of treatments in there. I have no idea how many of those are effective as meditation. We even have evidence that some of them are harmful, like Rasa Shastra, right? So I steer clear of that because, but then the problem in the Ayurvedic system is if you go talk to an Ayurvedic doctor, many of them will not say, oh, yeah, this doesn't work. That's a huge problem, right? They'll say, like, oh, we don't understand it well, or they'll like kind of poo, and maybe they're right,

maybe we're right, I don't know. So I'll be the first of my area of expertise is evidence-based complementing in alternative medicine. So the whole point is that there is something very valuable here, this is my belief, something very valuable here, and we need to separate the chaff from the wheat. We need to figure out what is actually really useful here. One of the things that I think we can learn a lot from is that I do believe that their generalized approach, because this is what we end up doing in clinical medicine anyway, is we focus on an individual. But there is always a translation problem from the RCT down to the individual. But there are some major advantages that we get for that. The biggest advantage that we get for that is that on the human race,

we have outperformed Ayurvedic medicine. On the level of population, we have outperformed because in these Eastern systems, they do not have ways of testing validity. They do not have ways of separating the good from the bad. They do not have ways of measuring a good person and a bad person. So this used to be there, theoretically, if we want to be optimistic, this used to be there historically because of the way that it was taught. So there's this concept of barampara or lineage where like if you had a good teacher, and now things have changed, we can get to this with meditation. So you had this lineage where like you basically have like a system of mentorship where if you trained under this person, you're like going to be good because this person would not let you out unless they were good. There's still problems with bias there. but I think the biggest challenge that we've had in Ayurvedic medicine is we've lost some of their

fundamental safeguards like lineage, and then we've replaced it with like standardized education because that's what we do in the West. And so now we have a system that from its bones is open to things like validity, open to things like not being critical of itself, and then we are removing the one safeguard, which is this concept of barumpur our lineage. Now we're giving people degrees and certificates from universities, I have no idea how to tell whether someone is good or bad. And what I have seen as a medical doctor, like part of the reason that, you know, I studied Ayurveda, fell in love with it, and then I went to medical school. Because what I saw is that I have no idea what's the quality of education I'm going to get. I have no idea what's the

reliable, what the reliability of some of these methodology are. I've seen things that are medical impossibilities from Ayurveda. With my own eyes, I've talked to patients that are medical impossibilities, like paralysis being able to polio paralysis, right, which is a permanent condition, that's not something that generally speaking gets better. These people are able to walk. And so when I look at that, it gives me pause, and it says to me, there is potential here. So what did I do? Did I say, oh my God, there's potential here? Let me go to Ayurvedic doctor and I'm going to indoctrinate myself. No, I went to medical school, focused on evidence-based complementing alternative medicine, realize that in the grand scheme of being a doctor in the world

today, each of us can make a contribution. What do I want my contribution to be? I saw something that I thought was very worth. I saw something that I saw potential in. And I said to myself, even if 90% of is shit, I can't judge whether 90% is good, 10% is good, 50%. I have no idea. But there's something here that we in the West can benefit from. And that's been what my focus is on. What do you like about Ayurvedic medicine? What is that part? So I like that they focus on the individual. Got it. What else? So I like that they look at, so just as a psychiatrist.

So like one thing that I really appreciated was this concept of like a cognitive fingerprint. So we have this in some ways in terms of like five factor model and stuff like that. We have these personality assessments. But these personality assessments are usually done at the population level. And so the translation down to the individual is not as clinically useful as some of these Eastern conceptions of cognitive fingerprint. So when I work with a patient, doing a five-factor assessment has very little bearing on my clinical practice.

But doing more of an Ayurvedic personality assessment has a lot more utility in my limited biased experience compared to some of these generalized. personality assessments. There are some cases where those can be good, but I think that some of this stuff is quite revolutionary because it helps me understand. So even like, for example, depression, understanding like, okay, what is this person's Ayurvedic dosha? It helps inform me about how to approach this kind of thing.

Also, in my clinical practice, what I've seen is if people adopt Ayurvedic diet, they're more likely to have sustained remission at lower medication doses or be able to come off of medication. That is nothing magical, by the way. I think they just sort of figured out gut microbiome observational, and that now we're discovering the mechanism. But it's really interesting that their first-line treatment for mental illnesses seems to be diet. And my guess is the mechanism has gut microbiome modification to support serratron, I mean, neurotransmitter precursor production. That's my take. And what I've seen very clinically is when I apply some of these principles to my clinical practice that patients tend to do better.

So I'm going to keep track of it. Individualism, stratifying personality types, cognitive fingerprinting, as you called it, and then diet, lifestyle, I guess, is one of them. It seems to me, based on this conversation, Ayurvedic medicine is fraught with a lot of bias issues, etc., that you pointed out, reliability, all that. Since so much of it is inaccurate, and there's a few things that you think is very valuable that are missing for modern medicine. Why not take the concepts of those things,

like improving the cognitive fingerprinting of modern tools, focusing more in the individual approach, and stop calling it and talking about Ayurvedic medicine. Because it's sexy to talk about Ayurvedic medicine because people are passionate about it. But 90% plus is crap. And yet I feel like we're keeping it afloat.

Well, I don't know that it's crap, and you don't know that it's crap. Well, we know that it's crap because of how it got to where it is, because of the lack of reliability, the randomization. No, but we don't know it's crap. We just don't know that it's not crap. There's a big difference. And when someone makes a claim that this water will prevent you from dying or this is the anti-aging water, do you know that this is not going to prevent you from living forever? Like, do you know that I'm lying about this?

No, I don't. Right? You need to do a trial. But I'm very comfortable as a doctor now saying, no, that's not happening. Yeah. So mechanistically, it's not there. The evidence isn't there. And I've gotten to the point where even though I don't have the evidence to say. So, Mike, what frustrates you so much about Ayurvedic medicine? I'll tell you why. It leads to a fundamental misunderstanding of health care for a large percentage of patients. It opens room. for health gurus and hucksters to take advantage of people and it actually diverts our attention from ways that we can improve medicine okay so now i'm understanding this conversation a lot better so i so i noticed that this was becoming very antagonistic which was really weird because i actually

agree with the majority of what you're saying i see that yeah right so i'm the first to kind of say like I'm the one who said, hey, like 90% of it, I think could be crap. And so I was kind of struck a little bit. And then that's when I realized, like, I'm not talking to someone who has an open mind. I'm talking to someone who has a mind made up. I'm talking about it from a truth-seeking perspective. So my mind's not made up. If you presented some data or information here that showed Ayurvedic medicine is way more accurate than you think it is, I would have changed my mind today. yeah so so that's it's interesting but i think i definitely have a bias yeah so from what i've learned so so how is this conversation for you emotionally exciting in what way so do you feel anything besides

excitement full excitement that we're finding a way to truth seek together because i unlike many people who talk about iuretic medicine in this space i think you do it incredibly honestly so because i i agree with you, but I think there are a couple of things to keep in mind. So when you make a statement, like, you know, 90% of it is crap, that indicates bias to me, because we don't know that. You make a very good argument that we can't, we have to be skeptical based on our understanding of things that if I say, I show up today and I say, like, oh, like, here's a pyramid. If you meditate under the pyramid, like, it could work. And then you can always make the counterargument that until you study it, we don't know they could be right. Right. And what I'm also detecting from you

is like I think I'm detecting this emotion of frustration because of hucksters and these kinds of people. So I think your understanding of Ayurveda comes from these people. And so that's why I was I was kind of surprised because usually in conversations, I am representing your view a lot more. Yeah. Right. So I'll go to these academic conferences with a lot of Ayurvedic practitioners and I'll say like, hey, like we don't know. There are eight disciplines of Ayurveda. We have some limited evidence of this particular thing, Brumme, turmeric, Ashwaganda, like a set of herbs. We don't have a whole lot of stuff on this. And so I think it's just been really interesting. Now I understand a lot more why this conversation is going the way that it is, which is that you're asking me all

these questions, which I get the sense that you're sort of open to the answer, but I think you're asking questions that are not open-ended questions. You're asking questions where you already have a hypothesis, and you are asking me to reflect upon that hypothesis. or even counter that hypothesis or support it. That's fair. Which is, I was just... And I think our hypothesis is similar. Yeah, so I think, though...

And our standpoint is similar. I think that you would benefit from studying Ayurvedic medicine. Agreed, which is what I'm hoping in this conversation I can learn more about it. So I think just this individualized approach, it's so axiomatically different. I think there's value to it. Without a doubt. And in terms of why not translated... I think there are a couple of, I think that's good, and I think that's part of the direction we should

move in. And I think there's a slight problem with that, which this rubs me emotionally the wrong way, which is that there's a certain amount of cultural appropriation to it. So if we look at meditation, let's go back to meditation for a second. So we look at meditation and we kind of say, okay, mindfulness is scientific, this is good, this is good, this is all woo-woo. But if we kind of think about it, what's happening is we're taking the, all of it was woo-woo, and then we're taking this, saying the rest of it is woo-woo. We're taking this and we're saying the rest of it is woo-woo. We're taking this and we're saying the rest of it is woo-woo. Now, this is very reasonable from the sense of how does science progress. We have the unknown. We take a chunk and now this is known

and here's the unknown. We take a chunk. It's very reasonable. On the flip side, I think what ends up happening is if this was our original chunk and we say that this much is, and I don't think we're here, we're nowhere near that. We're like right here in meditation. If we say that this much is valid, there is a certain bias that can set in of we're not sort of recognizing that 60% of this stuff was correct. We're sort of saying 100% of it is always wrong because we move the stuff that is scientifically valid over to science and we remove it from the realm of, let's say, spiritual tradition. But have we done that? That's what's happening. Absolutely. In what way, Can you give me a specific example of that?

Yeah, so like cardiac coherence breathing. So, for example. What's that? So we have this, in the east, we have this system of prana. Okay, so this is chi or vital life force. There's no scientific evidence of this. The best example that I've ever heard is, once again, researchers at Harvard discovered that there are channels of electrical conductance in the interstitial space that are variable.

So they were like, oh, if you heard of meridians or noughties like this in Tai Chi? I've heard of them, but I don't really understand. There's this idea that we have this vital life energy that flows through us. It flows through these channels. We've biologically looked for it and it doesn't, we can't find anything. Well, we can't measure it yet, right? We might in the future. We might not just have the tools to currently measure it.

Yeah. So I'm open to that. Yeah. So that's where some people are looking for it. And one person, for example, discovered that there are interstitial channels, basically, that don't have a tissue difference. There's a change at the level of the electrical conductance, but there isn't like a physical like, you know. Atatomical thing.

Yeah. So it could be there, sure. But I think what's really interesting is we have no scientific evidence for that. So then we have these systems of something called Brana'am, which is you do these techniques, which are designed to basically stimulate this vital life energy, which we have no scientific evidence for. Okay. So when we move something, and so then we'll take this Sanskrit practice of Brana'am, and then we'll turn it into a scientific term like non-sleeing. deep rest or cardiac coherence breathing or things like that these are all yoga practices what do they mean just so i can follow along better what are the what is a cardiac breathing

a cardiac coherence breathing is basically alternate nostril breathing it's this old yogic practice called brown i am i mean or not he should be and what we kind of do is we try to figure out okay what is the distillation of the scientific principles and we're going to kind to give it a new name and i think something is lost there because the moment that we denude it of spirituality there's a good reason to do that because i think you You sort of need to do that because from a scientific RCT perspective, you need some way to standardize the protocol, and you need to make sure that everyone is, like, working with the same thing.

So there's good reasons to do that. But there's also losses in that, which is that we're removing it from the spiritual tradition, which I think is actually where a lot of the therapeutic value is. So one example of this is there's something that's growing a lot, which is non-sleep deep rest. Have you heard of this? Okay. Like micro-naps? No.

Okay. So it's a practice that's called yoga nidra. So yoga nidra is yogic sleep. So it's this like ancient yogic technique. And we basically medicalized it by protocolizing it, sort of reducing it in some ways. And what they actually do is intentionally remove a lot of the spiritual woo-woo stuff. So then we do studies on it and non-sleep deep rest has good outcomes. So we know, for example, that yoga and Tai Chi outperform standard exercise when it comes to things like osteoarthritis or mental illness.

are RCTs? You're familiar with that? Familiar with that research? Yeah. That they outperform it? I'm not sure. Okay. So there are some studies that show that. So actually, let's do a quick aside.

So that's what makes me really wonder about the value of some of these traditions. Because if we look at studies that show that yoga is superior to physical exercise. So there's one paper from, I think, 2016, the New England Journal of Medicine on Tai Chi and osteoarthritis that basically showed that it was very effective. So then, interestingly, from a scientific perspective, if we say, okay, like, if all that exists is physical, then exercise should be the same as Tai Chi. The other way to think about it is that even if it's still physical, it's not necessarily that energy exists. But when you use this heuristic or this concept of energy and you develop a practice based on that concept, the physical, biological postures that you do are somehow superior to this other set of postures that is exercise. Does that make sense or did I lose you there? No. And I'm simple. I'm not, I have to

really dump things down in my mind for me to understand them. And I'm going to tell you how it's landing for me and you tell me if it's accurate. When you put meaning into what you're doing, spirituality is a form of meaning, you get better outcomes. I don't think that's it at all. Oh. Yeah. Okay. So I think that there are. are mechanisms at play. So let's, here's, let me try to explain it better. So we have a study. You can look at the paper.

I'll send you the reference. So Tai Chi and osteoarthritis outperforms physical exercise. Okay. So now let's understand Tai Chi is based on this theory of vital life energy, which we have no scientific evidence. So then the question becomes, how do we explain this result that this practice, which is based on a non-real thing outperforms a seemingly comparable practice they're both just moving around. So there are two explanations for this. One, or probably more, one is that this thing

does exist and is not measurable. The second is that even if it doesn't exist, the concept of this existing and something about the way that they developed those practices based on this concept, It's still just completely biological, but because we were considering Chi, we developed this different set of movements, and if you look at someone who just does stretching or calisthenics or whatever, these other physical practices, that there is a difference in the physical practice. Does that make sense? Yeah, I mean, I could send a patient for physical therapy, and the physical therapist can target, like let's say someone has a low back strain, and I send them to physical therapy.

They can focus on massage and movements of their thoracic spine and loosening that up. They can focus on glute strengthening and hamstring tightness and posterior chain strengthening. They're all movements, but they're going to yield radically different results. Yeah, perfect, right? So that's what I'm saying, is that there could be, there's something about the theoretical, there's something about the theoretical backdrop that they developed, whether it's real or not real, that leads to a particular protocol, which outperforms our understanding of exercise. Right.

So I think that even if we assume that latter case, I think we could be losing something because if we even remove that theory that gave us the practices in the first place, we could be depriving ourselves of a certain methodology that leads to interventions that are quite good. I don't know if I lost you there. This is the most technical conversation about this I've had. This is great. I love this.

It's a very heady conversation because we're talking about tertiary level concepts right now of imaginary concept. So where my mind is going is that you feel that the way Tai Chi was created, we shouldn't just focus on Tai Chi. We should focus on how Tai Chi was created because there's value there. potentially, right, right. Focus on in terms of investigation. Right.

So just to give you another example, so like I was, when I was at, like, McLean hospital, I was developing protocols for specific brachyam or breathing practices to target specific illnesses. So if you look at the RCTs, what we see is RCTs on mindfulness. But if you look at what is the actual thing that people are doing, it's wildly different. Of course. And what we see is that in DBT, we'll call something mindfulness, but these are very different from mindfulness for, like, stress reduction.

So for something like MBSR, these are open awareness techniques, and there's some great research that Silberswig out of Brigham and Women's has done about sort of the different types of meditation. So not all mindfulness is the same. And what I've sort of found is that if you do traditional mindfulness for people with a history of trauma, it has the opposite effect. So traditional mindfulness is just open. non-judgmental awareness of the flow of your thoughts.

If you have a patient who has BPD or trauma, and you just tell them to openly non-judgment, open awareness of non-judgmental appraisal of your thoughts, we have all these psychological defense mechanisms that are keeping these traumas at bay. As soon as that opens up, they're going to get overwhelmed by their trauma. So if you look at the mindfulness

in something like dialectical behavioral therapy, these are not open awareness techniques. These are grounding techniques. These are things like ice diving, where you're not non-judgmentally observing anything. You are actually inducing a particular sensory focus that is so demanding that you can no longer think. So when we look at these two things now in Western science, we don't really have a good understanding of that differentiation. So I absolutely think we need that. What I'm saying is that when you take it from a theoretical process from where it was developed and you sort of consider that, it gives us a lot of,

basically lead time into scientific investigation. Because when I'm developing a particular set of breathing practices or meditated practices for anxiety versus depression versus trauma, I have this Eastern conception, which has this whole thing where they basically say this will work for anxiety, but they don't call it that. So they'll say, for example, this practice will slow down the thoughts in the mind. This practice will energize the prana. This practice will cool the prana. They use all these weird heuristics. And what I have observed in my clinical practice, so this is a small sample size. My path took me in a different direction. But what I was really working on is trying to see, okay, if we use this theory and we develop a set of protocols, this is basically

what Marshallina did with DBT in some form, we can actually accelerate the rate of our scientific research because we have these answers already here. So where is the cultural misappropriation or appropriation come in that you have a problem with. Yeah. So the moment that we remove that spirituality from it, I think we we lose that value generating aspect. Right. So why do we have to lose that? Like for example, you took the principles of those breathing practices of slow the mind or energize the mind and you adapted them to modern medical defined conditions. Yeah. Why does it, why in this scenario do you feel like you're losing the spiritual connection. Because when we publish papers about it, the more that I

include that information, which is really where I got my answers from, right? The more that I include that, the less likely it is to be published. Why? Because people don't publish that. Why? I don't know. Because it's not scientific. But the science mechanisms, theories are not scientific in nature. Yeah. So I could have a thought today that I would put up for scientific testing. How in the world would a company not want to publish something if something works simply because the beginnings of it weren't scientifically valuable? If you look at the studies, the evidence-based studies, right? These are the studies that are published. So if you look at like New England Journal of Medicine thing on Tai Chi, you'll find almost no, you'll see a small section in the background that

Tai Chi is an ancient practice based on this theory. You won't have a single line about what is actually happening to the chi in your body when you do this kind of thing. Correct. So there is a strong publication bias against this kind of stuff. I don't know why. I mean, you have to ask the journal editors. What is the value of including the history of it?

It's not history. What I'm talking about is they have a mechanism, right? So they have a theoretical mechanism with which they develop a practice. And we know from evidence RCTs that the practice is quite effective. Right. So what I'm saying is that the moment that we publish that paper and we remove the theoretical basis, it's kind of okay because we still see that Tai Chi works. There's other problems that we get into. But then what we're also doing is where we're not, it's not about credit, but where the way that this practice was developed was based on this theoretical model. And if we remove the theoretical model, we don't have that theoretical model to generate other practices or to work with that theoretical. model. So let me put it this way. Let me give you an analogy. So let's say that there's a group of aliens and I introduced to them microbiology. And I say, here are the principles of microbiology. And then I give them, let's say, I don't know, penicillin. Okay. So if I do an RCT on penicillin,

I say penicillin is great, but by the way, microbiology is all BS. We just can study penicillin. We know penicillin works. And then this alien civilization's starts just delivering penicillin because they, but they don't understand anything about microbiology. What are the problems in that? We have an RCT that penicillin works. And then we give them, and they start administering penicillin, what's the problem? Resistance? Absolutely.

Right? So this is one example where understanding the underlying theory, it becomes very important for the implementation of the practice. And what we are losing in Western medicine is we are removing that underlying theory, which opens us. up to different prospective problems. And antibiotic resistance is just a good example, right? So that was like, I knew what you were going to say.

I knew what the answer was. That's why I picked that example. So it's not sufficient to just do an RCT because there are other principles at play, and there are RCTs involved in those principles. We have RCTs on antibiotic resistance. But that's where they're understanding the theoretical basis of our treatments becomes critical to avoid pitfalls like this. Can you give me an example of something like that within the field of Ayurvedic medicine or spirituality?

Yeah. So, man, this is where things get fun. So let me ask you this. Where do the thoughts in your mind come from? I don't know if I have the answer to that. What do you think? Neurons, blood flow, firing, creating action potentials. Okay.

So neurons, blood flow, firing, creating action potentials. action potentials are all the same, right? Like you're, okay, so you're having a thought right now? Yeah. Where's that thought coming from? My brain. Okay. But is there any other thing in the causal chain that is creating that thought?

Is there anything else in the causal chain creating the thought? Sensation, receptors, et cetera. So the simple idea. So one of the places that thoughts in our brain come from, this is based on the yogic concept, So sure, it's translated through the brain, but we know that our sense organs are a source of thoughts. This is why advertising is a thing. If I show something to your eyes over and over and over again, it will trigger certain

thoughts. It will trigger certain desires. Agreed? Okay. So where else do thoughts come from? So we can also have thoughts. I'll speed run this. You're welcome to question it.

Memories, et cetera. Yeah. So memories of sensory experiences. So how do I want a hamburger? So later tonight, when you're relaxing at home, you're going to be thinking to yourself, man, I wish Dr. Kay would touch my toes again, you know, right? And so where does that thought come from? That thought comes from a memory.

So we can have thoughts sometimes come from sensory impressions and sometimes come from memories. We can also think about something like studying, right? So I'm asking you questions. You're asking me questions. Where does this information comes from? It comes from our memories. So let's take someone like anxiety, someone who has anxiety or someone who has something

like trauma. So these people literally have thoughts in their brain. they have, let's say, low self-esteem. But what does low self-esteem mean? There is a mechanism of low self-esteem. It is, maybe there's activation of the default mode network. We understand the neurology of this. But from an experiential standpoint, there is something in there, let's call it subconscious mind,

I can go into more detail if you want, that generates low self-esteem thoughts. So if someone gets me a nice gift, my mind will, this is a sensory input, right? So I hand you a gift, you hand me a gift. your mind can say oh this is wonderful this is great thank you so much someone else's mind can say oh i don't deserve this right so the thought is coming from somewhere during the volvo fall experience event discover exceptional offers and thoughtful design that leaves plenty of room for autumn adventures and see for yourself how volvo's legendary safety brings peace of mind to every crisp morning commute this september leased a twenty 26 xe 90 plug-in hybrid from five hundred and ninety nine byweekly at 3.99% during the Volvo Fall Experience event.

Conditions supply, visit your local Volvo retailer or go to explorevolvo.com. So, along comes Yoga Nidra. And what people, but the yogis basically discovered is that the more empty your or non-active your mind is, the less activity that is in your mind, the deeper something will sink into your mind. Does that make sense? Well, I don't know what deeper into your mind means. Give you a simple example.

So let's say you're studying for a test, right? So your licensing exam. And you're in your, let's say you're looking at a textbook. The more activity is in your mind. If you're thinking about this, let's say the library's on fire. There's going to be so much mental activity that what you're trying to absorb does not sink in. It doesn't enter your mind. It kind of bounces off.

So you have to read the page again. Retention is not there. Yes. Attention is not there. Retention. Retention and attention. So a one-pointedness of attention correlates with retention. Okay?

Agreed? Yeah. Okay. So now enter non-sleep deep rest. So this is a practice originally called Yoga Nidra. Now people are doing studies on it, lowers your cortisol level, all this good stuff, right? All these physiologic parameters. But the whole point of Yoga Nidra is not to do any of these things.

The whole point of yoga Nidra is to enter into such a state of rest. That's not the point of the practice. That's the prep. to implant thoughts into your deep into your mind so that they generate into your conscious mind. So what I mean by that is you take something called a sunculp or a resolve. So whatever sunculp you use during yoga nidra gets implanted into your mind and then starts populating your mind during your regular time. So when I use this with patients, for example, we have a history of trauma and have self-esteem

problems. So like, you know, we came up with one sunculp, which is like, I deserve to be whole. So it's not that I am a good person. I'm going to manifest things in the universe and there's interesting science on manifestation and stuff, which we can get to. And it's just this idea that if you literally look at a patient who is struggling, their mind will have a hundred thoughts over the course of the hour. And there is a particular practice that allows us to add 10 thoughts of whatever we want. So this is sort of the spiritual value of a Sunday. gulp, and even there's even more non-even psychological benefits to it. There's spiritual benefits and transcendental benefits and all this kind of stuff, which is really what a sunculp is

about. But the point is that when we just do non-sleep deep rest, you can look at all the studies on that. No one's going to say anything about a sunculp. But when you do the practice the way it was designed to be done and you add something like a sunculp, from a Western standpoint, there may be some kind of auto suggestion or something like that, some kind of cognitive reframing. We're not quite sure what the mechanism is. but there's something to put your state of mind into something that is like a hypnotic state of mind, and then whatever you implant generates thoughts. So when I do this practice in my clinical practice, which, by the way, I usually do proper

informed consent with my patients, I say, here's what the science shows, I spent seven years in India, this is what I'd like to try with you, here's what I think will happen, but there's no data to support that, so I go through all that with all my patients. And what I find is that there is immense therapeutic value in adding the sunculp. That's an example. And modern science doesn't yet do that. No. And why do you think they don't?

Because it's spiritual in nature. Well, two reasons. One is because it's spiritual and there's no basis for it, right? There's no mechanism to understand what a sunculp is. So it just gets removed from literally what happens is you'll get people who will study this stuff. And then they'll remove all the spiritual woo-woo for it. it because we don't have a mechanism for it because really what a sunculp is about is not the psychological manifestation it's even an external manifestation or a spiritual manifestation

in western medicine now that we've proven this uh non sleep depressed deep rest has some benefits that's step one wouldn't then be step two testing whether or not adding this suncult absolutely so that's what i said there's two reasons for that one is and this is why i think it's a double-edged sword. So if you look at something like mindfulness, I think we've lost a whole lot, but it is a absolutely necessary step. Because without the discovery of mindfulness and the protocolization and the removal of the spirituality, you've got this guru who's doing this mantra over here, you've got this guru who's doing this, you've got transcendental meditation. So now we have a research problem. Right. Which is all these people are doing different things.

What is responsible for the therapeutic change that we see in transcendental meditation or this kind of meditation or this kind of meditation. So we have to distill it down to some kind of protocol and then we grow from there. So that is literally what the work that I try to do. And at the same time, what I notice is that while that work is being done in my clinical practice, if I lean on just non-sleep deep rest in terms of instead of yoga nidra, what I find is a lack of, I'm leaving something behind clinically. But I think it's the way that we have to do it.

I think you and I see I-at-eye on this topic really pretty much one-to-one, maybe 99.9% of the way. I think we see eye-to-eye and Ayurbedic stuff almost. Yeah, that's what I was like really, really close. My question is, when you're doing that practice and you're doing the informed consent, and you're doing it before the evidence hasn't caught up to it yet, how would you feel if when you, let's say a patient comes into a doctor's office and the doctor says, hey, look, this medicine has never been proven to work for your condition through scientific rigor, but I'm going to give it to you anyway. Just trust me. Do you have an issue with that?

What do you mean by issue? Do you think that's ethical? Because you can go down the line and say there is off-label prescription. Yes, there is. So here's a fascinating study. guy named Ted Katchuk. So he's a placebo researcher out at Harvard and was a mentor to my PI. So he did a super interesting placebo study. He said, I'm going to give you a placebo. This is a placebo.

But we know that placebo's work. And he said, I think this will help you. And turns out that the placebo helps, even if people know it's a placebo. Sure. So I think that, you know, off-label prescribing, as long as you do it with informed consent, and the doctor has some kind of

rationale behind why they're prescribing it i think that's reasonable so what is your rationale for adding the sun kip sorry i'm saying it wrong probably so i have some experience and i also believe that like i'm kind of saying some of these roots some of the roots have value so then what i'll do is i'll even explain to my patients so i'm pretty clear about you know this is what the data shows so this technique will absolutely be in line with what we understand is the evidence-based practice of mindfulness. Based on my spiritual training, there is an additional component which, if you're interested in, we can do.

Secondly, here are the two or three, I've seen this to be very effective. Here are the mechanisms that I would hypothesize from a Western standpoint. Here's what I think could be going on with neuroscience, with this, with this. And then I'll put it to the patient and let them decide. Right. aren't you just giving them a placebo and calling it a placebo by doing that what is a placebo you're giving them something that is unproven so far by our western methods and saying there's no evidence for it so you're saying it's a placebo you're admitting that to them to the patient

but you're saying you think it would help what is a placebo how would you to me the description of placebo is something that we do not feel like would help the patient through a mechanism by which we understand. Yeah. So here's how I would describe placebo. Placebo is things that work that we just don't have mechanisms for. That's where, yeah. Yeah.

Right? So, and that's where I would say, here is the hypothesized mechanism, but I think we have to do it. I wouldn't call it a placebo, but you could absolutely make the argument that you were in engendering the placebo effect. But I think that that is absolutely necessary. You have to do that, right? Because talking about ethics, you can recommend things that are off-label that we may not understand the mechanism for.

That's actually okay. So whether you call it placebo or off-label prescribing, I think it's somewhere in there. Are people engendering the placebo effect? Almost certainly. And this is where there's even a, I'm in a worse position for this, to kind of support your point, which is that there's a huge selection by us. of people who come to my practice. So people who come to my practice

are looking for, they already have a preset idea of, okay, this guy's going to teach me something special. I give something special. It fulfills their expectations and they see a clinical benefit. The clinical benefit is,

the reason people come to me is because people have been to 10 psychiatrists before I'm not trying to toot my own horn or anything. A lot of people will come to me and they've tried other things. I mean, I even started a consult service at MGH, where the majority of my patients

were from other psychiatr because they wanted to learn this stuff. So there's even a selection bias, which I absolutely have to consider. My take, though, is that there is a very real mechanism to this. So I don't think, and that could still be placebo.

Yeah, my question is, how do you, you're so honest with this and I love this. So I have to give you huge props to this because I can't tell you how many doctors will claim, I've helped 10,000 people. And I'm like, but selection, like the people who are coming to you. No, I have a bigger placebo.

So that's amazing that you're taking that into consideration. Terrifies me, Mike. So now the question is, how do you decide or decipher between what you're doing being truly beneficial versus is this a placebo effect or does it not matter? So I can't decipher. And does it matter? Is it important to decipher? In a theoretical perspective, absolutely.

So how would we? you get there? So that's where I'm trying to do like so before this whole healthy gamer thing. I was trying to develop clinical protocols for specific meditation regimens for particular diagnoses. Right. So we'll have studies on mindfulness for anxiety and mindfulness for depression. But my whole belief is if you have an energizing brown I am, these people who figured this mindfulness crap out also had other things that they figured out. And they said certain kinds of breathing practices are energizing, and we even have some physiologic evidence of the support of this, and this is why I do it, basically, because we know that some breathing practices

will activate your sympathetic nervous system, some practices will activate your parasympathetic nervous system, and oh, shit, they seem to have figured that out. So then when I look at that, I think that, okay, so here's kind of where I am, which is like, okay, this much is correct. Oh, it's interesting, there's like some stuff that's correct here. One really fascinating thing I was talking to a cardiologist who teaches Branaam. And I was asking him, like, you know, what do you think about this stuff? Because you're a cardiologist. This is back before I was in med school. And so he said, oh, like, I think I, I think this stuff works really well. And he says that the particular practices that I, maybe even you can figure this out, you know, practices that I do

involve very low respiratory rates. So if I have a very low respiratory rate, what does that do to my parasympathetic nervous system? Can activate parasympathetic nervous system. So we're dropping our O2 levels. We're increasing our CO2 levels. You're practicing this for a long period of time. What his observation was is that when he has patients who do Bronayam, and they induce transient low O2 levels and high CO2 levels for extended periods of time over the course of years, that when he ends up doing bypass surgery on them, they have a lot more collateral circulation around the heart. So he believes that the mechanism through which Bronium protects against heart attacks, transient O2, oh, crap, our blood vessels, our vascular around the heart is like,

we're running out of O2, we need collateral. Of course, yeah. Right? So physiologically inducing collateral circulation. Yes. Okay. Right? By transiently decreasing O2.

Acute stress a lot of times yields great outcomes for the human body. That's- Yeah. Yeah. So that's where it's, it's acute stress in a controlled and safe way that doesn't tip you past to the point of what your heart can't handle. Correct. Right. So I think that there's, I've seen enough mechanistic support to where I think that this is not

just what we call placebo, but then the flip side is, is placebo just mechanisms that we don't understand yet? Well, yeah. Right? It can be. Yeah. So I think that for me, it's fine. So the other thing for me is that I think informed consent is very important.

I think letting people know what is scientifically support and what is very important. important. The other thing that I personally feel, so here's, I think, one thing that we haven't really gotten to, because you're like, why don't we do research? Why don't we do research on it? Here's why I don't do it, or why I haven't done it. So I have a sense of desperation. So, like, especially when it comes to Healthy Gamer and, like, all this stuff on video game addiction. It's like, so I got two amazing job offers from two just amazing people. And, you know, one of them was like, here's the academic track at Harvard Medical School. And like, you're going to apply for this grant and this grant and this grant. And 10 years from now, 15 years from

now, you're going to be the guy. And this is amazing. It's beautiful. I had such amazing mentors who are so kind to give me this opportunity. In the back of my mind, I was thinking, what happens to all the people who are struggling over the course of those 10 years? Right. So what really bothers me about it as a clinician is that like, it's fine that I think we should do all this research and you're absolutely correct. I agree with you 100% that we start by studying the basics and then we study the next mechanism and then we study the next mechanism and eventually we elucidate all of these Eastern principles and what are the biological mechanisms can we discover something like Brian Archie but here's the question is what happens to the people in the meantime how much time will that

take and I don't think it's in either or I think we need to do both it's just for me personally I find a lot more value enjoyment and I think that like I just worry about my patients I worry about all these people who are addicted to video games or all these people who are being loaded up with like psychotropic medications and I think medication is good

I'm not anti-medication but I do think that there are other mechanisms that we can harness that will impact someone's life this year, this month. Where does that come from from you? That's an interesting question.

So I think part of it comes from my own understanding, or my own experience of how much a month, three months, or a year costs. So when I was an undergrad, I was a freshman in college, and I wanted to go to Harvard Medical School because I was an Indian kid and my parents were doctors and everyone was screwed to Harvard and you're so smart. Oh, my beta, you're so smart.

Going to Harvard. I was going to be the best doctor in the world and save lots of lives, right? And then what happened is I started failing my classes. And then, like, the damage from a single F, like, you're f. Like, there's nothing you can do, right? So that transcript is forever. And so what I started to, and then it took me time, and I wound up there anyway, paradoxically. And then so what I really started to appreciate was like how much time matters, that one month, for someone who has a mental illness that is out of control, if you are in college and you lose one month because you have a depressive episode that is light in the grand scheme.

we're talking about 12 months, 15 months for some people, even one month, one failed test, one month you don't go to class, the trajectory of your life is altered. So for me, it took me like, I mean, I started med school at the age of 28, and it took me time to quote unquote catch up. I don't really see it that way. It's all the better of it. And so what I really recognize is when I work with my patients that they're living their lives and their lives are passing them by.

And frankly, like, I don't know that they can. afford to wait for me to spend 15 years to do research. It's very noble, and I think it's great that people do that. And the reason that I'm able to do the work that I do is other people, thankfully, researchers have made, not that sacrifice, but they've done 15 years of research so that I now read that paper. Like, think about how many years of effort goes into one publication that you or I just read, right? And then we apply it clinically. So I think that just an appreciation of time. And, like, I think patients don't have time. They can't afford to be sick, mentally ill, you know, it's tough. So that's a big part of it.

Why do you put a heavier weight on time as opposed to the magnitude of impact that research could have longer term? I think it's just personal. So, so I think for me, it's just an appreciation of that. And what I see and what we see in our community is like the reason I started doing the work that I was doing is I see a generation of people who are getting screwed by technology. And like some, like what I see around me is that there's lots of people studying doing mindfulness research, which is great. And what I saw around me was that a lot of people are not like solving this mental health crisis. And I don't blame them. It's just that the institutions can't keep up. So if we think about like my academic mentors, which are awesome and

brilliant and even to this day I am where I am because of them like I even reach out to them on a monthly basis asking for guidance and stuff so it's it's wonderful work and it absolutely needs to be done but I saw that there was work that was not being done which is that if you look at our mental the mental health right now people say you know there's like people are falling through the cracks it's not cracks it's like it's like the Grand Canyon the majority of people are falling through so therapists are burnt out overworked I'm not sure that The part of the reason that I think we see an explosion in the field of coaching is because I think psychotherapy does not address or we have not been trained to address a lot of issues in a very good way. So if we look at something like dating or getting promoted or achieving financial independence, what I was taught, and maybe this is a sample size issue, but I don't think it is.

You know, what I was taught when I was training in in psychotherapy is if a patient comes in and says, can you help me get a girlfriend? what do you think the right answer is no so you want a girlfriend uh-huh do you want to get a yeah why do you want a girlfriend help me understand where that comes from so like in the field of psychotherapy we we as psychotherapists no longer hold ourselves to the outcomes of our patients right I think it ties back to something you said at the beginning of this interview of we're in health care trained to go from zero negative 100 to zero as opposed to zero to 100 and what happens a lot of therapists are very good at going from zero to 100. So even if you look at, for example, the Institute of Coaching at McLean Hospital in Harvard Medical School, Institute of Coaching

started by psychologists, started by therapists who focused in positive psychology. So the reason that I went the road that I did is because I saw that there's like no one helping these people and that the existing institutions were not good enough. Student health services isn't good enough. If you go to a psychotherapist, I heard this so many times. Someone's addicted to pornography. They're addicted to video games. The mental health practitioner doesn't even to ask them, like, do you play video games? It's not a part of our standardized interview. And so what happens is they meet clinical criteria for depression.

They get some medication. They go home, they take that their SSRI, and they play video games all day. So what I saw was that there's a lot of people doing research, and it's amazing, the kind of research that people are doing, but that if you look at any individual institution, whether it's the office of the surgeon general, they do amazing work there, but like they're not shouldering the responsibility of clinical care because that's not their job. An individual therapist is not shouldering the responsibility of fixing video game addiction. We have teachers are struggling. There's a lot of people. And so what's happened is our institutions are

responsible for their thing. But what's happened is the problems are in those gaps and those gaps are widening, which is why I think we have a mental health crisis. And this is what's so tricky is, I don't think you can blame anyone. I mean, what is the responsibility of like a medical board? it's to do licensure, what is it responsible of the Surgeon General's office, it's to raise awareness, do policy stuff, what's the responsible of a clinician, it's to help this person, what's the responsibility of a researcher, it's to do research. But even though all of these people are doing these things, there is a lot of stuff that still needs to be done. And that's what I chose to focus on.

Yeah. I think you gave a really clear sort of architecture blueprint, if you will, of the current system. But I'm curious about yourself why you chose, like all of it needs work, you're saying. But you chose the clinician work. So I'm curious why that speaks to you. Yeah. So a couple of things. One is I enjoy clinical work more than research. Okay. So my first PI at this place called the OSHA Research Center, I told her when I was going to med school. I was like, you know, I'm sorry to say this, but I don't really like research. And she was like, although I wouldn't, I keep an open mind. says, you may like research, which you don't like is being a research assistant.

Right, because I was her research. And she's a brilliant woman. So just an amazing mentor. So that's, I just like clinical work. I like sitting with people. The other thing is I do believe I have, it's part of my spiritual path. So I believe I have a Dharma or a duty, the way that I conceptualize my life is like, I'm really lucky. So I got to spend seven years studying yoga and meditation, like in all corners of India, South Korea, Japan. So I studied with a ton of different teachers, a ton of different gurus.

I learned so much different stuff, really high value stuff, transformed my life from being like 2.5 GPA failure to like literally being faculty at Harvard Medical School. So I found it personally very helpful. And then I also had the chance

to train with amazing mentors. And I went to medical school at Tofts and like had some just brilliant psychiatrist that inspired me to become a psychiatrist, trained at these amazing, institutions. And so what am I supposed to do with this? Right? So I have this very unique advantage. The world has invested 15 years into me. And what am I supposed to do with this?

So I did what most people usually do. So I'm complimentary alternative medicine. A lot of people from famous people and CEOs. And I was in Boston. So HBS and MIT and all these like fancy people who are very wealthy started coming to me. And then I realized that there's like literally millions of people out there that no one is and and these people that were coming to me like they have no shortage of people who want to help them right because they cash practice you pay out of pocket you charge a lot of money right and and so but there's no one helping these other people so i i sort of view it as my dharmic which means duty or karmic goal to try to disseminate this information i was the world has invested like 15 years of understanding the mind from both eastern and western

perspectives. And am I supposed to use this to enrich myself and fly first class and go on vacations? No. Right? I'm supposed to disseminate this, try to help people in the world. And that's what really drives me. Debt. That's really interesting. You mentioned earlier when you were talking about the benefits of spirituality, no, the benefits of Tai Chi having benefits within the spiritual and transcendental REM. What does that mean? Because you said you would touch on it. I'm curious. Yeah, so I think one of the weirdest things, so let me ask you, like, so do we have scientific existence of the proof of thought? Or do we're scientific proof of the existence of thought, sorry.

I mean, that's so abstract that I guess, you can answer it both ways, I guess. Yes. What would you say? I would say yes. How so? Because you can speak to a human, you can give them commands, they can follow them. And to me, cognition is thought. Yeah. So, but how do we know that cognition exists? Because we can test it. How can we test it?

By asking someone a question, by giving them a command, and seeing an outcome. Right, but so then what are we actually measuring? We're measuring words and actions. We're not, we can't detect a thought. So for all you know, so like am I thinking right now? Like to me, the definition of a thought is a signal. So you have an experience of thoughts, right? Correct. But we don't have, so we can do EEG, we can do everything. fMRI, but this measures electrical activity. It measures blood flow to the brain. We can observe the impact of thought, but we actually have no, and maybe someone will prove me wrong. I've been asking this to a lot of neuroscientists and psychiatrists. We don't have any proof of the existence of thought. So we just can't measure thoughts, right? So I can't detect thoughts. I can't verify for you that thoughts exist. We have a lot of implications that are based on thought. How do we have a strong, like for example, we don't have randomized controlled studies that smoking is

really problematic. But we have such strength in correlational data that we don't need the randomized control data. Same that I feel about thoughts. There's enough correlational data that thoughts exist that I'm sufficient with. I completely agree, but we have no proof. It was sufficient evidence, fine, for the faith of it, but we have no proof that thoughts actually exist. They have no material form. We don't know, they may have a correlation with electrical activity. We know we can stimulate certain parts of the brain to trigger some kinds of thoughts. That's how we know which parts of the brain do what. Because we ask people, what are you thinking when your amygdala is active?

Oh, that's where anxiety or fear comes from. Or injuries in those areas leading to deficits. Absolutely, right? So if we have bilateral amygdala lesions, people have the stress-freeest life on the planet. It's amazing. So if we kind of look at it, there's a whole dimension to existence. And this is where I go off the rails. There's a dimension to existence, which is kind of this.

dimension of thought and other things, which we actually don't or not scientifically, there's no material to it. There's an energetic correlation. Sure, there's tissue activation, sure. But that's biology. That's not actually the subjective experience of thought. So if you look at a lot of the way these spiritual techniques were developed, they weren't looking at the biology. And that's why they didn't develop instrumentation. They were looking at this subjective realm of experience. And in that subjective realm of experience, if you explore that and refine your mind, and other parts of you, you are capable of experiencing things that will be, will have all kinds of different effects.

So you can gain knowledge. So this is sort of like the concept of like intuition, right, which we also have some degree of access to. But what are the practices which hone your intuition, let's say? And then that's on the more believable or scientific. Like visualization, et cetera. Yeah. So there's visualization that maybe does something.

And we have some of those mechanisms. we have intuition, which is different from like logical thinking. But then as you experience particular things in meditation, these are what I would call transcendent experiences because they're not of the mind. So they're not a thought or an emotion, but they are like a raw experience. And this can be transformative. And depending on what you believe or what your experiences, you can even like work on some weird manifestation, now we're getting a Deepak Chopra realm.

I think some of that is legitimate, by the way. And then, like, you can start to affect change. So just as a simple example, I think a big thing that is responsible for my trajectory, which is a statistical very improbability. So what's the likelihood of getting into medical school with, like, a 2.5 GPA? My MCAT score was pretty good. So there's still, like, a chance. I was like a 1 in 10,000.

I looked at the, you know, the AMC publishers of that data. So I looked at it. So I'm like a 1 in 10,000 chance. And so there's just a lot of things that are statistical improbabilities. I mean, the fact that the sperm chose the egg is already the most wildest. Yeah, right?

So for me, though, I started a spiritual practice, which my teacher, my guru, told me, like, if you do this, he said, do you want a spiritual practice that will help you in the material world or help you in the spiritual world? And I said, can I have one that does both? And he's like, absolutely, we can do that for you. So I think a lot of my, I really do believe

that a lot of my success, comes from the utilization of a mantra that harnesses this weird transcendental energy stuff. Now, when you come to science, we have some mechanisms of this, and it may not be so crazy. So we know, for example, that if you look at the healing power of psychedelics, first thing to understand is that psychedelics activate circuitry that exists in the brain, right? So psychedelic can't make something new. All we can do is activate receptors in a potentially,

non-endogenous way, but the circuitry's there, which also means that there are ways to theoretically activate it through the practices like meditation, which is I think basically what goes on. And then we also know from science or from studies that deactivation of the default mode network correlates with like a sense of wellness. We can also predict what kind of trip you have and whether that will be healing for mental health concerns. So if you have a trip where you're just flying around, that doesn't actually lead to, or doesn't appear to lead to mental health improvement. If you have a trip where you have a sense of ego death, that's what correlates with mental health improvement. And so then we have some of these transcendental practices

which dissolve your sense of identity. So like you have this sense of this is who I am, and with that comes all kinds of problems. Because now if you're a person, I'm tall, I'm short, I'm this, I'm that. There's a bunch of spiritual practices that are designed to dissolve the ego. And in that process, once you dissolve your sense of self, then you get access to transcendental states. So some of this stuff we know is scientifically correct. Some of this stuff, we have some scientific theory of mechanism, like default mode and psychedics, ego death, and meditation. And then even beyond that, though, the transcendental stuff, we have no idea what's going on there.

What is going on on a practical level? Like, maybe not on a measurable level, but how would you describe it to me? So I would describe it to you as the basic unit of existence is consciousness, and consciousness coalesces into energy and energy coalesces into matter. So we can affect things in the material world by working on the level of matter, or we can access the consciousness level, which will then dribble down into manifestation in the real world. And I'll be the first to admit that that makes no scientific sense. I think it does.

why not. It's the same way that, you know, when people incorrectly say, this coming from you, Mike? What? Wait, no, why? I just expected the staunchest. That's why you think I'm a disbeliever, but I'm not. I think also, you have to remember, I'm not an allopathic physician. Oh, that's your deal. I'm an osteopathic physicians. So that there's, there's, there's, there's value here that's unmeasurable to some degree with our current tools. And that's why I don't always throw out the baby with bathwater it's the worst example of the worst saying ever but when we incorrectly say depression is a disease of chemicals in your brain right that's not really what's going on and our seroton hypothesis has been disproven all this stuff and some people say well you have to take medications

for it because you have a chemical issue and if you take the medicine it would change your neurochemistry and et cetera when you meditate when you go through CBT, when you take certain actions in your life, those aren't medications, and yet it changes your neurobiology. Why is it unreasonable to say that when you experience this higher state of consciousness, you're not also impacting your neurobiology? Oh, you absolutely are. So I think the only thing that is unreasonable is, and I'll be the first to say this, and apologies

if I misjudged you, the only thing that I think is unreasonable is positing the existence of consciousness. us. But these are just terms, and I hate that about science. What do you mean? We get caught up on the nomenclature of things instead of talking about what's actually going on. Like two people can talk about the same thing, and they'll argue about the word for three hours. It's like, who cares that it's called consciousness?

There's clearly something going on, whatever we call it. It's clearly having some impact. We can't yet measure it, but there's something happening and we're observing it. yeah so so i i mean i i'm with you there like a hundred percent so i i think just in my experiences of higher states of consciousness and like that's hard to describe but like we can sort of say that you know when you're asleep there's a lack of awareness when you're dreaming there's a lower level of awareness although there's mental activity um when you're consciously awake there's also variations in the degree of consciousness and mental activity when we see

things like thought fusion when someone is having a panic attack, their thoughts are forming their reality. Yep. So if you literally look at, I have a video that I made about this about, so if you look at the states of consciousness, the more you think that your thoughts are real, the more mentally ill you will be. So if you look at someone who is in psychosis, their thoughts and the reality are one in the same.

If you look at someone who has a panic attack, this isn't quite psychosis, but their thoughts are so likely to be true that they feel real. And then you have generalized anxiety disorder. Then you have your breakup where even in a breakup, if you have no mental illness, you will think I will be alone for the rest of my life. Right. And then what happens is we start to detach from our mind. We become more and more. We change our level of consciousness. So then you have everyday thought where your thoughts are kind of real. Then you have things like the flow state where you lose track of time, your mind is completely absorbed in one thing, and you're not, it's a different level of flow. And then even beyond flow, you have a no mind state. So flow is a one-pointed mind

state. And so the more that we separate our awareness from our thoughts, the higher we go on the consciousness realm. And then there are even practices to go beyond flow. That's usually what we call a meditative state of dhyan. And then even beyond that is samadhi, which is temporary enlightenment. And those are these, these blissful or ecstasy kind of states where you also start to like see weird things and stuff like that. Got it. Okay. Well, I thought that was an awesome conversation. Thank you for enlightening me because I think there's a lot of learning opportunities here for us. It was awesome, Mike. Thank you so much. We have room for part two.