The Checkup with Doctor Mike - How Cancer Doctors Failed Her | Hannah Fry

Episode Date: March 20, 2023

Watch the full video interview here: https://go.doctormikemedia.com/youtube/HannahFryVOD Hannah Fry is a British Mathematician and the host of several science/education shows, including her newest project "The Future with Hannah Fry" available through Bloomberg. I invited her on the show to discuss biohacking and what the future of medicine holds for us, as well as Hannah's history of cancer, monogamy, dating apps, and how you can use math to find true love. The Future with Hannah Fry: https://www.bloomberg.com/originals/series/the-future-hannah-fry Follow Hannah here: YouTube: https://www.facebook.com/FryRSquared/ Instagram: https://www.instagram.com/fryrsquared/ Twitter: https://twitter.com/FryRsquared Executive Producer and Host: Dr. Mike Varshavski Produced by Dan Owens and Sam Bowers Art by Caroline Weigum CONTACT: [e-mail]

But I think if you really think about it, actually, the idea of monogamy is, I definitely should not be talking about it. No, this is so good. This is what we need. Please welcome to the Checkup podcast, Hannah Fry. I should really say Dr. Hannah Frye because she has her PhD in mathematics. She works out of the UK, but she's found global success with her streaming shows, her podcast, her radio persona where she gets people excited about math by creating practical scenarios of where you could use math to improve. your life. So I had to have her on the checkup podcast to talk about how we could use math to maybe improve our health, to talk about some really controversial subjects like love. That would maybe a controversial subject for me. And also to talk about her unique health story. She was actually diagnosed with cervical cancer. She didn't have the best experiences with doctors. So we talk all about that and more. Hope you enjoy the conversation as much as I did. Please welcome Hannah Frye to the checkup. I want to talk about the future. But as my therapist always says, we should

Start with the present, Sean. So right now, I'm speaking to a world-renowned mathematician, and mathematics actually has a very near and dear place in my heart. Does it? Because, not because I'm in love with the field. I was not particularly great at mathematics. But my mother had a PhD in mathematics, loved it so, tutored everyone in all who would like to learn mathematics.

And then when we came to the States, she had to give it up because we needed to create a foundation for ourselves. So while my father tried to reapply it to medical school all over again, she swept floors for $5 an hour and put her knowledge to the side, only then 10 years later to then again get her teaching degree here in the States and restart her journey of teaching university students, the beauty that is calculus. Amazing story. In all of that, none of it crept in and got you hooked on the.

subject though it made me nauseous it's like it sounds like the plot to a film and then the ending's like yeah yeah it's a it's an indie flick because that's how they all end um but in this case she loved mathematics more so than i feel like the average teacher or professor loved mathematics yeah because she saw beauty in it and when i watch your content i feel like you see that same beauty where it excites you, you see understanding on a deeper level of mathematics more so than numbers and you think about practical implications into our daily lives. Yeah, totally. I think it's like it's just, I think it's like a portal to a playground for the soul. That's how I see it. And of course there's some stuff that's very, you know, obscure and theoretical and doesn't really have any

relevance. But when you're in there, when you're in it, when you are like playing with your mind, It is just the most glorious thing. There's one description that I really love. And it's this idea that you are, when you're trying with different equations, right, when you're like bending them and breaking them and trying to like catch them out and see what you can find, it's almost like you're burrowing through a really thick undergrowth and you can't see where you're going. It's all like overgrowing, you can't see anything. And then there will be a moment, right?

You have to fight for it really hard. But there will be a moment when you turn a corner and like, Suddenly, this beautifully manicured garden comes into view. And all of a sudden, you can see everywhere that you were. It's like all of the lights come on immediately. And you realize that it's there before you. You are not creating it. You are discovering it.

And I cannot tell you, and I know that for people who are traumatized by math, when they were high school students, I'm aware that it sounds like I'm describing something so fundamentally different to what you've experienced. but so you're just going to have to take my word for it wow okay that's a great i mean that was poetic you're welcome did you see um goodwill hunting yes do you remember the professor sitting in the staircase saying uh a beautiful equation is erotic and he's trying to like awkwardly lure the students i think i think that says more about him than it does about my brother but i'm saying the beauty

that you all see seems like it's all tied to this problem solving nature And I feel mathematics gets a bad reputation, at least in the high school sense of things. Because of the way it's taught, do you agree? Because to me, it's all about getting it right on the test as opposed to enjoying the process and the journey. Yeah, I do think that's true. I do think that's true. I also think that unless you tear down the entire system of education and start from scratch, I'm not totally sure how you can fundamentally change it.

But, you know, I think you have to remember that tests were only, you're never really testing how good somebody is at something. You're testing a proxy, right? We want people to have good educations, but what does that mean? You can't, it's not tangible. So instead,

we say a good education equals being able to recall a series of predefined facts in a timed manner. And I think that that's just not something that lends itself well to the discovery of mathematics. Because the problem is with math, right? Is that if you, it's like sequential. So, you know,

If you miss one building block, it makes it really hard to take the next step on. And then that makes it even harder to get the next step on and so on. And I always think that it's really notable how you never meet an adult who is like ambivalent about math, right? You never meet someone who's like, I can take it or leave it. It doesn't really happen. You always get people who either really love it like me or really hate it like you. I don't really hate it.

I'm probably in that unique camp of ambivalent. Do you think you're ambivalent? Yes. Because I've studied mathematics further than most people would in the States. I've had to take the advanced calculus classes. And yet it makes you nauseous. And yet it makes me nauseous. But then I see the love that my mom had for it.

So I kind of love it there. So I fall somewhere in that 50 percent percent. I do think that I think that nobody is born with like a predisposition to it one way or the other. I don't think. But I think that what happens is your experience is end up being these little feedback loops. So for me, it just so happened that my mum was really keen on, like, torturing me during summer holidays and, like, making me do extra math problems, which meant that I had a little bit of a head start when I went back to school and then felt more confident, enjoyed it more, was happier to practice. And essentially, it's like a little feedback loop that ends up being this tidal wave. And that's what happened.

And then I think for other students, it's like, you know, one day you're a bit tired and you don't pay a test. in class. And then the next class, you're like, well, I don't really understand what's going on. And then suddenly you feel like you're the problem and you're not smart enough to get it. And then maybe someone says something to you about how you're not good at it. And on, on, on, on, on, on and on it goes until it's actually genuinely traumatic and makes you nauseous. Yeah. That's a really good way to evaluate it because that one misstep really carries a heavy burden when you're 10 lessons deep. Yeah. And unlike other subjects that you can cram and memorize things for, mathematics, it's learned by doing. and repetition, which is why, at least in the states, I feel like coming to the states as an immigrant, I had a distinct advantage that my parents would make me do the same, do the

repetition when I was in first grade and kindergarten. So when I came to the states in first grade, the math they were doing there was so much easier than what I was already exposed to so that I didn't even have to pay attention in a math class. And I feel like that repetition needs to be packaged in a way that's exciting, fun, and practical, which is how I wanted to begin my discussion with you. How do we sell mathematics in a fun way during this conversation by giving people some practical applications of how they could use math in unique ways in their everyday lives? Okay. I mean, you have come to the right place. This is perfect. I'm excited. This is my modus operandi. Okay. I mean, I think you're right, though, right? I think ultimately

math is not a spectator sport. You've got to like, you've got to learn it by doing it. But I do also think that it is about I like doing it by stealth so I have two young girls two young daughters and for them like I don't really care if they know their times tables right I don't really care if they are good at addition

or mental rhythm I don't really care do I really do at this stage I genuinely I mean they're gonna have a calculator with them okay my mental arithmetic is yes genuinely embarrassing no really sometimes like sometimes I end up so I do a lot of TV in in the UK and there's one like big comedy show that I was on and they like started asking me mental arithmetic questions in the middle of the recording oh that's tough it was

traumatizing I know how you feel I'm in that position a lot with the science angle of things really when people are like oh well you're a doctor I just did a podcast the other day from an eye surgeon and he's like I'm going to ask you a few questions about the eye I'm like great the one organ I probably know least about because I don't do much with it yeah it's hard to get out of that situation. But okay, so back to the girls, like, I don't care if they have memorized it or not yet. The thing that I care about is that they find it fun, right? That they are motivated to want to play with it. So the things that I do with them, for example, I will like get loads of jam jars, wait, jelly jars. What do they call it? Jelly jar. We have both. Okay. I don't know the difference,

but I heard there is one. Is there between jam and jelly? I think so. Sam, fact check. okay it was in a movie with um this is a terrible movie reference with ashton kutcher called spread and he said is it jam or jelly and he's like i love that you know the difference oh i remember random movie lines that's my utility so i can't do mental arithmetic was spread like to do with the jam absolutely not it had a more sexualized theme than that so ashton kutcher was a womanizer that took advantage of wealthy individuals i see i see jelly is made with strained fruit juice jam is made with mashed fruit

oh so there are no pieces of fruit in jelly I see even PhDs and Dio's can stand to learn I mean there you go and every day's a school day I enjoyed that if there's one thing I take from thank you Sam but then there are also preserves oh what's that and then there are marmalades oh okay that's you just introduced like exponential

versions of, whole level of layers and layers. You bring jam jars. Okay, bring jam jars. Now preservative charge. Okay, so like let's say that I'm, you know, whatever, washing up some different jam jars and there's like a few of them on the table and then you've got different lids. So I might say to them like, okay, well, which lid do you think is going to go with which one? And it's not, it's like, you know, make it into a bit of a challenge or like a little bit of a puzzle. Or one thing my mom used to do with us when we were kids was, my mom's not a mathematician, by the way. She has like no higher education. But she just like has this sort of mind, she would say, okay, we're going to walk into town. What's the way that we can go that

crosses the least number of roads? And then you're sort of like, oh, trying to work it on your head. And like that's the kind of thing that I think makes the difference. It's not about like, you know, no one enjoys being forced to sit down with pen and paper and do example, example, example, example. But I think that if you can create a scenario where people are motivated to learn, motivated to find out more, I think that's the way to do it. You're gamifying it. Yeah, yeah. So in that case, yeah, I'm gamifying it. But I also think, you know, there was one point during the pandemic where I was in a cab with like a London cabby.

And we were having a conversation about exponential curves and where the logarithmic axes were better than linear ones. Oh, my God. Right? And I was like, I'm having this out-of-body experience here because the idea that like some kind of, you know, random person off the street would have this as a question in their minds right of like which is the better way which graphs are better is so wild yeah and like had that happened in 2018 I mean it's the no universe would that have happened but the thing is is that because people had the reason to understand it because people had the motivation to find out more then all of a sudden you know there's no limit I think

to the to the level of conceptual difficulty that members of the public are interested in but they have to have a reason to want to find out about it. So you're saying the motivation has to precede the learning? Always. Okay. Always. So you believe carrot not stick? Totally to my core.

And it's not because of your hair coming. I mean, it helps, right? Sure. But I think that's wise because even when I speak with patients, in order for me to get them to a destination of health or helping them with their disease process, it has to be with them recognizing what the issue is and them coming to the solution with me sort of being as the guide. And that's more so in the mental health space of things, less so in the physical. But then there are instances where, like, in the case of obesity, that is a lot of mental versus physical

because the result is physical, but the journey really has to be a mental one. And a lot of people, especially of an earlier generation, believe discipline, the stick is the only way to go. and while I think it's certainly not the only way to go, we may be missing some of the discipline these days. Do you agree? I mean, I think you can't only have carrot. I mean, what I think is really noticeable. Because you turn orange.

I mean, yeah, you're right, like famously, famously. How do you think I got this? I think when you go to other countries, like Singapore, for example. So I've spent some time talking to mathematicians and math teachers in Singapore. And there is just a completely different attitude. They regularly top the international tables, by the way, in terms of achievement in mathematics. And there is just this different attitude.

And I think the best way to describe it is, okay, let's say I showed you a page of Japanese, right? It was like, okay, well, can you read this? I mean, I'm assuming you're not fluent at Japanese. That's rude to me. Correct assumption. Say I'm telling. Hang on, fact check.

Let's, uh... No, okay, I cannot. You know what? I went to Japan recently. Yeah. And, um, so you would be the same, right? They, they have to call you sense if you're, like, really educated. So I was going around, people are like, Frye Sensei.

Wow. I honestly, I've never... I'm a black belt in Taekwondo. Are you really? So people call me Sensei as well. Are you, Senses? I don't know. I'm making that up.

I feel like I got called Sensei. when I would teach class, though. Yeah. Yeah. Anyway, whatever. Interesting. I completely got off on the power. Okay.

Anyway. Are you in the UK? Are you doctor? So in the UK, I am, I have a PhD. Of course. But in the UK, you don't get called a professor until you reach tenure. Oh, okay. So professor is more impressive than the UK than doctor.

Whereas here I think it's kind of the other way around. Yeah. Then there's like, arguments of whether or not someone with a PhD can be called doctor. Is it confusing? I'm curious your take on it. What would you say? The MD is the honorary doctor, right? Why is that? Because doctor means to teach. Oh, that's interesting. Well, it's a good thing. I'm not an MD either. I bet you don't even know what kind of doctor I am. What kind of doctor are you? I'm a DO. I don't know if you know what that is. Yeah. You probably have some in the UK, but in the United States,

there's two types of doctors, MDs and DOs. They're both able to be licensed. go to medical school, four years of medical school, then residency programs of whichever they choose. And there's two accreditation councils. The only real difference is DEOs learn an extra hands-on skill about learning how the body can heal itself more through manipulation. And we have a higher focus on prevention, primary care, more of a holistic view of how the body heals itself

as opposed to looking at disease processes and pathophysiology. But yet we all learn the same thing. take the same licensing boards. It's all the same stuff. So I'm not an MP. You're still an ordinary doctor. Okay, fine. Yeah. So that's the world we live in. So, okay, what's your take? Do you think PhDs should be called doctors? I'm curious. Yeah. Okay, cool. Take that people in the comments. Yeah, I mean, I accept it's kind of confusing. Like, I mean, sometimes I get emails of people saying, hey, I've got this rash inside. No, you get that? I do sometimes. Wow. Okay. Is there doctor on board. Like, I mean, yes, but I think my two-dimensional model without

I don't know. I don't know. Watch some of your videos. There's a lot of health advice. There is. There is. It's true. Okay. So show me your Japanese paper. Right. And I say to you, can you, can you read it? You'd be like, well, no. And obviously, and you wouldn't feel bad about it. You wouldn't think that it was an indication of your own smartness or stupidity that you weren't able to do it. Because you haven't been taught it yet. And you haven't put in the work to learn how to do it. And yet, if I gave you a page of maths that you haven't seen before, like suddenly it's a completely different feeling people recoil as though it's like their fault that they can't do it where's that stigma from i i don't really know i'm not really sure i think this idea that we have people who

are math geniuses and people who are math idiots is part of it but i think in in places like singapore actually they are those two things a page of japanese and a page of of math actually they would have a similar reaction to it they would be like you know what of course i don't know it yet because I haven't put in the work. And so I think that's what I mean about carrot and stick is that you, I think it works better when you have carrot, but this stuff doesn't happen by osmosis, you know, you still have to put in the work. It's just that you have to feel comfortable with knowing that you need to put in the work

and not thinking that that's an indication of your own intelligence. Yeah. Yeah, I think the stick also gets a bad name because it's called a stick. Because I think if you look in Asian countries, the reason why. they're so disciplined is less so of the physical stick, but there's a layer of pride attached to it. Definitely. Where they're proud to learn this and they feel like it represents them, their families, their countries. Yet we're missing that. Yeah, I agree. You know, I have this really good friend, a YouTuber called Matt Parker, mathematician, and he says, he says that the difference

between mathematicians and non-mathematicians isn't that the mathematicians are the people who find it easy they're the ones who enjoy how hard it is and i think that's true you know i think that nothing that is worth having is comes easy and i think the fact that you are in that thicket that undergrowth and struggling and frustrated and like feel like you can't find a way out and then when you finally get it it's so much sweeter so much more enjoyable because you had to go through that struggle. I don't know if it's my history having this effect on me right now, but do you think you could make everyone fall in love with mathematics? Yeah. Like if I gave you a hundred people, and there's a wide distribution of their love for the subject. Subject, yeah. I haven't yet

failed. Wow. That's like me saying I can cure anyone right now. No, no. No. No. No. No. I think, okay, look, I think that there's going to be a different appetite in different people. Of course there is. I don't think that everybody is destined to be, you know, someone who sits all these exams. I don't really, I don't really mind, right? I don't, not everyone's destined to be a singer or like, you know, that's fine. But I do think that what can happen is because people are traumatized by this subject, they can end up being just very dismissive of it. and scared of engaging with it.

And I think that maybe there was one point in time where that wouldn't really matter that much. But I think that now that we're in a world where algorithms and artificial intelligence and data is shaping so much of everything, I think that if you recoil from any of those conversations, then I think that sometimes people end up being exploited. Because I think that the sort of the, you know,

the people who, I've seen people use equations to, like, to obscure meaning rather than to illuminate. And I've seen people use like graphs and data to kind of, you know, intimidate people into doing what they want them to do. And I just, and I think that, I don't know, I just think it's kind of important that you can just open out this subject. Maybe not to make everyone a mathematician, but to make everyone realize that there is value in it and that actually there isn't really that much to be afraid of. The reason I ask it this way is because in the day and age we live in the algorithms, the AI, the calculators, our phones, there seems less practical utility whereas before, you know, having that skill set really helped you on a day-to-day basis.

Now it seems it's more of a theoretical benefit. of knowing mathematics and how it works. Is that right? But I think it depends on what type of math you're talking about there because, okay, sure,

mental arithmetic. We've covered this. I'm terrible. I mean, calculus. I adore it, but I haven't done a derivative an angle.

You show me an integral right now? I'm going to faint. Get the sick bucket. No. I mean, I haven't touched like an integral in, I haven't seen an integral

in the wild for quite a certain time. So I don't think it's necessarily about like the techniques or the rote learning that you learn in school. But I do think there's something about the way of thinking. I do think it's something about like constructing logic. And that I think is something that is very valuable and will never go away. Can you teach mathematics without numbers? I think you can then.

If you're doing it based on what you're saying. Jam jars. Hello. Oh. Sorry, jelly jars. But I'm saying. But I'm saying like on a more advanced level. Like if you're, for example, are you familiar with LSAT?

Yeah. It's like the legal exam that folks take here. And it seems like a lot of what they do is mathematics. And yet there has nothing to do with numbers in the questions that they ask. It's more of a logic based logic games they call them. So I'm curious if you view that as mathematics, even though there's no numbers involved. Yeah, totally. I think it's a way of thinking.

I really do think it's a way of thinking. There's so much stuff that I think. fits into that category yeah well take me through one that I've had trouble locking down love okay so sure you're like I'm going to ignore that he said that sorry go ahead I mean you're welcome to give me more details no it's okay okay so uh all right this um I did this a few years ago and frankly it was a very silly private joke that got terribly out of hand oh wow okay um so at the time i um was single and was obviously using all of my mathematical prowess to optimize my own dating wow okay you did that of course of course of course okay so is it truly a numbers

well kind of yeah really yeah so more is better well no oh i mean have you seen dating apps yes of course the like the the paradox of choice is just yeah i think not helpful can you take us through that um okay so uh right let me let me uh which which shall i start with okay right the the first thing is that there's all kinds of bits of data that you can collect from how people interact with one another um so like the type of pictures that do well the type of comments that do well um also things like uh okay cupids which actually was founded by a group of mathematicians um pretty sure they was just trying to get a date. But they are really open and have been open about the ways they experiment on their

customers. So things like their match percentage, right? They can demonstrate that if you lie to people about the match percentage that they have, the impact that that has on how they talk to each other, right? So it's almost like the belief that you'll get on with somebody is enough to, yeah, right? Is enough to like, you know, let you get on. if it is it evil or is it like actually genius no it's evil but then think about arranged marriages for a moment okay you substituted one evil for although people in arranged marriages

actually report much higher levels of life satisfaction um you know it's like the sort of commitment thing that we were talking about you know with like eastern philosophy of like this will succeed yeah um yeah so uh there's lots of things that you can that ways that you can get into this um and then i so i did this talk on this subject um uh which ended up um i was kind of trying to prove a point right that you can like this applies to everything so let's pick something that's really hard to describe okay um and i uh yeah it ended up going very viral which was um and then i ended up being called dr love oh by the british papers which is not a world i ever wanted to be.

Ironic because the last person who sat in your seat was Dr. Love. Who's Dr. Love? Yeah. She's a microbiologist and public health scientist. Oh. Yeah. Oh, I see. Actual Dr. Love.

Yeah, literally. Her name was Dr. Love. Amazing. Yes. So, okay. Then, so the stuff that's happened since then, I kind of think, you know how I was saying, like algorithms that end up impacting our lives, right? I think dating apps is a really clear example of this.

I think that dating apps have had as negative an impact on people's romantic relationships as the Facebook news feed algorithm has had on democracy. Bold. Bold statement. I thought you were going to say in a different direction. Can we swap it to be that Facebook had on people's exposure to misinformation? Okay, sure. Yeah, fine.

Because that's easier to prove. Okay, fine. Let's do that. Yes. Don't want to say it again. Yes, I agree. Okay, fine. That I think that makes a lot of sense.

Because when I look at Facebook being negative for democracy, I look at areas of the world that may have not been able to have people speak out, but then they use Facebook as their tool to get out of that. True. So here, yes. Other places. Well, I agree with that. I agree with that.

I mean, I think there's also, there are positives about dating apps, right? Like there are good things about it that people can find other people much easier than they used to be able to. but I also think that when you like take something and you take the math too far, right? When you sort of codify everything, then what you end up with is you shift the sort of human psyche, right? So whereas before, you know, when I was last single, right, in like 2010 or whatever it was, you would go into a bar and like you'd meet somebody and you'd be like, right, great, thank God I found that you'll do. you'll do i hope that's not how you dated don't say that to your partner if you're listening at

home only a mathematician can say that only mathematician yeah exactly um because you're you're like the the number of possibilities sorry the number of possibilities that were available to you it felt like it was much smaller whereas now when it feels like you essentially have an infinite number of people available to you you don't have that fear of never being able to find a date with somebody it means that every interaction you have is so much less valuable each individual interaction that you have but then I think the other thing is that all those algorithms they are they're optimizing for the wrong thing so they're optimizing to find people who you like the look of who maybe have like all of the kind of checkpoints that you that you would tick off but none of them

are actually optimizing for the things that we find difficult about the beginning of relationships like finding someone who you fancy i mean whatever like we all know what what we like but is that what the problem is no i mean this is for a lot of people okay okay okay but i think it's like actually opening yourself out to a new person yes you know forming that that connection that's the bit that we find harder right like packaging up your whole history and presenting yourself to a person as like someone who you're inviting in, that's the bit that's really difficult. And the technology can't help with that. And I think if anything, actually, the technology is making that a bit a bit harder.

So what's the solution? I'm not really sure. Oh, okay. I only asked the questions. Oh, I thought you were Dr. Love. I'm going to solve this matrix. Very definitely not Dr. Love. Okay.

I mean, from personal experience, from listening to my patients in the exam room, This is very true everything you're saying in terms of the paradox of choice. You know, it's great to have three options, sucks to have one because then you're kind of stuck with just one. The second you get 13, it's, oh, my God, how do I narrow this down? And then one of two things happen in my eyes. One, you end up not choosing anything and you end up dating because there's ultimately millions of options.

or you just settle down and you end up picking something. You'll do. You'll do. Your approach. You'll do. And then to me, I'm trying to figure out, now zooming out and thinking on a longer scale, which one is actually better? Because right now we're speaking as if finding the one partner from a monogamous sense of

things is the goal. And dating apps are a hindrance to that. Yes. But is that the optimal goal? So I could not agree with you more I could not agree with you more And that I think is what I mean About how this whole dating app scenario

Is shifting the entire way that we think about romantic relationships Because I think that there are I think that the whole question of whether monogamy really is the right way forward I think that that is a Fascinating question that has been Pushed forwards by I think that the introduction of dating apps right You know I think that actually when you really analyze it, it's like, okay, well, where did the idea of monogamy come from?

It's kind of like, well, you don't want a cuckoo in the nest, right? You sort of don't want your wife to, like, end up being pregnant by somebody else's baby. And you don't want to actually transmitted diseases in your home. So, you know, let's sort of splitting roles while someone was hunting. Sure, sure, sure. But I think if you really think about it, actually, the idea of monogamy is, I definitely should not be talking about this. No, this is so good. This is what we need.

This is health and math meets love. And feminism. Yes. Okay. So the thing is that like actually if you really think about the idea of monogamy, we all know that like rich princes and, you know, counts and, and whatever, barons, I mean, they had mistresses all over the place. So this idea that monogamy has been like this natural human state and, you know,

and like whatever, CEOs like playing away from home and having, you know, affairs with their secretaries, actually monogamy as an idea has never really existed it's just been that like the women were supposed to be monogamous and so actually I do think that there is this whole thing about like this idea that you're supposed to have one partner forever is sort of a way to control women wow I don't know if I really think this this is just today I think no I think this is what happened today what happened on your way did you fly in today? No, I'm going to get in so much trouble.

But why would you get in trouble? I think, look, you're postulating a theory, you're a mathematician. Yeah. And you stand behind this theory and we need to create a hypothesis here. Sure. And from my medical side of things, I find it hard for me to wrap my head around that thought for one specific reason. It's because I'm not good with numbers.

Right. And when I say why I'm not good with numbers for this. specific example is my brain can't zoom out a thousand years let alone a thousand years zoom out you know a million years and in reading certain books on the subject of the evolution of humans and how we've all changed and how we were once slightly different species even though we look the same now it's confusing to me how to think about what we call humanity Like what is humanity? During what period do you speak of that this monogamy was or wasn't the choice for humans? And I don't know how to answer that question. Yeah. I mean, I think you're right. I think it's, I kind of agree with you that, you know, I'm really talking about very recent history in the way I'm describing this. But I think that in some ways, I do think there's a lot to be learned from recent history. Because I think that actually the whole,

whole concept of marriage, right, you know, as an institution has in itself already shifted quite a lot in the last century or so. You know, it used to be that actually marriages were, where you would forge a connection with somebody to create sort of financial ties, to unite two families. Dowry. Yeah. And there was no expectation that you would love your partner, right? I mean, read Jane Austen. Clearly, I didn't do. enough reading in my high school days either. So math and reading were both weak points for me. Okay. Sure. Did the reading make you nauseous? That's supposed to. Probably put me to sleep more than nausea. Sure. Okay. The whole range of bodily reactions. So, you know, like all the hope you

would hope maybe that you could marry for love, but it wasn't in an expectation. It was a practical solution. Yeah. Yeah. And that's because I think that humans had the sort of ultimate connection that we had as individuals was to God, right? It was like that was the perfect relationship that was above reproach, right? And then I think as society has become more secular, as, you know, religion has fallen away to be less important, that shifted and then we expected that perfect relationship to be the one with our romantic partner. We expected that you would meet the one, you would have this flawless connection with them for your entire lifetime. And when that then proved to be unrealistic and divorce rates increase.

I think what we've done now is we've slightly shifted so that it's the perfect relationship that we have is the one with our children. And I'm not sure how that's going to turn out. Well, if we look at the research from the 90s, how we try to find that self-esteem was a defining factor between those who were successful and not, and then we started artificially trying to boost self-esteem

in those youngsters. We saw the drastic negative effects of that where we've created people, who have narcissistic personality disorders, higher rates of anxiety than ever before, because they never truly went through challenges and won the self-esteem that they naturally would have developed as opposed to someone just giving it to you like they were knighting you in a ceremony. So I think we've seen some of the negative effects of falling in love with our children from that sense. Something that humans do from a psychological perspective,

which I find quite interesting and bears in mind this conversation, is we frequently make decisions based on historical tendencies and then like to reason them based on something that's happening now. So if I make a decision on whether or not to purchase a home as an example, a lot of times I'll make the decision and then logically create an explanation for it that makes sense, but it has nothing to do with what the reason is to actually purchase. I mean, sure. So I feel like we're really good PR people or bullshitters of our own decisions. And that's why I find it hard to accurately assess what the hell the decisions were 100 years ago. Because if I can't even decide what I decided yesterday to be accurate as far as to why I made the decision,

how do I even begin to understand what someone did 100 years ago? I think you're right. I think you're right that you can't tell about the motivations of one individual person. But I still think that when you zoom out from that individual view, to look at the patterns that people in general create over time, I think you can start to see general trends. This is not like as precise as, I don't know, like measuring particles in a box, right? Or like heat along a wire.

This isn't like, you know, this isn't like doing physics. But I do still think that you can say something useful and interesting and insightful about changes in human behavior over time. I think it's very true that you could. The accuracy of with which you do, I feel, is not proven to me. Oh, yeah, totally. I agree. Because I've seen very smart people come in and make statements that were utterly

horrendous after we watched them make those statements. An example, actually, I gave a TED talk in Monaco in 2017 with Dan. And there was a gentleman there that talked about how these Italian farmers came to a city in Africa. and they were trying to help the people of this village. I'm probably butchering the story. But the simple story was the villagers were trying to grow tomatoes and they were small. The Italian farmers came and they said,

we can teach you our methods. You're growing the tomatoes incorrectly because you're growing them at the middle part of the hill. If you just drop them to the base, you're going to get more sunlight, you're going to get bigger tomatoes. So they said, we're going to do it for you. They start growing the tomatoes

and what do you know? They start growing bigger. And then when the Italian farmers come back, all the tomatoes are gone and they're like where are the tomatoes and the villagers are like well all the hippos ate them because you planted them at the bottom of the hill so it's like this overconfidence in our abilities that I feel like backfires so often in trying to either predict the future or understand the past that I think make me so skeptical of all this stuff oh I could not agree with you more I could not agree with you more I think like I basically think that no one has any idea what

they're doing right so we're all impostors well no not necessarily all imposterous. It doesn't mean that no one has any idea what they're doing. I love what you just said. No one has any idea what they're doing. Not every. No, I do, wait, I think that no one knows exactly what they're doing. Okay.

Which is different to saying. And no one knows what they're doing. Yeah. But I do think that there's this thing called Bayesian probability theory. Do you know about this? Yes, obviously. Okay. No, I have no idea.

Oh. Okay. Okay. You just showed me a Japanese transcript. Here is a page of Japanese. So I will not feel shame for not knowing this theory. At the top of the page, it says Bay's theorem. Okay, no idea. Okay, is this idea that actually you are basically never certain of anything,

but it's okay. It doesn't matter. And I think that actually when you apply it to science, it's really, really helpful. So if you think about, okay, I can tell you pretty much for sure that if you jump out of a plane, a parachute, will increase your chances of survival, right? Okay, that's like pretty much like there's a good causal understanding there. Sure.

It's a pretty good fact, okay? On the other side, you know, if I give you statins, maybe I know at a population level that it will have an effect, but for you as an individual, I can't be sure whether it's going to help you or not, right? Or chemotherapy is another example. Sure. And I think that what Bayesian probability, or this kind of Bayesian way of thinking, helps you to do is to realize that actually there isn't these two buckets of true or force.

Actually, everything kind of exists along this spectrum of like really certain and really uncertain. And I think that when you frame things like that, the brashness that you see with overconfidence of people saying things as though they are cold, hard facts, I think you realize that actually the best approach that you can have is intellectual humility. And so all of this stuff I'm saying, I mean, I don't know what, I mean, I believe it today. No, I mean, you're talking about the half-life effects. I'll update my priors as then more evidence comes in.

Yes. Well, that's what you're supposed to do. Yeah, exactly. But then people get upset when that happens. Yeah, but that's the, I think that that is a mistake that we make as society. You know, I think the idea that we don't allow U-turn, right? Or that in business, the opposite of a good idea is another good idea rather than working out, you know, what went well and badly and then changing.

I think in medicine, actually, you guys are really good at assessing a situation and looking at what could have been done better, which is a very Bayesian approach, by the way, like that feedback, that sort of effective learning and changing your idea of what the best thing is to do based on what's gone before, rather than being like, this is the way and we're going to do it until we decide it's not the way and we do another way. There are some ways medicine isn't both of those camps. Like we do have M&M rounds, which are called morbidity and mortality rounds, where we go over someone's illness or their death and we try and see,

is there anything we could have done better. But then there's times where it's like, no, no, no, this is the way. And I'm like, well, it's the way on a population level. But with the individual sitting in front of me, maybe we have to apply different rules here. So can I tell you a story about exactly that? Yeah, please. So I don't know if they sent it through to you, but so I made a film about cancer.

Of course. Did you see it? Yeah. Oh, okay. So in that, there is this, so in this film, there was this one moment where I got to sit in on a cancer clinic with a woman called Anne who had been diagnosed with breast cancer. She just had her lump removed. And she was sitting in front of the doctor. And the doctor said to her, okay, look, if we don't touch you again, we never touch you again, then your chances of seeing another.

10 years of life at 84% right she's kind of a pretty good number yeah um but if you take everything we've got to throw at you radiotherapy hormone therapy chemotherapy we can increase it to 88% and that i you know she's in her late 60s right and like that i thought was a difficult decision for her to make so i went outside and i spoke to her and i said you know how do like how do you feel about this and she said oh um if i i have to have the chemo because if i don't then i'll die and she just hadn't totally understood what was going on which you know it wasn't my place to correct her and i think sometimes people just want to be taken care of and i think that that was the position she was in but i went back into the doctor and was having a conversation with her about it and sort of said like

i'm not sure how comfortable i feel about this because if we are if it's about informed consent and someone doesn't understand what they're doing. Is it, can you, can it really be informed consent? And she sort of said, well, you know, I think you're much more uncomfortable about this than I am because I know that on average, getting people to take the chemo will save more lives. And I was like, well, I don't know.

You know, I just, people don't know what they're signing up for. And she said, if they did, then they wouldn't do it, right? Which I thought was an astounding statement. Like, there's such a compassionate and smart doctor. but like I mean really kind of stopped me in my tracks but that whole idea then I was talking I was in the pub with a with professor Sir David Spiegelhalter who's like a very very famous statistician in the UK has worked in medical statistics for his whole life and while we're in the pub I told him the story and he said well you know actually I think that that entire thing is so anchored on the 10 year survival right those numbers are fully and completely based on that exact statistic and that actually if you looked at the 15 year survival it would possibly even switch around the other way that chemo ends up causing more deaths than it than it saves and i think that that is this idea that i'm saying about intellectual humility it doesn't mean that doctors

don't know what treatment or what path might be right for you it doesn't mean that we don't understand how you know these drugs work but i think that it means that things are just much more of a spectrum than off you go and have the chemo. That was like the beautiful explanation of the uncertainty of medicine. Here's the challenge. You have 15 minutes with the person you don't know. You need to figure out what's wrong with them. You need to create the diagnosis.

You need to find if they understand it. You need to make sure they can afford it. You need to make sure that there you have the time to go get it done. And the system kind of ends up falling there and falter. I totally agree. I totally agree. I don't think that this is, you know, in any way, like a statement about doctors' inability to explain this stuff. I think that the idea that you would have 15 minutes for somebody who, you know, like I'd been in that moment, right? Like I had cervical cancer myself. And it's like when the floor of your world has fallen out from underneath you and you are so frightened and so unsure and you have to make. this decision about what path you're going to take, and you have to make it instantaneously, I think that that is too much to ask of people. But I also think that, you know, doctors, as you said, right, as a doctor, the maths makes you nauseous, right? And I think that that's true

of a lot of doctors. You know, they're not natural statisticians. Sure. And I think that asking doctors to be the ones that take this conversation forward is a difficult thing to do. But I know that when I was diagnosed with cancer, there was a moment when I got to go, um, after I'd spoken to the doctor, there was a nurse who took me to a little room. It was kind of like, this little side cupboard. Okay. It was, um, a closet. Yeah, basically. And I knew that it was the cancer room because it had a picture of an orchid on the wall. Terrible. Okay. And it's like the idea of someone being like, well, you know what's going to make this day better for this person? Picture of an orchid. Terrible. Anyway, so I was in that room and I got to ask it.

any question I wanted about the procedure, anything I wanted about what time of day, I have to take this drug, that drug, you know, all everything about diet, about, you know, money worries, about all of that stuff. And I had no time pressure. And I just sort of think that if we're doing that for the procedures, right, for the surgical procedures, for the medical procedures, why are we not doing that for the conversation around uncertainty and the conversation around risk and choices? Because you don't have to get somebody. in and show them loads of graphs and sit them down with loads of pages of Japanese and get them to understand the numbers. I don't think that that would work and I don't think that that would

be right. But I do think that you can take somebody into a room and you can say to them, okay, what is important to you? What are the things in your life that you most want to preserve? And how can we choose a path for you that allows you to focus on the things that are important to you? Those are the conversations that are mandatory. I mean, technically, the idea, the idea, of end-of-life care conversations should be happening with everyone of any age, with any medical condition

or without medical conditions on their physicals. But the way that our systems currently set up is people will come into their physical instead of having those conversations, seeing what problems could arise based on their activities, changing some lifestyle habits

that may reduce future problems, maybe get them vaccinations, cancer screenings that are actually proven to extend life and all cause, decrease all-cause mortality, we don't do that. They save whatever problems they've had throughout the year, and they present them on their physical.

And you want to be a good service for them, and they want to be a client, and you want to match their expectations, and you end up matching expectations that aren't actually good for them. So the business model falters. And I will say the trouble I have as a practicing physician with the uncertainty angle is not so much that patients can't wrap their heads around it. It's more so that it creates major anxiety that a patient that's coming in and has already has a baseline level of anxiety, which these days is abundant. I also have patients that now I have to say, this is what I think is going on,

but I'm not sure. And it could be a lot of other things, but this is what I think is going on. So let's take this treatment. Okay, well, with this treatment, are there any side effects? Here's a list of 400 things that could be this. And I just planted the seed for each one of those side effects to happen at a higher rate. And then they say, well, doctor, are you sure this is what's going on with me? I'm like, no. I can't even be sure that if when you walk out of here, you don't have a heart attack. And now I've just created the most agitated anxious patient in the world.

And I don't know how to fix that in terms of a human communication standpoint. Because you want to teach, you want them to be comfortable with uncertainty, but you want to do it away we're not freaking people out. Have you ever had a doctor do that well for you? No. No. No and I've definitely had to talk to do it badly. Really? Tell me about your doctor. So my situation was that I had I mean I made a documentary about this right so this is all like out there public but my my situation was that I had I was diagnosed with cervical cancer and there was a question of whether it got into the lymph nodes or not. So I knew that it was in the lymphatic system. It was just whether it had established in the nodes.

So then, ultimately, I had to have a radical hysterectomy. So basically they take out like everything between your bladder and your bowel. But the question was whether to take out my lymphatic nodes as well. And the way the conversation went was, okay, right, what we could do is we could just take out your cervix, right? But the chance of the cancer coming back are much higher. So don't do that. Wouldn't recommend it. or we can take out everything including your lymph nodes.

The complications are you could have an infection, you could have this, you could have this, you could have lymphedema, which is a lifelong chronic condition that gets progressively worse, where you have swelling in your limbs, or you can have this thing, this, and this thing, right? It's like, okay, what do you want? Do you want this option A or option B, right?

And again, like I was saying, you know, I now realize out the other, side of it that it wasn't two categories it wasn't true or false there was an entire spectrum of options that lay between those two points and um of course i was too scared to just have the service out i mean i still think that that would have been a too risky thing to do um so i just kind of submitted myself to the situation was like okay fine anyway i did indeed end up having lymphedema um and it's been i mean not fun um but i think that the problem with that conversation it wasn't so much that he didn't give me the list of things that went wrong,

that could go wrong, because he did. It wasn't that he didn't give me the numbers because he did. But it was that, and this is why I'm saying that, like, just having the numbers and just having those things is not the right answer. Yeah, that's just a legal answer. That's not a life answer. It's not the life answer. But what it meant was that when I did indeed develop lymphedema,

it felt as though my cancer treatment had been something that I that had happened to me rather than with me you know it it felt like a decision that I didn't really ever have autonomy over and that's quite hard to square in your mind because I don't know if I'd gone back and realized that actually they could have just taken out the sentinel nodes right there's there's nodes that are I mean you know this much of me right but like there are certain nodes that are kind of keystones. They could have just taken out the sentinel nodes. They could have done something called a frozen state where they leave you on the table

and then they test your nodes and then take them. At what point did you realize that those were options on the spectrum? After everything had gone. How? I researched and researched and researched. And I'm not blaming you for any of this. What led you to do that then but not do it when the choice was in front of you? Was it time limitation?

Time. yeah it's time but it's also you know you are in the worst moment of your life of course right and it's like i wasn't really in a state where i could properly search in the way that i normally do i just wasn't like because you know if you're a doctor right especially if you're an oncologist this is your 9 to 5 right so your day to day people coming in you know it's a low low adrenaline situation for you whereas for the person there's this asymmetry because for the person sitting opposite is by far the worst moment you know that you're the well maybe not by far it was for me but you know for a lot of people it's the worst moment of their life um and so okay i guess what i mean about

those different spectrum of options um i didn't need to see a list i didn't need to see a list of probabilities because i know that each one of those carry their own different risks but i think what I would have liked is that conversation where it felt like I was being given more of a choice rather than there was a ticking clock of a 15 minute consultation and the legal things had to be read out to me. Do you think that there's a chance that given more choices, you would have fallen to the paradox of choice and been like, whoa, these are too many options. Now I don't know how to choose? I think it depends how they're presented. How would you have liked for them to be present it I think I would have liked to sit down I mean it's kind of what I've said right I would have

like to sit down in a room and say to send somebody to talk to me about my life and about the things that are important to me and the things that I wanted to preserve and the things that I was frightened of and to work out because if it is really I believe in individual choice and if you really are doing individual choice then that means individual appetite to risk and I think that you have to take that into account when you are helping somebody to come to their decision. And I know that doctors have tried to do this already. I know that they do. I mean, they do and they don't. There's a spectrum, obviously. We're talking about spectrum of disease. There's also a spectrum of personality and styles. I think sub-specialists kind of have a tail to the other end of the spectrum of not having

the time because they're always working in this academia, rigorous. This is what it is. These are the numbers, let's move on because we need to keep furthering our field as opposed to a general doctor may be more interested in your general life, holistically, how is this going to impact you? In fact, when a patient comes into my office and I make a diagnosis, one of the first questions I asked them is what they think is going on. Because ultimately, if they come in with a cough and I spent all this time diagnosing it and then telling them, this cough is caused by a virus, not a bacteria, so you don't need antibiotics. Here's all the reasons. And I list off all the great reasons and I think I'm a fantastic doctor and I give myself a pat on the back and I leave

and then the patient goes oh man I'm still worried that I have cancer that my cough is due to cancer and I never answered their question so that's a great way to sort of figure out where people's minds are going when it comes to these symptoms and the trouble is when they do think it's cancer not being able to give them a definite answer but relating it to yourself as a human sometimes is a good approach. So you, like if a patient worries that their cough that I think is caused by a virus as a cancer, I'll say, I don't have any reason to believe that your cough is caused by cancer as much as if I had your cough. And that all of a sudden kind of makes it more humanistic. Totally. But at the same time, makes it inaccurate when we're talking about the science.

Does it really make it inaccurate, though? I mean, yes, risk factors change. Okay. Okay. I mean, yeah. I mean, yeah. I mean, if we're being very technical. Because, you know, we're mathematicians today's at least one of us is. The thing is though I sort of think that in the same way as if you have got a patient and they are you know you're providing medical care rather than healthcare right where you are you are seeing them when a problem arises rather than like prevention right if if you wait until that moment where you you need to intervene I think in the same way conversations about risk and uncertainty can't just happen and at that moment when you need to intervene, right?

You cannot wait until you are in the doctor's office facing a life-changing decision about what treatment plan you need before you realize that there is uncertainty in medicine. Yes. Like, I think that these are the conversations that you have to have in advance. And, like, I think, you know, people like me

are the ones who have to have them. So there is just a better awareness overall. Because I think that people's perception of medicine, certainly my perception of medicine, was that, you know, okay, you've got an ingrown tone out you go in and they cut it right you've got like a rash you put cream on it urgent care model right it's like here is a thing you do a thing the thing goes away right that's a surgical world by the way okay sure that's how they no that's how they work

there's a problem they cut they fix and they move on and then done yeah now carpentry and plumbing yes exactly um and i think that that is how i thought cancer care was but actually i realized that you are dealing with an invisible enemy that may or may not be there and we're where the treatments may or may not work or may not like even make your life worse and there's so much uncertainty there and I just think that it's not a nice situation to be surprised by that when you are finding yourself in that position. For sure. I think you're making probably the best argument I've ever heard for getting a primary care doctor and establishing a good relationship with the primary care doctor because what I see young folks doing these days is treating it like a store

where they're like, oh, I have an ingrownial, so I'm going to go to the urgent care, get it taken care of, as opposed to developing a relationship lifelong with either the same doctor or the same group of doctors where now there is a relationship. They know you love playing sports

and musical instruments, so a tremor would impact you in a significantly worse way than it might somebody else with a medication side effect. And all those things can only be brought out when someone has continuity with a physician. And it's sad because I'm a family medicine doctor

and that's what I'm passionate about, why I chose the field. But it's the field that's losing the most applicants, that gets paid the least, that has the worst working conditions. And I'm always trying to find new ways to reinvigorate students to go into it. So I appreciate you sharing your personal perspective and how important it is to be proactive because there are certainly ways in medicine where we can be proactive and prevent problems. It's not a lot, but we have certain ways to do it. There will also be instances where there are going to be acute moments where you're going to have to

make a decision in a blink of an eye. For example, there are certain surgeries that we want to consider elective. Why? Because an elective surgery, I can do a preoperative clearance. I can optimize you for the surgery. Make sure your blood sugar is optimal. Your cholesterol levels are optimal. Maybe give you some medications. But then there are certain surgeries that are emergent surgeries. Therefore, we need to do them right now. So even though the outcome is likely going to be more dangerous, meaning the risk is going to be more dangerous, it's still worthwhile to do that based on the trade-off of the emergency of the situation. So there's a lot of different spectrums in medicine,

but the fact is every situation gets worse if you don't have good continuity. Because you can't make a good decision in the moment without good continuity, and you can't plan ahead without good continuity. So thank you for being an advocate. I mean, you're welcome. I'm so jealous in a way that the British system

just doesn't really, it's very, very, very difficult to get that continuity in the British system. Really? Why is that? Is that the NHS, like, model? Yeah, I mean, you have, so you have a GP. I mean, you are supposed to have a name GP. And I think if you really fought for it as an individual, you could make sure that you saw them every single time.

But it's just there's a real crisis in the NHS at the moment with underfunding and increased need for it, really. You know, we have an ageing population. There's all sorts of different reasons. But, I mean, I don't think I've seen the same doctor twice. Wow. Apart from my oncologist. That's terrible.

and like that almost significantly is going to be the biggest factor on whether or not you're going to get good care. Yeah, and it's a false economy, right? Yeah, it's not even that whether your doctor is going to be good or well trained or went to the top school, but it's going to be that, the fact that the relationship doesn't exist. So it's sad to see that even someone of your stature, imagine someone who's living paycheck to paycheck

or doesn't even have a paycheck, how much worse their health care is in that situation. Oh, well, that's the one thing about the, the British system is that everyone has equally bad health care. Yes, but transportation becomes an issue. There's other barriers. Healthy eating is an issue. All these things that maybe we don't even count as health care,

but play a big role in whether or not you have good health care outcomes. This conversation leads me to something in your new show about the future. One of your episodes, your premier episode, I believe, was on biohacking. Take me through how a mathematician looks at biohacking. in the way that it exists today because I have a very strong stance on the subject. Interesting. And I won't tell you what it is

until you reveal your cards. Okay. Excellent. You have set the trap. Yes. And here I go trotting off into it. It wouldn't be fun without a trap now, would it? Okay.

So in the spirit of intellectual humility, I don't have a, strong opinion on the science. I have actually a medium opinion on the science. Okay, so the stories are incredible. I mean, the things that people are trying to do to live longer are wild. So there are people who take unimaginable amounts of vitamins who won't touch any water apart from very particular pre-specified types of water

who you know avoid any oil that is derived from nuts right sees there you go thank you you know really really really limit their the way that they live their lives in order to extend it as much as possible um i think that if longevity is your ambition then i think you know knock yourself out i believe in in individual choice in terms of the science i think that there is some really interesting stuff happening around the hovath clock which is what we feature in the show about the sort of difference between your biological age and your chronological age as it were that some people go through the aging process physically faster than others and it's quite a good metric on which to measure other interventions broadly speaking I mean there's a couple

of things that look quite promising but broadly speaking I think any of those silver bullets that exist, including living your life, you know, in a really regimented way. I mean, we are ultimately talking about, you know, marginal gains in terms of the difference that you make. Of course, if you live a healthy lifestyle with moderation versus if, you know, you eat lots of processed foods and don't do any exercise and so on, of course, there's a dramatic difference that can be made then. But if you start from the baseline assumption of somebody who is already quite healthy and living a sort of normal life, as it were, those incremental differences that you can make by any of the interventions I think that exist so far are very slight.

All of that said, I also, for the show, got to go to Japan, where Japan has the highest life expectancy in the world. And it's, I can't remember the exact numbers, but it's like a lot higher than the US. Eight to ten years. Yeah, yeah, like a decade, right? and that is a big thing and of course part of it is going to be down to diet there's a very very diet in in japan lots of kind of very healthy foods obesity you know really doesn't happen in the same way and there's a very outdoor outdoorsy there's lots of you know exercise and walking and that

kind of thing but one of the things that I really um hit upon while I was looking into things for the show is that I think that there is really an element of the Japanese philosophy that ends up having a positive impact. So Japanese philosophy, there's something in there called Ikigai, which has sort of made its way into Western media, but it's often misunderstood. So the idea of it is it's about finding the joy in small things, finding something a purpose, a meaning. And when you look at the statistics of people when they retire, I mean retirement is ultimately like the biggest killer, right? So there is definitely some evidence that having purpose will end up prolonging, you know, having meaning and purpose do end up prolonging your life. But the really

nice thing about ikigai is that it's not just about like, oh, you know, loving the smell of a fresh new book or, you know, whatever, you know, I don't know, whatever your Ikega might be. But it's about seeing the universe in a teacup, right? So if I can explain that, the guy who I got to interview Ken Mogi, who is a very famous neuroscientist, Japanese neuroscientist. The way that he described it, for him, his Iki guy was butterflies, right? And he loved them when he was a kid. He used to, like, draw them and paint them. And then when he went to university, he studied them.

He did his master's dissertation on butterflies, I think, and just really, really likes them a lot. And every morning he'll get up and he'll go for a run. And when he's on his run, he looks to see if he can spot any butterflies. And in that process of doing that, when he sees one, he said that the really beautiful thing about it isn't just like their physicality. It's also that butterflies' lives are really, really short.

And so your chances of encountering one are very small. And the chance that you will never see that same butterfly again, right? It's a passing of two moments of two creatures. And it reminds him of the transient nature of mortality and of like the finiteness of. of his enjoyment of things and just enriches the entire experience of him. It's kind of a meditative thing almost. And there I think there is something really beautiful and really profound.

And that ultimately for me was the conclusion of all of this show. It's like actually I don't really mind if I don't get to live a long life. I just want to live a good one. And I think that if instead of seeing life as this, I don't know, like challenge or like problem that to be solved of what the kind of pills and medicines you can take to prolong it. If instead, I think if you can manage to see it as a series of moments to be enjoyed, then I think the kind of question of longevity sort of dissolves into the background slightly. Okay. So if I was to summarize your statement, it would be that

there's potentially some science on the horizon, some things that potentially work right now to prolong life, but the goal shouldn't be prolonging. It should be enjoying. Yeah. I agree with oh thank goodness for that with with i would say most of it significantly all of it um and i don't think we even disagree on anything i think it's more of my viewpoint and perspective on where those things start actually causing harm and my issue with it starts with almost the same issue that you raised about this uh individual you interviewed in japan how we frequently count the number of years as opposed to enjoying the years it's not the amount of breaths you take it's the moment's take your breath away all the beautiful statements that we have but it's more so that question is aging

actually a disease and people who want to prolong life view it as a disease and i think i philosophically and fundamentally disagree with that because i think it's part of the process and i think that there's something to age and gracefully and i've been in the final moments with so many patients that were enjoying their final moments. I've been with people who've regretted things, and I've seen the spectrum of emotion during those times, and I feel like it's not a disease, because it's not something that's to be cured.

And in fact, one of my last questions for you is going to be on that subject. But the reason why I dislike the entire field of biohacking is it's based on that premise, that aging is a disease, and I disagree. And the second is, it is fundamentally based on what the future can hold versus where we are in reality and it's not based in any sort of reality. So all of the tools and vitamins and supplements and promises are largely based on

theoretical models, on mouse experiments, on petri dish experiments, and we've cured diabetes and illnesses and mice, and yet we can't do even remotely the same thing for humans. We've cured cancer and mice over and over again. And that's great news for mice, but we can't do the same for humans in most cases. So. Have you seen that Twitter account where they take news articles that say like gene found for this or like this drug, what they just do is they retweet it and it just says in mice. Yeah, we should, we need to do that more often. And these biohack people start praying on individuals to sell them things and turn it into a business model

with so much false promise that it actually distracts people from the simple fundamental things that in your theoretical example you said let's take that person who's living a healthy life so many people are not living that healthy life and if i as a doctor can get them to do the fundamentals which is so hard to do great but instead we're putting the focus on maybe extending a few years or potentially changing our biological versus chronological age, so much emphasis is put there, whereas the emphasis with the big realized gains happen with changing of the fundamentals, because no one's doing the fundamentals if I really look at my office.

So, you know, we were talking earlier about the carrot and the stick, and we were saying about how something that's worth having, you have to sort of suffer for it a little bit. Yeah. I mean, I do kind of think that that's true in general of life, right? Like, I do notice that there is this sort of tendency to want to kind of cheat, right? Like, eat all of the cheese cake. The hacks, yeah. Right. And then, and then take the pill, right? You know, like, sit on the sofa and then use the little electric thing to give yourself a six-pack. Yes. And I just think that it's this false promise. I think it's this, it's something that doesn't exist. And I just kind of think that if you want to have the richest, most fulfilling life possible,

it does involve doing things that you don't really want to do. But I think that in the long run, everything that's worth having is, you know, you have to sort of fight for it a little bit. Sure. That's why I think hacks ultimately leads on happiness, which is a funny thing to say. And I also think that the fundamental,

even potential benefit that some of these companies talk about pails in comparison to the risk we face as humans in our everyday lives, driving, airplanes, whatever you do on a rock climbing, bungee jumping. The things that we do carry a level of risk that if you add it all up, the fact that you're changing percentage points here and there should not be your primary driver unless you derive insanely magical levels of happiness and joy from doing it. But then you're just enjoying the journey as opposed to that end result, which I'm pretty sure those businesses are not trying to do.

I couldn't agree with you, mom. I couldn't agree with you, mom. And the reason I brought it up was because I constantly have to do that on this YouTube channel because my patients come in and they want that pill. They want the miracle. They want, but doctor, can't you give me something to lose weight? Can't you give me something to just to control this? Can't you give me something without side effects?

I'm really sad right now. Can you give me something? And there are things that we have, some tools, but they carry risk and they're not perfect. And yet it's the fundamentals, the boring things. Even I had a professional athlete here, an NFL player, Brandon Marshall, and he's doing this giant course and teaching people. And he's top level athlete. And yet he's telling people the success is those like five things, the fundamentals.

And yet no one wants that. They want the shiny silver spoon that will take out the calories out of their foods. And I think that's like a psychological concept that much in the same way we need to break that math is nauseating. we need to break that there is no shortcut yeah and i mean i think it comes back to that thing that we were saying earlier right of like you know true or false black or white right like everything is a spectrum there is no absolute certainty to pretty much anything and and and i think that that just means that all of these things that you're describing it's like it means there's no shortcuts either you know you've just got to you you just got to put in the work i feel like the people who

sound most certain in medicine, healthcare wellness space are the people who are selling those things. And that's what gets me frustrated. There was an article I just saw in the New York Post where it was like, the doctor who is 63 years old has body of a 43 year old based on his biological age and he has like a six pack. And who knows? Genetically gifted testosterone replacement therapy, growth hormone, whatever it is, or truly a healthy lifestyle. Who knows? Who knows? But what I know as a doctor is that's not reality for most. And being in the influencer space, I know the people who look the best, who take the best pictures, have some kind of thing helping them out, whether it's Photoshop, surgery, injectables, et cetera. So breaking that fourth wall for people and saying like, this is not reality was actually the reason why I wanted to start the YouTube channel to get people to sort of connect more, not learn individual facts from my channel.

love you cool too but more so understand the principles of doctors don't know anything you know that thing of like the 63 year old with the 40 year old body to me it's a little bit like um having a newspaper article who says lottery winner is rich you know what it is like yeah i mean i sort of think that of like some of the i do a lot of palates right and like some of the pilates porn as i call it um on instagram like these these they look amazing like they look incredible but it's not that Pilates made them look incredible, although Pilates is kind of good for your essays. It's more that they have the bodies that look incredible and then Pilates helped them. And then it's like, it's sort of, you know, you're, you get kind of caught in that

misunderstanding of the causal chain of things. And it's very dangerous to do that. I think it's okay in instances where you're trying to get people to do something positive. Like why I'm okay with that in Pilates is because Pilates is a healthy thing limited to no side effects. And when I think about doing the same thing, misleading people with dating apps trying to tell you you're more connected to somebody else, I get upset because I don't feel like that carries zero risk. I feel like that has negative implications that we're playing with fire. Yeah, I think I agree with that. I think I agree with that. I think I agree with that.

I mean, the ethics of it is very dodgy. It's wild. It's like the question I always pose to clinicians or maybe even scientists that aren't seeing patients. Is it okay for me to upsell a treatment that I know has like a 30% efficacy rate. I know it's the correct treatment for the given patient in their condition. But what if I upsell it with a lot of excitement to try and get a little bit of the placebo effect in there because I'm wearing a white coat and I'm trying to get them happy about it? Is that ethical? That is difficult. You know, there have been times actually where I've had something wrong and I have sort of says, I just want to go into a doctor and have them prescribe me a sugar pill. But obviously I can't tell them that's what I want. Right? And I think

that actually it's kind of the reason why I think a lot of alternative medicine works quite well like I mean look I think that alternative medicine can be seriously problematic at times but I also don't really I mean look if you've got a rash right and you can either put a steroid cream on it or you can take some some like water some fancy water um you know and it gets better both times then I think you're sort of better off taking the one that doesn't have the side effect so heavy for me to say because what if that's skin cancer. Now we're missing it because you were putting magical water. Agreed. Okay. I was working on the baseline truth that it's just like contact dermatitis or something. But that's the

fear that I have as a doctor. And then again, with all that water, like for example, the pH of the water thing, like drives me up a wall with the alternative health folks because they tell me you have to drink alkaline water. And I'm like, do you know where it goes? It goes into your stomach with a pH of two and it doesn't matter and your blood pH doesn't change from the water because it's so tightly regulated from 7.35 to 7.45 and if it leaves you're screwed so and like your body regulates that you don't even have to think about it because if you did there would be a big problem you'd miss everything and you'd die instantly I remember going for a massage when I was pregnant and they wouldn't they wouldn't let me have the massage and I was like well why and then they said oh it's because because we're moving

toxins around your body oh Jesus and I was like okay just Can you give me the chemical formula of these toxins? Like, what are we, what are we talking about here? This is what they were taught. So they're just repeating someone else's words. I know. And that's, it's so frustrating. I can't, in the same vein, they're telling you acid is terrible.

Anything acidic is terrible for you and causes cancer. And in the same other sentence, they're saying, take vitamin C because it prevents cancer. When vitamin C is a friggin acid. It's a sorbic acid. You just told me, cancer has caused my acid. The cancer is prevented by acid. So it really comes from that limited knowledge is very dangerous. I think that's true.

Without oversight. I think intellectual humility is the way forward for everyone. Agreed. And I don't have all the answers. No one does. And I remember even in my TED talk, my TED talk was the power of saying I don't know and how if you pull the PhDs in the room, you'd probably say you've created way more questions than answered in your studies that.

the more I've come into medicine, the more I realize, wow, we don't know anything. And the little things that we do know, I can help you with, great, but there's so much more unknown to navigate. And navigating the unknown uncertainties, I think the art of medicine that I'm trying to get students excited about. So the book that I'm writing at the moment is called No One Knows What They're Doing. And I think it's really similar to the thing that you just described. Oh, my God. Okay. All right. You ready for me to check your reflexes? Sure. Okay. You know, it's like a doctor's show, so we have to do something doctory. We used to call it a lightning round, but now we have to check your reflexes. I'm suddenly

terrified. Go on. This is going to be really fun. Question number one, what's the healthiest part of your body? Oh, my hair. Oh, okay, for obvious reasons. For those who are listening on audio. Frankly, the amount of time and effort and care I put into it. Oh, really? Do you put, like, what's your care routine? I think you could send a child through private school for the amount of one of us. Is it like a keratin thing? What are you doing? I honestly don't get me started. Wow. Okay. What blow dryer do you own? I actually, a Dyson, but I very, very rarely use it. Okay.

Why? Because you're worried about the heat. I saw a study that said if you let hair air dry, it actually creates more damage than on a low heat setting. So I like, do you disagree with that? This is not the direction I thought of this quick fire. What do you mean? This is beautiful. It's going to go in.

Okay, so what I do? For people who are. listening in audio. I think it's important to state that the hair is flawless. The head, the hair is flawless. But also, anyone who may or may not wish to give me a deal with the shampoo company, I'm fine with that. That's what I'm saying. I'm fine with that. That's how it works in the industry. As long as you washed your hair with the shampoo before the shoot, it's legal. So, actually, I take your shampoo. Maybe a conditioner company. Dyson, no shampoo. I'm taking notes here. Okay. One part of your body you wish you could

place? I nearly died from cancer, so I quite like my body. Okay. But maybe I thought you would say because of your cancer diagnosis, you would say my cervix. I would like a cancer-free cervix back. Yeah, my cervix is currently in a medical dumpster somewhere. Well, that's what I'm saying. You could have replaced it and maybe you could have gotten a special one. No, I think, no. Or is the struggle worth it? Yeah, I do. Honestly, I think. I think if you said here is a button and if you press it, you can undo that entire period of your life. I wouldn't press it. Wow.

That's powerful. Wow. Okay. I did not think this would be checking your reflexes. I'm sure that some people are going to be on Twitter to be like, she should say her nose for fun. People are savage in the comments. If I could let you live forever, would you want to?

No. Why? Because I think that the reason why it's so valuable is, because it's finite. Like a butterfly. Yeah. Have you ever almost died? Yeah.

When? With the cancer stuff. Was it that? No, it was. Well, I suppose it could have come close because it was caught on a smear test. And I put it off for a really long time, a smear. Or pap smear. What do you call it here?

Yeah, pap smear. But what was the reason that you put it off? It was just busy. Oh, okay. and so that played on my mind actually for a really long time that had it happened earlier maybe I wouldn't have wouldn't have been so serious maybe it wouldn't have been quite so traumatic

but I think that actually I spoke to one doctor while I was making my film actually and she said okay but you just don't know right like you don't know that that was the path of things because it could have been that you'd gone and got your smear test earlier and then it'd come back all clear and then they would have put you on the three year renewal so you can't you can't like blame yourself it's just dumb luck yeah um so i think that that's but there was a period

of time it's in the documentary actually but there was a point in time when i was in the hospital and it was during covid so i had no visitors i was like totally isolated um and in the surgery four of the four or five of the nodes had come out and they were enlarged and the way the surgeon had like explained it to me it was basically like you know and i'd seen the statistics before i went in And if it was in one node, if it was in no nodes, I think I had like a 95% chance of survival. Like five years or so one node it was down to 60, two nodes it was 40. And then this guy was saying it's in five. And I was there like tubed up to the nines, right?

You know, like drains and all sorts coming out for an entire week, like paralyzed with fear. And just thinking that that was the end of it. And how did you manage it? I mean, I don't think I particularly managed. Well, you're here. That's true. You know, when you see films of, like, World War I, right? And people are in the trenches.

And there's some people where they're like, right, come on then, let's go. Like, and they take the fear and they're like, let's go. And then there's other people who are sort of like quivering in the corner crying. I realize I'm definitely the latter. But that's not a negative, like you're painting it in a negative light. That's compassion. Yeah. Like, that's a normal human response.

Do I have to pay you for the therapy session? No. No, I'm saying it not becoming your doctor because that would be legally and medically, ethically, incorrect. But I think too often we view normal human emotions as pathologic. So kids, adolescents frequently who come to me and say that they have depression when their best friend just died. And I'm like, well, you're like, if I told you, I lost my mom last week. week, would you tell me that there's something wrong with me? No, your mom just died. So why are you

doing that yourself? And we treat ourselves unfairly like that all the time. And then through a process that I actually wanted to discuss with you earlier, kind of missed it, through concept creep, they would take that and say, I should be nice to myself at all times and never challenge myself and only comfort and the pendulum swings too far the other way. So we need to keep that pendulum really firmly planted in the middle of the carrot and the stick. Is my take away? Spectrums. Is that a word of the pod? Yeah. Yeah. Spectrum. I didn't expect that to be the word, but that's a good word. What did you expect it to be? Pie. Maybe because I was hungry. Or maybe because you're mathematician. Fine. Well, thank you for sharing your stories. And I'm glad you obviously didn't

die and they're here to share your wisdom with all of us and continue to do so. Where can people learn more, watch more? Where do you want to send them? So the future with Hannah Frye, got my name and the title. Can't sack me. Thank you. That's also dangerous because then if you do something wrong, goodbye. Oh, no. Don't say that. Well, tell people, where can they watch it?

So it is on Bloomberg, but you can stream on Apple and Amazon and all of that. We will be streaming and we will be learning and we will fall in love with math. Thank you very much.