The Checkup with Doctor Mike - Which Country Has The Best Healthcare? | Dr. Zeke Emanuel

Episode Date: January 4, 2026

I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Thanks to Dr. Zeke Emanuel for appearing in the show. Buy his new book here: https://www.ezekielemanuel.com/books00:00 Intro01:53 Building Obamacare / Expensive Premiums11:20 Vertical Consolidation of Pharma18:15 AI Tools29:42 Private Equity In Healthcare35:00 Biohacking39:26 Supplement Regulation / Dangerous Testing46:34 Corruption Of Young Doctors / Copays52:45 MAHA / Subsidies56:13 Best Healthcare In The World58:37 Worst Habits / Fiber1:02:28 Ice Cream1:08:48 Blue Zones / Raw Milk / RFK Jr.1:13:05 GLP-1'sHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline Weigum Editor: Juan Carlos ZunigaEdited by Nabil El Hamdaoui* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

I'm curious, if you had to be born today, what nation would you be born in because of their health care system? I wouldn't want to be born in a country only because of their health care system. In this hypothetical, you have to choose. Well, look, first of all, let's be, I do have a book called, which country is the world's best health care. Oh, there you go. I only went to 11 countries.

I didn't go to every country in the world. So the big winners were that. Welcome to the checkup podcast. Today's guest is Dr. Z. Eke Emanuel, an oncologist who, amongst many other things, helped design the Affordable Care Act or Obamacare. Currently America's entire health care system. So you can blame him the next time you accidentally book a doctor, that's out of network. All kidding aside, Dr. Emanuel has been extremely influential in establishing the structure of the average American's health care, both the good and the bad.

Providing coverage for Americans with pre-existing conditions? That's Zeke. Having to enroll in a new policy every year for the rest of your life, Let's also kind of Zeke too. But he's not just a physician and bioethicist. He's also the author of a new book called Eat Your Ice Cream, Six Simple Rules for a Long and a Healthy Life. It's full of great tips to improve your health,

including the dietary benefits of eating ice cream. Am I reading that right? Yeah, we'll dive into that for sure. Everyone in America seems to hate our healthcare system, me included, and while people throw out suggestions like universal healthcare or let the free market decide, The reality is that providing health care for over 300 million Americans is more complicated than social media comment sections might have you believe.

So, given we've all had frustrations with receiving health care in this country, I want to ask what he thinks the real problems and solutions are and which countries he thinks are actually doing things much better. Please welcome Dr. Zeke Emanuel to the Checkup Podcast. Dr. I'm so happy to be here with you today. It's great pleasure. To chat about the state of the world as it exists today with biohacking, health insurance, health, prevention, the way news media covers are medical stories. What's at the forefront of your mind these days?

What's keeping you up at night? What are you concerned with? Well, I think that there are two separate things. The thing that keeps me up at night is, frankly, the health system and the fact that it's crack. and there are lots and lots of problems, and we have no path from here to realizing any of the goals of a health care system. Universal coverage at reasonable cost with high quality, decreasing disparities and satisfaction by everyone. Every one of those goals we don't fulfill. Many other countries get two, three, even four, but we can't get to any one of them. So that keeps me up at night.

Why do you think that happens? Oh, I think that's a, I think that's a, First of all, it's the book I'm working on now, and I think it's a direct result of the structure we have created. It's so complicated. There are so many different ways of getting insurance and therefore falling through the cracks. It raises costs because of all this duplication, and it has a lot of opportunities for gaming, which also raises costs tremendously, and so we have no way to get everyone covered. we raise costs and we have taken our eye off the ball of health. And the problem there is, goes to the second topic, which is we've actually created a society

where ill health is actually kind of built in. And we see it all around us, the fact that our life expectancy is shorter than almost every other country, the fact that we have, you know, 40% obesity, 30% overweight. weight. We have all these distractions, high levels of mental health. So those are the two things that worry me. They obviously overlap, but they also have differences. If you really want to get people healthy, it's not only about the health care system. It's about the food system. It's about school. It's about a lot of other things. Yeah. And you played a major role in the ACA. Can you take us through that? How long do we have here? I thought this is. Free flowing. Let's go. So I was

lucky enough to be asked to come into the administration, the Obama administration to work as an advisor on the ACA. Obviously, lots of things took 15 months to get it passed, but it got passed. Were you happy with what was passed? What passed improved the health care system? Am I happy? It didn't solve the problems. And it, you know, in retrospect now created some additional problems because it's very complex. We added complexity to the system instead of simplifying things. But look, look, we added 24 or 5 million people got coverage through Medicaid, the exchanges, employer-sponsored insurance.

We kept health care costs flat. Alone did the ACA keep health care costs flat? No. Was it a major factor in that? Absolutely. Those are two big achievements that no one else has realized. We're now 15 years out with a lot of opposition by the. Republicans, no help in trying to actually improve it.

And there's no business in the world that I know of that would put in place a plan to go forward and not revise it over time. We, in the United States, in our public policy, we put in a plan and we sort of let it go and we don't come back to it. We don't build in a way of making modifications and improvements in general. Sometimes they do. Massachusetts, when they implemented Romney Care in the early 21st century. They actually had a mechanism for making minor modifications constantly, and that was really important.

So we're seeing cracks and we're seeing problems that have to be addressed and will be addressed. I had Senator Schumer sitting across from me not too long ago during the peak of the shutdown talking about his fears of premiums rising for individuals, for couples. Is that a fear of yours given what's going on in government these days? Oh, it's not a fear. It's a reality. It's horrible. So today, for 2026, the average family premium from an employer, $27,000 for a family, $27,000.

That's a new car every year for health insurance for a family where, you know, you probably have two adults working, two children, they're relatively healthy, they're not probably using a ton of health care. That's outrageous. And we can't, I mean, that's... How does that compare it to the year prior? It's up about $1,500 or $1,500. But, you know, that's just, and the projections for the future are up, up, up. Of that, I mean, the economist will tell you the worker pays for it all, either visibly through wages where they have to pay their part of the premium

or invisibly through wages they don't get or otherwise would. And that's, you know, even if we could cut that back, three, four, five thousand dollars, a family, there's almost, I don't know any single family except the, you know, top five percent where three or four, five thousand dollars wouldn't go a long way towards making them just a lot calmer, reducing a lot of the financial stress. That, I think, is a, that is the major issue. You know, if the shutdown did anything, it catapulted health care affordability to the top of the agenda. Now, in that context, a lot of what the Democrats wanted was the enhanced subsidies for the exchanges to be maintained. Only 24 million people in the exchanges. Really important for them to get financial relief. But there's 150 million people with insurance from their employer who would get zero relief.

We have to deal with the whole system, not just a small part of it. And, you know, I've written a new op-ed about that. And I think it's really important that we focus on everyone in the, the country having affordable health care, not a small segment. In this op-ed or perhaps otherwise, have you come up with some ideas of how to address it more globally or nationwide? Yes, I think there's a two-step process. The first step is we have to put in some things that can reduce costs, importantly in the

next few years, capping hospital costs, doing what's called site-neutral payments where you pay the same price for a hip replacement, whether it's in an ambulatory surgery, surgery center, hospital outpatient or hospital input. Exactly. Facility fees need to be evened out. That's on the doctor, on the hospital side. On the pharmaceutical side, we have to bring down the cost. There are multiple things, you know, I think, look, why don't we adopt a policy they have

in Australia in Japan, which is at five years, there's a mandatory price cut, not price increase. We could also think about, you know, making restrictions on PBMs, so that's. Their fees are not dependent upon the price of the drugs they sell. The flat fee, that's the first thing. The second thing is, anytime there's a biosimilar for a specialty drug has to be included on any formulary they create. Right now, they have a big incentive not to include the biosimilars, and in many formularies,

they don't. That just drives prices up for everyone. Similarly, we need to tackle administrative costs. In the United States, we spend $1 trillion on administrative costs. for your listeners who don't spend a lot of time. That's $3,000 per American on administrative costs in health care alone. That is insane.

Well, that's the great chart that I show so often to people in explaining why health care costs have gone up because they assume doctors are somehow become more rich. When in reality, the amount of administrators has skyrocketed, doctor salaries stayed relatively flat if not dropped. They're flat compared to inflation. Yeah, exactly. And the administrative, not just costs,

but also burden on doctors. Everyone, patients, too. The hassle factor, you know, the technical term for that is sludge. Lots of hassles. And we can, I mean, McKinsey has a report where they say we can probably get a quarter trillion dollars out of those administrative costs. Simplifying the system, that's without radical change. Simplifying the system would help. So I think those are some of the areas where I think we have to actually reduce our,

we implement fast to reduce costs. That won't change the underlying system. So that's step one. Step two has to be much more comprehensive reform. And I'll tell you, to be perfectly blunt, we don't have a big debate about what is that comprehensive reform going to look like, and we need to have that debate starting now because we have to vet ideas. We have to say, no, that's not going to work.

This will work better. I really think the affordability thing is becoming so oppressive to people that, in the 2028 presidential election, if not then, for sure in 2032, it's going to be top of the presidential debate. Yeah. You mentioned PBMs, and I've been quite vocal about the lack of transparency, the way that they even were instituted in the first place in order to save us money. And lo and behold, that's not exactly what's playing out.

They've created basically new billion-dollar industry from it. What's your take on the various ways that you see very? vertical versus horizontal consolidation between, you know, the pharmaceuticals, the pharmacies, PBMs, hospital systems. To me, there has to be something antitrust happening here, but it doesn't seem like it's addressed enough. What are your feelings on that? Yes, I think you're 100% right.

We have, again, part of the gaming of the system is more consolidation. You see this in the hospital sector. That tends to be more horizontal, although there's some vertical there where they're buying physician practices and not just buying other hospitals, but physician practices, ambulatory surgical and ambulatory imaging centers and other things. So that has to be addressed. And then I think I totally agree with you, this vertical integration. And we've just, you know, we've had reports about companies that are vertically integrated where one part's feeding the other part so that they can charge high and the profits stay within the company. All of that has to be.

address. And unfortunately, the FTC and the Department of Justice haven't had the resources, really, the manpower to go after this and set new standards for it. But if you look at, certainly on the hospital side, the consolidation in most markets is terrible. Now, everyone is one of two systems, and that's it. And so you have really no choice. And the payers, you know, we all love to blame the insurers, but they have no opportunity. to actually, you know, drive prices down from competition. So we have to instill more competition. And I think there are, again, mechanisms.

I'll give you one that was originally proposed by a Republican, and I think it's a very good idea, which is we have to cap hospital prices and the cap that we use, how much above Medicare they can be, directly relates to how concentrated the market they're in. If the market has a lot of competition and we can rely on competition to keep prices down, we don't have to cap them so low.

If there's only one health system or two health systems in the market, then we have to have a lower cap because competition won't keep the prices down. So one or the other. And I have to tell you, people are sufficiently frustrated by hospital prices that you have new legislation in places like Indiana, Indiana, not a blue state, right, about capping hospital prices for commercial insurance because it's like this isn't working. The system and the competition just isn't working.

Yeah, I think about, you know, in medical school learning Stark laws and then looking at vertical consolidation being like, how is this not basically the breaking of those laws? 100%. So I would love to see the Justice Department play a role here because it is multifactorial, just like when we were thinking about weight loss. It's not just about exercise.

It's not just about diet. I recently had a psychiatrist on who's talking about shifting from mental health to brain health. When we're improving brain health, we're also improving all the other body parts and thinking about metabolism improves the brain. So here, attacking it on every front seems to be crucial. And yet there's some kind of distraction happening where despite the calls from the people, we're not seeing it play out on an actionable governmental front. Why is the government not listening in this case?

Well, it probably is no surprise that the healthcare industry is the biggest lobbyist in terms of dollars. It's also separate from the actual dollar spent, the friendliness with the Congress people, the importance of a hospital or medical group in their district. Those things play out. And I would also say the complexity of the system. And we have to be really clear about this. 99.5% of Americans don't understand. I would say doctors are probably in a same. I would agree with you.

You know, people ask their doctor, but doctors, they don't understand how the system works. You know, what's a PBM? You ask most doctors. They couldn't explain exactly what is happening behind the veil. And so part of the- And that's not their fault either. No, no, not at all.

Because they're supposed to know the science and how to treat health care issues. Exactly. And so they're not health policy. experts. They're health care experts. And part of the issue is it's so complicated that most legislators don't understand the system. They have a few talking points about it. They might understand a corner of it, but they don't understand the whole system. And that I think makes it hard to develop reforms that aren't going to, you know, come back and haunt you as well as

makes it hard to develop comprehensive reforms. And then, by the way, sell it to the public. So they get lobbied by, you know, some company do this, and then it has knock on effects that are bad for the whole health care system. And we're seeing that, you know, upcoding. So it's rational that we should pay doctors and health insurers more for sicker patients. That's very rational. Okay, now how do you determine a sicker patient? And then you've got a lot of gaming that can go into it and everyone's manipulating. Here's the system. They'll figure out. how to manipulate it because it's complicated. And that, I think, inhibits more comprehensive reform. So I think we've got to figure out how not everything has to go back to Congress or state

legislatures because it's hard for them to figure out, is this solution going to work? And we need a different mechanism for reform. Is it a partial solution to this having more physicians run for office? No. Again, as we pointed out, a lot of them don't understand health policy. policy, have made mistakes. So I'm not sure. I mean, there is good reason to have physicians add their voice. I think, for example, on vaccines. Not all physicians are good on vaccines, but the vast, vast majority believe in them.

And in some other very important roles to say yes or no, that's a good idea or not a good idea. But I don't think it's physician, not physician. And I really do think the complexity system now overwhelms anyone who doesn't study it for a long time. And most legislators because of the nature of the job can't study it for a long time the way they used to in the old days, as it were, like 20, 30 years ago. I've had AI experts on the show, and I've seen episodes on 60 minutes on AI, and everyone's talking about the future robots, this, that. And to me, I would just like to see AI remove some of the administrative burden in selecting a health insurance plan, in removing the need for 16 administrators to bill my outpatient family medicine visit. Why aren't we utilizing these technologies? Are companies not innovating in them because they might cut into profit margins?

Or is there some sort of side benefit that I'm missing? I'm very bullish on AI in medicine. I do think it's going to make a big difference. I do think it'll make a big difference on the administrative side. I do think it'll make it a big difference on decision supports. I actually do think it's going to make a big difference on delivering care. The more you look at some of the innovations and some of the ways, you know, there's a lot of AI a lot. There are AI systems out there that can do great at a differential diagnosis.

Here are all the possible things when you describe a patient. Tell you what tests to order to efficiently get to an answer. Tell you what the guideline concordant therapy is. That's a lot of what medicine's about right there and then even monitor patients. So I think the future is going to be very positive. The issues are integrating it into workflow, pretty mundane issue. All change requires how does the workflow go, how do we adjust it, how do we integrate, making sure that there's payments so that people actually have an incentive to use it.

Those things, all of those things are lacking at the moment. They're not all lined up together. I do think in the next three to five years we're going to see a massive impact of AI and health care. And in exactly the way that you want, which is reducing administrative burdens, making things like scheduling much easier, probably even answering a lot of patient questions from the scenario and flagging ones that are complicated and need nurse practitioner, physician engagement. So I think that's a big, big, likely direction. But again, we're going to have to get the payment right so that if you use AI, you actually don't lose a lot of money.

Sure. And we're kind of at this awkward growth stage where right now the AI that I am having access to is making it worse because we're essentially training the models and putting an extra work in order for it to develop perhaps into something valuable. But I use open evidence. Sure. And it's pretty, it's very, very impressive.

Yeah, for sure. There is value to be had at times, though, especially with some apps. I've been shocked at the things that I've come up in my time teaching residents. They bring me something and it's completely out there with these hallucinations. So it does happen. So I would say a big AI expert in California, who's a big investor in AI in medicine, was telling me,

he says, look, you have to understand AI, the best analogy to an AI, he said, is like a car, right? Some cars are tuned for racing. Formula 1, okay, you're not going to take a car who's going in New York City traffic and put him on a Formula 1 track. They have to be tuned right. So general AI, not good in medicine, right? They will hallucinate a lot more.

AI that's trained in medicine and trained, as you say, repeatedly in medical encounters, they are going to be much better, fewer hallucinations if you force them to give you the citations and you can run and check them. So I think there is a training of the AI and a cultivation of the AI that's going to be necessary. Look, generative AI, LLMs, right? They're three years old. Okay? It's like, oh, that's right.

So in the next few years, I mean, three more years and it's going to be amazing. One of my colleagues at Penn, Ethan Mollock, is fond of saying, The AI you use today, the worst AI you'll ever use. That's a good one. So that's an important lesson. So it's only going to get better and better and better. Optimistic viewpoint? Yes, I am very optimistic.

I have been, you know, I have, not every prediction I make comes out. I think my prediction rate is pretty good, but I could be wrong about this, but I am bullish. Is there a world where AI replaces physicians or cuts their workload? Yes. How so? I don't know if you know about Amy, the Google primary care doc. So they've developed this system. It's called AMIE, and I can always forget what each of each.

Autonomous, interactive. Advance, I think, is the problem. But I could be wrong. I know the last words explore. Anyway, they tested it against board certified PCPs, primary care physicians. with patient actors who were playing out a clinical scenario. The patient actors evaluated them for empathy, confidence in their judgments, and a few other things, and specialists evaluated them for the recommendations they gave, the management proposals, etc.

There was not one of, I think, 27, 28 metrics that Amy didn't exceed the PCP. There were somewhere they tied, including empathy. So, if you combine the ability to have a differential diagnostic tests and therapeutic recommendations that are guideline-driven, with greater empathy than your primary care doc, you're going to have to tell me why we're not replacing primary care docs with chatbots. And this is when both were doing chat, so it wasn't face-to-face interaction. Nonetheless, that's pretty impressive, in my view. Of course. From a technological standpoint, absolutely. And it's not in the clinic, so we have to test it out actually.

with actual patients in real-life scenarios, not made up, not a few, you know, sort of classic patient scenarios. But I think that, that does suggest to me that there's a law, that, you know, it could be pretty impressive. Yeah, I'm curious how it plays out from the human model of it all, because ultimately, I've went to school and I've had friends that were the brightest minds in terms of test taking, medical knowledge, can quote you every substep of the Krebs cycle with 100% accuracy. And they turn out to be crap doctors. I agree. So I had the same exact. So when I was an

intern, and I had taken four years off for a PhD. And so I was a bit of a rusty intern. I had a rotation with another intern from Hopkins. And we were on the oncology war together. We would go into of Hodgkin's disease, and I would fumble around a little about, and he would just, like, report out. Harrison's textbook, you know, here's a differential. Here's a test you're doing. Here's a chemo if it really is, Hodgkin, blah, blah, blah. And I'm like, God, this guy's great. Then we were on night call together.

And, you know, well, you know what night call is. Someone goes south. Something happens. You've got to make decisions. You've got to implement treatments, blah, blah, blah. He froze. He just couldn't take all that responsibility for having to make a decision. in the moment and analyze, you know, what's this most likely to be and what should our

intervention be and when do we reassess? He left internal medicine and went into pathology. Less patient interaction there. I don't think that's going to be the problem with AI. I don't think that is going to be the problem that it has all the book knowledge and can't apply to scenarios because they're going to trade it on scenarios. I think that they can definitely apply it because it's clear with their winning empathy points. They can clearly apply it. The question is, does the human trust the robot equally long-term? And I'll present you a real-life scenario that's happening right now with an industry leader, Elon Musk, who has his own LLM, very popular, integrated on X.

And, you know, Elon Musk is a fan, or at least has been a fan historically of Secretary Kennedy. He pushed for his appointment. He says what he's saying is great. But if you ask Elon Musk's own LLM, what are the – percentages of accuracy of what Secretary Kennedy, when he makes a health claim, what is the accuracy? It's zero or low percentage points. But Elon Musk doesn't seem to care. So will humans care about what the AI say? I think so. A great proportion of consulting LLMs relates to health care. And I think people are looking for answers.

They look for answers at times that doctors aren't available. So I do think they're going to trust LLMs, especially LLMs, that are trained on medical information and give them references so that they can be somewhat confident. So in the era of AI that we have right now, we have pretty good LLMs to give us general information. Why is the anti-vaccine movement growing? Oh, because I don't think they – this is a perfect case of ideology over interest. Well, I think most people, when they consult an LLM for a medical thing, are going to be confident. I want the answer.

They're not – they don't have an ideology in it. Oh, I see. Okay. So the ones that are consulting will be happy with it. Yeah, absolutely, 100%. So do you think there will be patients who say, like, I'm proudly, I see a non-AI physician, and then some patients will say, I don't care, I see an A physician.

I think that's right. And, you know, there may be differential in pricing. There may be differential in time to access, et cetera. You know, I work with a company that has developed a platform for children and focus on children and trying to make various therapeutic activities gamified. That children will engage with. So, for example, in occupational therapy, physical therapy, or mental health therapy,

They've got a game, we've got a gamified system, and kids love interacting with it, and it means that they can actually see the in-person therapist less frequently because between in-person interventions, they're doing these kind of physical therapy routines, which they were suggested before, but of course, no one did. Now with the game, they're actually like doing it. We've limited the number of times they can do it so that they don't get addicted to it. And it both allows them to progress faster and lowers costs. That's the kind of intervention I think we're going to see more of that doesn't necessarily displace a health care provider, but augments what they're doing in the therapeutic realm. We're very excited about it. And you can also see how it might be useful for, well, we know it's useful for behavioral,

health. We've done it. Self-regulation of kids and things, anxiety and working with them. It'd be useful for diagnosing autism and things like that where a lot of the diagnosis is already, we're going to film you and then we're going to code it. Well, the AI can do that better. I worry about private equity being so involved within the healthcare space because I feel like the healthcare space, unlike a traditional consumable product, it's life or death. So it's not a choice of whether or not people want the luxury of this toy or this jacket, it's their insulin that they need. So when people start messing around with that, I get concerned, and I've seen it play out negatively, like even in the telemedicine space as an example. Telemedicine was, to me, when I was

studying in my residency, a great option for patients who needed to see a sub-sub-specialist to look over labs and imaging and give guidance about chemotherapy from a distance, from patients I didn't need to take a day off work and can remotely connect to me, and I can go over their hemoglobin A1C with them and manage their diabetes virtually. Yeah, it changed their insulin dosage. Great. Then companies started popping up where they used telemedicine for everything, and they basically become a prescriber mill, maybe not for opioids, but for finesteride, for hair loss,

for Viagra, for antibiotics. Like, there's websites now you can go on and literally self-diagnose without really talking to a physician and request whatever prescribed medication you want. I saw commercial playing when I was on Fox and Friends the other day for a travel kit that includes all sorts of antibiotics and antiparicitics that you could just call in and basically get now. Any concerns that world taking over a... There are two things there. One is, you know, calling in and getting medications, which have, I mean, the problem with

antibiotics and antiparacytics, there's a lot of consequences for the rest of us, antibiotic resistance when it's used incorrectly, etc. The issue of PE is a, is a, in some ways, a separate issue. I think that is a real problem. And I, you know, I just taught my class on PE. And I said, Look, I don't know of one area in health care where the entrance of PE has actually improved care, improve quality, and reduced costs. You can't point to a single area. They either reduce costs or they drive costs. I mean, they reduce cost, increase profits. Reduce quality, increased costs.

Right. And some kid said, well, you know, there's IVF clinics. So we looked into the data. The data are not that PE improves IVF. they improve access well they they consolidate there's also not-for-profit consolidation it turns out that consolidation is good because they bring the same standardized care they also quantitatively measure outcomes turns out that PE is actually not better at the ultimate outcome are you having a baby than private not-for-profit chains so even in that scenario which was raised to me by one of my

students not, not improve the system. So I don't think anyone in PE can point to an area where they've actually improved the system. Yes, they consolidate, they bring, you know, whether it's dermatologists, emergency room doctors, et cetera, together. Typically, they raise the prices in multiple different ways. They change the patient mix, the kinds of visits that they're getting to raise more money. So I am quite skeptical that there's a place where PE has a good role in health care. I think their model and the health care model, as you point out, don't mix. So I'd love to be. Well, are you concerned about that mixture of AI and PE merging to create a Marvel Thanos, if you will? No, maybe I should be. But I, I, I,

I'm not that concern. You know, I do, I actually think many of the big tech companies have, they have to make it in health care. Hitherto, their track record in health care can be summed up in one word. Sucks. You know, whatever it is, it's verily at Google, no real successes. It's, you know, Amazon, no real successes. It's whatever, Cigna's bought some products. Microsoft doesn't have any successes.

But health care and AI is different. If the trillions of dollars of valuation are going to be justified in the AI space, they have to succeed in one place. And health care is the place that they can succeed and generate hundreds of billions of dollars in annual revenue. that I think is they have to focus there you know you can focus on law and trying to disrupt law how big is law or hundred billion dollars you know medicine dwarfs law it's 12 times bigger so I think if they're going to justify all the investment in the excitement they're going to have

to succeed in health care despite the fact that you're so bullish on AI you're quite bearish on biohacking That seems a little paradoxical. No, I don't think they're related, actually. I think if you were to take a subset of individuals who are bearish on AI, almost all of them are bearish on biohacking. That's probably true, and that's just because they don't understand biology at all. Yeah, I mean, I think this idea that we're going to outsmart the body.

And, you know, if omega-3s or whatever, pick your best favorite supplement is good, more's got to be better well you and i know in biology that doesn't work more often is worse right you create problems and we know this from the you know simple model of the immune system oh we've got not enough immune system function okay we're liable to infections and other problems we've got too much immune system function we're liable to you know autoimmunity diseases and other sorts of problem. You know, a lot of biology is about a very complicated balancing act, and so overdoing it, which is mainly the direction biohacking goes, not a good idea. And so I think they've got, again, it's a typical tech approach. They've got the wrong model. I mean,

an AI, throwing more and more compute power is how they've succeeded, right? Throwing more and more supplements or more and more stuff at the body is not how we're going to succeed. So if you ask a lot of the LLMs, even the medical ones, about these medications, supplement wise, biohacking. They'll be honest and say what you said because they look at the available data. But the founders of AI companies take a completely different approach. So are, are they not trusting the current evidence that exists or they're just trying to jump ahead? Is it a mortality crisis? I think it's two things. I think it's narcissism and a little excessive belief in their own brilliance and invalability. You know, they think they've succeeded in this area, LLMs, and therefore

they must be a genius across the whole realm. I mean, you've met these kind of billionaires, right? That's their view. You know, I succeeded here. You know, I know everything. And so I think they don't actually pay attention to the, they don't really have the time to pay attention to the underlying data, the underlying understanding, and they think, oh, well, we haven't tested this. That's right. We haven't tested that. That doesn't mean your hypothesis about more is better.

And we do know in the supplement world that, in fact, most supplements, I mean, not all, but most supplements are not helpful. There are contexts in cases, and you and I know them, where it's really important, you know, woman who's trying to get pregnant, thinking about pregnant, or is pregnant, you know, got to make sure that she has folate, she has enough iron, et cetera. Vegans, well, they, you know, unlikely to get enough vitamin B12, right? They've got to take supplements. There are other areas, older people, same thing.

They might not be able to generate, absorb the B12. So we do need people to take, or some people to take some supplements. That is far from the billions of dollars in multivites and although, I mean, I'm always shocked. I go into CVS and, you know, probably the single biggest thing they're selling their supplements. And they're all always reduced because, you know, it costs nothing to make and they charge 20, 30 bucks per bottle. For the label. Yeah. Yeah.

Do you think there's ever a world where the FDA gets involved in the supplement space? What do you mean? There was a world, and then Orrin Hatch took that world away because a lot of the supplement makers were based in Utah. You know, could we go back? I don't know. You know, maybe as part of some comprehensive health care reform package, it would be kind of important. You know, I do think if we had a situation where supplements were contaminating, a lot of people

died from it in a visible way, that actually could generate interest in going back to regulation. Yeah, well, a person I was debating supplements with the other day, their argument was way more people die as a result of pharmaceuticals than they do supplements. And I'm like, but that doesn't tell you nearly the full picture. Right, right. Depends what disease is you were a tree. And mostly supplements are for healthy people, right? And mostly pharmaceuticals are for sick people. Yeah. And the idea at least my notion is when people say supplements are fully safe when they're trying to sell you. They're like, this is natural, it's safe.

To me, anything that's 100% safe has no action. Because in the body, every action has a reaction. So if it's fully safe, that means it's bullshit not doing anything to begin with. So my version of that exact point is there's no medical intervention I know of that doesn't have side effects. Just doesn't, even a simple blood drug

can have serious side effects. Okay. So it's low, low probability, but not zero. probability. And that is definitely true. You are, as you point out, you're trying to provoke a reaction by the body for a good, but sometimes it goes awry, either because of your genetics or because you know, maybe you've injected that medication and it didn't get into the vein. There are all sorts of reasons. Yeah, of course. You could have a problem. So I imagine you have really smart friends. You have billionaire friends. Your family is in the upper echelon.

of society. What do you do when someone comes to you really saying, come on, you got to say this IV therapy that I get after a night of drinking or these supplements really work? I want to get a full body MRI. How do you talk them out of it? I don't know that I succeed to the billionaires because, again, they think they know everything. They're rich. But I do get asked questions about all sorts of things. And I try to explain the data. First of all, I say, why do you want that? The most important question is, what are you worried about?

You know, you're a 33-year-old person, no-help problems. You want a full-body MRI. Are you crazy? You know, first of all, there's nothing there. And if there's something that shows up, it's most likely to be a false positive. So now you're going to go through a bunch of other tests for nothing. You have to target what you're doing and just shooting, you know, randomly, getting a bunch of, quote, unquote, predictive blood tests or gene markers doesn't tell you anything. And then you have to know, do we have a treatment for whatever it is that you're coming up with?

And I think people don't think, you know, my experience is a lot of the people who ask me these questions don't either know the data, which is one reason they're coming to me. And that's fair. I'll tell you what I know. And if I don't know, I'll look it up. Someone actually recently sent me an article. He says, you know, you said melatonin is no good for sleep. But I have these data that suggests it might be good for endurance. What do you think?

Well, turns out it might be good for endurance. I just covered a study that it causes heart failure. So I guess it depends on what you're studying. Well, but that's part of the issue is, you know, we've got to actually look at the comprehensive set of data. So I try to give people the data. I try to give them my best recommendation about whether this is a good idea for them, given their situation, their age. In general, we overdo it.

And for, I would say two things. A lot of people, especially probably people listening to your podcasts, are probably already healthy. And they just need to be reassured. You're doing the right thing. You're going in the right direction. and don't get diverted by all this other stuff. And I think that's very important.

One of the problems we have as human beings, and there's some interesting research, our natural tendency is we've got a problem, we want to solve a problem, let's add something, right? So we add a supplement, we add an exercise, we add, you know, a sleeping aid. That, I find that in wellness at this moment, what we mostly have to do is take away.

Stop doing the bad stuff because we have a lot of bad stuff in our lives, whether it's food and nutrition, it's risky behaviors that are out there. It's things that people have been doing forever, but the risks have become much more obvious like alcohol. So I think part of what I try to convince people in the wellness space is chill out and actually focus on getting rid of bad stuff. some really good stuff you should do, and then we can make it easy, a few steps. The other thing I like to emphasize to people is we know that you can't do this by willpower.

You have to develop a habit, and the habit you have to be able to stick to it. And one of the problems is you kind of stick to it for life. So someone that, you know, it's extreme self-denial or you're not going to stick to that. or if you do stick to it, you're going to have a very unpleasant, unhappy life. That's not a formula for success. You know, you want to enjoy the 75, 85 years you have on the planet. So I try to say, let's figure out what the habits are that you can do or work towards and that you're going to enjoy and you're not going to suffer.

That's one of the reasons I really like to emphasize for wellness, social interaction. Social interaction is good for you. It's good for the other person. and you get the results today, immediately, as well as long-term results in terms of health and longevity. So it's a, it, you got to, I mean, I think people are nervous at this moment. They're feeling like the world's out of control, which it is. And they're going to control the part they can in terms of their own wellness.

Well, that's good, but, you know, don't go overboard. Yeah, the hyper-optimization of it all is where I think it goes wrong. Like, it's all right to try and optimize your health. But once you're in that hyper stage, that's where you're getting into. Now the opposite end of homeostasis, where you're getting the negative repercussions of it. Yeah, yeah. I remember there was an ER doc that I trained under where we were doing some coterie off

of a nosebleed for a patient. And we got it to mostly stop. And I said, but it's not perfect. Let's get it perfect. He said, the enemy of good is trying for perfect in health care. And that really stuck with me because I think it applies in a lot of these biohackers. scenarios. Totally. Totally. I agree with you. And also, you know, we might know optimization on a population basis, but for an individual, yeah, we don't know what optimal for you is or me

given our, you know, genetics. Well, now you can buy a kit. I will tell you what's right for you. It'll check your stool for the microbes. And my favorite is what a lot of these companies do is they'll check your stool or your microbiome and they'll say, you should eat more fiber. I'm like, hey, I could have told you that for free. Yeah, exactly. Seven percent of Americans haven't get enough fiber. I love those raspberries and Brussels sprouts. Exactly. I have a concern. I'm curious if you share it. If you look at the specialties that young doctors want to enter, usually, and it's not one-to-one, but the pattern is higher-paying specialties end up receiving the most attention, primary care, psychiatry, pediatrics.

The most important specialties, really, if you ask me, the foundation of a good health care system, get reimbursed the least, least amount of attention. And I think about how that's playing out today. And I see what kind of physicians and gurus are making good financial outcomes. And I worry how this is going to impact the future education of students, where are they going to see the model we're talking about, this boring old yell at the clouds mantra that we're doing, versus Brian Johnson's lived to 150 model

and say, even if his is a little off, he's still telling people to be healthy, and I can become a millionaire doing that. Do you think that might shift the way young, brilliant minds might end up entering the health sphere? Oh, I don't think it's a future thing. It's a current thing.

I mean, when we look at the number of students going into pediatrics or the number of students going into internal medicine or going into psychiatry, as you point out, you don't have to be a wealth maximizer to say that the 5x difference between an orthopedic surgeon and a primary care doctor per year, which is going to be compounded over 30 or 40 years of an entire career, that's going to drive people, especially if they come in with 200,000, 300,000 debts.

We have to change the model. You know, in the Philadelphia area where I'm at, the insurers are paying four cents of every health care dollar to primary care. And I keep chastising them. That is absurd. You are going to hollow out and then you're going to bemoan. Oh, we have no primary care doctors. Yeah, you caused it.

And we have to change that reimbursement system. And I've been arguing for a long time that we need a different model. You know, if we took just two or three percent from hospitals and we took another two or three percent from specialists, we could double primary care doctor pay. And then you would see a very different scenario. and not just internal medicine, but as you point out, pediatrics is way underpaid, especially pediatric specialists are way underpaid, and those are things where it's a real,

it's a problem now, it's going to be a huge problem in 10 years, and there's problems you can't fix overnight. It takes decades to fix that because of the long pipeline of medical training. So I totally agree with you. There's good evidence, adding more primary care doctors to a community, increases longevity, decreases mortality. Adding more specialists does the reverse. Actually increases mortality.

Not a good scenario. And so we need more primary care doctors. And again, they don't have to be wealth maximizers to say, you know, we've got to narrow this gap between us and the orthopedic surgeons or the urologist or the neurosur, whoever. You kind of get them closer to that money. So maybe the difference is two times, not five times.

Yeah. The idea of insurers wanting to focus on primary care, to me, make so much sense. Because if you invest in primary care, you're investing in preventive care, you're saving yourself as an insurer money down the line. However, what I've seen happen is that rarely the same person is covered by the same insurer after five years. so as a result there is no incentive to invest in prevention when you know you're going to lose this person to another plan has there ever been talk on the back end of making not maybe a lifetime

plan for an individual but some kind of policy where insurers have to stick around with a person so yeah i've written a lot about this um you're a hundred percent right this churn you're switching insurance companies totally undermines a financial incentive of an insurance company, not just to invest in prevention, primary prevention, but to invest in anything where the payoff is going to be a year or two down the line. The rotation among plans is pretty high, 15% per year. So you're absolutely right. Churn is a problem. My solution to that is you're not going to get a lifetime plan, but you could get five-year contracts where someone signs up for an insurance company for five years, and, you know, if you change, you lose a job, you move, you get married,

whatever, you can change plans, that changes the financial incentives, as you point out, to invest for the longer term, not forever, but for longer term. And I think that's a very important model for us. So I agree with you, why do we have annual re-enrollment? It seems crazy. Yeah, it seems wild. Exactly. Wild. They don't sign annual contracts with docs typically. They sign three years or five-year contracts. We should do the same. And by the way, as we're at it, maybe what we do is, you know, same premium for five years. We're not going to increase the premium for five years. So everyone's got some predictability. You create an incentive for people.

Well, you'll tell them you can't change the premium. They'll just raise the co-pay or whatever. Well, I have other ideas about that, too. Because, you know, you could say co-pay for visiting the primary care. zero for three visits a year. Well, that, again, changes the incentive of people about how they're going to use their health care plan. But I think you're absolutely right. If we believe prevention's important, we have to think about why aren't we getting it?

Well, we're not getting, turn is one of the major factors. You know, I love politicians when we were doing the ACA. They would say, you know, we have a sick care system, not a health care system. I said, do you understand why? You pay for sickness. pay for help. Yeah. Well, that's what I was going to say, my frustration with the current Make America Healthy Again movement, which I don't quite understand what again means, because

when were we healthy and not having issues? If we're going to talk about improving outcomes, we would be investing in primary care. We'd be investing in research. Yet NIH budgets for ALS, HIV, you could name all the conditions across the border being cut. Kevin Hall, phenomenal metabolism researcher, metabolic researcher, was a guest on this podcast after he was fired, well, indirectly fired, I guess he resigned, but because of them trying to alter

his work, these are the people that are going to be doing the work to create preventive programs, to give us guidance on nutrition, to help us get rid of junk food that we so often call out as what ails our society. But we're not doing that. And

maybe because I'm naive. Why aren't we doing that? Because it seems like we have this national budget that is in debt and we want to save money. And this is a surefire way to do it. And while they're not clear ways of doing it, there are some basic steps we can take, but we're not doing it. I agree. I don't think Maha, you know, I think some of their goals are quite admirable. Less ultra-processed foods, focus on chronic conditions. I totally- But to say that, those things and then put something into action are two different things. Ah, you knew exactly where I was going. I don't think they're consistent in the policies that

they're advocating to get there 100%. I mean, look, if you want to change the food system and what people eat, you've got to change the subsidies we have for the ingredients that go into ultra-processed foods. You know, we have huge subsidies for corn and soybeans and rice and wheat. Well, you know, what are those doing? Yes, they're making ultra-processed foods cheap and inducing people to buy them. Do we have the same kind of subsidies for, you know, your pistachios, your raspberries, your blueberries, your apples? Absolutely not. We know those are very nutritious. You know, they have good fiber.

Go back to your fiber point. They enhance the microbiome. We don't have good subsidies for those. So they are not being consistent. Similarly, you know, we have a lot of pesticides and a lot of additives. You want to make people healthy. We need a robust environmental protection agency. but in fact, we're undercutting.

So I think you're 100% right. The idea and the implementation are divorced, and that is a major problem here. Now, I understand, I'm no expert on the Maha movement, but I understand that there are people within the movement who are upset about that. Well, that is good, but they have to push for more consistency in what the government does. some of it may be their general suspicion of the government's doing it can't be good that's wrong a lot of this stuff only the government can do you know who wants to spend all their time looking at every bottle under their sink is it got a toxic or not I'd rather the government take them out and do it systematically and maybe overreach a little bit than my having to take a lot of time

and be obsessive about that every person doing it individually is not the way to go that's one One of the reasons we have a government, they can do it, they've got the expertise, and they can do it effectively. So we don't have to do it. And doing it at scale should be cheaper. Yes. For sure. So there should be financial savings there. Yeah.

I'm curious, if you had to be born today, what nation would you be born in because of their health care system? Oh, well, that's not a fair question. I wouldn't want to be born in a country only because of their health care system. Well, if there's a whole community, you have to choose. Based on the health care system, well, look, first of all, let's be, I do have a book called which country is the world's best health care, but I only went to 11 countries. I didn't go to every country in the world. So the big winners were the Netherlands, Germany, and Norway.

What are they doing well? What are they doing? Well, they're definitely emphasized, especially the Netherlands and Norway, emphasizing primary care. To get to a specialist, you really have to go through a primary care doctor. They put controls on prices. They do give you, especially in the Netherlands, they give you choices of different sickness funds. They call their insurers. They make their primary care doctors manage mental health conditions. So almost all of them have nurses who manage mental health. They have doctors or nurses who are accessible 24-7, who have access to your medical records.

So they have a lot of things that are going in the right. And they only spend 11, 10, 12% of budget. So they have a lot of other money that can be spent on enhancing schools, infrastructure, environment, and other things that make people healthy. I spend a lot of time in Norway because I have a research project with Norwegian University. So I love Norway. It's a beautiful, beautiful country. If you haven't been there.

I haven't. I've got to go check it out. I've got to go check it out. I've got a good apartment you can stay in. It really, it's a wonderful place. And most everyone speaks English. They have great food. What's a food tip in Norway? What's the food tip? They have a lot of fish for one thing. They also have really invested in heritage food. So people doing, you know, the old way of getting goat cheese. They've got a lot that they invest in people who want to do that. And a lot of it's fresh, you know, the fishermen went out and it's on your plate at dinner. And so that's a pretty special. Okay, that's a good one. You mentioned earlier that avoiding bad habits is more important than trying to biohack your way out of bad habits. What are the three worst habits that folks have these days that are harming their health? Well, let's just focus on food for a second because there are lots of other habits.

There's habits related to smoking, habits related to guns. But if you focus on food, so my suggestions on food in my book are, one, three don'ts, no sugary sweetened beverages. Sotas, for example, you know, have 140 calories. That's about 10 teaspoons of sugar. Just a minute, 10 teaspoons of sugar in that little can. No nutritional benefit. Now, the good thing is Americans are actually decreasing. But then they're increasing their Starbuck Frappa Papacinos.

Yeah, and that problem is it's way more than 140 calories, about 400 calories. Because then you're getting fat in as well as the sugar in there. The second is to decrease your salty snacks, your package cakes, your muffins, your cookies. We have over the last 30 years increased the amount of those packaged sweets that were snacks and sweets that we're eating to be about 500 calories a day. 20 to 5 to 20% of an adult's recommended diet. That is a big mistake. There are good, nutritious snacks you can have, whether they're nuts or fruit or hummus,

too many packaged snacks, ultra-processed foods. And then there's the more general ultra-processed foods. Just shy of 60% of all our calories are ultra-processed foods. We have to reduce that substantially. That requires a whole social change. what you can buy and afford, what you can cook. One of the things I learned from my research assistants who are just fresh out of colleges,

they have no idea how to cook. They have no pots and pans. Their parents never taught them how to cook. There's no home economics in their classrooms. They didn't know. They can't even, I gave one of my research assistants in frustration. I said, here's a roast chicken recipe. It's not complicated.

It's about the easiest thing you can get. He had no roasting pads. He didn't know what a whole chicken was as opposed to eight individual pieces. It was like, are you kidding me? This is ridiculous. And a super smart guy. So we got to change those three things.

And then there are some positive things. I noticed you didn't say get rid of dyes in our foods. Oh, looking, getting rid of dyes is fine. It's just not going to make us healthy. These other three things are way more important. Way more important. And then there are two positives that I'm really hot on. One is fermented foods.

yogurts, kimchi, kiefer, miso, sourdough breads, aged cheeses. Those are very good for the microbiome, and they've got, you know, yogurt especially has a lot of protein in it, kimchi has a lot of fiber in it, very, very good. And then the flip side is, as we mentioned, fiber is probably, it's going to be the next fad, right? Protein at the moment is our fad. I don't know, fiber is big now with lentil pasta and chickpea pasta and all this stuff. Fiber is very important, and we have too little. It probably, its most important thing is to nourish the microbiome, increase the diversity.

And taking the supplements is no, supplements have one kind of fiber rather than a whole diverse range of fibers. And what I've seen is now people are popping up with fibrous drinks, which have tricked the FDA definition of what fiber is. Yeah. Well, I think, look, that is almost invariably, if it's going to taste good and it's not not going to be. Take your fruits and water, coffee, or tea.

Don't, don't try to mix them together. Not a good idea. Makes sense. What about ice cream? I really like ice cream. That's the title of the book for a reason. Ice cream is, so it's a dairy, and dairy is good for you. I'm a, you know, not everyone agrees with me.

One of my old professors from Harvard School of Public Health, Walt Willett, who's a real pioneer in nutrition. You know, Walt is not high on dairy. He's got a very objective analysis of it in the New England Journal a few years ago. I would say he's not a wild fan. Partially, that's because the U.S. has pushed dairy for its calcium. But it's not to do with calcium. It's good protein, right?

It's got saturated fats, but its saturated fats are contained in globules and don't have the same effect. It decreases the risk of diabetes. in the case of kiefer and the case of yogurt, very good nutritionally, got a lot of protein in it. We know that kids who have lots of dairy as children actually grow taller, one of the reasons the Dutch are probably the tallest people in the world. So I'm a big fan of, and then you've got ice cream, and it tastes good, right? Yes, it does have sugar, as long as it doesn't have amulsifiers and other things.

You know, every night, a big scoop. No, there are some people who've done it. But, you know, a couple times a week, great. It's a good thing. And, you know, it's a good for you treat to have. And, you know, my wife's grandmother had ice cream every day of her life. She lived to 100 in her own house. Well, that's not a great way to look at it.

Because that could be weaponized the other way very easily. What she said is, there's always room for ice cream. It just squiggles in on the side of your stomach. It was her last meal. She enjoyed life. Well, that's great. The issue that I run into with people talking about certain foods or individual ingredients is a study comes out showing an association of consuming whole fat ice cream or whole fat

milk with a lower association of heart failure, whatever, cardiovascular disease. And then people jump to the conclusion of, oh, it, lowers the risk. Well, that's, the causation hasn't yet been proved or elucidated. So how do we take this bit of knowledge that comes out every so often with the nutritional study, an observational one? What do we do with that knowledge? So I think that there are, let me make three points there. But first is the point you're making, which is, look, an association is not causality. On the other hand, you get, you know, five, six, seven, eight studies in different countries. with different populations where you see an association,

you're going to have to really, really convince me that this is just all artifact. So I don't think every association study is the same. And obviously, bigger association studies done more rigorously help. The second thing you would like to see is some plausible mechanism. So one of the things we're beginning to see a lot of

as so there's a association seen in the observational studies, as you point out, that aren't causal. and then you see people going to like the U.K. Biobank, this is very common. And they're looking, well, how does this potentially affect the physiology such that the outcome, you know, preventing diabetes actually occurs? And once you see that, you're like, wow, that really adjusted the inflammatory markers and it really looks like it's more than just an association. The third thing is we've seen now in some other studies, like, for example, of diet, of artificial,

There's a study out of the Whitesman in Israel published in Cell where they took people, put them on artificial sweeteners in sodas, and they showed that there was a microbiome change. And then they took the microbiome from the people who had the diet sodas and put them in mice, and the exact same phenomena happened. they gained weight, their microbiome was reduced. So that lends a lot of plausibility to the physiological approach. So I like to see, are there lots of studies done differently, different populations? If they're all observational, I put a lot of strength in it. And then, you know, is there a plausible biological mechanism done in a biobank or some other kind of study? So that's the way I like to assess them.

Yeah, nutritional research historically has been hard to apply generally because it's so culturally dependent. What foods are you consuming at the same time you consume this specific ingredient? Are you talking about the American standard diet versus a culture that eats wild caught fish? So it's very hard to take one bit of data and then extrapolate it to the general population. That's where I struggle. I totally agree. And also, one of the points, and you were hinting at it here, is what are you substituting?

So, you know, you've got fish. What are you taking away? Are you taking away red meat or are you taking away vegetables, right? So part of, you know, a lot of this stuff is we look at it in isolation, right? Milk in isolation. Well, what is it substituting for? Sotas, oh, then it's probably going to be better. Substituting for water, oh, then it might not be.

So we have to put it in a larger context. And the other thing is, and I think people who are skeptical of all this nutrition research, and there are plenty of people, they often say, well, you know, are you doing just a diet diary where people are remembering what they ate, which has a lot of flaws in it, like what was the last meal I ate, or are you actually monitoring it? You know, you mentioned Kevin Hall, one of the great researchers. and, you know, he puts people in a room, which he controls everything about it. In baggy scrubs, so they can't even tell if they're gaining or losing weight.

Exactly. And so I think that's a very big, important question that, you know, again, if you've got five or six studies, different populations, that lends more support, I think, to... You don't like the blue zones. No, I do like the blue zones. Oh, you do like the blue zones. I actually believe... So there's a lot of criticism of the blue zones.

Like, you know, it's a lot of fakes and... blah, blah, blah. Actually, if you look at the original findings of the Blue Zone, they have one of the absolute best Belgian epidemiologists, most rigorous guy, not just look at birth certificates, but look at church records and school records and other things and really confirm the ages of people. Then it became commercialized, and, you know, but I think a fair amount of that data, especially initially, very, very good, high-quality observations about the diets of those people.

Actually, I praise them. I think the blue zones are more accurate. I think the current criticism is not as rigorous as the initial studies that they did. Okay. You mentioned milk, feelings on raw milk. Are you going to take shots with Secretary Kennedy in the White House?

There's a reason we celebrate Louis Pastor. And think he's one of the great geniuses of all time. It's called pasteurization. And it saved us from terrible things like getting TB or other infections from milk. Raw milk is not nutritionally substantially different from regular milk and homogenized, pasteurized milk. And it has no proven advantages. And it's got plenty of infectious disadvantages.

So are you concerned that now certain states are moving forward to allowing the sale of I'm concerned actually that RFK has changed the attitude and changed the threshold and convince people like, you know, to roll back vaccine mandates. We've just seen some of that happening recently to roll back fluoridation so that kids don't get cavities to permit things like raw milk that have serious dangers. And we're going to see a lot more of this. And I'm worried what's the end result? Well, we're already beginning to see it with the measles vaccine, but people are going to suffer. Children are going to suffer. People are going to die as a result.

This is not the direction we should be going. Do you think he should resign? I don't think he should have been approved in the first place. And I think Bill Cassidy, Senator Bill Cassidy from Louisiana got a piece of paper. It's clear that piece of paper was worth nothing. And he should be, his conscience should plague him. Things he believes in. Senator Cassidy, he's a physician.

I respect him a lot. He's actually quite thoughtful. And he just, the pressure on him to vote, yes, and we have all suffered because of it. So you want him to stay in office? No. So you want him to resign now? I just, however. However we could get him out, you're happy with it.

Because I did a whole video and article. Actually, we got it published in Fox, of all places, calling. for his resignation because he's just doing anti-science work in a position that requires the highest integrity of science. I totally agree with you. And he's been a big danger, you know, all this vaccine. I mean, he may. I mean, the Tylenol Autism Press Conference was the biggest disaster, I think.

And he's creating a situation where we might not have manufacturer of vaccines. He argues, I'm not taking vaccines away from people, but you're going to create an environment where no vaccine manufacturer can make a profit. That is going to take vaccines away from people. How do you feel? And that, by the way, on a day, or I guess it was yesterday, where we got data that the shingles vaccine, you know, slow dementia, right?

I mean, it's like, what, this is crazy that human papilloma virus, you know, prevents cancer. I think he doesn't believe, this is my personal belief, that he doesn't believe in germ theory. Interesting, interesting. Because like the whole HIV poppers thing is just strange to me. And it just seems like he doesn't believe bacteria is an issue or viruses are an issue.

Most people either love or hate, I rarely see someone who's indifferent, GLP-1s. What are your feelings on them as a class of medications? I've written a lot about them. I am actually quite bullish on GLP-1s. If you look at the data, they make a big difference of people with obesity, a big difference people with diabetes and looks like they have big impacts on addiction now and because of the impact on diabetes and heart disease, you've got a big impact on cardiovascular mortality, got a big impact on renal disease, you've got a big impact on arthritis and the need for hip and knee

replacements. Do they have side effects? Yes, probably the major most worrisome side effect is muscle mass loss and we still don't know the optimal way of using them. You know, how much diet wrap around do you have? Can we sort of treat people for a year, get them to 15 to 20 percent weight loss, and then microdose them and maintain it? We've got a lot to learn. And there's new ones on the horizon. They're remarkable, remarkable drugs. I'd like to say that there are, you know, five big innovations since the human genome project. You know, there's CRISPR technology. There's gene editing, which was done at Penn, there's CART therapy, which was done at Penn, there's MRI therapy, which was done at Penn, and there's GLP-1s. All of those are huge breakthroughs,

and it's a huge breakthrough. Philosophical question about GLP-1s. Given that we as society, love shortcuts, is there a world where we fall in love with GLP-1s to a level where it perhaps becomes an unhealthy medication, even though it has so much process for these conditions? No. And I think, you know, people are, especially in the Maha movement, we shouldn't use GLP-1s. People should have responsibility and they should eat better and exercise it. You know, one of the things I think that might happen with GLP-1s is people actually improve and their entire attitude towards life changes.

They now see a future. they see themselves in a different place. They might then begin to invest in wellness, you know, eating better, exercising, sleeping better, having more social abilities because their body image has changed and the like. So I actually think that could be a real positive, you know, self-reinforcing cycle. What bothers me is that people who are, you know, have a BMI of 25 or 26 are now. For a PED use.

Oh, that is. awful. And I don't want to pay for that. And through our health insurance system, I don't think that's right. But I do think people who need it, who have a BMI of 35 or, God forbid, 40, they definitely should be trying it. Now, they might not be able to last. The side effects might be too great, et cetera. But there are real benefits. And costs are still an issue, even though we have this wonderful press conference. Well, look, it could be a game changer for the whole health care system if we could get the cost under $100. One of the biggest problems, it seems to me, is that we haven't thought creatively about the cost.

And, you know, let's face it, Eli Lilly, I think last quarter made $10 billion in revenue of $10 billion on GLP1s, and a lot of that was profit. but there are lots coming on the market and hopefully there will be more competition and we'll be able to drive the price down especially when semi-glutide goes off patent. Yeah, because I've seen the prices that they announced not exactly hold true A for everyone's plan, but I even had patients who have a commercial plan

working in a hospital system, let's say, they were getting their Wagovi covered and then once this announcement came out, they said, oh, well, now the out-of-pocket is only $300, you can pay for it yourself. So people who have gotten it covered, now are paying out-of-pocket in order to make up the difference

from the loss of the insurance company. It's like all these shifting budgets, as we said earlier in the episode. Very, very good, I see. But I do think the drugs themselves are a big positive. We've seen it in our patient population. I've even had a physician on the show

who talked about how food noise destroyed her life to the point where she couldn't focus in school. She had to make the choice between being morbidly obese or failing out of med school. And by trying Wagovi, it allowed her to be human during a dinner with her husband to allow her to focus on research. And now she works with the U.S. figure skating team. So it just shows how for some individuals who especially have this issue with food noise, that's where the word game changer really needs. to be used. I agree. I have a friend from college, very dear friend, and I suggest him, you know, you should think about going on Mongero, Zebound, and he said the next day, his

obsessions with food, his need to constantly combat eating more, totally changed. And his relationship with food has changed, and he's dropped about 10% already. You know, it is a dramatic, dramatic medication. You know, the research surrounding willpower being a limited resource is not clear, and there's some good books on it, and I've read them as well, but there's been some conflicting reports based on how you grew up and adverse childhood experiences and how all that plays into it. But the reality is your brain is still has a finite amount of energy and decision-making

capacity, and I think that's a prime example of that. Yes, I agree. And somehow it, you know, the reward system, GLP-1s interfere with the reward. system and it's not just rewards for food it's rewards for many many other things you know whether it's alcohol or smoking or drugs we're going to find out that it's yeah what exactly it is you know no one predicted it would have a central nervous system effect but here we are yeah well doctor this is a very fun conversation for me very cathartic in some ways i don't think we quite solved the health care system but i think there's room for part two of our conversation perhaps

when some exciting news comes out or another book of yours comes out. Great. It's been wonderful. Tell us real quick where listeners can find your work, where can they follow along. So I've begun to be on Instagram and TikTok. My book is Eat Your Ice Cream will be available January 6th. You can pre-order it now. I hope it's a fun read.

I've been told it's a fun read. It actually was a, so I wrote it out of anger at a lot of these wellness gurus. But I tried to infuse a lot of humor and a lot of my family stories and stuff into it. And I'm working on another book. And so I publish every few, a few times a month, I guess, in the op-eds and the New York Times, the Atlantic, the Washington Post. Perfect. All right.

Well, thank you so much for your time. Great. It was been a lovely interview. Thank you so much. Awesome. Huge thanks to Dr. Zieg for coming to the city for this interview. His energy was so positive that it literally put me in a better mood.

and I'd say that's a fantastic quality for a doctor, but even more so for an oncologist. For another episode you might like, scroll on back to my chat with Dr. Crystal Guevara. She's the doctor I talked about in the episode who started taking JLP ones and described it as a game changer for her. A lot of interesting takeaways there, and if you enjoyed this episode,

I'd be very grateful if you can leave a comment, telling me what you liked, and if you can give us a five-star review, that'll help a lot because it's the best way to help us find new listeners. And as always, stay happy and healthy.