The Dr. Hyman Show - The Future Of Medicine: Precision And Personalization with Dr. Daniel Kraft

Starting point is 00:00:00 Coming up on this episode of The Doctor's Pharmacy. We're all touching our smartphones and other consumer devices frequently. They can become a bit of our health bubble. They can give you smart nudges over time to help nudge you in the right direction in ways that match you. Hey everyone, it's Dr. Mark. Most people don't realize that our exposure to light has a huge impact on our health. And that's because we're wired to respond to the changing position of the sun, which regulates our body's circadian rhythm and either helps us to feel energized and awake or lets us know it's time for bed. But our modern always-on culture means we're now surrounded by

Starting point is 00:00:34 conventional LEDs and fluorescent bulbs and digital devices with bright lit screens that emit junk light around the clock. My friend Dave Asprey actually coined that phrase, junk light, to describe the excess of blue light as well as green and violet light that disrupt our circadian rhythms. Junk light reduces our ability to produce melatonin, which is a key hormone for regulating our internal clock, sleeping well, and even aging well. It's important to realize we actually need to be exposed to certain amounts of blue light in the daytime. Otherwise, we may feel as too sleepy or tired. It's the excess of all that blue light along with other types that

Starting point is 00:01:05 leads to a long list of potential problems. So how can we get just the right amount of light throughout the day? Well, going outside is of course key, but we almost all work on computers these days and have our phones with us 24-7. And that's why I was really excited to learn about the TrueDark Daylight Glasses. TrueDark Daylights are meant to be worn during the day. They come with either clear lenses that block 40% of blue light or yellow lenses that block 75% of blue light. Some of these daylights also act as transition sunglasses that, in addition to blocking toxic blue light indoors, also have photochromatic lenses that are darker when exposed to natural sunlight outdoors and block 99% of UVA and UVB rays, so they double as sunglasses.

Starting point is 00:01:46 With TrueDark Daylights, you help prevent eye strain and headaches from overexposure to junk light, but you stay awake and alert. TrueDark also has a Twilights connection for nighttime to help you get deeper sleep. These glasses use red lenses to block the full junk light spectrum, including blue, green, and violet light. Right now, you can get 15% off at truedark.com forward slash hyman with the code drhyman15. That's truedark.com forward slash hyman with the code drhyman15. Now, supplements are one of those things that I'm always being asked about. Is it worth spending money on them? Do we need them if we really eat well? Can your body even absorb them? The answer to most of these questions is it worth spending money on them? Do we need them if we really eat well? Can your body even absorb them? The answer to most of these questions is, it depends. There are definitely certain

Starting point is 00:02:30 supplements I'd never recommend taking because they aren't made in a way that your body can take advantage of and you just pee them out. And there are definitely some supplements we can benefit from because our food supply, even if we're eating whole organic foods, because that doesn't just provide enough of the nutrients that we need for optimal health. A major one of those nutrients that I suggest people supplement is magnesium. Most soils have become depleted magnesium, or there's not organic matter enough to draw the magnesium out of the mineral-rich soil into the plants. So it's a tough mineral to get enough of through the diet. 80% of Americans are actually deficient or insufficient in it, as it's as crucial for hundreds of reactions and enzymes in the body and impacts everything from metabolism to sleep to neurological health, energy, pain, muscle function, and more,

Starting point is 00:03:13 it's really important we strive to get enough of it. Magnesium also plays a role in our stress response, and everyone I know could use a hand in better managing stress to promote better overall health. I like to call magnesium the relaxation mineral. My favorite new magnesium is from a company called BioOptimizers. Their magnesium breakthrough formula contains seven different forms, which all have different functions in the body. There's really nothing like it on the market. I really noticed a difference when I started taking it. I've tried a lot of different magnesium products out there. I also love all their products and how they're gluten-free, soy-free, lactose-free, non-GMO-free, a chemical fillers, and made with all whole real natural ingredients.

Starting point is 00:03:48 Plus they give back to their community. For every 10 bottles sold, they donate one to someone in need. Now that's pretty awesome. Right now, BioOptimizers is offering my listeners 10% off your order. Just go to magbreakthrough.com forward slash Hyman. That's M-A-G breakthrough, B-R-E-A-K-T-H-R-O-U-G-H.com slash Hyman and use the code Hyman10 to receive this amazing offer. I think you'll love it as much as I do. Now let's get back to this week's episode of The Doctor's Pharmacy. Welcome to The Doctor's Pharmacy and that's pharmacy with an F. I'm Dr. Mark Hyman and this is a place for conversations that matter. If you care about healthcare, the future of medicine, where we're

Starting point is 00:04:26 going, what's coming around the corner, and how our healthcare is going to be over the next few decades or even a hundred years, you better listen up because we have a great conversation today with a good friend of mine. This has been with him for a long time, Dr. Daniel Kraft, who is a Stanford and Harvard-trained physician, scientist, inventor, and entrepreneur. He's currently chair of the XPRIZE Pandemic Alliance Task Force. He's been in practice over 30 years. He's in biomedical research, healthcare innovation. He's chaired the medicine department for Singularity University and is the founder and chair of

Starting point is 00:04:56 Exponential Medicine, which is an amazing medical conference all about the future of medicine that I've been at and spoken at. And it basically explores the convergent, rapidly developing technologies and the potential in biomedicine and healthcare. He's published in lots of journals and he's just a cool guy. He's a faculty at the UCSF Medical School and is involved in lots of innovation.

Starting point is 00:05:17 He's a pilot, which is cool, like my dad. And he served in the Massachusetts, California Air National Guard and officer and a flight surgeon with F-16, F-15 fighter squadrons. That's pretty cool. Not many doctors get to do that. And he's just looking always at the future of where we're going and how we're getting there. So thanks for joining us on the Doctors Pharmacy, Daniel. Thanks a lot, Mark, for having me. It's exciting to be here and to mix up our worlds again. Yeah, it's great. So you're a major pioneering voice in medicine.

Starting point is 00:05:45 I remember hearing you speak at TED Med so long ago, and you were painting a picture that was very refreshing to me because you were looking down the microscope at where we're going, or maybe the telescope, or you had some special glasses on that allowed you to see what is the most important trends in medicine and technology and health and what the future of medicine might look like. So what does the future of medicine look like to you? And how is healthcare changing with all our evolving technology? Because it's changing so fast and

Starting point is 00:06:15 yet we're still seeing mass amounts of chronic illness, mass amounts of poor health that's only getting worse. So on one hand, we're doing all this great stuff, but on the other hand, our population is getting sicker and sicker and dying more and more. So how do we reconcile that? And how do we think about what the future could look like? Well, first, we need to start to look at where we are and where we've been and where we're going. I think we don't actually practice healthcare. We practice sick care. As we both know as clinicians, more often we wait for the patient to show up with a heart attack, the stroke, a late stage cancer. And so we live in this age of intermittent data where you only usually collect that in

Starting point is 00:06:47 the four walls of the clinic or, God forbid, the emergency room or ICU. And that leads to our reactive mindset. And where the future is heading and it was starting to unlock and unleash, particularly with COVID as a catalyst, is to move to an era of much more continuous data. It could be from your smartwatch, from your smart bed, from your Internet of Things home, from your mobile devices. And that's going to enable us much more personalized, proactive, true healthcare that can start to happen anytime, anywhere, arguably at lower cost with better health equity. So in a nutshell, the future of medicine is that this convergence of new mobile technologies, new forms of data, everything from your

Starting point is 00:07:23 physio, your digitome, to your microbiome, to your genome. Hopefully not just the data, but the insights that we can then use across the continuum to help the optimize wellness, to do earlier diagnostics, to do smarter therapies, and then of course, to apply to global and public health. I remember being at one of your lectures years ago,

Starting point is 00:07:40 and I've stolen this because it just was so brilliant, where, and I don't know if you're still using this framework, but you talked about five converging trends in science and medicine and technology that were going to transform our approach to health and disease. And they were, in no particular order, the omics revolution, which includes everything from our genome to our microbiome to our proteome and transcriptome and all the omics, which we're still sort of plumbing the depths of. The quantified self-movement, which is sort of the digitization of our data, not the intermittent data you're talking about. In other words, your aura ring or your continuous glucose monitor or your Fitbit. And there'll be more and more

Starting point is 00:08:19 sophisticated tools. They'll be able to track all sorts of things through our biology that are decentralized, democratized, and allow that data to be used to track all sorts of things through our biology that are decentralized, democratized, and allow that data to be used to help analyze our state of health. Then there's the systems biology revolution. Some people call it P4 medicine from Leroy Hood, or functional medicine, network medicine. There's a new textbook of network medicine out of Harvard. And so it's this framework of redefining the body based on biological networks and systems rather than the typical organs and specialties and diseases. And you take all that quantified self-data, the systems biology layer on top of that to filter the data, the omics revolution, and you run that through our technology platforms of big data analytics and AI, and all of a sudden everything looks different. Because when you think about how traditional doctors practice, we do a physical exam, which is pretty rudimentary, most anomaly, you can pick stuff up, and then a bunch of lab tests. But the lab tests we do

Starting point is 00:09:16 are pretty basic. They're often not really abnormal until you're really sick. And we're looking at a limited data set of maybe, you know, dozens to at the most hundreds when there are literally maybe hundreds of thousands of data points that we could be using. And when we are missing looking at all that, we're literally just sort of, you know, someone said, someone said, you know, traditional medicine is like, you know, trying to diagnose what's wrong with your car by listening to the noises it makes instead of lifting up the hood, you know? And I think this new framework that you laid out that I've borrowed and talked about is so profound. So can you kind of take us down the rabbit hole of each of these things and how they're going to transform medicine, healthcare, and our approach

Starting point is 00:10:00 to disease? Yeah, you're spot on. It really is that convergence of multiple fields that enables all those elements. And I love your point about, you know, what we normally do as clinicians, we get maybe a Chem 20 or a Chem 40, you know, 40 limited pieces, we get the basic vital signs. And that leads to our sort of incremental medicine. But now in this, you know, exponential age

Starting point is 00:10:19 with, you know, the power of my, even my, I'm holding right now my iPhone 2, that's 12 years old. It was amazing 12 years ago. Now it feels slow and clunky. Now our smartphone devices have become integrated medical tools. The camera can diagnose your urine. The microphone can diagnose your cough.

Starting point is 00:10:34 The camera can now pick up your heart rate, your heart rate variability, even potentially your blood pressure or your blood sugar. And the point being from intermittent to continuous is that normally as clinicians, we get that spot check. But what's really interesting, of course, in health is how those data points change based on your baseline. So the Mark baseline versus the Daniel baseline might be quite a bit different. If my resting heart rate when I'm sleeping is detected by my mattress, you know, goes from 55 to 75, maybe something's going on. And the challenge is how do we take those digital breadcrumbs or your proteome or other elements that might be measurable and changing and understand when are you shifting from normal to some early sign of disease so we can cut it off at the pass?

Starting point is 00:11:15 Or understand diseases much more through their continuity. Now there are ways to detect hormones from your saliva. Voice is a biomarker. It can sound, you know, your sound of of your cough is that covet or just a cold and so putting all this together um it's still the early days because right now as clinicians we don't want more data from our patients we want the actionable insights and information knowledge and do something with right if I'm streaming my EKG from my watch you don't want to see every EKG you don't want to be liable for that what we're starting to learn as we start to crowdsource millions of people wearing wearables,

Starting point is 00:11:48 millions of folks getting their genome done, which has dropped from price, you know, $1 million 15 years ago to basically $200 US or less, is to put that into the workflow of the clinician. So you're not overwhelmed by trying to read omics and raw data from a sleep tracker, and synthesize it using AI, machine learning, big data to make it really actionable for your exact patient, not for the average patient because none of us are, of course, average. So we're still in the early ages of this digitization and connecting the dots. It's starting to unleash a bit, particularly with COVID and new forms of telemedicine and

Starting point is 00:12:22 our ability to connect the dots to our mobile devices into our medical records and beyond. But tons of potential. But I would I would stress it was early days. And we need the regulators, the F word, the FDA to help unleash this, which are starting to do with software as a medical device. We need to help the payers pay for some of these new whether it's your omics or your digital exhaust to integrate that into our care across the continuum, particularly on the prevention and wellness side, not just waiting for when disease hits us. Yeah. It's such a different vision because I remember once sitting in my office talking to a guy who worked for Fidelity and his job was analyzing financial data. And I said, how many in your field use computers to analyze data, to make decisions about what to do with money.

Starting point is 00:13:06 It's like, what are you talking about? That's all we do. That's it. I'm like, well, guess what? We don't do that at all in medicine. We're relying on the person sitting in front of you, your doctor, healthcare provider, who went to medical school, who knows how many centuries ago, who may or may not have kept up with the 900,000 scientific papers published every year, who is trying to sort of see 30 patients a day and make sense of your story and hoping that they're going to figure it out. Whereas our possibility, given the painting, the picture you just painted of interpreting enormous amounts of data, sifting that through a filter, making sense of it, and having decision support for providers is just a whole new world. It's something we really

Starting point is 00:13:51 haven't really barely touched. And in functional medicine, we try to collect a lot more data, and we try to understand much more data points and filter that through the lens of functional medicine and systems biology. But it's still only like a tip of the iceberg in terms of what we're headed towards, right? So I think we're now entering this golden age of, you know, functional medicine, what you've been doing for years. Now you can actually get a true microbiome and measure that every day if you'd like to. You can understand someone's metabolomics. I'm holding here, I just did my own CGM, you know, these low cost continuous glucose monitors. I'm not diabetic, but I get insights in how I respond to certain diets or foods or drinking orange juice or exercise or stress. And particularly with nutrition, which you're so honed in on, now I think we can enter this age of

Starting point is 00:14:33 precision nutrition where you integrate microbiome, genome, metabolomics, and really move from just a one-size-fits-all diet to ones that might really match someone's physiology or their disease state. So I think it's a super exciting time, not just for the clinician who can hopefully not be overwhelmed by all this data, but make sense of it, but empowering the individual, the consumer. We talked about quantified self. And yes, right now I'm on my phone. I have my Aura ring, my Fitbit I'm wearing, my Whoop and my Apple Watch. And they give me empowerment. And you glow in the dark. You glow in the dark. I do. And it's fun to compare how much they measure my sleep, my sleep score, et cetera.

Starting point is 00:15:14 But that could give me insights to hopefully self-coach my sleeping. I don't need to go see a sleep doctor. Similarly, if I have a medical condition like hypertension or diabetes, I can now collect that data, blood pressure, blood sugar, and share it hopefully to my clinicians from quantified self to quantified health where that data can flow, be interoperable, not overwhelming, and eventually sort of crowdsource. Just like when we're driving now with Google Maps and Waze, we can't imagine driving without those now. We're crowdsourcing our driving and location. If we can build a bit of a Waze for healthcare, sharing what we have on our own health or wellness or disease journey with our fellow patients, patients like us, or our clinicians to really make sense and not use, again, that sort of average clinical trial, double-blind randomized trial for, you know,

Starting point is 00:15:54 a set of patients that really don't match the individual. And one example of that starting to happen is a company out of Israel called StuffThatWorks.Health is really building this ways for healthcare. You can share, if you have psoriasis, ulcers of colitis, my conditions, plantar fasciitis, I share what's going on with my foot. I'm learning from hundreds of thousands of others who have plantar fasciitis, what might work for me. Isn't that like patients like me and our friend Jamie doing that years ago? It was, but now it's more accessible. Patients like me started for very sick patients, like with ALS, Lou Gehrig's disease. Now it can be almost any condition. And we're starting to see what really works for different drugs, different interventions,

Starting point is 00:16:28 whether it's mindfulness training or a certain diet, because, you know, not every patient is in the same subset. You know, it might be older, different comorbidities. And that's the challenge with our medical data today. It's often an average patient. And I think we're now entering this age of precision personalized medicine using some of these new tools, some of these new diagnostics. And what's interesting as well is care is moving, of course, from hospital to home, to our phone, to on and inside our bodies. The fact that now sitting on my desk, I have a disposable PCR box that can diagnose COVID,

Starting point is 00:16:59 and these sorts of home diagnostics have only accelerated in COVID. And they'll not just be used for infectious diseases coming downstream, they'll be used to pick up non-infectious elements and really give us a whole new lens for new forms of actionable information. Yeah. I mean, well, the whole issue is what is the actionable information and how do we decide what to do? You know, my challenge, and I'd love you to answer this question is if we get all this data, but we're still filtering through the same diagnostic lens of conventional medicine, which is based on these IDC, ICD-10 codes, essentially categorizing people according to symptoms and geography, what symptoms do you have and where is in your body or what are your lab to

Starting point is 00:17:40 show as opposed to the causes and the mechanisms. You know, for example, Watson is this computer that might be the best chess player, but also went to medical school and the Cleveland Clinic, they are partnered with Watson. And I said to the developer, Watson, you know, this is really great. But if you're, if you're sort of using, you know, this powerful tool, but using an old paradigm, it's almost like rearranging the deck chairs in the Titanic. How do we get to a place in medicine where we are taking advantage of the new framework of systems biology and using that as the filter for the data as opposed to our current diagnostic model, right? So right now we have the filter of diseases, but maybe we need to think about a filter that looks at these biological networks and the dynamic interactions.

Starting point is 00:18:30 And the microbiome is the best example of discovery that's blown up our ideas of disease. Right. How does the microbiome cause heart disease, cancer, diabetes, obesity, Alzheimer's, autism, autoimmune disease, allergies? You know, I can go on and on depression. It doesn't make sense. You know, when you go to a psychiatrist, they're not looking at your poop, or the rheumatologist, they're not looking at your poop, but maybe that's where the answer is. So that's just one example of how our framework of disease is so outdated. But I'm wondering how you see, given all the trends that are happening, we move from that paradigm to filter the data to a new paradigm. Well, we move from that paradigm to filter the data to a new paradigm. Well, you respond on the paradigm. That's also shifting in how you define, quote-unquote,

Starting point is 00:19:09 disease. So something as common as type 2 diabetes, there are at least three different genetic subtypes who respond. If you have type 1 versus type 3, you respond very differently to diet, medication, and other interventions. So almost every element from autism to Alzheimer's to, of course, cancer, you know, lung cancer is just lung cancer. There's probably a thousand or a hundred thousand different molecular variations can now start to be understood at this molecular multi-omic level, which means we can then design both prevention and therapy to match them, including on, particularly on the prevention side, you know, very few diseases have one gene like sickle cell

Starting point is 00:19:43 or thalassemia. Now we're understanding this idea of polygenic risk scores, a base genome, which doesn't change. You know, many genes play a role in your risk for diabetes, atrial fibrillation, cancer, et cetera. And I think part of our future and really truly functional medicine is to understand each patient based on their underlying, you know, genetic risk factors, also based on their sociome, where they've lived. If you grew up in Beijing with lots of pollution, maybe you have to change your screening for lung cancer. And give that multi-omic, sociome, polygenic elements in a way that the clinician can digest, that the patient and their families can understand,

Starting point is 00:20:18 because it's just completely overwhelming. And platforms like IBM Watson can play a role. But again, they're only as good as the data they're trained on. And many of these- Right. That's what I mean. Yeah. Yeah. They can only be, if they're only taking data from European Caucasians, it may give you the wrong answer if you're dealing with folks from Asia or from Africa by heritage. And so there's a big attention now being paid to not just health equity, but data that's collected in forms that match the population. One great example is the NIH has this All of Us trial, allofus.nih.gov is the website, where you can sign up as a data donor and share your genome, your medical records, your Fitbit data and beyond. And that's essentially like a Framingham trial on steroids. It's going to be a million or more Americans. And we're going to learn, instead of just from relatively healthy nurses in Framingham, Massachusetts, what really

Starting point is 00:21:07 might be the best guidelines for you for high cholesterol, to managing hypertension, to cancer prevention, et cetera. So big challenges, big opportunities. The data alone isn't enough. How we analyze it and how we make sure it's matching the folks you're targeting at are key as well. Well, that's right. So you kind of have to have the overlay of the paradigm you're filtering the data from, whether it's junk in, junk out. And I think that's what I worry about is that it's so difficult for that paradigm shift to happen for traditional medicine. Like the structure of scientific revolutions, like Thomas Kuhn talked about this idea of

Starting point is 00:21:40 paradigm shift in normal science and how difficult it is for people to shift out of the normal science, the normal way of seeing the way they see things. It's like they have blinders on, and it's just striking to me how challenging it is to get people to kind of come along and get the ideas of a new paradigm. Well, part of the paradigm shift, of course, in healthcare, there's many misaligned incentives. And the practice of care is, again, sick care. You get paid to often do more biopsies, more procedures, more transplants to keep the hospital beds full, not to keep patients out. And so part of that paradigm shift has to occur in the context of how the clinical care is performed. How do you reward the clinician? If they want to prescribe a connected blood pressure

Starting point is 00:22:17 cuff or one that's embedded in your smartwatch, are they going to get rewarded for looking at that data and manipulating it? Or will the AI system be paid for that can help tweak your medications or 3D print them in your home? So part of the paradigm shift has to be aligned with the practice of care, who's doing it, how we get paid for it. Because in many cases, you know, the incentives are to treat the disease, not the symptom. I mean, we see that, for example, in clinical care right now with diabetes, you know, it's one in three Medicare dollars, which are spent usually on intensive treatments, medications, hospitalizations, surgeries, all the things that are needed to keep diabetics from getting more complications. And yet we know that food is the biggest driver of diabetes and that for most people, it is the biggest treatment.

Starting point is 00:23:01 And yet we don't provide payment for people to actually get treated with food, which is striking to me. I know the Geisinger study looked at food insecure diabetics and David Feinberg is now at Google, gave them $2,400 of food a year, plus some support and food for their family, which doesn't look like a lot of money or food. And they're able to save about, you know, almost $200,000 per patient and improve their blood sugar simply by providing the food. And that's really what's frustrating to me is that we have a lot of the beneficial treatments that optimize health, but we don't pay for them. We pay for, well, you know, what we do in medicine now, which is usually drugs and surgery. Yeah.

Starting point is 00:23:41 And Hippocrates said a long time ago, let food be the medicine, but medicine by the food.. And now what's interesting in this digital age, I've got on my desk here randomly my little lumen device. I can track my metabolome if I'm ketogenic or not. I've got that CGM that I mentioned. There's other handheld spectrovertometers that can wander food and detect how many calories, if it has peanuts in it, if it has gluten. And again, that might lead to enabling all of us to use food as medicine or as health in easier ways and to connect those dots and again, learn. I think that's, you know, back to the, you know, this idea that we can crowdsource. I use the Waze analogy early, but to the car analogy, you know, there's all these new sensors coming into your car, 400, 500 sensors. You don't pay attention to any of them. You don't even know most of them. When you do pay attention to is when that check engine light goes on and that hopefully makes you take your car to the mechanic before you blow a gasket. I think part of this future of medicine will be sort of that simplified user interface that can match the individual's age, education, culture, communicates in the right way to

Starting point is 00:24:42 help nudge us towards a better diet, to getting checked up, to addressing a problem before it gets challenging. And in the car model, now we have Teslas, which are essentially computers on wheels. And when they are driving in their self-driving or quasi self-driving mode, if they learn that they need to slow down on a curve, they upload the map to the other Teslas when they do the update in the cloud. So there's that hive mind element. So whether it's with nutrition or treating cancer or diabetes, the more we can start to cross-fertilize, share, connect those dots and update the maps for all of us, we'll do better across the nutrition

Starting point is 00:25:12 side and every other element of healthcare, including public health. Our data out of Stanford and its scripts can show that your smartwatch can find changes in heart rate variability and other elements that predict that you're catching COVID before you're even symptomatic. And imagine part of our future public health measures where we're all part of that map going forward. You know, definitely looking at the quantified self stuff is interesting. I put on the levels glucose monitor and track my blood sugar over a number of weeks. And it was fascinating to see, you know, what I ate, when I ate, how it affected my blood sugar, when it was up, when it was down. It was really quite interesting. And I'm not diabetic or don't have any metabolic issues, but it was still very

Starting point is 00:25:52 instructive about, oh, if I do this, this is going to create a bigger spike or a bigger drop. And this is how I keep my blood sugar even. And we know that, for example, keeping your blood sugar even is one of the key to longevity and health. it's these spikes in insulin and blood sugar that really cause a lot of our problems. Or looking even at my aura ring and my heart rate variability, you know, when I moved to Maui for the winter, I really noticed over time, I started to see my heart rate variability improve. In other words, my metabolic health, my heart rate all improved as a result of lower amounts of stress by living in Maui. And I was like, wow, this is really interesting. I'm getting more stress-proof by simply doing the behaviors

Starting point is 00:26:30 like sleeping well and eating well and exercising and meditating and just having a more balanced life than running around like a crazy man like we used to do before COVID when I both were like that. And it's like, wow, this really is something you can pay attention to and then impact. Hey, everyone, it's like, wow, this really is something you can pay attention to and then impact. Hey everyone, it's Dr. Mark. You probably heard me talk about how much I love infrared saunas on the podcast. They've been linked to many different benefits like better muscle recovery, calming of the nervous system, improved circulation, and even activation of the immune systems to support

Starting point is 00:27:00 protection and healing. Saunas also promote the release of feel-good endorphins that give you that blissed-out feeling and give your skin a healthy glow. I think it's fascinating that so many cultures around the world have some kind of history of sauna use, and I don't think it's a mistake. People have recognized for centuries that heat exposure and sweating has therapeutic effects, and now it's easier than ever to take advantage of that ancient wisdom on a regular basis. I know not everyone has the room or the budget to have their own sauna at home. So I was really excited to learn about infrared sauna blankets from Higher Dose. It gives you all the benefits of infrared and easy to use portable blanket at a much lower cost than a standalone sauna.

Starting point is 00:27:39 The blanket is so cool. It has a layer of amethyst to deepen the infrared benefits, a tourmaline layer to generate negative ions, and a layer of clay to balance heat, and a charcoal layer to bind pollutants as you detox. If you don't have the budget or space for a full-size sauna, this is an amazing and less expensive option to up-level your wellness routine. Higher Dose is offering my community an exclusive discount of $75 off with the promo code pharmacy75 at higherdose.com. That's higherdose.com with the code pharmacy, F-A-R-M-A-C-Y 75. Now let's get back to this week's episode of The Doctor's Pharmacy. Daniel, what about the term exponential medicine? This

Starting point is 00:28:18 is something you coined. What does it mean? How do we leverage it to impact our health? And how is it going to transform healthcare? The framing of exponential medicine is to understand the pace of change. So we mentioned earlier, you know, Moore's law, the power of computing in your smartphone is doubling in performance and half the price every year. So the fact that our sequencing a genome or microbiome has dropped, you know, from millions of dollars to $100, the fact that our internet of things and connected devices are going up at an exponential rate. And just a reminder for those who are not mathematicians, the fact that our internet of things and connected devices are going up at an exponential rate. And just a reminder for those who are not mathematicians, our brains are fine

Starting point is 00:28:49 thinking linearly, 30 linear steps will be across my house. But if I took 30 exponential steps, two, four, eight, 16, 32, 64, by the 15th step, I'd be at about 32,000 meters. But by the 30th step, I'd be 26 times around the planet, a million meters, a billion meters. Wow. And that's sometimes the surprising power of exponentials. And so what we need to keep in mind as we look to build our future of health and medicine is what's going to be possible with the next generation of wearables or Internet of Things or 5G moving to 6G. The fact that we're now seeing, you know, satellites now from SpaceX, trying to bring high-speed bandwidth pretty much anywhere in the world. How do we think about drones, which 10 years ago were toys, now we're delivering drugs and medications? How do we think about gene therapy, which now is accelerated with CRISPR and next-generation mRNA therapeutics? So a bit of the framework of exponential medicine, the conference I chair and founded, is to get people looking at all those technologies, how they come together, and how you converge those to address challenges and pain points and to learn from others that are doing it.

Starting point is 00:29:53 For example, we had our friend Leroy Hood there sharing his perspective around precision wellness that ties into a lot of your work and where that might go. And how not only to have the technology, but how to integrate it in with the payment models and the healthcare systems and the incentives and the policymakers. So that's a bit about the exponential going. And I would argue that many of the things that we had, you know, it was actually 10 years ago this month, I did a TED talk called Future of Medicine. There's an app for that. And at the time, I think there were 60,000 healthcare apps. Now there are, I don't know, 600,000 or more. But what's interesting is those have shifted from the consumer app for mindfulness or maybe tracking your steps to being medicalized. They're getting paid for. They are being FDA approved. Like there's now video game app video games for treating ADHD that are approved or for managing

Starting point is 00:30:41 PTSD. And so we've gone from sort of the shiny objects, and these are kind of cool widgets, to where they're being integrated into care models. They're being regulated. They're being paid for. And that's a bit on this exponential. Of course, as clinicians in healthcare, we're often a little slower to adopt

Starting point is 00:30:56 than if it's just a pure video game. Another fun example of an exponential many of us have experienced is virtual reality. You know, six years, seven years ago, the Google Glass was kind of a fun example, but now there's Oculus Quest for $200. VR can be great for playing video games and putting grandma on a roller coaster, but now VR can be used for therapy to treat pain or for medical education. You go into a virtual operating room and you practice your procedure just like a pilot

Starting point is 00:31:22 would be on a flight simulator. So these are examples of things coming together in surprising ways that we all need to appreciate and leverage into health and medicine. Dr. Justin Marchegiani I think all these things are going to change healthcare and change our approach to our own health. But being a little bit of a devil's advocate, we have all these great technologies, but technology in the end doesn't save us because at the end of the day, it comes down to the simple things that create health, which are what we eat, how much we sleep and exercise and our stress level, and a few other simple things like our nutritional status and toxin load and overall health. And how do we get people to focus on those changes? Because right now, as we sort of start out talking about, you know, we have 88% of Americans

Starting point is 00:32:07 that are metabolic and healthy, 75% overweight, 6 in 10 of a chronic disease. It's driving, you know, one out of five healthcare dollars is one of five dollars in our economy is healthcare dollars for healthcare. And about 80% of that is for chronic illness. It's mostly related to lifestyle. So that's the big question is behavior change, right? We know what to do, right? I can cure someone's diabetes. It's mostly related to lifestyle. So that's the big question is behavior change, right? We know what to do, right? I can cure someone's diabetes. It's not hard. Change their diet. The data is there. It's not controversial. And yet it's really hard to get people to do. How do we deal with that? How do we get exponential in terms of behavior change?

Starting point is 00:32:42 Right. Well, comment number one is, of course, technology only plays about a role in about 15% of our health. And a lot of it are the core elements, you know, food, sleep, social connection, diet. And putting on my pediatric hat for a second, since I trained in medicine and pediatrics, we know now that if you give a child at six months of age, not that sort of cheaper white rice, yummy, sweet cereal, but they give them whole grain cereal, it changes their microbiome, their epigenetics, and the risk for obesity and diabetes goes down dramatically. So number one, start young, you know? And I've got young kids, and sometimes they like their sweets, but you try and moderate. But of course, now we know you don't need to be quantified self to know you're supposed to exercise more and eat less, but behavior change is super hard. But what's getting interesting now is

Starting point is 00:33:20 we can start to use some of these new tools to become that digital coach that really matches you. The avatar you might want is Einstein. I might want my mother as my coach. And these avatars can feel real even if they're just something living on your phone or through voice. And I think what's going to be part of this element in the future, we're all touching our smartphones and other consumer devices frequently, they can become a bit of our health bubble, kind of like your almost personal health avatar that can give you smart nudges over time to help nudge you in the right direction in ways that match you, right? I'm an INTP, you might be an ENTJ, we might relate to health information differently.

Starting point is 00:33:59 If you're a baby boomer versus a millennial, how you communicate, how you have the user interface on the wearable app might be quite different. So I think it's a bit of a blending of all these things to meet people where they are and give them the power of why. If you can show them in the mirror, not just you of today, but you of the future, if you keep smoking, drinking, not getting enough sleep, stressed out, that can be a powerful lever and that can be done with augmented virtual reality as well.

Starting point is 00:34:22 So I think it's a blending of those tools. And now it's a bit dystopian or big brother. There's even insurance companies, health and life insurance companies that will track your steps. And if you're walking 10,000 steps a day, you might get a lower premium. So there'll be other financial and other incentives that come into play. I think we haven't been asking that question enough when it comes to technology, which is what is the signs of behavior change? I think you know BJ Fogg and others. Charles Duhigg from the New York Times wrote about the signs of behavior change? And I think, you know, BJ Fogg and others, Charles Duhigg from the New York Times, wrote about habit change, behavior change. And I think we really are often ignoring that piece of medicine because at the end of the day,

Starting point is 00:34:58 if people don't change their behavior, none of these things really matter, right? Because yes, you can find a precision way to match this drug to this disease, and that's great. And we need to do that and wonderful. But when you talk about the majority of what we're suffering from in terms of chronic disease, that's not going to cut it. And we need to get into the homes of people and get out of the hospitals and the clinics and decentralize health. Like you said at the beginning, we have a sick care system and a healthcare system. So health really happens at home. Nigel Crisp wrote a book called Health Happens at Home, Hospitals Refer Pairs. And I think that's a good way to think about it. Yeah. I actually recently chaired a conference on the future of the hospital with a bunch of

Starting point is 00:35:38 CEOs from hospitals. And our takeaway was that the future of the hospital is no longer the hospital. It's increasingly virtualized. It's moving to your corner pharmacy. It's moving to your smartphone. I've been the host of the CVS Healthy Conversations podcast. A lot of it is bringing in other voices that you might always hear from them. It could be the pharmacist or the pharmacy executive, you know, struggling with how do you, you know, manage everything from COVID testing to the social determinants elements and equalizing care. Because now we have the ability to connect the dots, you know, through the sort of digital connected mobile age, it can happen in our home. More and more patients are being admitted to the home, not the hospital for maybe a simple pneumonia. And with sort of the, you know,

Starting point is 00:36:19 technology piece where, you know, when we were medical residents, you remember, we keep someone in the hospital for an extra day or two just to check their temperature or lab. Now you can send them home with the lab or, you know, a wearable device like this one that is basically an intensive care unit level patch that can stream their, you know, ICU level data and enable you to do a better job of that home-based care from hospital to home or hospital to homespital is going to be- Home, homespital. I like that.

Starting point is 00:36:44 Homespital. I was going to say, think about what do you have in a hospital? It's usually an IV pump, which now can be converted to a smart pump at home. Some drugs, which we used to give only by IV or subcutaneous infusion, can go into a robotic pill that you might swallow and inject the biologic into your gut wall. Our Wi-Fi now can pick up our vital signs. MIT project by Dina Katabi showed that modifying Wi-Fi can pick up the vitals and behaviors of 10 or more people in the same home. So again, a bit big brother, but we're exuding our digital exhaust 24-7. That enables us not just to do the wellness side, but when folks have an acute or chronic medical condition, you can manage them remotely. Something as simple or common as someone just had

Starting point is 00:37:24 a total hip replacement or came home from the hospital with COVID, is their wearable device showing that they're walking more, doing better, or walking less? And if you can intervene early on the folks who are walking less before they have a fall or other complication, that could be a big game changer as well. So a lot of the new digital breadcrumbs will come from the home and enable us to do smarter, more holistic, and integrated care. And one of the most interesting things was I was on a flight back from a conference with Mike Roizen and Dr. Oz, and they were sharing this phone technology, which is a sensor in the phone that detects your voice. And you touched on it earlier,

Starting point is 00:37:57 which can tell you what your mood is, whether you're at risk for different problems. And it's just fascinating based on the tone of your voice, the quality of your voice. And so we're able to pick up data that's going to inform us about, well, maybe this person is about to commit suicide, or maybe this person really needs some help with this or that. And you can begin to really create a system that responds to the real needs of people in real time, which is very different than sort of our one-size-fits-all approach. Well, that whole field of voice is a biomarker. I mean, the ones that have come up this year are the sound of your cough, is that COVID or croup or cold, but mental health can be picked up. I talked to a startup in the San Francisco Bay Area yesterday. They have a way

Starting point is 00:38:36 of picking up depression and scoring it based on your voice. And then another advent that's accelerated is digital mental health. So they can then connect you to a platform that might help you manage your stress or your anxiety or PTSD or your depression, and then have ways of actually quantifying that because mental health and the brain has been so hard to quantify. You can't put people on MRIs every day. Another piece of voice that can pick up signs of early neurologic conditions. And given the scourge of Alzheimer's and other neurologic challenges, what if you could detect 20 years before someone's symptomatic that they are likely to get dementia? Maybe just like we give a statin for high cholesterol, we're going to start to give some of these drugs that reduce neuroinflammation or can reverse and stop plaques early on in the progression and use these biomarkers from voice

Starting point is 00:39:17 to your eye tracking to your omics to actually move the needle on preventing these horrible diseases as well. Yeah, so true. You know, I think what I want to dive into a little bit is this whole field of precision nutrition. And I just published a book called The Pagan Diet, which is focused on two big concepts, which is food is medicine. It's a biological response modifier. In other words, it changes every aspect of your biology in real time. And two, personalization.

Starting point is 00:39:40 How does the future look to you in personalized nutrition? What will we be doing? How will it inform us? Because there isn't a one-size-fits-all diet for everybody. So how do we begin to get to a closer approximation of what's going to work for us? Well, I think as we start to understand nutrition at the true biologic level, which is relatively new, the fact that we can all now wear a CGM, and glucose is like one part, of course, how we can start to measure even some

Starting point is 00:40:05 people do it every week, their microbiome, and we're seeing new ways to collect your microbiome from other parts of your gut, as well. We're seeing the ability now to see the impact on other levels of biomarkers. So I think hopefully it doesn't have to get super complicated where you're quantifying your meals every day, but you get a bit of a best picture look at what's really going to keep you healthy, optimize your health, whether you're trained to run a marathon or you're trying to reverse your diabetes or reduce your risk of cancer or treat a cancer. So I think the way it looks, it might be along the lines that, number one, our smart kitchens might be tracking some of this for us. Maybe can even order the right meals or give you better points for shopping in healthy ways that already exist.

Starting point is 00:40:45 But ideally, it becomes something that's fun and integrated and much more appreciated. Yes, you can still go and have your fast food occasionally and have that big chocolate cake. But we are understanding its real impact in measurable ways. And we can integrate that into medical education because we don't get much nutrition in medical school. I don't know. I think I had one hour at Stanford. And it can be part of our healthcare prescription. Prescribing a diet, for example, will become much easier. And that will be something that will be tuned. And in some cases, we're going to want to, you know, modify things in real time. One element, since I trained in medicine and pediatrics, is like dosing. And that you might dose a meal,

Starting point is 00:41:23 but also dosing your medications. Ideally, we want to have folks off medications, but one technology I developed is a way of sort of 3D printing your own personalized poly pills. So someone who has an aspirin, statin, beta blocker, synthroid, vitamin D, you might imagine you could print that pill every morning based on their data or even print the right dose of statin or Lasix into their breakfast bar or into their coffee. So ideally it becomes a little less hard to do and you don't need to be a quantified cell for tracking every calorie or every cupcake. Yeah. Yeah. It seems to me that, you know,

Starting point is 00:41:55 when I look about mom and I see what's happening in the future of Madison Nutrition, you know, I think we're going to be able to use a lot of different tools to assess a person's individual needs, right? Their genome, which looks at enzymes. I mean, one third of our entire genome codes for enzymes and all those enzymes require nutrients or vitamins and minerals, and they require different kinds and different amounts depending on your genetics. That's just one aspect. You can look at nutritional testing that may be done through saliva or urine or blood or transdermally or through your eye. Who knows what we're going to be able to figure out and detect what's going on with your nutritional status. Are you alone? This or that nutrient. We'll be able to look at

Starting point is 00:42:34 your metabolic features, whether you're pre-diabetic or not, or whether your blood sugar is off or not, and even more subtle things that we'll be able to measure. We'll be able to look at your stool and look at your microbiome, which plays a huge role in how you respond to different foods. So we're going to collect all this data, plus our own family history and our own personal history. And I think it's going to look like a very different landscape where we're going to be able to see, okay, you're somebody who may need to be on a higher fat, lower carb diet. In other words, you might be on a lower carb, higher fat diet, or you might

Starting point is 00:43:09 do well with saturated fats and you might not do well with saturated fats, or you might do well with eating, I don't know, blueberries and you might not be okay with eating blueberries. And I think that is going to be a really breakthrough moment where people can start to get off of the dogma that they're on around what they should or shouldn't be eating and really understand that this is a personalized future, both in terms of pharmacology, but also in terms of nutrition and in terms of our own ability to personalize our wellness. You know, we call it, you know, Leroy calls it scientific wellness. I just call it functional medicine. Dave Asper calls it biohacking. You know, we call it, you know, Leroy calls it scientific wellness. I just call it functional medicine. Dave Asper calls it biohacking, you know, we call it exponential medicine,

Starting point is 00:43:47 whatever we want to call it, it is what's going on. And it's, it to me is one of the most exciting things that I've been, I've been doing it for 30 years. And I can see over that time, I've, we've gotten better and better at understanding what to look at, what tools there are, how to, how to personalize these approaches. And when we see the outcomes of those interventions, it's just striking to me when I work with my patients that way. I mean, I had one woman who was, for example, very overweight, struggling to lose that, you know, 20 pounds that she needed to lose. She was struggling because she was, you know, really having terrible lipids with super high

Starting point is 00:44:21 cholesterol, super high triglycerides, low HDL, was really having trouble. And she's like, I'm like, I've tried everything. Well, why don't we try a ketogenic diet? So I basically put her on coconut oil and butter, 70% of her diet. And she literally transformed. Her weight dropped off 20 pounds, just like that. She had a dramatic reduction of 100 points in her cholesterol, 200 points in under triglyceride, or HDL went up 30 points, which is unheard of. It was a miracle. Another guy who was a 50-year-old biker who was relatively healthy but wanted to optimize his health, wanted to try ketogenic diet. I'm like, okay, try and see how you do. We checked his numbers, and it was the opposite. He got terrible

Starting point is 00:45:01 cholesterol particle number, really high, large, small particle, the opposite of what you would see with this woman. So same diet, totally different biological responses. So I think we have to be humbled by the fact that we're just at the beginning of this discovery process. And through these new tools and technologies, we'll be able to really drive in a much more personalized approach to, you know, scientific wellness or health. And one key part of that is the evidence base, right?

Starting point is 00:45:26 There's always, I like to drink my coffee. You know, most of the recent studies saying coffee is good for you, but occasionally you'll hear one where it's not or vitamin A or vitamin D. And what's interesting now in a bit of our connected days, we can all now become members of virtual clinical trials, whether it might be a form of nutrition or a particular medication that's dropped off by drone, and then your apps sense that. I think building the evidence base to match the potential is really critical. And now we can accelerate clinical trials and evidence as well. Well, let me challenge you on that, because in the field of exponential medicine and thinking

Starting point is 00:46:00 differently about the future and understanding network biology. Our current two tools that we use, aside from sort of animal studies, are randomized clinical trials, which are looking usually at specific interventions for a specific disease in a specific population that may or may not be generalizable using, you know, a statin in 70 kilogram men from Kansas who all, you know, wear overalls, you know, basically it's the perfect study versus the real world where we see all sorts of size, shapes, colors, and ages of people. And the second tool we use is public health studies, which are epidemiology. We look at large populations, we see trends over time. And again, those are generalizable to a population, but not to individuals. And the randomized trials

Starting point is 00:46:40 are specific to individuals, but not super generalizable in my view. And there was even a great paper in JAMA that kind of talked about this challenge with research in the field of the future of medicine, whatever we call it. How do we reimagine research to be able to look at the complexity of biology and get out of this reductionist paradigm of just looking at the single intervention for a single disease or the single drug? The one example of that is verily Google's spin out in health is doing the baseline trial where they're taking, I think, 10,000 plus volunteers, looking at their digital exhaust from their wearables, their genome, their diets, their health history, and starting to connect the dots and sort of do a continuous clinical trial to understand health and also

Starting point is 00:47:22 see disease in a normal distributed population, at least the normal ones who signed up for the study. I imagine we could all be part of a continuous clinical trial going on, potentially if your food intake is tracked by the future spectrophotometer on your smart device. And so we'll start to opt in, I think, into sort of more generalizable, holistic clinical trials that using big data and multiple streams of information can give us, you know, better, less narrow insights that can apply to precise prevention diagnostics or therapy. So huge challenges, how do you pay for it? What data do you look at? And then even in the form of nutrition, you know, one form of milk, it might be different from another depending on the cow. So I wonder how we can sort of start to standardize some of the nutritional

Starting point is 00:48:12 components as well. Yeah, right. Milk isn't milk, isn't meat. Meat isn't meat, isn't meat, right? So we talked about this in my book and on other podcasts, but you know, kangaroo meat or wild animal meat is very different in its biological effects than feedlot meat, where, you know, the feedlot meat raises inflammation, the wild meat reduces it. Or if you're eating, like you say, milk from a sheep, which has A2 casein, it has different biological effects than a cow milk that's A1 casein. And so it even gets more complicated about how do we begin to focus on that. But I'm sort of excited about it. And I can tell you, the more I dial in what I see in my patients' data and lab tests, the better their outcomes are clinically. And I wish we had a way

Starting point is 00:48:52 to really study that. At Cleveland Clinic, we're doing outcome data on everybody. I wish we had tons of money to study this. I know there's so much money, like billions and billions and trillions being spent on things like COVID. And it seems like just a fraction of that spent on studying some of these issues in more detail would be so powerful. Well, a question for you related to that. I mean, functional medicine really is this integration of all these different fields, but healthcare is still practiced among specialists that often don't talk to each other. And they just, you know, one specialist for the right arm, one for the left in some centers. How do we better integrate these elements? So it's not just your primary care doctor who's trying to struggle to connect all those dots? And how do we make functional medicine truly functionalized for every individual and almost every clinician? Are there ways you've seen that work? Because not everyone I've had this unique perspective because I've had the privilege of working at Kenya Ranch,

Starting point is 00:49:48 which is a health resort where people are very affluent, and also in my own private practice where I saw people from all over the world, and they could afford significant testing. And so we would do sort of an experiment. I would say, look, let's just get this data, and the more data we have, the more we'll know about your biology, and the more we'll be able to personalize in this approach and help you get healthy. And so I've seen literally millions of data points on tens of thousands of people, and it's all in here. And I can see those patterns in the data, which is what sort of AI does, but you know, I'm not that smart. And so I'm probably missing a bunch of stuff. And I have also seen stuff that I know nobody else has seen or noticed because I

Starting point is 00:50:23 just had so much data. And my dream is to actually get this convergence to happen where we somehow get the right people in the room who can use AI and the right AI programming to understand all this information that's being fed into this big data fields, right, of omics, quantified self, systems biology, paradigm shifts, and kind of create a decision support system for providers to say, okay, here's the thing you should think about. Here's a patient with Alzheimer's, and based on their history, based on these lab diagnostics, that the likelihood is that they probably have an insulin-resistant-driven Alzheimer's, or this patient

Starting point is 00:50:58 might actually have Alzheimer's that's caused by some latent infection, like Rudy Tenzi's talking about some low-grade infection in the brain, or maybe it's from Lyme disease, or maybe it's from heavy metals, or maybe it's a microbiome issue that's causing brain inflammation. And we'll be able to then begin personalized nutrition and medicine and then come up with the right therapeutics based on those algorithms. That I see coming. I don't know anybody who really is working on it. I've talked to Peter Diamandis and his group working on the sort of personalized longevity programs that they're developing. I know we've talked to Human Nucleus and folks down there, Craig Venter and his team, and now a new team down there. They're trying to get to this, but it's tough. Leroy Hood tried to

Starting point is 00:51:39 do this with his study at Aravel. Unfortunately, the business model didn't work, but he really has done this sort of quantified data on 100 people, wants to do it on 100,000 people, looking at all these variables and what happens when you start to impact these over time. Those are the kinds of things that have to happen for us to really move forward. But I think in all the people you know and all the things that are really going on in the world, if somebody who had money could catalyze the research field in this way to kind of put these pieces together that you talked about, it would be transformational. Well, one part of that transformation is it has to be part of the, we talked about workflow. We

Starting point is 00:52:14 know a clinician wants to be looking at all the raw omics. And I even went through the RFL program. It was fantastic, but it was very, you know, very intensive. You had one coach. They still looked at very fragmented sets of your data, your genome, your microbiome, your scan, your other element. And hopefully the trick is, and you've told these stories of your experience with like heavy metals and mercury poisoning, you know, what if the little AI computer decision support suggested for the primary care doctor in rural Idaho that, wow, this patient really keeps not doing well. Have you considered checking the mercury levels or other elements? Sometimes, you know, we have so much misdiagnosis. So many folks get to late stage and it's often fragmented amongst different specialists who never see the complete picture that I think if we can smartly start to integrate that into

Starting point is 00:52:54 the workflow and ask those questions even before you see the clinician, we'll start to move the needle. That's part of that paradigm shift. It's pretty exciting. I want to get there fast because I see so much needless suffering and there's a huge gap between our current knowledge and current practice. And we hear, you know, average of 17 years for things to get into practice from when they're discovered in the scientific literature or 50 years, you know, doesn't even take a while. And often people are vilified or discounted because of that. But I think we'll get there. And I think your work is just so important because it connects the dots for people and

Starting point is 00:53:28 helps them look at the future in a really different way. I want to sort of turn the tide a little bit and talk about COVID with you for a minute, because it's really created these unprecedented social economic challenges and given us also an opportunity to think about how to make a difference in our whole approach. So how do you see COVID has been a catalyst for change when it comes to the future of medicine? I have some ideas about that, but I'd love to hear what you're thinking. Well, one lens is that it's forced us to collaborate faster. I've been sharing the XPRIZE Pandemic Alliance Task Force, which is made up of some amazing folks, like you know,

Starting point is 00:53:59 like from Dean Kamen to the chairman of IDEO, to the folks who head up life sciences for Intel, but also 100 organizations from small companies to academics, to Fortune 50 companies to help address what are the challenges of this pandemic and how do we prevent future ones. So part of COVID as a catalyst has been to accelerate new forms of communication, new forms of data, from studying the genomics of COVID patients and figuring out what blood type might be causing more morbidity or susceptibility, all the way to catalyzing new forms of diagnostics. We launched a, with Jeff Huber, the founder of Grail, a cancer testing company, we started a, and launched and finished an XPRIZE for rapid COVID testing. And that generated 700 different teams from 70 countries. And the winning teams, some of them were using the basic pcr but

Starting point is 00:54:45 they could make it faster cheaper better uh some were picking up ways to use uh smell as a screening test in very precise ways others were using breath and new forms of physics and so covet has forced us to be smarter to collaborate faster and i think the silver lining of the pandemic and some of these like testing solutions we talked about will lead to better diagnostics for many diseases. Certainly, we've learned around the vaccine element that it was amazing. January of 2020, we sequenced the virus. A month later, we built the first basic vaccines, mRNA-based. We're into trials a month later, and we have vaccines in the market less than a year later.

Starting point is 00:55:21 So I think the lessons that we've learned, narrowing the gap from data to insights to action will serve us in this sort of reinvention of healthcare going forward. And it means we all need to use this as an opportunity to break open our old silos and do things smarter and faster. And totally. And I found also, you know, our practice, we, like many people when COVID hit, we're like, what are we going to do? Because people aren't coming to the office anymore. Everybody's staying at home. So we had to pivot to virtual health care. And we were doing some of it before, but we switched basically to running our practice on Zoom, which is pretty amazing. And initially, almost entirely, now people are coming in a little bit.

Starting point is 00:55:59 But we're seeing that the silos, for example, between states, now we can treat people from other states with all these artificial barriers that are regulatory, that kind of limited medicine. Like you have to have a license in every state to treat someone in another state, or they have to see you in person. I mean, these are things that have been established and honestly have no really good reason for them. And now we're like saying, oh, well, you know, we can do really good medicine online. Yes, it would be good to see the patient. Yes, it would be good to do a physical exam. But I often do good exams online or, you know, I had an orthopedic consult with a patient.

Starting point is 00:56:33 And I saw the doctor was like, okay, do this, do this, Ben, here, do this. And it was like he was telling her how to sort of do all the moves that would trigger whatever you wanted to trigger. And it was like, wow, you know, we really have to rethink our whole approach to treatment. I also think the decentralization of care, the democratization of care, getting care out of the clinic and the hospitals just makes sense. And I asked the chief of staff at Cleveland Clinic years ago, I said, where do you see Cleveland Clinic in 10 or 15 years? And I see Cleveland Clinic without walls, which is exactly what you were talking about before, which is transforming where care is delivered, how it's delivered, you know, what kind of information we're doing. It's really the most exciting time, I think, in medicine. I'm just thrilled. It's just frustrating it's not happening

Starting point is 00:57:11 faster, you know? Well, you know, we do have to still make sure things are safe and effective, but on the telemedicine side, which is exciting, of course, you know, HIPAA released or relaxed some of its regulations so you could do a Zoom visit, reimbursement models changed. And I think part of our future telemedicine business, now that many of us experience both as clinicians, as patients, like, why do I need to go in for that little checkup when I can just do a Zoom chat? But what I think is going to get exciting is before you even see the clinician in the future, you'll have talked to the AI chatbot. Maybe you have abdominal pain and it will ask you 20 questions and figure out whether you really have appendicitis or not. And it will already know if you had your appendix out or if you're pregnant.

Starting point is 00:57:48 Also, when you see the clinician, they will potentially hopefully have, you know, months or years of your digital exhaust. How have your heart rate changed from your wearable, your aura ring? What is your genome? So it will not just be the face-to-face visit, but you'll be integrating that with a whole other set of tools and insights. And particularly in functional medicine, like you was like, how's your diet been? How's your bowel movements been? No one can quite remember that, but your smart connected toilet might remember that. I think it's part of your virtual visit integrated into what you see on the screen.

Starting point is 00:58:16 Okay. So take us forward 25, 50 years. I'm having a problem. Let's say I'm having digestive issues or I'm having a problem. Let's say I'm having digestive issues or I'm having memory issues. And I walk into the doctor's office or I walk into our, what does it look like? I want to go get help. What does it look like? Take us through an experience of the patient in the future and how we're going to come up with a way to treat them. Let's take something a little more complex to put together, like an autoimmune disease,

Starting point is 00:58:44 something like Lyme disease or motor arthritis. Often there's many manifestations of that disease that are often hard to put together and hard to measure. showing signs of early dementia or rheumatoid arthritis or any other number of diseases. And just like a minority report, they won't throw you in jail, but they'll send you the proactive intervention. It might be dietary. It might be a form of exercise or a video game for your brain. But holistically, before you walk into the real doctor's office or virtual one, I think that sort of digital bubble of data that you've been generating, your digital exhaust, your digitome, will have been synthesized. It will have been analyzed, maybe continuously, but maybe in real time just around that question.

Starting point is 00:59:31 It might have parsed your microbiome data. And then when it's going to start to suggest a therapy, again, it won't be doing it on that average patient from Idaho where it wears the blue jeans and drives a truck, we'll do it for folks with your same age, your other genomic cofactors, your social, your environment, and really suggest the precise prevention to help it from progressing or the precise therapy. And in many cases, that will no longer be the sort of more generic, let's say generically acting drugs, which often have multiple side effects like steroids. They'll be targeted to, let's say, your base omics issue. So the mRNA technologies, which are moving very quickly on vaccines, are going to be multiple side effects like steroids, they'll be targeted to, let's say, your base omics issue.

Starting point is 01:00:09 So the mRNA technologies, which are moving very quickly on vaccines, are going to be applied to treating certain molecular diseases. And we'll have much targeted therapies that might even be, again, kind of printed at home to match what you need. So that's a bit of that touch. I think we'll still need the human in the mix. It's not, you know, your doctor's not going to be replaced by a robot, but the doctor using an AI or a robotic assistant will replace those who don't. And so it's a bit of that combination that's going to really hopefully synthesize these things. So we need to keep the human piece, but leverage all these new tools for proactive, preventative, personalized, anytime, anywhere care. I love that. And I hope it won't be just rearranging the textures on Titanic and doing the same thing better, which is actually the wrong thing.

Starting point is 01:00:45 Because, you know, we have an AI bot, but there's one called AskMD that I've seen. And it's very good. If you have a headache, it takes you through a series of questions. And at the end, you say, OK, you probably have a migraine. You should see your doctor and get these tests or do these potential treatments. But that bot is actually operating off of the ICD-10 diagnostic code system, which is based on the old scientific paradigm of diseases based on symptoms and organs, not mechanisms and causes and systems.

Starting point is 01:01:11 So we need an AI bot that does the latter in order to really create an exponential change in medicine. Don't you think? Number one, yes, exactly. Every disease needs to be recategorized out of its CPT code or neuro box bucket. But the biggest potential, I think, is you talked about rearranging the Dexiers on the Titanic. The Titanic was for the super wealthy, unless you were in the steerage. What's exciting about these new tools is they really can start to democratize healthcare around the planet from rural California to rural Rwanda, to the point where, you know,

Starting point is 01:01:35 almost everybody has a smartphone that gives you not just access to information, but now digital diagnostics, you know, where the camera on your smartphone can take a picture of your urinalysis dipstick and diagnose a UTI or early signs of kidney disease if you're diabetic. It can provide you that telemedicine console that can drop off by drone that device or vaccine or therapeutic you might need. So that's part of the exciting piece as well moving forward. Now we're not all riding the Titanic. As is happening in China, there's a platform called Good Doctor by Ping An that has I think 250 million users now getting sort of AI-assisted virtual care that they can connect them to human care when they need it as well. Yeah. That's so fantastic. I can't tell you how exciting it is to be alive and a doctor in this time. And because of this rapid transformation,

Starting point is 01:02:18 our worlds are going to look very different in 10, 15, 20 years. I mean, think about it. We didn't even have an iPhone 13 years ago. Like there was no iPhone. Now it's like, what do you mean? Everybody's got a smartphone on every corner of the planet pretty much, right? And it's that level of exponential change we're going to see in healthcare. Well, I just did the keynote for my Stanford Medical School alumni event last week. And I was realizing when I was a medical student, gosh, almost 30 years ago or so, like, yeah, we didn't have smartphones. We didn't have wifi. We were still having, you know, slides for presentations. We had a, we, we could Snapchat or, or, uh, uh, I don't know how we

Starting point is 01:02:53 communicated, but, but now 30 years later, we're still using, we're still, we're, we're, well, we're still using fax machines. Uh, uh, unfortunately we still have, I had a cardiac study done about a year ago and I got my result on a CD-ROM. I don't even own a CD-ROM anymore. So some of the elements of healthcare and practice are so ingrained that we need to break over the mindsets of medical education, of healthcare systems, of payers or regulators to really bring us to this age of exponential medicine and outside of the realm of the fax machine, which we're still stuck with in many centers. So it takes not just changing and seeing new possibilities, but getting out of our old mindsets as well. So moving from fax machines to AI bots, that's great. Well, Daniel, thank you

Starting point is 01:03:37 so much for your work in re-imagining medicine and re-imagining healthcare and being a voice for a real change. You've been in the mix of it for a long time, and I think you're a voice that really sees the potential for a whole new system. And it highlights some of the things that are happening on the fringes that are now kind of moving into the mainstream. And anybody who's listening should check out Daniel's work, should understand the importance of really looking at healthcare differently. And check out his new podcast with CVS Health called Healthy Conversations. He's the host and has all sorts of conversations about the future of healthcare in really deep conversations with great people across the spectrum of healthcare, from providers to policymakers to healthcare

Starting point is 01:04:22 insurers to behavioral therapists to pharmacists, pretty much anybody who's interested in healthcare, you're going to learn about a different way of thinking about things. And Daniel, thank you so much for everything you do. Thank you. It's been an honor and a pleasure. And I'll just close with the thought that we can all be catalysts in the future of healthcare. You certainly have been. There's that famous quote, the future's already here, it's just not evenly distributed. And so it's up to all of us to get out of our linear mindset, get into the exponential one, find the tools and solutions that might match you or your family member with a particular medical health issue and help move those into this future so it comes faster than

Starting point is 01:04:56 we might think is possible. Well, thanks, Daniel. And those of you who listen to the podcast and love to share with your friends and family on social media, leave a comment. We'd love to hear from you. How has the future of healthcare affected you? And subscribe wherever you get your podcasts. And we'll see you next week on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy.

Starting point is 01:05:18 I hope you're loving this podcast. It's one of my favorite things to do. And introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you do is go to drhyman.com forward slash pics to sign up. That's

Starting point is 01:05:56 drhyman.com forward slash pics, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Hi everyone, I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor

Starting point is 01:06:19 or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

The Dr. Hyman Show - The Future Of Medicine: Precision And Personalization with Dr. Daniel Kraft

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