# Part Two: Peter Attia and the Cult of Longevity

An episode of [Behind the Bastards](https://invisiblenetwork.ai/podcast/1373812661), 15 Oct 2026, 1 h 17 min.

Audio: https://podtrac.com/pts/redirect.mp3/pscrb.fm/rss/p/traffic.omny.fm/d/clips/e73c998e-6e60-432f-8610-ae210140c5b1/e5f91208-cc7e-4726-a312-ae280140ad11/54c7c95e-b14d-4d71-8819-b4e3015aaddd/audio.mp3?utm_source=Podcast&in_playlist=d64f756d-6d5e-4fae-b24f-ae280140ad36

In Part Two, Robert is again joined by Dr. Kaveh Hoda to discuss the rise and fall of the doctor at the center of the wellness podcast circuit: Dr. Peter Attia. From his stent as a McKinsey consult consultant to his pricey concierge longevity practice, a hit podcast, and a #1 bestseller. We break down "Medicine 3.0" and where the evidence holds up, where it doesn't, and how a smart, credible doctor can end up giving cover to the MAHA crowd. Finally, we get into his emails with Jeffrey Epstein, the fallout at CBS and his sponsors, and what it all says about doctors, fame, and wealthy patients. Content note: discusses Jeffrey Epstein and sexual abuse. Sources: Attia, Peter. Outlive: The Science and Art of Longevity. March 28, 2023. Johansson, Minna, et al. "Continuous Glucose Monitoring for Persons With and Without Diabetes." JAMA, August 3, 2026. Khullar, Dhruv. "How to Die in Good Health." The New Yorker, April 15, 2024. Mann, Brian. "McKinsey & Company to Pay $650 Million for Role in Opioid Crisis." NPR, December 13, 2024. Martin, Kristen. "The Problem With Peter Attia: The Longevity Guru Turned Up in the Epstein Files. Should We Have Taken His Health Advice So Seriously in the First Place?" Slate, February 26, 2026. Ruetenik, Daniel, and Arden, Farhi. "Dr. Peter Attia, Longevity Expert, Apologizes for 'Indefensible' Emails to Jeffrey Epstein." CBS News, February 2, 2026. Tyrangiel, Josh. "The Epstein Spectrum." The Atlantic, April 3, 2026. Walker, Graham. "A Skeptic's Review of Peter Attia's Outlive." LinkedIn, January 13, 2024. https://www.linkedin.com/pulse/skeptics-review-peter-attias-outlive-graham-walker-md-z6rsc Blum, Dani "Peter Attia's Ties to Epstein Spark Backlash From Doctors." The New York Times, February 10, 2026 Kaufman, Maya and Gardner, Laura . "I Think She Will Be Loyal: Jeffrey Epstein's Role in Peter Attia's Rise." Politico, March 16, 2026. Pollack, Neal. "The Plight of Peter Attia." The Spectator, July 15, 2025. Greene, Jenna. Epstein files up in lawsuit, over stock options by longevity expert, Peter Attia. March 20, 2026 Podcasts: The Peter Attia Drive. Episode 168, August 2021. The Peter Attia Drive. Episode 172, August 2021. The Peter Attia Drive. Episode 190, January 10, 2022. The Peter Attia Drive. Episode 298, April 15, 2024. The Joe Rogan Experience. Episode 1735, 1961 Jocko Podcast. Episodes 55, 56, and 392. The Tim Ferriss Show. Episode 398, "Peter Attia, MD: Fasting, Metformin, Athletic Performance, and More," November 27, 2019. See omnystudio.com/listener for privacy information.

## Transcript

[0:05] Speaker 1: Welcome back to Behind the Bastards, a podcast about the
[0:08] Speaker 1: very worst people in all of history. And here to
[0:12] Speaker 1: talk about, well, here to do a special reverse bastards
[0:15] Speaker 1: episode where I don't have to research and write about
[0:19] Speaker 1: a terrible person. My guest does is Dr. Kaveh Hoda,
[0:22] Speaker 1: who has been very kindly teaching us about Dr.
[0:26] Speaker 2: Peter Attia. Yeah. Atiyah? I don't know, actually. It's a
[0:29] Speaker 2: good question. Atiyah.
[0:31] Speaker 3: Atiyah.
[0:31] Speaker 1: Sorry.
[0:31] Speaker 2: Peter Atiyah. Peter, I apologize.
[0:33] Speaker 4: I know that.
[0:33] Speaker 1: You said that correctly. I got it wrong, because my
[0:36] Speaker 1: brain does not hold pronunciations well.
[0:38] Speaker 2: I might be wrong. Listen, I don't know if I'm
[0:41] Speaker 2: saying my own name right, so I can't be certain
[0:45] Speaker 2: about anyone else. So sorry, Peter, if that's the case.
[0:49] Speaker 1: Who's to say?
[0:57] Speaker 2: Okay. You guys ready to get back into this?
[0:59] Speaker 4: Yeah, yeah, yeah.
[0:59] Speaker 1: Let's do it.
[1:00] Speaker 3: Okay.
[1:01] Speaker 2: When we left off, our hero, Peter Attia, had left
[1:05] Speaker 2: the oppressive groupthink of medical training.
[1:10] Speaker 1: Finally.
[1:10] Speaker 2: It was finally. It was only a matter of time.
[1:13] Speaker 2: He was pretty upset about not being appreciated for attempting
[1:17] Speaker 2: to operate outside the Johns Hopkins protocols. Being a maverick.
[1:23] Speaker 2: A renegade. Yeah. He doesn't play by the rules, but
[1:26] Speaker 2: he gets results. Yeah. You want a rebel doctor.
[1:29] Speaker 1: That's what you want. That's right. I love it when
[1:31] Speaker 1: my doctors are rebel.
[1:33] Speaker 2: That's really outside the box.
[1:35] Speaker 5: Yeah.
[1:35] Speaker 2: Getting weird with medicine. Yeah.
[1:37] Speaker 1: That's what you want. A lot of people say smearing
[1:38] Speaker 1: poop into an open wound is bad for you, but
[1:41] Speaker 1: they're just sheep. I like to get away from the herd.
[1:44] Speaker 1: I like to try new things.
[1:45] Speaker 2: Yeah. Get that in there real good. Can we stop this?
[1:49] Speaker 5: Yep.
[1:49] Speaker 1: Nothing's bolder than sepsis i i don't get.
[1:52] Speaker 3: I don't get paid enough for this shit can we that.
[1:55] Speaker 2: Yeah well i mean if you didn't stop me i
[1:57] Speaker 2: might have gotten stuck in that yeah it is it
[2:00] Speaker 2: is disturbing how easily my brain can just like in
[2:04] Speaker 2: like get into that role of the manosphere dude and
[2:08] Speaker 2: that is it's easy it's funny to work on the
[2:11] Speaker 2: joke about yeah Yeah.
[2:13] Speaker 1: But back to Petar.
[2:15] Speaker 2: So let's get back to him. So he decides to join,
[2:18] Speaker 2: leaving the residency, decides to join a consulting firm called
[2:21] Speaker 2: McKinsey and Company. Oh, good.
[2:24] Speaker 1: Oh, I'm glad they're showing up. That's fun.
[2:26] Speaker 2: Yeah. Yeah, I was going to ask. Real peak McKinsey years.
[2:29] Speaker 1: Yeah.
[2:30] Speaker 2: Yeah. Okay.
[2:31] Speaker 1: They're one of those like bloodless consultants. Sorry, you're going
[2:33] Speaker 1: to talk about them. Yeah, yeah, yeah. No, no, no.
[2:34] Speaker 2: Please, please, please.
[2:35] Speaker 1: They're one of those like consulting firms who you bring
[2:38] Speaker 1: in to tell like, here's how many people you should
[2:40] Speaker 1: fire to maximize shareholder value and the like, right?
[2:43] Speaker 2: That is correct. They are a global management consulting firm
[2:48] Speaker 2: that advises major corporations, governments, both here and abroad, and
[2:54] Speaker 2: institutions on strategy operations some.
[2:57] Speaker 1: People call them bloodless ghouls but right no i don't
[3:01] Speaker 1: because i i support actually the bloodless ghoul community you
[3:04] Speaker 1: are valid you are beautiful and i love you bloodless.
[3:08] Speaker 2: You are seen they are one of the most influential
[3:13] Speaker 2: oldest and maybe controversial consulting firms in the world let's
[3:17] Speaker 2: talk about them because he decided to go work for
[3:19] Speaker 2: them and i think that says something about a person
[3:21] Speaker 2: good sign So they're firm with the history of being
[3:25] Speaker 2: criticized for a lot of things, including involvement with the
[3:30] Speaker 2: opioid crisis. Have you heard of the opioid crisis?
[3:32] Speaker 3: I have.
[3:33] Speaker 1: Oh, man. Yeah. I've had a few myself.
[3:37] Speaker 2: Robert.
[3:38] Speaker 3: Robert.
[3:38] Speaker 4: It's a bit.
[3:39] Speaker 1: It's a bit.
[3:39] Speaker 2: It's a bit. Please say it's a bit.
[3:41] Speaker 1: It's a bit. I'm a medical doctor.
[3:43] Speaker 2: I'm a professional.
[3:44] Speaker 1: I only do opiates in Mexico. And now I don't
[3:48] Speaker 1: do opiates in Mexico anymore because of fucking fentanyl. Man,
[3:50] Speaker 1: it ruins so much. You used to be able to
[3:52] Speaker 1: just buy opiates off of a pharmacy in Guatemala or
[3:55] Speaker 1: something and know that they were just hydrocodone. You could
[3:58] Speaker 1: pick it up at the grocery store. It was beautiful. Anyway, whatever.
[4:03] Speaker 2: So McKinsey- and company, both of them, were hired by
[4:07] Speaker 2: Purdue Pharma to work on strategies to increase opioid sales
[4:11] Speaker 2: because they just weren't selling enough.
[4:14] Speaker 1: Yeah, 2006 is like peak getting Americans addicted to painkillers years.
[4:19] Speaker 2: That's exactly what we're talking about here.
[4:22] Speaker 1: Yeah.
[4:22] Speaker 2: Oh, cool. They provided them service for over 15 years,
[4:27] Speaker 2: specifically advising them on marketing and sales strategies to aggressively
[4:33] Speaker 2: increase the revenue of of OxyContin, the opioid painkiller.
[4:37] Speaker 1: You want to aggressively increase people using Oxy, yeah.
[4:41] Speaker 2: That's what they did. So they advised Purdue, really focusing
[4:46] Speaker 2: their sales representative visits on doctors who were already writing
[4:51] Speaker 2: high volumes of prescriptions. And according to the New York
[4:55] Speaker 2: Times in 2013, McKinsey designed a specific strategy to turbocharge
[5:02] Speaker 2: OxyContin sales And they advised the Sackler family, the people
[5:07] Speaker 2: who own Purdue, to push the higher dose pills. They
[5:10] Speaker 2: did a lot of really fun stuff. Because of this,
[5:14] Speaker 2: they faced a lot of legal challenges and some setbacks
[5:18] Speaker 2: for the company. They've had to cut back at least 10%
[5:20] Speaker 2: of their global workforce. They had to pay nearly $ 600
[5:25] Speaker 2: million American dollars to settle investigations.
[5:28] Speaker 5: Yeah.
[5:28] Speaker 1: A fucking pittance, honestly. But yeah.
[5:31] Speaker 2: Probably.
[5:31] Speaker 1: Yeah.
[5:32] Speaker 2: And by these investigations brought on by 49 different American states.
[5:36] Speaker 2: I'm not sure which state didn't, actually. I wish I
[5:39] Speaker 2: had looked that up because I'm betting it's Alaska, but
[5:41] Speaker 2: I don't know. And the DOJ announced a settlement resolving
[5:46] Speaker 2: civil and criminal probes with McKinsey accepting responsibility for a
[5:51] Speaker 2: misdemeanor charge of conspiring to aid and abet the misbranding
[5:58] Speaker 2: of prescription drugs. So they also had a senior partner,
[6:02] Speaker 2: Martin Elling, who faced felony obstruction of justice charges for
[6:06] Speaker 2: intentionally deleting Purdue. And they had to pay also 125
[6:10] Speaker 2: million into the Purdue Pharmacy bankruptcy estate to fund treatment programs.
[6:14] Speaker 2: But what I have here is I printed out, I
[6:17] Speaker 2: went to the Department of Justice, the Office of Public Affairs.
[6:22] Speaker 2: And I printed out there some interesting stuff that they posted.
[6:27] Speaker 2: about these court hearings. So they leveled a couple of
[6:32] Speaker 2: complaints against the Perdue family, and they leveled a number
[6:37] Speaker 2: against McKinsey.
[6:39] Speaker 1: The Sackler family, yeah.
[6:40] Speaker 2: Sackler family, sorry. And two of the ones they leveled,
[6:44] Speaker 2: two of the charges they leveled were criminal misbranding and
[6:48] Speaker 2: false claims to the FDA. So this is fun. So
[6:52] Speaker 2: the DOJ, this is a quote from the Office of
[6:55] Speaker 2: Public Affairs, the Department of Justice, Quote, the DOJ leveled
[6:59] Speaker 2: a criminal misbranding charge against McKinsey for falsely marketing it
[7:03] Speaker 2: as less addictive, less subject to abuse and diversion, and
[7:07] Speaker 2: less likely to cause dependence and withdrawal than other pain medications.
[7:11] Speaker 2: This was specifically their recommendations that McKinsey made to Purdue.
[7:17] Speaker 2: They were like, they worked on messaging. They're like, hey,
[7:19] Speaker 2: we have to counter these emotional public health warnings. including
[7:23] Speaker 2: these complaints that mothers had of teenagers that had overdosed.
[7:26] Speaker 2: And so they had this whole marketing campaign to fight that.
[7:32] Speaker 2: Among other strategies, intensifying marketing to high-value prescribers, including prescribers
[7:38] Speaker 2: who were writing opioid prescriptions for uses that were unsafe, ineffective,
[7:42] Speaker 2: and medically unnecessary. So what McKinsey did, basically let me
[7:45] Speaker 2: translate some of that, was like, hey. Yeah. These people
[7:49] Speaker 2: who are writing the worst prescriptions, the most questionable prescriptions,
[7:54] Speaker 2: let's really drill down on them and get them to
[7:57] Speaker 2: write even more. Hit them up. That should be number one.
[8:02] Speaker 2: Don't go to the person that you have to convince.
[8:05] Speaker 2: Go to the person that's just doing it and just
[8:08] Speaker 2: work on them the whole time.
[8:11] Speaker 1: Makes sense.
[8:13] Speaker 2: McKinsey consultants spoke with Purdue about the concerns and increasing
[8:17] Speaker 2: reluctance of pharmacists and pharmacy chains to fill prescriptions for
[8:21] Speaker 2: OxyContin as abuse of the drug rose. McKinsey consultants also
[8:26] Speaker 2: went on several ride-alongs with Purdue sales representatives in the
[8:30] Speaker 2: field as these sales representatives called on prescribers and pharmacists.
[8:36] Speaker 2: In notes about one of the ride-alongs, a McKinsey consultant wrote, quote,
[8:41] Speaker 2: pharmacist had a gun and was shaking abuse is definitely
[8:45] Speaker 2: a huge issue they just kept doing it they set
[8:51] Speaker 2: them on ride-alongs to convince them to work harder.
[8:54] Speaker 1: It's insane that's nuts.
[8:56] Speaker 2: And then on top of that they also got uh
[9:00] Speaker 2: leveled uh for claims against the fda and McKinsey U.S.
[9:05] Speaker 2: knowingly misled the FDA by assigning consultants to concurrently work
[9:09] Speaker 2: on both FDA projects and competitively sensitive Purdue projects. So
[9:15] Speaker 2: basically what they did was they said to the FDA, hey,
[9:17] Speaker 2: we're going to give you some of our consultants. They're
[9:19] Speaker 2: going to help you with managing this opioid crisis. And
[9:22] Speaker 2: it was the same consultants that were working on Purdue.
[9:25] Speaker 2: Who had helped make it worse.
[9:26] Speaker 1: Yeah. These guys really know the opioid crisis because they
[9:31] Speaker 1: helped cause it. But they're experts.
[9:33] Speaker 2: Yeah. Yeah.
[9:34] Speaker 1: It would be like bringing in a bunch of former
[9:36] Speaker 1: SS guys as experts on denazification.
[9:38] Speaker 5: It's like, look, they know who the Nazis were, obviously.
[9:40] Speaker 5: They know what they're talking about. They know what they're
[9:43] Speaker 5: talking about. There's also criticism of their work with Enron,
[9:48] Speaker 5: as well as their work with China and Saudi Arabia
[9:51] Speaker 5: and their efforts to enable authoritarian regimes.
[9:53] Speaker 2: In those places. I'll leave that for James and Mia
[9:59] Speaker 2: to discuss it. that's probably more their wheelhouse. But they've
[10:03] Speaker 2: done worse things also in other places as well. Now,
[10:08] Speaker 2: Atiyah's work did not seem to be related to anything medical.
[10:11] Speaker 2: So I have to say, even though he was there
[10:14] Speaker 2: during the opioid crisis, it doesn't seem like he was
[10:18] Speaker 2: a part of it. He was focused on corporate risk,
[10:22] Speaker 2: and he worked as a management consultant during this time.
[10:26] Speaker 2: He considers this his recalibration phase, where he's exposed to
[10:30] Speaker 2: systems-level thinking. I don't know who he was working with,
[10:34] Speaker 2: but clearly it signals he has an interest in working
[10:37] Speaker 2: with affluent, optimization-oriented populations. Right. His core audience is high-income,
[10:45] Speaker 2: like high-income health-maxing professionals. People with the ability to pay
[10:49] Speaker 2: top dollar for the health. And I'm sure this is
[10:51] Speaker 2: a big part of why he ended up there. So
[10:53] Speaker 2: he's there for two years. And it kind of correlates
[10:57] Speaker 2: when the first major actions are taken against Perdue. So
[11:01] Speaker 2: I don't know if that was a part of why
[11:02] Speaker 2: he left or not. But he leaves after a couple years.
[11:06] Speaker 2: I think that's common for people doing the consultant gigs.
[11:10] Speaker 1: Yeah, yeah, yeah.
[11:11] Speaker 2: Right? And for reasons I'm not clear about, he's drawn
[11:14] Speaker 2: back to medicine. He gets very busy. He starts doing presentations,
[11:20] Speaker 2: lots of media stuff, doing TED Talks. He talks about
[11:24] Speaker 2: metabolic dysfunction a lot. He co-founds a startup called the
[11:29] Speaker 2: Nutrition Science Initiative, or NUSAI.
[11:32] Speaker 1: Yeah.
[11:33] Speaker 2: Gives him a very public-facing scientific role, and one that
[11:36] Speaker 2: he does without needing board certification.
[11:40] Speaker 1: Oh, that's handy.
[11:41] Speaker 2: That's great, right? His blog helps establish him as a
[11:45] Speaker 2: bit of a contrarian and... but one that can actually
[11:49] Speaker 2: discuss data. Sophie knows my thoughts about medical contrarians. It's
[11:54] Speaker 2: not great. And this is where the Atea content machine
[11:58] Speaker 2: really starts. These long form technical pieces framed as this
[12:05] Speaker 2: is what your doctor won't tell you. Again, has that real,
[12:08] Speaker 2: the one secret your doctors won't tell you energy. And
[12:11] Speaker 2: the rise of these doctors, these contrarian doctors, is something
[12:15] Speaker 2: that is very much a sore spot for me. Yeah.
[12:18] Speaker 2: And not that medicine's perfect, it's not. I'm not going
[12:21] Speaker 2: to say that it is. But a lot of these folks,
[12:24] Speaker 2: him included, did a lot of what is called, or
[12:27] Speaker 2: I call, I don't know if this is a term,
[12:28] Speaker 2: I'm sure it is, science washing. Like taking some of
[12:32] Speaker 2: the more blatantly crazy quack people, making them seem more legitimate,
[12:38] Speaker 2: and making the more blatantly anti-vax doctors seem a little
[12:41] Speaker 2: bit more legitimate, really paves the way for for the
[12:45] Speaker 2: Maha movement and where we are currently, again, in our
[12:49] Speaker 2: golden age of diarrhea. Now, eventually, in 2014, he starts
[12:56] Speaker 2: his own private longevity clinic, Early Medicine. And this is
[13:01] Speaker 2: really the scaffolding on which his whole shtick is built.
[13:05] Speaker 1: On moving forward. Yeah, yeah, yeah, yeah.
[13:09] Speaker 2: It allows him to operationalize the Med 3.0 framework that
[13:13] Speaker 2: he loves talking about.
[13:15] Speaker 1: I feel like you can see a hint of this
[13:16] Speaker 1: in the fact that he got so into nutrition, because
[13:18] Speaker 1: obviously nutrition is massively important for health, but also when
[13:22] Speaker 1: you're in the business of nutrition, because of the way
[13:26] Speaker 1: supplements and stuff are regulated, it means that you can,
[13:30] Speaker 1: I'm not saying he was, but you can be in
[13:32] Speaker 1: the business of just selling people nonsense and claiming it's
[13:35] Speaker 1: basically medicine, as long as you avoid certain phrasing, right?
[13:39] Speaker 1: That's exactly right. Anytime I hear nutrition, my warning bells
[13:42] Speaker 1: start going off, like when it's in the context of
[13:46] Speaker 1: a medical professional.
[13:48] Speaker 2: Absolutely true. It's really the Wild West, because being a
[13:51] Speaker 2: nutritionist could mean you have like two to three PhDs
[13:55] Speaker 2: in the matter or can mean you're a wellness influencer online.
[14:00] Speaker 2: And there's really a wide breadth of the conversation between
[14:04] Speaker 2: the two. So yeah, absolutely true. So during this time,
[14:09] Speaker 2: as he's creating this clinic, things he's doing are things
[14:13] Speaker 2: like continuous glucose monitors for non-diabetic patients, which you may
[14:18] Speaker 2: have already gathered from the way I said it is
[14:20] Speaker 2: not appropriate. repeated advanced lipid testing, VO2 max labs, routine
[14:26] Speaker 2: MRI scans, DEXA scans, is giving people expensive wearables, using
[14:33] Speaker 2: off-label drugs, doing after-hours consults. His clienteles are elite. They
[14:39] Speaker 2: want high-touch care. They aren't taking new clients, by the way,
[14:42] Speaker 2: I checked. It's a years-long wait list to get in.
[14:46] Speaker 2: And although it's not disclosed exactly how much, From the
[14:50] Speaker 2: accounts I've seen, he charges anywhere from $ 100, 000 to $ 500, 000
[14:55] Speaker 2: annually for this care in this clinic.
[14:59] Speaker 1: Nice work if you can get it.
[15:00] Speaker 2: Jesus. I mean, if I could find three people to
[15:04] Speaker 2: do that. Yeah, yeah.
[15:06] Speaker 1: I'll give you nutrition advice for half a million dollars
[15:08] Speaker 1: a year. Anyone listening, you know, wire the money ahead
[15:11] Speaker 1: of time, and I'll give you all the advice you
[15:12] Speaker 1: fucking want.
[15:14] Speaker 2: Will you be on call, though? Will you be on
[15:16] Speaker 2: call all the time? Sure.
[15:18] Speaker 1: You can call me.
[15:20] Speaker 2: I may not answer.
[15:21] Speaker 1: Eat more fiber. I don't know, man. Fuck it.
[15:25] Speaker 2: Hey, you're hired. You're in. Well done, buddy.
[15:29] Speaker 1: Could be worse.
[15:30] Speaker 2: If I start a concierge clinic, I am going to
[15:32] Speaker 2: hire you in a minute. Anyways, I could see why
[15:35] Speaker 2: it's so appealing. I will say this, though, as an aside,
[15:39] Speaker 2: I can only imagine as a doctor how annoying it
[15:44] Speaker 2: would be to be a regular doctor of one of
[15:47] Speaker 2: these patients once they leave this concierge clinic, and you
[15:52] Speaker 2: have to see them. Like the stuff they would expect,
[15:55] Speaker 2: it would just be wild. And I would not be
[15:57] Speaker 2: giving them. But like, they'd be like, my last doctor,
[16:00] Speaker 2: he did this and this, and he ordered this and
[16:02] Speaker 2: this and this, and he did this for me. And
[16:03] Speaker 2: I'd be like, no, I'm sorry. That's just, none of
[16:06] Speaker 2: that's appropriate or reasonable to do. And it would be
[16:09] Speaker 2: so painful. And of course, none of this is accessible
[16:13] Speaker 2: to the average patient, or I'm sure you can guess,
[16:17] Speaker 2: covered by insurance.
[16:19] Speaker 1: Yeah.
[16:19] Speaker 2: People like Atiyah or tech weirdo, Brian Johnson, other longevity enthusiasts.
[16:26] Speaker 2: They're famous. That guy, that's the guy with the sons
[16:29] Speaker 2: is blood boy for you listeners out there. Yeah.
[16:31] Speaker 1: Yeah.
[16:31] Speaker 4: Yeah.
[16:32] Speaker 1: And tracks his erections. Don't forget about that. Really loves
[16:36] Speaker 1: bragging about his four hour erections at night when he's sleeping.
[16:40] Speaker 2: Yeah.
[16:40] Speaker 3: Yeah.
[16:40] Speaker 2: Yeah.
[16:40] Speaker 1: Cool, man.
[16:41] Speaker 2: Great episode on him. And it was troubling. Um, lots
[16:44] Speaker 2: of weird tweets about his, um, girlfriend's vagina um yeah
[16:50] Speaker 2: and his and his son's erection just real weird real
[16:53] Speaker 2: weird stuff.
[16:54] Speaker 3: Really uh tmi my guy.
[16:57] Speaker 2: Yeah yeah and i'm not a person who says that
[17:00] Speaker 2: like i don't think i've ever said tmi before but
[17:02] Speaker 2: i think if i were to use it it would
[17:04] Speaker 2: be in this case tmi so uh these people the
[17:08] Speaker 2: reason i bring them up both him and natia would
[17:10] Speaker 2: would have you believe that this is all proof of
[17:13] Speaker 2: concept stuff And that, yeah, only rich people have it
[17:17] Speaker 2: for now, but eventually everyone's going to have it. But,
[17:21] Speaker 2: I mean, that's just not true. It's not scalable. These
[17:25] Speaker 2: longevity wellness people are essentially creating a two-tiered medical system
[17:30] Speaker 2: with a different level for the wealthy. I mean, you
[17:33] Speaker 2: could argue we already kind of have one, but that
[17:35] Speaker 2: gap will only grow. Right. Of course, like all bad people,
[17:41] Speaker 2: he starts a podcast. It's called The Drive in 2018.
[17:46] Speaker 2: They cover a range of topics built around his practice
[17:51] Speaker 2: and early medicine framework. He's really starting to build this
[17:55] Speaker 2: parasocial relationship with a high-value audience during this time. He's
[18:00] Speaker 2: making appearances on Oprah at least three times on the
[18:03] Speaker 2: Joe Rogan Experience. He's hanging out with Bill Ackman, Hugh Jackman. Oh, boy. Yeah.
[18:10] Speaker 1: A lot of Ackmans in there.
[18:11] Speaker 2: A lot of Ackman and Jackmans.
[18:13] Speaker 1: Yeah.
[18:14] Speaker 2: And Gwyneth Paltrow and other New York elites. Sure. His book, Outlive,
[18:18] Speaker 2: comes out in 2023 and shortly afterwards becomes a number
[18:22] Speaker 2: one bestseller.
[18:24] Speaker 1: Yeah, they love titles like that. I can see why
[18:26] Speaker 1: that one sold.
[18:27] Speaker 2: Really a good one, right?
[18:28] Speaker 1: Yeah, yeah.
[18:29] Speaker 2: Over 3 million copies and spent 131 weeks on the
[18:34] Speaker 2: New York Times non-fiction bestseller list. It's crazy.
[18:39] Speaker 1: That's bleak.
[18:40] Speaker 2: It's not great. He becomes a major figure in the
[18:44] Speaker 2: health and wellness scene. Millions of people tuning in to
[18:47] Speaker 2: what he has to say or write. And I am
[18:50] Speaker 2: a little, I don't want to get too far into
[18:52] Speaker 2: the medical minutia here, but I think it's kind of
[18:55] Speaker 2: important to do. And your audience is very smart. And
[18:58] Speaker 2: I'm not just saying that because I'm pandering, although I'm
[19:01] Speaker 2: clearly pandering. They are very intelligent. I think they can
[19:03] Speaker 2: hang with this. So I'm going to dig in a
[19:06] Speaker 2: little bit to the medical advice he's endorsing and why
[19:10] Speaker 2: it matters. Okay. He's moving past the lifespan stuff. He's
[19:14] Speaker 2: now about healthspan, the good years. Again, we are mind
[19:17] Speaker 2: and body sharp. I'm into that. I like that. And
[19:20] Speaker 2: this medicine 3.0, which his clients are paying top dollar for,
[19:25] Speaker 2: and he would describe as preventive, personalized, and data-driven approaches
[19:29] Speaker 2: to healthcare that focuses on avoiding disease rather than treating it,
[19:34] Speaker 2: treating disease. And what's, you know, by the way, um,
[19:41] Speaker 2: I get called a shill a lot for being part
[19:44] Speaker 2: of big pharma. And it's a lot of the same
[19:46] Speaker 2: people who are like, you only want these diseases. to
[19:50] Speaker 2: happen so you can be paid by pharma to treat them.
[19:53] Speaker 2: And I'm like, what do you think he's doing in
[19:56] Speaker 2: these situations? You think that these medicines he's giving you
[19:59] Speaker 2: are free? Anyway, sorry. A key part of his justification
[20:05] Speaker 2: for aggressive preventative treatments and aggressive pharmacology is this assertion
[20:11] Speaker 2: that he has that 90% of the U.S. population has
[20:15] Speaker 2: at least one of five markers of metabolic syndrome. Have
[20:19] Speaker 2: you guys heard of metabolic syndrome?
[20:21] Speaker 3: Yeah.
[20:22] Speaker 2: Is that real? It's real.
[20:25] Speaker 4: Okay, that's good.
[20:25] Speaker 2: It's real, but it is vague, so you are right
[20:27] Speaker 2: to be like, yeah, is it real?
[20:29] Speaker 1: I hear a lot of things called signs of metabolic
[20:32] Speaker 1: syndrome that just sound... Okay, so Cheryl, listen to you.
[20:34] Speaker 3: It's like, you know, a number of things that make
[20:38] Speaker 3: you at risk for other things. Am I in the
[20:41] Speaker 3: right space?
[20:41] Speaker 1: It just crops up a lot in grifty kind of
[20:43] Speaker 1: medical spaces.
[20:43] Speaker 3: Like, all these things means you might have a stroke,
[20:46] Speaker 3: or all these things means you might get type 2 diabetes,
[20:50] Speaker 3: or all these... Am I in the right... Is that correct,
[20:53] Speaker 3: my friend? You guys.
[20:54] Speaker 2: You guys are so smart. I'm not just saying that. Honestly.
[20:56] Speaker 1: I mean, I had a lot less specifics than she did,
[20:58] Speaker 1: but sure.
[20:59] Speaker 2: Yeah, that was good. But I meant you guys. I
[21:01] Speaker 2: meant her. This is really smart. I just don't want
[21:04] Speaker 2: you to feel bad. That is correct. Metabolic syndrome is
[21:08] Speaker 2: a real thing, although you're right to be kind of
[21:11] Speaker 2: questioning it because it's used by people both professionally who
[21:15] Speaker 2: know what they're talking about and by grifters to sell
[21:19] Speaker 2: you an enema made out of coffee. So you're right
[21:24] Speaker 2: to be concerned about it. Now, what it is, let's
[21:25] Speaker 2: go through it here, okay? Metabolic syndrome is important, and
[21:29] Speaker 2: we should touch base on what these five markers of
[21:31] Speaker 2: metabolic syndrome are. One, central or abdominal obesity, basically a
[21:37] Speaker 2: waist circumference greater than or equal to 102 centimeters in men,
[21:41] Speaker 2: 88 centimeters in women, just a big gut. You get
[21:44] Speaker 2: adipose tissue in your gut. It changes the way your
[21:47] Speaker 2: body acts with insulin. Another marker, elevated triglycerides, greater than
[21:53] Speaker 2: or equal to 150. Low HDL, which is quote-unquote good cholesterol. Right.
[21:58] Speaker 2: Lower than 40 for men, lower than 50 for women.
[22:01] Speaker 2: Hypertension or high blood pressure with a systolic of 130
[22:05] Speaker 2: or greater. And a diastolic, that's the bottom number. Systolic
[22:09] Speaker 2: is the top number. You see it's like 130 over 85.
[22:12] Speaker 2: That's top number systolic, bottom number is diastolic. Probably more
[22:15] Speaker 2: information than you need, sorry.
[22:16] Speaker 1: Right.
[22:17] Speaker 2: And the last of these markers is elevated fasting glucose,
[22:21] Speaker 2: if it's over 100. Now, Sophie is 100% right. If
[22:26] Speaker 2: you have metabolic syndrome, it puts you at risk for diabetes,
[22:31] Speaker 2: coronary artery disease, heart problems, and stroke. And his assertion
[22:37] Speaker 2: that 90% of people have at least one of these
[22:39] Speaker 2: markers is actually not far off. The CDC runs this
[22:42] Speaker 2: research program called the National Health and Nutrition Examination Survey,
[22:46] Speaker 2: or NHANES. And there was an NHANES study from 2009
[22:49] Speaker 2: to 2016, and it showed that about 12 only, I
[22:54] Speaker 2: should say, only 12% of US adults were considered, quote unquote,
[22:59] Speaker 2: metabolically healthy, or basically optimal on all five of those
[23:04] Speaker 2: markers I mentioned without medication. That implies that roughly 88%
[23:09] Speaker 2: of Americans have at least one abnormal test. I'm assuming
[23:12] Speaker 2: that's where he gets this 90% number that he talks about.
[23:15] Speaker 2: And that part is, I think, true.
[23:18] Speaker 4: Hey, everyone, this is Kaveh, you know, from the future
[23:21] Speaker 4: after this recording. And I just wanted to jump in
[23:23] Speaker 4: here real quick to say that what I said was
[23:27] Speaker 4: totally correct. No, nothing factually wrong. I just hear Robert
[23:32] Speaker 4: doing this every now and then. And, you know, it
[23:34] Speaker 4: sounded fun to me. So I wanted to give it
[23:36] Speaker 4: a try. But yeah, everything I said was right. So anyways,
[23:40] Speaker 4: back to the podcast.
[23:45] Speaker 2: But the thing is, That's not how you define metabolic syndrome.
[23:49] Speaker 2: To have metabolic syndrome, you have to have three or
[23:52] Speaker 2: more of those markers. Having just one isolated marker is
[23:56] Speaker 2: probably very, very common, but it's also clinically far less meaningful.
[24:02] Speaker 2: For metabolic syndrome, you have to have at least three
[24:04] Speaker 2: of those, and it kind of just drops it to
[24:06] Speaker 2: one to start treatment. Okay. Does that make sense? Let
[24:10] Speaker 2: me stop right there. Does that make sense?
[24:12] Speaker 1: Yeah.
[24:14] Speaker 3: Sure.
[24:14] Speaker 2: Yeah.
[24:14] Speaker 1: Yeah.
[24:15] Speaker 2: These things are important to note. And I want people
[24:18] Speaker 2: to be thinking about all these things. But this concept
[24:21] Speaker 2: of saying, like, he's changing the goalpost here about definitions
[24:26] Speaker 2: that would justify treating people aggressively. And we'll talk about
[24:29] Speaker 2: why you don't want to treat everyone aggressively. But I
[24:33] Speaker 2: don't believe this justifies it. It's certainly not justifying in
[24:37] Speaker 2: a uniform approach like he applies to his patients. We
[24:41] Speaker 2: always say lifestyle modification should be the first thing you discuss.
[24:44] Speaker 2: rather than reflexively treating people with medication. I'm the one
[24:47] Speaker 2: that gets accused of being a shill for pharma, and
[24:50] Speaker 2: I'm the one that's usually saying, hey, let's hold off
[24:52] Speaker 2: on this medicine that's unproven. I don't get it.
[24:55] Speaker 3: You do say that to me often.
[24:59] Speaker 2: Yeah, I get it a lot. I'm like, what do
[25:00] Speaker 2: you think of this thing?
[25:01] Speaker 3: And you're like, no, no.
[25:05] Speaker 2: Yeah. And writing medicine is like my bag. I'm an
[25:07] Speaker 2: internal medicine doctor at heart. That's what we do. Anyways.
[25:12] Speaker 2: You should think of interventions, I feel, as a staircase
[25:16] Speaker 2: and not a switch. And the first step should always
[25:18] Speaker 2: be lifestyle modifications, if you can help it. Now, metabolic
[25:21] Speaker 2: syndrome is a risk indicator, not an absolute risk. It
[25:24] Speaker 2: doesn't account for everything, age, sex, smoking, LDL, other factors.
[25:31] Speaker 2: Aggressive lab testing that he does is a big part
[25:34] Speaker 2: of his practice and recommendations. But in these cases, it's
[25:38] Speaker 2: highly questionable about what kind of use that serves. He
[25:42] Speaker 2: focuses on these aggressive tests for blood markers that could
[25:46] Speaker 2: potentially represent heart disease. His core panel includes something called APOB,
[25:51] Speaker 2: LP little a, CRP. And then he also recommends imaging
[25:55] Speaker 2: the coronary artery calcium or the CAC scoring.
[25:59] Speaker 1: Okay.
[25:59] Speaker 2: As well as a coronary CT. I don't think other
[26:01] Speaker 2: people refer to it as CAC, but I think it's
[26:04] Speaker 2: funnier to refer to coronary artery calcium as CAC scoring.
[26:08] Speaker 1: CAC scoring.
[26:09] Speaker 2: I'm not opposed to... early focused cardiac intervention. Of all
[26:13] Speaker 2: the stuff he does, I'm the most open to hearing
[26:15] Speaker 2: about this. But a lot of what he is recommending,
[26:18] Speaker 2: a lot of this testing outruns the evidence that we
[26:21] Speaker 2: have to support its use. Some of it hasn't even
[26:25] Speaker 2: been shown to be something we could change. So for example,
[26:28] Speaker 2: these CAC scoring tests that he does, they're expensive. They
[26:31] Speaker 2: expose you to radiation and downstream test events. And there's
[26:35] Speaker 2: no trial so far that shows that doing that actually
[26:39] Speaker 2: helps you in any way or decreases cardiac events. And
[26:43] Speaker 2: whenever you do a test, you should always ask, will
[26:46] Speaker 2: the results of this test change our management? That should
[26:50] Speaker 2: always be a question you ask. And if there's nothing
[26:52] Speaker 2: different you can do, if there's nothing different it will
[26:55] Speaker 2: give you, then you have to have serious conversations. It
[26:57] Speaker 2: doesn't mean you can't do it, but it means you
[27:00] Speaker 2: can't be applying that to everybody. He also is a
[27:05] Speaker 2: proponent for early screening tests for things like colonoscopy. Which
[27:10] Speaker 2: he sees as being proactive, but I see, as a
[27:12] Speaker 2: gastroenterologist who does them, as being a bit reckless. This
[27:16] Speaker 2: is my wheelhouse, of course. And we could talk at
[27:20] Speaker 2: length about when to start colonoscopy. But for someone without
[27:24] Speaker 2: risk factors, it's 45. That's our recommended time for screening
[27:29] Speaker 2: for colon cancer. And that's lower than 50 where it
[27:31] Speaker 2: used to be. He pushes for 40.
[27:35] Speaker 1: I mean, there's a lot more younger colon cancer cases, right?
[27:38] Speaker 1: So I don't know.
[27:39] Speaker 2: Is that wrong? I could talk to you about that.
[27:42] Speaker 2: This is a fascinating topic to me. In fact, I
[27:43] Speaker 2: just released an episode about early-onset colorectal cancer, and you
[27:47] Speaker 2: are correct. There are increasing rates. Overall, the absolute risk
[27:50] Speaker 2: is still low, but there is increasing rates of why
[27:53] Speaker 2: that is. But that's why we drop it to 45. Now,
[27:57] Speaker 2: people online constantly get mad when I talk about this.
[28:02] Speaker 2: Because they'll be like, hey, I want a colonoscopy and
[28:04] Speaker 2: you doctors are not giving it to me. And I'll
[28:05] Speaker 2: be like, how old are you? And they'll be like, 30.
[28:07] Speaker 2: And I'll be like, do you have any risk factors
[28:10] Speaker 2: like family with colon cancer or family with advanced polyps
[28:14] Speaker 2: or history of inflammatory bowel disease? Or do you have any?
[28:19] Speaker 2: signs or symptoms that are concerning? And the answer is no,
[28:21] Speaker 2: they just want it. I'm like, that's not what we
[28:23] Speaker 2: want you to do. I don't want you getting colonoscopies.
[28:26] Speaker 2: I'm a guy who does colonoscopy. I get paid to
[28:28] Speaker 2: do colonoscopies, but I don't want you to get it
[28:31] Speaker 2: unless you need it.
[28:31] Speaker 1: Yeah, it's not like free for everyone, not just out
[28:35] Speaker 1: of money standpoint, but like doctors don't have unlimited time. Yeah,
[28:38] Speaker 1: I get that.
[28:39] Speaker 2: Yes, that's a big part of it. And there's more.
[28:41] Speaker 2: We'll discuss that a little more. We'll come back to it.
[28:43] Speaker 2: But what I think he is tapping into here is
[28:47] Speaker 2: is a very real dissatisfaction, disillusionment with mainstream medicine. And
[28:54] Speaker 2: I feel that. People feel like doctors, for one reason
[28:57] Speaker 2: or another, are always gatekeeping healthcare. And to be clear,
[29:02] Speaker 2: I am 100% for preventative care. This idea is not new.
[29:06] Speaker 2: We've had primary cares for this exact reason. Why he
[29:10] Speaker 2: went into surgery, I don't know. He would have been
[29:11] Speaker 2: better off had he gone to endocrinology, but, you know,
[29:14] Speaker 2: not a lot of money there. So maybe that's, I
[29:16] Speaker 2: don't want to assume that's why he did it. But
[29:19] Speaker 2: there are other things you can do to get preventative care.
[29:24] Speaker 2: And I'm, as I said, I'm a simple country doctor.
[29:28] Speaker 2: Four years of medical school, three years of internal medicine training,
[29:32] Speaker 2: a year of chief residency, three years of gastroenterology, and
[29:35] Speaker 2: a year of liver transplant fellowship under my belt. simple
[29:39] Speaker 2: country doc stuff. And I feel so much less confident
[29:43] Speaker 2: taking the giant swings he does on all these medical issues.
[29:48] Speaker 2: He has no formal training in cardiovascular disease, neurodegenerative disease, endocrinology,
[29:53] Speaker 2: or even nutritional science, yet these are the pillars of
[29:56] Speaker 2: his practice. Again, Very smart, incredible potential as a doctor.
[30:01] Speaker 2: But what he's describing as research into these fields seems
[30:04] Speaker 2: more like maybe read a couple studies and having relationships
[30:07] Speaker 2: with people that are his friends that do know more
[30:10] Speaker 2: about than him. There's something you have to consider when
[30:13] Speaker 2: you're doing all these tests, all these advanced genetic testing,
[30:16] Speaker 2: CT angiograms, these colonoscopies. There's real harms, real risks associated
[30:22] Speaker 2: with them. And we have to weigh the benefits of them.
[30:26] Speaker 2: I'm assuming you probably want to take a commercial break
[30:29] Speaker 2: before we do that.
[30:30] Speaker 1: Yeah, why not?
[30:31] Speaker 2: Yeah.
[30:32] Speaker 1: Speaking of that, ads?
[30:35] Speaker 2: Why not?
[30:35] Speaker 1: Ads. And we're back.
[30:45] Speaker 2: Yes, we are back. Now, there was a JAMA study
[30:49] Speaker 2: I want to talk about because I think this is
[30:50] Speaker 2: really funny. And funny may not be the right word.
[30:54] Speaker 2: It came out of UC Davis in 2012. It's an
[30:56] Speaker 2: old study. And what it did was this. It showed
[30:59] Speaker 2: how happy a patient was with the care they received
[31:03] Speaker 2: and how that related to their outcomes. That study showed
[31:07] Speaker 2: that the most satisfied patients had not only higher healthcare spending,
[31:12] Speaker 2: but more hospital admissions, and most strikingly, a 26% higher
[31:18] Speaker 2: risk of death compared to the least satisfied patients cool
[31:24] Speaker 2: the satisfied patients were doing worse yeah what what thoughts
[31:29] Speaker 2: do you have about why why may that be we
[31:31] Speaker 2: don't know for sure by the way the test this
[31:33] Speaker 2: study was empowered.
[31:35] Speaker 1: I guess because people like are are satisfied because they
[31:40] Speaker 1: like their doctor and they feel listened to but that
[31:43] Speaker 1: doesn't necessarily correlate to actually improving their health care outcomes
[31:46] Speaker 1: at all it's just like how people can be really
[31:49] Speaker 1: satisfied with a doctor who's selling them like snake oil
[31:52] Speaker 1: that doesn't actually cure their cancer until they fucking die.
[31:55] Speaker 1: They don't notice something's wrong. I don't know. That would
[31:58] Speaker 1: be my guess.
[31:58] Speaker 2: No, that's right. So the more satisfied patients are probably
[32:02] Speaker 2: getting more than they asked for. More tests, more side effects,
[32:06] Speaker 2: more complications. Doctors who always say yes score very well.
[32:13] Speaker 2: And sometimes saying no in medicine is really hard. But sometimes,
[32:18] Speaker 2: and not always, declining a test or medicine or antibiotic
[32:22] Speaker 2: or refusing to do a low-value scan or imaging study
[32:25] Speaker 2: may actually serve patients better. Now, this is a big, nuanced,
[32:30] Speaker 2: and difficult conversation because you have to weigh those considerations
[32:33] Speaker 2: with listening to your patients and advocating for them. And
[32:36] Speaker 2: it is not an excuse to not listen to your
[32:38] Speaker 2: patients and take their complaints seriously. I'm fully aware that
[32:42] Speaker 2: our country has a very serious problem taking patients seriously,
[32:45] Speaker 2: particularly if they are Black and or female. This is
[32:48] Speaker 2: a real problem that we have in this country. But
[32:53] Speaker 2: it's always important to keep in mind that sometimes do
[32:56] Speaker 2: no harm is the right step. Not doing the thing
[33:00] Speaker 2: is the better approach. To be totally transparent also, there
[33:04] Speaker 2: have been follow-up studies to that 2012 studies. Some have supported,
[33:08] Speaker 2: some have detracted. I feel the weight of time has
[33:12] Speaker 2: sort of borne this out, though, and it does seem
[33:14] Speaker 2: to be true. There was a 2019 Cochrane meta-analysis that
[33:19] Speaker 2: showed real dangers to over-diagnosis and treatment. It can lead
[33:23] Speaker 2: to unnecessary interventions. One test leads to another test leads
[33:27] Speaker 2: to another test, and these things have risks. Sometimes they're necessary,
[33:30] Speaker 2: sometimes they are not. And these things carry not only
[33:33] Speaker 2: real harm, but also psychological burden as well.
[33:36] Speaker 3: So.
[33:37] Speaker 2: I think largely his reason for doing this is not
[33:40] Speaker 2: bad or malicious. I think he does want to help
[33:43] Speaker 2: before a problem exists. And like I said, a lot
[33:46] Speaker 2: of his advice is reasonable stuff. And I actually kind
[33:49] Speaker 2: of like some of it. Eat less processed food, exercise,
[33:52] Speaker 2: sleep well.
[33:52] Speaker 1: Great.
[33:54] Speaker 2: But it's also paired with this really over-the-top monitoring with
[33:58] Speaker 2: intense and very pricey strategies that lack evidence. And some
[34:03] Speaker 2: of the relationships he has to these things are not
[34:05] Speaker 2: ideal at For example, he, as I mentioned, promotes continuous
[34:10] Speaker 2: glucose monitoring for people without diabetes or signs of insulin resistance.
[34:15] Speaker 1: Yeah.
[34:16] Speaker 2: Not necessary. Yes. In your medical professional experience, you would
[34:21] Speaker 2: also agree with me, and you are correct. But it's
[34:24] Speaker 2: become a big hit with the MAHA crowd, these tests.
[34:29] Speaker 2: And there's no evidence that's of any use to non-diabetic patients.
[34:32] Speaker 2: And it can lead to unnecessary dietary restrictions, anxiety, even
[34:36] Speaker 2: disordered eating. And the information, the data you get from
[34:42] Speaker 2: these continuous glucose monitorings, it's often difficult to interpret. And
[34:46] Speaker 2: getting one with an ongoing data plan is hundreds of
[34:49] Speaker 2: dollars per month.
[34:51] Speaker 3: It's expensive.
[34:52] Speaker 2: A lot of.
[34:53] Speaker 3: People that have diabetes that need these sorts of devices-
[34:58] Speaker 3: are either unable to get it or the prices are
[35:03] Speaker 3: increasing because of things like this. And I know a
[35:07] Speaker 3: specific device that you're going.
[35:08] Speaker 2: To talk about.
[35:09] Speaker 3: And I know that it is extremely difficult to at
[35:16] Speaker 3: times get that device. And I can't imagine this helps.
[35:20] Speaker 2: No, you're exactly right. That's what happens. You, the resources
[35:24] Speaker 2: are limited. Our problem in this country is not so
[35:27] Speaker 2: much that we don't have the things to help patients.
[35:30] Speaker 2: It's that we don't have access for them to get
[35:32] Speaker 2: to it.
[35:33] Speaker 1: Yeah.
[35:34] Speaker 2: And also grounding out what Sophie was alluding to there.
[35:38] Speaker 2: He was a paid advertiser for a company called Dexcom
[35:42] Speaker 2: that sells these devices. That's not ideal. It's not ideal. Um,
[35:47] Speaker 2: He has been criticized for not disclosing that very well.
[35:51] Speaker 2: I have seen him mention it, but I don't think
[35:53] Speaker 2: he did it every time. So I think it's a
[35:55] Speaker 2: valid criticism.
[35:57] Speaker 4: Sure.
[35:57] Speaker 2: By the way, that company has since said his advisory
[36:00] Speaker 2: role ended in 2021. But when this topic comes up
[36:05] Speaker 2: of concerns, hey, aren't we just creating a new tier
[36:10] Speaker 2: of medical care for just those with extreme wealth? And
[36:13] Speaker 2: that it's preventative medicine for people who are already privileged
[36:17] Speaker 2: and probably doing better. He'll downplay the cost of these
[36:21] Speaker 2: things he's ordering by correctly pointing out that the end-of-life
[36:25] Speaker 2: care is also very expensive. And that is true. A
[36:29] Speaker 2: disproportionate amount of healthcare in this country spending is at
[36:33] Speaker 2: the end of a patient's life. The cost of all
[36:36] Speaker 2: the machines and the labor and medicine in those critically
[36:39] Speaker 2: ill hospitalized patients, that adds up quickly. But both things
[36:43] Speaker 2: can be true. And nobody's saying we shouldn't practice preventative care.
[36:47] Speaker 2: But the thing is this, even if his measures do work,
[36:50] Speaker 2: which is a big if, it's still just pushing the
[36:52] Speaker 2: end-of-life care and all the money that goes into it
[36:55] Speaker 2: further down the road. So you're not saving money this way.
[37:00] Speaker 2: You're spending money on both ends. A lot of it,
[37:03] Speaker 2: a lot of health care dollars are going to go
[37:05] Speaker 2: into this on both ends. And for that reason, actually,
[37:09] Speaker 2: real quick before we move on from end-of-life care– It's
[37:13] Speaker 2: an important reason that doctors recommend having those goals of
[37:17] Speaker 2: care discussion and what you would want done if you
[37:20] Speaker 2: were to become critically ill and not be able to
[37:23] Speaker 2: weigh in. Unfortunately, when this is reasonably discussed, Republicans refer
[37:27] Speaker 2: to it as death panels, and we never get to
[37:30] Speaker 2: have this.
[37:30] Speaker 3: Right.
[37:30] Speaker 1: I remember the death panel days.
[37:32] Speaker 3: Yeah.
[37:33] Speaker 1: And then we had real death panels under a Republican. Anyway, whatever.
[37:37] Speaker 2: We've had real death panels. But having end-of-life care discussions is,
[37:41] Speaker 2: is not only important for saving money, it's also just
[37:45] Speaker 2: really important for knowing really what your loved ones want.
[37:50] Speaker 2: So I think it's... Anyways, have that discussion, folks, even
[37:54] Speaker 2: if you are healthy. You should at least be having
[37:56] Speaker 2: those discussions along the way. Now, all this, I think,
[37:58] Speaker 2: are things that you kind of learn in the actual
[38:01] Speaker 2: practice of medicine, something he missed, this do no harm.
[38:05] Speaker 3: Yeah.
[38:06] Speaker 2: The colonoscopy part, I think, is... A great example of this.
[38:11] Speaker 2: So our current guidelines have dropped to 45. He wants
[38:13] Speaker 2: it to go down even further to 40. And again,
[38:17] Speaker 2: despite how strange it might seem to some people, there
[38:18] Speaker 2: are people who want these tests done as early as possible.
[38:22] Speaker 2: But as Robert said, one part of it is we
[38:26] Speaker 2: just don't have the people to do it. I mean,
[38:29] Speaker 2: I could... do colonoscopies every day, all day for the
[38:32] Speaker 2: end of time, and I will not have scratched the
[38:34] Speaker 2: surface of the colonoscopies that need to get done. So
[38:38] Speaker 2: we're taking it away from people who need it. But
[38:41] Speaker 2: on top of that, there's risk to doing these tests.
[38:44] Speaker 2: There's actual physical risks. Bad things can happen. It's rare, thankfully.
[38:49] Speaker 2: You should get colon cancer screening. But colonoscopy does have
[38:53] Speaker 2: some risk, and it's not cheap. And again, I'm telling
[38:55] Speaker 2: you this as someone who stands to make a lot
[38:58] Speaker 2: of money off of you getting colonoscopies.
[39:01] Speaker 1: Yeah.
[39:02] Speaker 2: So take my word for this one. You're like, it's
[39:05] Speaker 2: something we have to be more mindful about.
[39:07] Speaker 1: Yeah, for sure.
[39:10] Speaker 2: He talks about some other stuff with his patients that's
[39:13] Speaker 2: overall less fun for me. He emphasizes zone two training
[39:16] Speaker 2: as optimal for mitochondrial capacity and longevity. This does contradict
[39:21] Speaker 2: some substantial evidence behind higher intensity training. Again, kind of
[39:26] Speaker 2: what he's doing here is he's cherry-picking studies that look
[39:29] Speaker 2: at observational data in elite endurance athletes. I'm not sure
[39:33] Speaker 2: how that translates. But that cherry-picking study stuff is something
[39:37] Speaker 2: that RFK Jr. does as well. And what they all
[39:40] Speaker 2: do in this sort of world.
[39:41] Speaker 1: It's a vote these days, yeah.
[39:43] Speaker 2: It's the modus operandi of our current administration. So RFK Jr.
[39:48] Speaker 2: One thing that they will all do is they will
[39:51] Speaker 2: take a little bit of data and then extrapolate it
[39:54] Speaker 2: far beyond what that data was meant to do. Something
[39:58] Speaker 2: he does this with is one of his quote-unquote horsemen.
[40:01] Speaker 2: He talks about the four horsemen of the apocalypse, and
[40:04] Speaker 2: one of them is cancer. Sorry.
[40:08] Speaker 3: That was like an audible groan.
[40:14] Speaker 4: Okay.
[40:15] Speaker 2: Sorry, I'm back. I felt that way. Again, I actually
[40:18] Speaker 2: liked parts of his book. Parts of it were, I thought,
[40:21] Speaker 2: very reasonable. But, for example, when he talks about cancer,
[40:27] Speaker 2: he points out that cancer cells require more glucose than
[40:30] Speaker 2: normal human cells. And that is true. And you'll hear
[40:35] Speaker 2: a lot of wellness people take that little bit of information.
[40:37] Speaker 1: Yeah, starve your cancer by avoiding sugar or whatever. I've
[40:41] Speaker 1: seen that a lot.
[40:43] Speaker 2: Right. They take a little bit of truth and they
[40:45] Speaker 2: make giant leaps from there regarding the nature of cancer's
[40:48] Speaker 2: formation and sugar's role in it. And it's honestly, it's
[40:52] Speaker 2: still not clear what that means, you know. Is it
[40:54] Speaker 2: the cause of the cancer, the sugar, or is it
[40:57] Speaker 2: just some interesting feature of the cancer?
[40:59] Speaker 5: Yeah.
[41:00] Speaker 2: To make jumps from a simple lab-tested fact to saying
[41:04] Speaker 2: dietary manipulations could help the growth of cancer is shaky
[41:07] Speaker 2: at best. And diet is important. I'm a huge proponent
[41:12] Speaker 2: of a healthy diet that is high in fiber. Again, fiber, folks.
[41:15] Speaker 2: I'm deep in the pocket of big fiber. But while
[41:19] Speaker 2: there is solid evidence that healthy dietary patterns can lower
[41:22] Speaker 2: your risk for things, right now... There isn't the risk
[41:26] Speaker 2: of these things he's recommending, like ketogenic diets, prolonged fasts,
[41:30] Speaker 2: caloric restrictions. There's no evidence that those things work. When
[41:34] Speaker 2: we want people to learn, when I want people to
[41:38] Speaker 2: learn about what they're eating and how it affects them,
[41:40] Speaker 2: I want it to be broad and sustainable patterns. Mostly plants,
[41:45] Speaker 2: limited red meat, limited processed meats. And I don't disagree
[41:49] Speaker 2: with limiting sugar either. I agree. For the purpose of
[41:52] Speaker 2: maximizing your cardio metabolic risks, That's well proven. I don't
[41:56] Speaker 2: find it to be a good argument in the case
[41:58] Speaker 2: of cancer. The data just isn't there yet. Or if
[42:00] Speaker 2: you're cool, you call it data. Let's talk a little
[42:04] Speaker 2: bit more about the medications. Because, again, I'm the one
[42:07] Speaker 2: that gets accused of being a pharma shill. But if
[42:10] Speaker 2: a right-wing doctor tells you to buy a year's supply
[42:12] Speaker 2: of ivermectin, you do it out there. So I'll never
[42:16] Speaker 2: understand that. Not that he's recommended ivermectin.
[42:19] Speaker 3: For the non-pharmacist. Netflix watchers, I just rolled my eyes very, very, very, very,
[42:25] Speaker 3: very dramatically.
[42:26] Speaker 2: Yeah, you're going to strain something. You got to be careful.
[42:28] Speaker 2: So he's a big fan of aggressive pharmacologic intervention using medications.
[42:34] Speaker 4: Sure he is.
[42:35] Speaker 2: Off-label. Now, I'll give one example. I could give a lot,
[42:39] Speaker 2: but there's one, and I think it's a fun one.
[42:42] Speaker 2: And there's a little nerd in me that wants to
[42:43] Speaker 2: share this story with you guys. And I think your
[42:46] Speaker 2: listeners will enjoy it. It's about a medicine that he prescribes.
[42:50] Speaker 2: for his patients called rapamycin. You might have seen it, serolimus.
[42:55] Speaker 2: And he prescribes it for longevity-enhancing purposes. And, yeah, there
[43:01] Speaker 2: is a little bit of promising preclinical data to suggest
[43:06] Speaker 2: some longevity benefits. It's still very much a hypothesis, and
[43:10] Speaker 2: there's no phase three trials to prove it. As an
[43:14] Speaker 2: interesting aside, this rapamycin is actually an antifungal And this
[43:18] Speaker 2: is fun, how it was discovered. It was discovered in
[43:21] Speaker 2: the dirt of an Easter Island volcanic crater in the
[43:24] Speaker 2: 60s in Rapa Nui. Okay.
[43:26] Speaker 1: Which I hope I'm saying right. How did they find it?
[43:29] Speaker 2: Great question. What in the world is going on here?
[43:30] Speaker 1: Were they just looking at random, just sucking up different
[43:34] Speaker 1: things that they found on the island? Does this have medical?
[43:36] Speaker 1: I don't know. How did they find it?
[43:38] Speaker 2: Great, great question. So there was this microbiologist. who was
[43:42] Speaker 2: collecting soil because they wanted to take samples, and they
[43:45] Speaker 2: wanted to figure out why the islanders who lived there
[43:49] Speaker 2: never got tetanus despite walking around with no shoes.
[43:54] Speaker 1: Cool as that. Actually, that's a really cool thing to do. Yeah,
[43:56] Speaker 1: that makes sense.
[43:58] Speaker 2: But you can imagine some Republican talking about this in
[44:02] Speaker 2: the day being like, hey, we're wasting money testing the
[44:06] Speaker 2: dirt in Rapa Nui.
[44:08] Speaker 5: Yeah.
[44:08] Speaker 2: You know, that's how it is. Yeah, that makes sense.
[44:10] Speaker 2: You never know where research is going to lead you.
[44:13] Speaker 2: And it leads you to some really amazing places. Anyways,
[44:16] Speaker 2: since discovering it, people have studied its use for all
[44:19] Speaker 2: kinds of different things. It was actually found to have
[44:22] Speaker 2: some immunosuppressive effects. So because of that, it's used for
[44:27] Speaker 2: transplant patients to alter their immune system. So if you
[44:30] Speaker 2: get a transplanted kidney, you take this medication usually to
[44:35] Speaker 2: help prevent your body from rejecting it. Now, as I mentioned,
[44:39] Speaker 2: there is some early data that suggests it can affect
[44:42] Speaker 2: lifespan of mice. Human trials have been very limited, though.
[44:49] Speaker 2: Maybe it might help improve the flu vaccine response. It's
[44:52] Speaker 2: not quite clear. People thought it could be potentially used
[44:55] Speaker 2: for weight loss, but that really didn't pan out. And
[45:00] Speaker 2: it's not shown the metabolic stuff that they expect it to,
[45:03] Speaker 2: but it's a really small example of of something that
[45:06] Speaker 2: the anti-vaccine community and something that RFK Jr. do. Extrapolating
[45:11] Speaker 2: a small truth in a small study or an animal
[45:14] Speaker 2: study to a large truth in humans, something it's not powered, meant,
[45:19] Speaker 2: or designed to do.
[45:20] Speaker 1: Right, yeah, I see a lot of this.
[45:22] Speaker 2: Yeah, it's a big stretch.
[45:24] Speaker 1: Yeah.
[45:26] Speaker 2: And I mean, it's great clickbait stuff, right? You see
[45:28] Speaker 2: an article that says like, this secret medicine discovered in
[45:33] Speaker 2: the Easter Island crater is, will expand your life. And
[45:36] Speaker 2: you're like, that's awesome. And you read it. And sometimes
[45:39] Speaker 2: if you're lucky, they'll explain that it's not that, but
[45:42] Speaker 2: it's really fun. Clickbaity stuff. It's really, it sits with
[45:45] Speaker 2: people and it's exciting. So yeah, he's.
[45:48] Speaker 3: Also a guy that like is a soundbite guy. So you're,
[45:51] Speaker 3: you know, you're going to get, you know, two minutes
[45:53] Speaker 3: of him talking on some other guy. We hates podcast
[45:57] Speaker 3: talking about how great said thing is. And it just
[45:59] Speaker 3: spreads like wildfire and, and is actually just not scientifically sound,
[46:06] Speaker 3: and you're just spreading scientific misinformation and causing harm.
[46:11] Speaker 2: That's exactly right. Yeah. Thank you. Now, because it's off-label,
[46:16] Speaker 2: there's no regulating the dose. There's no guidelines on dosing
[46:20] Speaker 2: or monitoring. Maybe there's some protective effects against aging, but
[46:24] Speaker 2: these same exact pathways... drive immunosuppression. So you can't take
[46:29] Speaker 2: these things lightly. You don't want to be immunosuppressed if
[46:32] Speaker 2: you don't need to. No. Because as the title suggests,
[46:37] Speaker 2: your immune system is being suppressed. And your immune system
[46:40] Speaker 2: is a good thing.
[46:41] Speaker 1: Yeah, I wouldn't want to take immunosuppressants as a longevity
[46:44] Speaker 1: treatment because your immune system sometimes helps you stop dying.
[46:47] Speaker 1: Like I get why it helps your longevity if you've
[46:49] Speaker 1: got like a transplant. That makes sense.
[46:51] Speaker 5: Right.
[46:52] Speaker 2: And people haven't studied its use in situations like this.
[46:56] Speaker 2: It's long-term risk of use for people who don't have
[46:59] Speaker 2: a transplant, for example. And, you know, there's some real
[47:03] Speaker 2: risk with it that we do know about. There's some
[47:06] Speaker 2: increased risk to infection, as I mentioned, the development of lymphoma,
[47:11] Speaker 2: and some metabolic problems that the whole field of longevity
[47:14] Speaker 2: is really supposedly aimed to prevent. So it's this kind
[47:20] Speaker 2: of fast and loose relationship to science and medicine that's
[47:23] Speaker 2: made him a pop culture scientist and star. He sounds
[47:26] Speaker 2: really convincing, intelligent when he talks about the stuff, especially
[47:29] Speaker 2: if it's in these short bursts. He knows how to
[47:32] Speaker 2: talk about data in a way that's even more convincing,
[47:34] Speaker 2: I feel, than Andrew Huberman. He's good at it.
[47:37] Speaker 1: Yeah.
[47:37] Speaker 3: Yeah.
[47:38] Speaker 2: And he's influencing people. He's getting the attention of everyone
[47:41] Speaker 2: in the manosphere. His approach to medicine is great for
[47:44] Speaker 2: people like RFK Jr. and anti-vaxxers. He can speak intelligently
[47:48] Speaker 2: about the data and sound authoritative, but And it can
[47:51] Speaker 2: help science wash them a little bit. He's got a
[47:53] Speaker 2: real credibility behind him. It's like when Brian Cox shows
[47:57] Speaker 2: up in Super Troopers. He gives them this whole sense
[48:01] Speaker 2: of gravitas.
[48:02] Speaker 3: Great.
[48:02] Speaker 1: I often think about Super Troopers when I'm considering the
[48:05] Speaker 1: validity of different medical opinions. Yeah.
[48:08] Speaker 2: He doesn't even need to vocally support RFK Jr. He
[48:11] Speaker 2: doesn't vocally support him. He's pretty careful about what he
[48:14] Speaker 2: says about him. But all he has to do is
[48:16] Speaker 2: give them the plausibility by not refuting them And coexisting
[48:20] Speaker 2: in the same world with them and going out of
[48:22] Speaker 2: his way to not trouble them. For example, when he's
[48:27] Speaker 2: asked about RFK Jr. 's accusation that Tylenol causes autism,
[48:32] Speaker 2: something that every doctor I know of, even ones who
[48:35] Speaker 2: don't have the same political links as me, they look
[48:38] Speaker 2: at that, they've seen it, they know anything about it,
[48:40] Speaker 2: they're like, that's kind of nonsense.
[48:42] Speaker 3: Yeah.
[48:42] Speaker 2: When he's asked about it, he describes it sort of
[48:44] Speaker 2: as a low probability event and kind of tries to
[48:47] Speaker 2: move on from that discussion.
[48:48] Speaker 3: Okay.
[48:49] Speaker 2: A low probability. Is it Pete? From all the available data,
[48:52] Speaker 2: it's a no probability event. That's the kind of thing
[48:55] Speaker 2: you have to be able to stand up. You have
[48:57] Speaker 2: to be able to take a side. And I know
[48:59] Speaker 2: people will say doctors shouldn't be political, but this isn't
[49:02] Speaker 2: even political. This is not political.
[49:04] Speaker 3: This is just due diligence.
[49:06] Speaker 1: This is just.
[49:08] Speaker 2: Yeah. Say the truth. Say the medical truth. Say the
[49:10] Speaker 2: scientific truth.
[49:12] Speaker 3: This is just the sky is blue bullshit. Yeah.
[49:15] Speaker 2: It absolutely is. So when it comes to his bastard-ish, bastardocity,
[49:21] Speaker 2: is he a medical bastard? Obviously not on the level
[49:24] Speaker 2: of Marion Sims, who we discussed before.
[49:26] Speaker 1: Right, or on RFK Jr. even. Or Dr.
[49:29] Speaker 2: Oz either, who I really don't like either.
[49:32] Speaker 5: Sure.
[49:33] Speaker 2: He's not as creepy. He's not as creepy as some
[49:35] Speaker 2: of the other longevity gurus.
[49:38] Speaker 3: I pre-laughed at that. Sorry.
[49:40] Speaker 1: No, no.
[49:41] Speaker 2: He's not as creepy.
[49:42] Speaker 3: You're not wrong.
[49:46] Speaker 1: He's not as creepy.
[49:49] Speaker 2: He's not as creepy as some of the other longevity
[49:52] Speaker 2: guys like Brian Johnson who deserves his own episode. Have
[49:56] Speaker 2: you done Brian Johnson? No. No.
[49:59] Speaker 3: I mean, he comes up every now and again.
[50:01] Speaker 1: Nah, he's not, because he's not really a bad, he's a,
[50:03] Speaker 1: we might do him because he's funny. Yeah. But he's not, like,
[50:07] Speaker 1: the thing about him that I actually do respect a
[50:09] Speaker 1: little bit is that, like, of all of the super
[50:11] Speaker 1: crazy rich maniacs out there, most of them are spending
[50:14] Speaker 1: all of their money on, like, horrible shit or really boring,
[50:18] Speaker 1: bland shit, like, I've got a bigger yacht, no, I've
[50:20] Speaker 1: got a bigger yacht, he's spending a lot of his
[50:23] Speaker 1: money on, like, dangerous self-experimentation. And that kind of mania
[50:27] Speaker 1: that I actually do respect a little bit, like, well,
[50:29] Speaker 1: you're genuinely kind of unhinged, but you're committed to being unhinged. And, like,
[50:36] Speaker 1: I kind of respect that more than, like, the way
[50:38] Speaker 1: Bezos spends his fucking money.
[50:39] Speaker 2: Yeah, no, he walks the walk. Yeah, that's a very
[50:42] Speaker 2: good point.
[50:43] Speaker 3: Yeah.
[50:43] Speaker 2: Very good point. It's the same way that, like, I mean...
[50:46] Speaker 2: I'll never totally understand deeply religious people because it's just not,
[50:49] Speaker 2: I don't have that part of me. But when somebody
[50:52] Speaker 2: believes it enough to proselytize, as annoying as that is
[50:57] Speaker 2: and how little I want to see it, there's a
[50:59] Speaker 2: part of me that's like, okay, well, they seem to
[51:01] Speaker 2: really believe it or they wouldn't care to proselytize. Like
[51:04] Speaker 2: the proselytizing, they really believe these people are going to hell,
[51:07] Speaker 2: so they want to change their minds about it because
[51:10] Speaker 2: they really believe it. So I kind of see that. Anyways,
[51:14] Speaker 2: so he's not that bad. And actually, compared to ghouls
[51:18] Speaker 2: like that, he actually kind of seems reasonable. He did
[51:21] Speaker 2: go to medical school. He didn't finish his residency, but
[51:23] Speaker 2: he did some of it. If you saw him profiled
[51:26] Speaker 2: on 60 Minutes last fall or read some of his
[51:28] Speaker 2: stuff in Scientific American, he actually comes across as a
[51:31] Speaker 2: pretty sound thinker. But this whole shtick is based on
[51:36] Speaker 2: critiques of what he calls Medicine 2.0. And all of
[51:39] Speaker 2: this is based on limited experience actually practicing Medicine 2.0.
[51:45] Speaker 2: A key point he makes in his book, which he illustrates,
[51:48] Speaker 2: is that the mortality rate per 100,000 people declined relatively
[51:53] Speaker 2: little over the course of the 20th century, if you
[51:56] Speaker 2: subtract out the deaths from the eight top infectious diseases,
[52:01] Speaker 2: implying that contemporary medicine has made scant progress against the
[52:06] Speaker 2: horsemen of things like cancer and neurodegenerative diseases. Yeah, very frustrating. Well,
[52:12] Speaker 2: first of all, yeah, one, if you take out all
[52:15] Speaker 2: these deaths that we're avoiding with, you know, treating these
[52:18] Speaker 2: infectious diseases, which is like, come on, that's pretty good.
[52:20] Speaker 2: Let's be.
[52:21] Speaker 1: Yeah, the problem is that, like, there are individual cancers, like,
[52:24] Speaker 1: up until recently, because there have been, there do seem
[52:26] Speaker 1: to be some, like, breakthroughs maybe occurring in pancreatic treatment, but, like,
[52:30] Speaker 1: there wasn't a massive amount of progress made on pancreatic
[52:33] Speaker 1: cancer compared to some other cancers up until fairly recently, but, like,
[52:36] Speaker 1: lung cancer, we've gotten... way better at dealing with.
[52:39] Speaker 2: Right.
[52:40] Speaker 1: And like, yeah, there's still some sorts of, there's still
[52:42] Speaker 1: varying sorts of like, you know, heart disease or whatever
[52:45] Speaker 1: that we don't have, but we've gotten better at like
[52:46] Speaker 1: a lot of other kinds. Like it's, it's just people are,
[52:50] Speaker 1: I think a lot of it is like, yeah, you
[52:51] Speaker 1: lose a loved one to like a disease that we
[52:53] Speaker 1: just haven't gotten a good handle on. And it's easier to,
[52:57] Speaker 1: for people in that situation to be like, Medical science
[53:00] Speaker 1: still hasn't made any progress. And it's, well, I'm sorry
[53:03] Speaker 1: you got hit by that fucking bullet, but that's not
[53:05] Speaker 1: the only thing going on, you know?
[53:08] Speaker 2: No, you're exactly right. And it is medicine 2.0, as
[53:11] Speaker 2: he would call it, that is providing those advances in
[53:14] Speaker 2: things like pancreatic cancer, which, I mean, agreed, not as
[53:18] Speaker 2: fast as it should be. And we should be pushing
[53:21] Speaker 2: this forward. But I don't think that's what medicine 3.0
[53:24] Speaker 2: really is. this, this whole thing is really not only
[53:29] Speaker 2: downplaying the role of antibiotics and vaccines, but these horsemen
[53:33] Speaker 2: he's talking about in particular cancer and Alzheimer's are diseases
[53:37] Speaker 2: of older people. The fact that he gets to write
[53:40] Speaker 2: books about how we're not treating them aggressively enough is
[53:44] Speaker 2: because our public health system had improved enough to keep
[53:47] Speaker 2: us alive long enough to get these diseases, these diseases
[53:51] Speaker 2: that are largely of older people, not completely, but largely. Um,
[53:56] Speaker 2: And this whole 3.0 thing doesn't even make sense internally.
[54:00] Speaker 2: In his book, Outlive, he discusses how immunotherapy is amazing,
[54:04] Speaker 2: and it is, but that's very much 2.0 medicine. That's
[54:07] Speaker 2: conventional medicine and research working. At the end of the day,
[54:13] Speaker 2: who has the time and the money to do these things?
[54:17] Speaker 2: We have a real problem in this country with access.
[54:21] Speaker 2: It's not enough tests, as I said. It's enough access.
[54:24] Speaker 2: And he's clearly chosen on purpose to surround himself with
[54:27] Speaker 2: only the wealthiest Americans who have the time and the
[54:30] Speaker 2: money for all the exercise he recommends, the ability to
[54:34] Speaker 2: pay for all the things, the testing, the wearable devices,
[54:38] Speaker 2: and the desire to live forever. And that's what brings
[54:41] Speaker 2: us to the last part of our conversation. But first.
[54:44] Speaker 1: Speaking of the last.
[54:46] Speaker 2: Oh, yeah.
[54:47] Speaker 1: Toby's got it. But first.
[54:56] Speaker 3: And now, Jeffrey Epstein. There we go. I know it's here.
[55:01] Speaker 3: I know it's here. I brought it up in the beginning.
[55:03] Speaker 2: Carly Rae Jepstein himself. So that's right. Where does all
[55:07] Speaker 2: this lead us to? All this Medicine 3.0, all the costs.
[55:13] Speaker 2: Who can do it? Only the wealthiest people. And that
[55:17] Speaker 2: is how our hero, Dr. Peter Attia, gets connected with
[55:22] Speaker 2: one person. Jeffrey Birmingham Epstein. I'm just kidding. I don't
[55:26] Speaker 2: think that's his middle name.
[55:28] Speaker 1: No, that was it.
[55:29] Speaker 2: Earlier this year, you might have heard CBS News announced
[55:33] Speaker 2: a whole new slate of 19 contributors as part of
[55:36] Speaker 2: the efforts. They are trying to go with Barry Weiss
[55:40] Speaker 2: to revamp the network's public image. One of the contributors
[55:44] Speaker 2: that they had hired, along with, again, Andrew Huberman, which
[55:48] Speaker 2: we could do another two-parter on, conservative Mel Ferguson- was Dr.
[55:53] Speaker 2: Peter Attia. Three days after that, the DOJ released a
[55:59] Speaker 2: chunk of Epstein files, which included over 1,700 mentions of
[56:04] Speaker 2: the name Peter Attia, and a lot of very embarrassing
[56:09] Speaker 2: and very douche-chill-inducing emails between Attia and J.E., as he
[56:16] Speaker 2: calls him, J.E., And also with Epstein's handlers, live emails
[56:20] Speaker 2: with Atiyah Epstein's handlers. Because of this, Atiyah was forced
[56:26] Speaker 2: to step down from his role at CBS. Because it
[56:29] Speaker 2: turns out, before he became this wellness influencer that he
[56:33] Speaker 2: was destined to become, with millions of followers, a very
[56:37] Speaker 2: influential book, he relied on Jeffrey Epstein's advice to help
[56:41] Speaker 2: get his concierge medical practice going. So let's get into
[56:46] Speaker 2: the Epstein files here.
[56:48] Speaker 3: Yeah.
[56:49] Speaker 2: Here we go.
[56:51] Speaker 1: Okay.
[56:52] Speaker 2: Yeah. So from Atiyah's own report, he met J.E. in 2014.
[56:58] Speaker 3: I hate every time you say that.
[57:00] Speaker 4: I know.
[57:01] Speaker 2: But like, it's just, well, it gets worse. Wait, hold on.
[57:05] Speaker 3: Yeah.
[57:05] Speaker 2: So he met Joffrey while he was raising funds for
[57:11] Speaker 2: scientific research. And interestingly, he makes a point to note
[57:15] Speaker 2: that it was facilitated, the meeting, by a female healthcare leader, Dr.
[57:20] Speaker 2: Eva Anderson Dubin. Interesting person. She was a former model,
[57:25] Speaker 2: became a doctor and philanthropist. That makes sense. Epstein clearly
[57:30] Speaker 2: kept ties across academia. They remained in contact over the years,
[57:34] Speaker 2: exchanging emails. They exchanged advice. Eventually, Atiyah lets Epstein know
[57:40] Speaker 2: that he's looking for someone to help run his office.
[57:42] Speaker 2: I have this office, it's concierge practice, but I need
[57:45] Speaker 2: a patient care coordinator, someone to like walk them through
[57:48] Speaker 2: the whole thing, someone that's going to make the experience
[57:51] Speaker 2: really enjoyable for them. And he's asking for his help
[57:54] Speaker 2: in finding him or her. Epstein invited Atiyah to his
[57:59] Speaker 2: Upper East Side mansion and introduced him to a foreign-born
[58:03] Speaker 2: model Okay. Yeah. You might see where this is starting
[58:08] Speaker 2: to head.
[58:08] Speaker 1: Oh, this is 2014, right?
[58:12] Speaker 2: Yes, 2014.
[58:12] Speaker 1: Okay, so he had been convicted and everybody knew.
[58:15] Speaker 2: Oh, yeah. That was 2008, if I remember correctly.
[58:18] Speaker 1: Just always really want to highlight when somebody befriends Jeffrey
[58:22] Speaker 1: after that. Yeah.
[58:23] Speaker 2: Yes. Oh, yeah. We're going to get to whether or
[58:25] Speaker 2: not he had a sense of what was going on
[58:28] Speaker 2: or not here, too. I think there's some telltale signs
[58:31] Speaker 2: in his emails. So, Atiyah, is introduced to this foreign-born model.
[58:38] Speaker 2: They exchange emails. And in other emails, it's clear that
[58:42] Speaker 2: Atiyah has invited her to a hangout with some other
[58:46] Speaker 2: potential candidates, other people at Swanky Bar in Midtown. I
[58:51] Speaker 2: think she will be loyal, Epstein writes to Atiyah in
[58:55] Speaker 2: an email. Turns out this woman was also a victim.
[58:58] Speaker 2: Her name is redacted, but she was one of Epstein's victims.
[59:03] Speaker 2: And from Atiyah's spokesperson, they say that this person never
[59:07] Speaker 2: ended up working for them. After all, they said... that
[59:10] Speaker 2: for some other reason, they went with somebody else. That
[59:13] Speaker 2: wasn't even the reason he was at Jeffrey Epstein's apartment.
[59:17] Speaker 2: But Politico reports that it was visa issues that were
[59:20] Speaker 2: the problem. And you can see this in the emails.
[59:22] Speaker 2: The emails are like, hey, she's great, but there's this
[59:26] Speaker 2: visa issue, and I don't think we can be able
[59:28] Speaker 2: to get past that. And this is the kind of
[59:30] Speaker 2: thing you see a lot in these emails, Atiyah relying
[59:33] Speaker 2: on Epstein for referrals and providing him with health advice
[59:37] Speaker 2: and testing. He downplays their relationship. He admits to hanging
[59:40] Speaker 2: out about 10 times after that until Jeffrey Epstein's arrest.
[59:46] Speaker 2: He says the hangouts happened at Jeffrey Epstein's home, although
[59:49] Speaker 2: from emails, he did have interest in going to the island.
[59:52] Speaker 2: And there was even a plan to go to the
[59:54] Speaker 2: New Mexico ranch that Epstein owned, but there was no
[59:57] Speaker 2: evidence that actually proves that.
[59:58] Speaker 1: He actually did that. The Zorro Ranch.
[1:00:00] Speaker 2: Is that what it's called?
[1:00:01] Speaker 1: Yeah, the Zorro Ranch.
[1:00:02] Speaker 2: Yeah.
[1:00:02] Speaker 1: Oh, my God.
[1:00:04] Speaker 2: So he definitely did stay at one of Epstein's apartments
[1:00:06] Speaker 2: in New York for some time period. Cool.
[1:00:09] Speaker 3: Yeah.
[1:00:10] Speaker 2: He used Epstein to help fill out his clientele as well.
[1:00:14] Speaker 2: That's really where I think Epstein came on big.
[1:00:17] Speaker 4: Great.
[1:00:18] Speaker 1: Yeah, because he can connect him to other rich guys
[1:00:19] Speaker 1: who are interested in longevity stuff.
[1:00:21] Speaker 2: That's exactly right. And it looks like he's giving him medication.
[1:00:24] Speaker 2: He's probably giving him metformin, which is another diabetes medication,
[1:00:27] Speaker 2: which I don't.
[1:00:27] Speaker 1: Think Epstein had. It's very popular for life extension folks.
[1:00:31] Speaker 2: Right, yeah. In return, he provides medical care and advice.
[1:00:36] Speaker 2: And to quote Atiyah later, he says, to be clear,
[1:00:39] Speaker 2: I never witnessed illegal behavior and never saw anyone who
[1:00:43] Speaker 2: appeared underage in his presence. But, To also be clear.
[1:00:47] Speaker 1: Appeared doing a lot of work. That is a very,
[1:00:51] Speaker 1: very strong piece of verbiage there. There's a lot weighted
[1:00:56] Speaker 1: on that.
[1:00:57] Speaker 2: Yes, exactly right.
[1:00:58] Speaker 1: Disgusting.
[1:01:00] Speaker 2: It's not ideal. No, no, no. No, men are terrible.
[1:01:04] Speaker 2: I don't think you're going to find Robert and I
[1:01:05] Speaker 2: defending men in general. No.
[1:01:08] Speaker 1: I'm being very specific about who I'm attacking here.
[1:01:13] Speaker 2: Okay. Also... To be clear, it was not a mystery
[1:01:18] Speaker 2: at this point who Epstein was. As you mentioned, he
[1:01:21] Speaker 2: already had a record and a reputation well known, and
[1:01:25] Speaker 2: you can even tell from these emails that Atiyah knows
[1:01:28] Speaker 2: his friend is infamous. I reviewed as many of these
[1:01:32] Speaker 2: emails as I could tolerate, and there's a couple lines
[1:01:34] Speaker 2: I want to read through some of these for you
[1:01:36] Speaker 2: guys that I think stand out. 2015, an email thread
[1:01:40] Speaker 2: from Atiyah with a redacted photo. and the subject line,
[1:01:45] Speaker 2: got a fresh shipment. Not clear what Atiyah was referring
[1:01:49] Speaker 2: to there. Hold on. It's not clear what Atiyah's referring
[1:01:53] Speaker 2: to there. He said later it was the medication metformin,
[1:01:56] Speaker 2: but that kind of weird. But Epstein responds with an
[1:02:00] Speaker 2: email that says, me too, with an attached photo, but
[1:02:04] Speaker 2: the attached photo is redacted.
[1:02:07] Speaker 1: I got some theories.
[1:02:08] Speaker 2: Well, Atiyah's response, let me tell you first before you
[1:02:11] Speaker 2: tell me your theories, Atiyah's response was, Please tell me
[1:02:15] Speaker 2: you found that picture online. Dot, dot, dot. Bastard. Cool. Yeah. Yeah. Fuckers.
[1:02:23] Speaker 1: Not a lot. We're not exactly. We're not exactly connecting. Like,
[1:02:27] Speaker 1: this isn't like a crazy board situation where we have to, like,
[1:02:30] Speaker 1: draw pictures with, like, twine. It's pretty obvious what's happening here. Yeah.
[1:02:38] Speaker 2: Epstein's response was, afraid not. He just. He's so ghoulish,
[1:02:44] Speaker 2: even in his emails.
[1:02:46] Speaker 1: What always takes me is not Epstein's ghoulishness, because he's Epstein.
[1:02:50] Speaker 1: It's the degree to which you can tell there's so
[1:02:53] Speaker 1: many of these guys that all cool is to them
[1:02:56] Speaker 1: is having access to frighteningly young women. Like, that's cool.
[1:03:01] Speaker 1: That's what makes you have, like, an enviable life is
[1:03:03] Speaker 1: the young girls around you.
[1:03:07] Speaker 2: Cool. And to be clear, Atiyah's not the only doctor
[1:03:11] Speaker 2: in these files. providing medical care or doing something for, for,
[1:03:18] Speaker 2: for Epstein. And that bums me out so much. There's
[1:03:22] Speaker 2: like one normal Norman Finkelstein to every like 20 other
[1:03:27] Speaker 2: dudes trying to like get in on Epstein in Epstein's world.
[1:03:32] Speaker 2: You know, Norman Finkelstein was invited to go to his, uh,
[1:03:35] Speaker 2: he's the Columbia professor. I don't know if you know
[1:03:37] Speaker 2: who he is. Cool dude. Um, Anyways, he was invited
[1:03:41] Speaker 2: by another academic colleague, and he was like, no, and
[1:03:44] Speaker 2: if I ever see you bringing your daughter to hang
[1:03:47] Speaker 2: out with Epstein, I'll throttle you. There are some cool
[1:03:51] Speaker 2: dudes out there. But for the most part, it's just
[1:03:54] Speaker 2: dudes like this who just want to be close to power.
[1:03:58] Speaker 2: They want to be close to it. They want to
[1:03:59] Speaker 2: suckle at the teat of these rich and powerful people.
[1:04:03] Speaker 2: And doctors are no exception, and that really... bums me out.
[1:04:08] Speaker 2: And not just because we took a stupid oath, but because, like,
[1:04:10] Speaker 2: it's not our job. And it leads to more... We'll
[1:04:15] Speaker 2: get to that. I got something to deal with. Anyways, okay.
[1:04:18] Speaker 2: So anyways, Epstein said, afraid not. So, you know, in
[1:04:24] Speaker 2: defense of Etia, he said it was a picture of
[1:04:28] Speaker 2: an adult woman. Now, I don't think that makes a
[1:04:31] Speaker 2: lot of sense, because if it was a picture of
[1:04:33] Speaker 2: an adult woman... why would he say, please tell me
[1:04:36] Speaker 2: you found that picture online, dot, dot, dot, bastard? Yeah.
[1:04:40] Speaker 1: I mean, I guess because he's like, theoretically, maybe just
[1:04:43] Speaker 1: some hot adult lady that he's like, oh, please tell
[1:04:45] Speaker 1: me that's not someone you're in front of right now
[1:04:48] Speaker 1: because it's so cool that you get to fuck her, right? Like,
[1:04:51] Speaker 1: that would be the defensive thing, knowing what we know
[1:04:53] Speaker 1: about Jeffrey. My assumption isn't that she's of age.
[1:04:56] Speaker 2: I don't think so either. And I also doesn't, I mean,
[1:04:59] Speaker 2: if my buddy was like, hey, this is this hot
[1:05:01] Speaker 2: chick that I'm hooking up with, and she's of age,
[1:05:05] Speaker 2: and it seems like normal. I don't think I'd be.
[1:05:07] Speaker 1: If he just sends me a picture of her sight unseen,
[1:05:10] Speaker 1: that's also upsetting.
[1:05:11] Speaker 2: That's pretty weird.
[1:05:12] Speaker 1: But also, I mean, here's what I'll say. There were guys,
[1:05:16] Speaker 1: and I kind of suspect Bill Clinton was one of them,
[1:05:17] Speaker 1: who Jeffrey would have played them with women, but would
[1:05:20] Speaker 1: have played them with adult women, because he didn't just
[1:05:22] Speaker 1: automatically send someone underage. That's not what every creepy guy prefers.
[1:05:26] Speaker 1: There's some creepy men who prefer to have sex with, like, 20-year-olds, right?
[1:05:29] Speaker 2: Right. Like.
[1:05:31] Speaker 1: that are provided to them by a service or whatever.
[1:05:33] Speaker 1: So that's not impossible. But even if, even if the,
[1:05:37] Speaker 1: he's playing you with adult women, you know what Jeffrey,
[1:05:40] Speaker 1: you know, he got arrested for trafficking children. You know
[1:05:44] Speaker 1: what he's doing to other guys, just because your taste
[1:05:47] Speaker 1: is like not a felony. Doesn't mean that you're not
[1:05:50] Speaker 1: enabling and supporting a guy who's trafficking children as a pen, right?
[1:05:55] Speaker 2: Even if you never saw it, You know what was happening.
[1:05:59] Speaker 2: You know.
[1:06:00] Speaker 1: And I don't believe that never saw it.
[1:06:03] Speaker 2: Right.
[1:06:04] Speaker 1: I think I think Jeffrey brought out a smorgasbord, you know,
[1:06:07] Speaker 1: for the rich, powerful men. And some of them were adults.
[1:06:09] Speaker 1: Some of them weren't. But the guys, they know what's
[1:06:12] Speaker 1: happening and they often see what's happening, even if their
[1:06:16] Speaker 1: tastes are not in that direction.
[1:06:18] Speaker 2: Yeah.
[1:06:18] Speaker 3: Yeah.
[1:06:20] Speaker 2: So another email from 2016, Atiyah tells Epstein that he would, quote,
[1:06:25] Speaker 2: love to add five years or more to your life,
[1:06:27] Speaker 2: even if the only reason to do so is to
[1:06:30] Speaker 2: have more sex. It's so gross.
[1:06:33] Speaker 1: Cool stuff, Peter.
[1:06:35] Speaker 2: It's so gross. Nice.
[1:06:36] Speaker 1: Yeah, disgusting.
[1:06:38] Speaker 2: I'm going to read this next one also, but I
[1:06:41] Speaker 2: want you to take a drink of your water while
[1:06:42] Speaker 2: you do it.
[1:06:44] Speaker 1: Okay.
[1:06:44] Speaker 2: Okay. In a related exchange, he asked J.E., have you
[1:06:48] Speaker 2: decided if you're interested in living longer? Solely for the ladies,
[1:06:51] Speaker 2: of course. Spit take.
[1:06:53] Speaker 1: I was going to do a spit take, but I
[1:06:54] Speaker 1: don't want to actually like.
[1:06:55] Speaker 2: I don't want to have to then clean up after that.
[1:06:58] Speaker 1: I've got like vegetable powder in my water.
[1:07:01] Speaker 2: I don't want you to ask me about eating vegetable powder. Okay,
[1:07:03] Speaker 2: another email. And this one's a big one. The biggest
[1:07:07] Speaker 2: problem with becoming friends with you, the life you lead
[1:07:11] Speaker 2: is so outrageous, and yet I can't tell a soul.
[1:07:14] Speaker 2: Why not, Pete? Why can't you tell a soul, Pete?
[1:07:16] Speaker 1: Yeah, because of the felonies. Because of the felonies.
[1:07:20] Speaker 2: Listen, he knew the guy was a dirtbag, but I'll
[1:07:23] Speaker 2: say this. I've become friends from doing this podcast with
[1:07:26] Speaker 2: a couple of famous people. I tell everyone about it
[1:07:30] Speaker 2: because they're not ghouls, Pete. They're not ghouls. If you
[1:07:34] Speaker 2: hang out with people that aren't terrible, you can tell people.
[1:07:39] Speaker 1: Yeah. It's this idea that like what cool is and
[1:07:42] Speaker 1: like the real, like the only kind of life that's
[1:07:44] Speaker 1: really worth bragging about is one in which you just
[1:07:46] Speaker 1: have constant, very young women or girls around you all
[1:07:49] Speaker 1: the time. And it's all about like, it's, it's a very,
[1:07:52] Speaker 1: wasn't cool enough in a high school and never got
[1:07:54] Speaker 1: over it attitude as opposed to like, I don't know.
[1:07:57] Speaker 1: Like when I think of the people I know who
[1:08:00] Speaker 1: are like really cool and who I like tell people about,
[1:08:02] Speaker 1: cause their lifestyle is so amazing. It's folks who like,
[1:08:06] Speaker 1: have hobbies and do stuff like, you know, they participate
[1:08:09] Speaker 1: in like fucking incredible races or they like build things.
[1:08:12] Speaker 1: They make like weird custom cars or motorcycles, uh, or they,
[1:08:16] Speaker 1: they engage in like incredible feats of athleticism. You know,
[1:08:20] Speaker 1: they build things, they into 3d printing or like they
[1:08:23] Speaker 1: have skills and they make stuff and they, I don't know,
[1:08:26] Speaker 1: that all takes money, but it's, it's actually impressive as
[1:08:29] Speaker 1: opposed to just like, Oh yeah, you're just hanging out
[1:08:31] Speaker 1: a bunch of around a bunch of like really young
[1:08:33] Speaker 1: women who you're probably applying with money.
[1:08:35] Speaker 2: Cool yeah okay um another email that struck me it
[1:08:39] Speaker 2: was him pleading with epstein's handlers to basically help arrange
[1:08:43] Speaker 2: a play date with him i go into je withdrawals
[1:08:45] Speaker 2: when i don't see him uh famously there is the
[1:08:48] Speaker 2: email from a tia to epstein discussing the issue of
[1:08:51] Speaker 2: cunnilingus that i brought up in the very beginning of
[1:08:53] Speaker 2: the first podcast and i apologize i'm sorry Pussy is
[1:08:59] Speaker 2: indeed low carb. Still awaiting results on gluten, though. Okay.
[1:09:04] Speaker 2: Now I'm going to say something that's very, very controversial here.
[1:09:07] Speaker 1: Okay?
[1:09:08] Speaker 2: And I apologize in advance. Feel free to cut. But
[1:09:12] Speaker 2: in a vacuum, this conversation I don't think is completely
[1:09:16] Speaker 2: terrible for a couple reasons. One, It would at least
[1:09:20] Speaker 2: suggest they're attempting to provide some pleasure. But that is
[1:09:24] Speaker 2: something that I encourage men to do in general with
[1:09:26] Speaker 2: their partners because I think there's a potential health benefit
[1:09:30] Speaker 2: in terms of probiotics for men to get. And more
[1:09:32] Speaker 2: men should be doing it if their partners want it.
[1:09:35] Speaker 2: But I don't know if there are benefits because nobody
[1:09:36] Speaker 2: will ever fund that study. But the point is, if
[1:09:39] Speaker 2: one of the two people in this conversation weren't the
[1:09:41] Speaker 2: worst people in history, this could be a genuinely interesting
[1:09:46] Speaker 2: scientific question. The nerd in me has curiosity.
[1:09:50] Speaker 1: If, if Jeffrey, if someone's talking about like giving a
[1:09:52] Speaker 1: massage to like a partner, that's perfectly fine. If it's
[1:09:56] Speaker 1: Jeffrey Epstein, it's not because that partner is probably not
[1:09:58] Speaker 1: an adult, right? Like that's the thing.
[1:10:01] Speaker 2: Yes.
[1:10:01] Speaker 1: That's the issue. I think is that you just have
[1:10:04] Speaker 1: no idea.
[1:10:05] Speaker 2: It's very gross. I agree. It's very, but I mean,
[1:10:07] Speaker 2: as a scientist, there's a part of me that has,
[1:10:11] Speaker 2: has questions. Um, but let's, let's move past that. Um,
[1:10:16] Speaker 2: There's one other thing that his emails shed light on.
[1:10:19] Speaker 2: It's something that was dug up afterwards. I'm not sure
[1:10:21] Speaker 2: if it got enough attention. In his book, he shares
[1:10:25] Speaker 2: that in July of 2017, while he was in New York,
[1:10:28] Speaker 2: his one-month-old son back in California almost died. Has to
[1:10:32] Speaker 2: be resuscitated by his wife, who's a nurse. And for
[1:10:35] Speaker 2: four days, his wife is begging him to come back home.
[1:10:39] Speaker 2: She had to perform the resuscitation herself. The child is
[1:10:41] Speaker 2: in the ICU. She needs him back home. And he
[1:10:45] Speaker 2: didn't because he felt his work was too important. That's
[1:10:48] Speaker 2: his own admission. Now, he will say that this was
[1:10:51] Speaker 2: a mistake. He frames it as having deep disgust with
[1:10:54] Speaker 2: himself for doing that. He's like, I thought my work
[1:10:57] Speaker 2: was so important, I had to stay to do my work.
[1:11:00] Speaker 2: But here's the thing. In his book, he shares the
[1:11:03] Speaker 2: date being July 11th. And when you go through the files,
[1:11:05] Speaker 2: the Epstein files, he has an email exchange on July
[1:11:08] Speaker 2: 13th to Epstein, where basically he's planning to meet him.
[1:11:12] Speaker 2: And he's like, yeah, I'll meet you wherever you want. Like,
[1:11:15] Speaker 2: so during this time while this kid is in the ICU,
[1:11:19] Speaker 2: he is still there doing important work, quote unquote, but
[1:11:22] Speaker 2: really it's to try and hang out with Epstein. And
[1:11:25] Speaker 2: that is rough out of all the things. That's a really,
[1:11:28] Speaker 2: that's a tough one. And I will say this. I
[1:11:32] Speaker 2: think if anything gives him shame, it is that. That's
[1:11:36] Speaker 2: the only good news is that he probably does feel
[1:11:38] Speaker 2: terrible about that.
[1:11:39] Speaker 5: No.
[1:11:40] Speaker 1: Yeah.
[1:11:41] Speaker 2: Along with the CBS fallout, he also parted ways with
[1:11:44] Speaker 2: protein bar company David and powdered supplement maker AG1 or
[1:11:48] Speaker 2: Athletic Greens. And he's currently in a lawsuit with wearable
[1:11:51] Speaker 2: medical tracker Aura, the Aura ring, after they distanced themselves
[1:11:55] Speaker 2: from him. They sound kind of like a sketchy company themselves.
[1:11:58] Speaker 1: But I don't know.
[1:12:00] Speaker 2: The thing about this, this is really a cautionary tale,
[1:12:03] Speaker 2: I think, for all doctors. It's the cautions of interacting
[1:12:06] Speaker 2: with people with fame and power. Doctors, as I mentioned,
[1:12:10] Speaker 2: are people pleasers at heart. And just like anyone else,
[1:12:12] Speaker 2: we can be drawn to the appeals of the rich
[1:12:15] Speaker 2: and famous. And doctors can find themselves doing things to
[1:12:19] Speaker 2: and for these people that they wouldn't do for other patients.
[1:12:22] Speaker 2: And like that 2012 study, this is not always a
[1:12:25] Speaker 2: service to people. Nope. Patient satisfaction doesn't always correlate with
[1:12:30] Speaker 2: good outcomes. They want to be liked by these individuals.
[1:12:32] Speaker 2: They want to be seen as useful patients. And that
[1:12:34] Speaker 2: can land the doctor, and more importantly, the patient, in
[1:12:38] Speaker 2: serious trouble. Look at Michael Jackson's doctor, Matthew Perry's, Joan Rivers.
[1:12:43] Speaker 2: These are all examples of when doctors probably overstepped the
[1:12:46] Speaker 2: bounds of what they should have done, in part at
[1:12:49] Speaker 2: least because they were dealing with a famous and rich person. So,
[1:12:53] Speaker 2: my closing thoughts. Again, there's a lot of what he
[1:12:57] Speaker 2: does that is not bad.
[1:12:59] Speaker 1: Uh-uh.
[1:13:01] Speaker 2: I'm well aware, as I said, that he is not
[1:13:03] Speaker 2: the worst person, one of the least bad people we've
[1:13:05] Speaker 2: ever done on the show. And I still hold out.
[1:13:07] Speaker 1: I don't know.
[1:13:08] Speaker 3: Hung out with Epstein.
[1:13:09] Speaker 1: The Epstein stuff really changes my opinion on that a bit.
[1:13:12] Speaker 2: Yeah. I still hold out hope for redemption arc as
[1:13:15] Speaker 2: I do for everyone. I don't know why I do that,
[1:13:17] Speaker 2: but I can't help but do that. But. What it does,
[1:13:21] Speaker 2: it says a lot about the practice of medicine in
[1:13:24] Speaker 2: this country and how it is moving towards becoming something
[1:13:27] Speaker 2: even more economically inaccessible and unequal. It says something about
[1:13:30] Speaker 2: the common pitfalls doctors make once they become public figures
[1:13:35] Speaker 2: and what can happen when influence outweighs the actual science,
[1:13:41] Speaker 2: becomes more important than the actual science. I think he's
[1:13:44] Speaker 2: sort of the missing link between the dangerous maha pseudoscience
[1:13:48] Speaker 2: practitioners and the more mainstream, but kind of also problematic
[1:13:52] Speaker 2: healthcare leaders like recent FDA commissioner, Marty Macari, who he
[1:13:57] Speaker 2: claims is his close personal friend. He's not a bastard
[1:14:00] Speaker 2: because he's malicious. He's because it's consequential. He's part of
[1:14:05] Speaker 2: this push that's making medicine. I think he's a bastard.
[1:14:09] Speaker 3: I'm just going to.
[1:14:11] Speaker 2: Say it. I will say this. Like, I feel comfortable
[1:14:14] Speaker 2: when he talks about certain things. He talks about strength training. Fine.
[1:14:18] Speaker 2: Do it. Um, And I do want people listening to
[1:14:22] Speaker 2: these things and learning about metabolic syndrome and learning what
[1:14:24] Speaker 2: it is. I also don't want them being so hyper-focused
[1:14:27] Speaker 2: on it. I think... We face bigger problems when he
[1:14:30] Speaker 2: faces into areas where he doesn't have expertise. For example,
[1:14:33] Speaker 2: we talked about colon cancer and I know what's right there.
[1:14:36] Speaker 2: Then it sounds really silly to me. And I'm like,
[1:14:38] Speaker 2: you just can't be an expert in all things, which
[1:14:41] Speaker 2: is something that we have to address and grapple with
[1:14:44] Speaker 2: as medical podcasters. And this is something I have to
[1:14:46] Speaker 2: wrestle with all the time, which is how do we
[1:14:50] Speaker 2: do what we do and not fall into these common mistakes?
[1:14:54] Speaker 2: And I try hard, but I don't know, maybe I'm
[1:14:56] Speaker 2: not perfect either about this. I don't consider myself a
[1:14:58] Speaker 2: medical influencer like he is, but it's always concerning to
[1:15:03] Speaker 2: me if I'm overstepping my expertise or my bounds. So
[1:15:07] Speaker 2: having the air of authority but without the same responsibility
[1:15:11] Speaker 2: and guardrails of real medical practice is a concern for
[1:15:15] Speaker 2: all physician podcasters, myself included, and is a concern here
[1:15:19] Speaker 2: with him. It's something we should all be aware of.
[1:15:20] Speaker 3: Yeah.
[1:15:22] Speaker 2: But the long and short of it is I think
[1:15:24] Speaker 2: he is a part of this push that is making
[1:15:26] Speaker 2: medicine less scientific and it's making medicine less accessible. And
[1:15:30] Speaker 2: it really worries me and concerns me. And that is
[1:15:33] Speaker 2: my shtick on Dr. Peter Attia.
[1:15:38] Speaker 1: Well, thank you.
[1:15:39] Speaker 2: Thanks, Kaveh.
[1:15:40] Speaker 1: Yeah, bastard ends of things. You want to plug things
[1:15:43] Speaker 1: before we roll out here?
[1:15:45] Speaker 2: I certainly do. I want to plug my podcast, The
[1:15:47] Speaker 2: House of Pod. It is a fun-ish medical podcast. We
[1:15:51] Speaker 2: look at science. We look at wellness grifters and make
[1:15:53] Speaker 2: fun of them. And we talk about what RFK Jr.
[1:15:55] Speaker 2: is doing to our terrible country. But even more than that,
[1:15:57] Speaker 2: I want you to listen to my brand new podcast
[1:16:00] Speaker 2: that I'm very excited about called Persian of Interest. It's
[1:16:03] Speaker 2: about Persian contributions to art, music, philosophy, science, a lot
[1:16:08] Speaker 2: of the fun stories that we've been written out of
[1:16:11] Speaker 2: or minimized in. And we're going to cover a lot
[1:16:13] Speaker 2: of great topics with a lot of great guests. It's
[1:16:15] Speaker 2: going to be a really fun time. Please check it out. Bye. Bye.
[1:16:20] Speaker 1: Bye.
[1:16:24] Speaker 3: Behind the Bastards is a production of Cool Zone Media.
[1:16:27] Speaker 3: For more from Cool Zone Media, visit our website, coolzonemedia.com.
[1:16:31] Speaker 3: Or check us out on the iHeartRadio app, Apple Podcasts,
[1:16:34] Speaker 3: or wherever you get your podcasts. Full video episodes of
[1:16:37] Speaker 3: Behind the Bastards are now streaming on Netflix, dropping every
[1:16:40] Speaker 3: Tuesday and Thursday. Hit Remind Me on Netflix so you
[1:16:43] Speaker 3: don't miss an episode. For clips and our older episode catalog,
[1:16:46] Speaker 3: continue to subscribe to our YouTube channel, youtube.com slash at
[1:16:50] Speaker 3: Behind the Bastards. We love about 40% of you, statistically speaking.

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