The Peter Attia Drive - #37 - Zubin Damania, M.D.: Revolutionizing healthcare one hilariously inspiring video at a time

Episode Date: January 21, 2019

In this episode, Zubin Damania, a.k.a. Zdogg MD, a Stanford trained physician and founder of Turntable Health, discusses his evolution from disillusioned doctor suffering burnout to leading the charge for a radical shift in how we practice medicine. We also go down the rabbit hole on all sorts of juicy topics from meditation to nutrition to the nature of consciousness itself. We discuss: Med school antics [7:00]; Hierarchies in healthcare, physician burnout, and a broken system [20:15]; Why Zubin left medicine, and what lead to the ZdoggMD persona [31:30]; Peter’s tough decision to leave medicine [44:00]; Benefits and challenges of meditation [54:15]; Zdogg’s theory of consciousness [1:11:30]; Nutrition: Peter’s current strategy with patients [1:31:00]; The anti-vaccine dispute [1:38:15] The common thread of all “diets”, the obesity epidemic, and Peter’s dream experiment [1:44:30]; Do we have free will? And how do we make better decisions and learn from our mistakes? [1:55:15]; Peter’s current obsessions: fasting and rapamycin, measuring autophagy, and becoming a kickass 100-year-old [2:03:15]; Reforming the healthcare payment model [2:14:45]; How to find doctors like Peter and Zubin in your area [2:28:15]; Zdogg’s amazing videos [2:31:15]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.  

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peteratia-md.com.

Hey everybody, welcome to this week's episode of The Drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and why instead we've chosen to rely entirely on listener support. If you're listening to this, you probably already know, but the two things I care most about, professionally, are how to live longer and how to live better. I have a complete fascination and obsession with this topic. I practice it professionally, and I've seen firsthand how access to information is basically all people

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from monthly subscription. My guess this week is Zubin Demania, aka ZDog MD. Zubin and I have been friends for about 20 years, and we talk about that actually at the outset, so how we met and things like that. We kind of lost touch for a few years, but then reconnected at Ted Med in 2013 when we both spoke.

This is a kind of interesting episode in the sense that I wanted to interview him, but he wanted to interview me. So when I got to his studio in Vegas, which is where we did this, and his crew is there, we filmed it and actually ran it as sort of a Facebook live. And in the end, it really I think comes across as a pretty equal balance of about a 50 50 of just two dudes sitting there talking about this stuff. And it was really a mutual interview. Zubin or as we call him Z dog is kind

of one of the most talented people I've ever met. I mean, not only is he talented as an amazing dog, but he's just musically gifted. He is comedically gifted. And he has put those things to an amazing use in what he does. So he has all the usual accolades. He trained at Berkeley, UCSF, Stanford, in internal medicine, and of course, that's where we met. And he went on to found something called

turntable health in Las Vegas, which was part of this broader ambition of the urban revitalization in Las Vegas that was spearheaded by Tony Shea, who is the CEO of Zappos, and that's the guy who recruited Zubin there. This all started because Zubin was working as a hospitalist at Stanford in internal medicine,

but he had this whole side gig of doing comedy and music, and it was that which Tony saw that made him think, hey man, you gotta do something a little bigger than just being an internist at Stanford. His videos are amazing and we're going to link to a lot of them. In particular, ain't the way to die. Lose yourself in seven years are my three favorites, but I've seen every one of them multiple times and I've been following this for a long time. Many of these videos have gone viral and I think in aggregate, he's got about half a billion views on Facebook and YouTube. These are educating patients, educating providers, and kind of mercilessly creating a satire of

our entire dysfunctional healthcare system. We do talk quite a bit about healthcare and Zubens given this much more thought than I have, but it was just so interesting to get into this stuff. We get into some really deep philosophy stuff. Basically, he just stumps me all day long with philosophical questions about consciousness and the mind and other things like that. I would say overall, this is probably one of the most enjoyable discussions I've ever had with somebody in this sort of format. I've talked a lot about how the discussion I had with Jaco a few years ago was one of my favorite. I would put

this up there as well and probably the top three discussions just in terms of overall enjoyment. So the show notes will link to a bunch of really cool stuff that you can also go to his site ZDog and that's just two Gs on thedogmd.com. So I'm really excited to introduce all of you to Zubin Demania. We are live.

What is up ZPackets your boy ZDogmd? I am live and direct at a studio Z. You are not gonna believe it, but we're doing something absolutely different. What's this big phallic symbol in my face? It's called a microphone, okay? Learn about it. And I have it because I have a good friend

that goes way back to my Stanford days. He is a physician, he's an engineer, he's done crazy stuff, work with the world's top performing individuals to try to teach us not just how to live longer, but how to have a longer healthy life, a health span. He is one of my favorite people because he's uber smart, hangs out with all kinds of hoidy-toidy people like Tim Ferris and Sam Harris and all these smarty pants intellectual

darkwag people. But more important than that, he's a bald, off-white doctor. Welcome, Dr. Peter, it's you. Thank you so much for having me on this co-hosted event today. That's right. So what we're doing different now is we're co-hosting this. You're in Vegas to give a talk. You have your own podcast called The Drive,

which is a stunning deep dive into the nerdiest shit I've ever seen in my life. I love it. Like you're talking about, I heard say free, Dr. Say free, about how cancer may be a metabolic illness and how the mitochondria abnormal and your liking is faced going, well, just because they're morphologically abnormal doesn't mean that the function have you actually fractioned what's your ideal trial. And I'm just going, nerd, nerd, nerd, nerd, yes.

But also you are even more than that. You're talking about how to maximize human potential in a way that's uniquely human. And that's what I love about you ever since our Stanford days. Well, speaking of those, let's retell that story. So I'll do this from the lens of how I would introduce you to my listeners, but I think your listeners

will also be intrigued by this. So I was one year behind you in medical school. Now you went to UCSF, I went to Stanford. Is that correct? That's right, it was a gang war type of deal. That's right, this was back when the merger was trying to happen unsuccessfully. That's right.

Pure animosity between the two best programs on the West Coast. That's right, you guys thought you were all that because you were rich and we were ghetto as fudge. But in the end of the day, you come to Stanford to do your residency in internal medicine. So you are now an intern in the internal medicine program. I am a fourth year medical student. Yeah, and I had already decided I was going into surgery.

So I had done the heavy lifting to begin that application process. So I'm doing internal medicine, but there's no pressure because Stanford has passed fail. And it's like, how can you fail the rotation? It's not like I wasn't gonna show up, but I didn't have to be the smartest kid in the room. I didn't have to impress the hell out of the residence.

I was like, hey, I'm gonna be a surgeon. I'm gonna as well learn whatever things in medicine apply to taking care of surgical patients. So we show up on day one and you're the intern. I don't remember who the second year was. I don't either, yeah. The third year, I'm blanking on his name, but you called him Darth Vader.

Because his fantasy, he said, was to walk, we can't name him now because he's a human, if you remember, but he's described that his fantasy was to walk down the hall of the hospital with a cape because he was so smart and everyone would think he was Darth Vader. I know exactly who he was. You know what I'm talking about?

Yes, oh my God. I remember his name now. Malignant, not his name. Yeah, we're not gonna say his name. We won't say it, yeah. Yeah. Welcome to Stanford. So I was kind of like, this guy seems like a douchebag,

meaning the chief resident. I was like pointing at me, because that also is just, yeah. And the second year was a non-personality, was my recollection. Like, they were sort of there, but not there and you were the intern and it was out of control I could not imagine how much one could enjoy a rotation of internal medicine I don't even remember where we were were we the VA like it was we were at the mothership We were at Santa. No, it's weird. I'm getting like this weird emotional reaction because I remember you so well.

And the thing is, look, look, dude, I've taken care of a lot of people. I've been through a lot of teams. There are very few people I remember. And I remember fucking Peter, it's you coming up medical student fourth year, cocky as hell because you were going into surgery. Did you already match? No, I had a match. But you in your mind, you were.

I knew I wanted to go into general surgery. You knew. And so on a medicine team, we've already written you off as someone who doesn't matter to us because you're not going down there's no point putting any energy into teaching me anything and then you sat down and did the entire monologue from Austin Powers doctor evil in the therapist like oh my life is I don't even remember it yeah and you were bald at the time or shaved head had the. And had the finger here and did the whole thing. And I'm an intern, right?

The only way I can cope with this shit is through comedy, through humor. That's, humor was my co-op mechanism from the beginning. And this guy does this thing and you're a medical student. First of all, you have the balls to come up and do that thing, which in the hierarchical system like that. Right. Already, I'm like, this guy's my hero,

because I'm oppositional to find it. And then you nailed it perfectly. And I'm like, who is this guy? So there's an interesting backstory to that. So my very, very first rotation was pediatrics. Because when I went to medical school, I thought I was going to be a pediatric oncologist. Wow. So I figured, I better figure this out quick.

And so I'm going to do pediatrics first. And this was the moment when I knew I couldn't be a pediatric oncologist, was when I realized I couldn't be a pediatrician. I was when I realized I couldn't be a pediatrician. I'm not saying that to upset the pediatricians, because maybe it was just I couldn't be a Stanford pediatrician. But on about the fourth day of the rotation, there was like this really chubby cute little baby in the nursery. I forget what was wrong with dehydrated or something like that.

We were taking care of it. And I just decided at that moment, it made sense to walk down the hall and pretend I was fat bastard and talk about wanting to eat the baby. So I came out of the room and I was like, baby, get in my belly! And the whole rest of the night, all I did was talk about the other, other white meat. Oh my god. And literally not one of them. not one of them even smiled. They were mortified by my existence.

Humorless bastards. Forget about fat bastards. You know what's so funny? See, this is why you and I get along. You're an introvert, I'm an extrovert. You're incredibly science-minded, diligent, industrious. I'm the opposite. I'm lazy.

I procrastinate. And I use smoking mirrors to get any success I can and grasp onto it desperately. But the truth is we have a very similar disturbed sense of humor, one time in hematology. So here I am like I'm a second-year resident. And the attending is a guy named Steve Kutre, really renowned guy.

And we're on everybody's stress. It's young people who are dying, like all over the place. And I had already built, you know, what happens in medicine, you start building this brick wall around yourself so that you don't feel what's going on. Because in a minute you feel it, you're in the stairwell crying back and forth, and it's just morally distressing. So to cope with that, I built a wall, but then I'd started using humor. So Kutre, we had these really hard sick service, and there was this creepy puppet that one of the patients had donated to F-Ground, which was our onc floor,

and it was this weird hobo, like, had a little stick and these little things, you put your hand in the butt and you make it do stuff, and that's not, that came out wrong. It's a big thing. You know what I'm saying? They have very large heinus. Extremely loose sphincter tone.

Yeah. And so... And no curvature in the colon. It's more of a mono, like the GI tract basically goes the esophageal anal canal as one. It's a straightened and shortened track. You know what that always bothered me? That being said, rounds are happening and Kutrego so, D'Amania, did you see Mr. Pickles in three?

And I go, I didn't, I'm sorry. And you could see him just like, you know, this Pickles and three and i go i didn't i'm sorry and he and you could see him just like you know this guy fucking sex and i go but but many he did and i pull out the hobo hobo clown and he's like the people at this guy is okay he's federal overnight he's probably got some to realize the syndrome and and kutra looks at me for a second? And I'm thinking, I'm done. I'm fired.

And he breaks into laughter with tears rolling down his face and the whole team is laughing. And I'm like, you know what, I found my path. It is to try to bring some levity to situations that are disastrous. And that gave me hope because it could easily have gone the other way.

I've been told things like, hey, you speak and then think, you should just reverse that. Or better yet, just think. And attending told me that at UCSM. So when you and I took USMLE2, so the final exam to graduate from medical school, we were about the last classes to do that

before they switched to like live patient actor interactions. Is that right? Yeah, we were very close to it. We were close to it. Because I had just a scan trial. That's right? Yeah. Or we were very close to it. We were close to it. Because they used to. I had just a scan trial. That's right. Yeah.

As did I. But then they brought in, they said, you know, Stanford's going to be one of the test sites for, you know, doing this whole thing. Because USMLE 2 is moving towards half the test being written and half the test being clinical with actor patients. You know, we were basically just being asked to do this so they could figure out the, you know, the kinks in the system.

So, for whatever reason, it was just too long a day, and I just wasn't really in the mood to deal with these actors and actresses who were annoying as hell to me. You know, you'd go in there and you sort of knew what was going on, you'd ask all the right questions, and then they'd give you this scathing feedback. Like, they didn't even know what they were talking about, and they just bugged me, right?

But you can picture this, right? I don't know if you guys can hear me breathing angrily, but I had the exact same experience keep going. So we had to do nine of these in a full day. Each encounter took 30 minutes, 20 minutes to do the thing, 10 minutes to get the feedback. I do a really honest to good job for the first eight. I really, I'm trying as hard as I can, I'm doing the best I can, I'm taking my beatings,

we're going into the last one, and I just lose it, I can't do it. And so I pull the chart out of the medical thing and it says, you're seeing Mrs. Smith and Mrs. Smith is here to talk about her daughter, Suzy, who is wetting the bed at night. That's all the information you have, so you've got to go in and now play the pediatrician or whatever. So I walk in and I say, hello, Mrs. Smith.

And she looks at me kind of funny. And she says, hi. And I said, my name is Dr. Evil. I went to evil medical school. And she's, okay, well, Susie is, and she starts talking about Susie. And I said, I don't really want to hear about the details of Susie's life. Let me tell you about the details of my life. And then I do the entire monologue for Austin Powers. They are quite inconsequential. And so ending with a Zerustrian

and Wilma ritualistically shaved my testicles. And as a Zerastrian, you can appreciate this. And it's close to home. And I keep going and then all of a sudden the door like basically breaks down because they're videotaping this whole thing, which you knew I knew that this was happening. And they get so pissed.

They run and they go, this is over. This is absolutely done. What it is totally inappropriate what you just said, and I said, I said testicles. I said, shorn testicles, that's a medical term. That's completely legitimate. Did you tell them have you ever experienced shorn testicles?

It's quite exhilarating, I suggest you try it. I suggest you try it. So I got the boot, it was a huge deal. They basically dragged me out of there. That is the most amazing thing I've ever heard in my life. I am so proud of you, Peter Atia, as your superior officer in school. Because I thought that those patient actor things

were the stupidest bullshit. And we're, okay, this is what they do. This is what they tell you. You know what, you need to have empathy. You need to be able to read people. You need to be able to see through lies and get to the heart of what's going on. So what do they do?

They put you in a room with a professional liar. And when you see through it, when you see it for what it is, which is zero's and one's, you go, this person's faking it. I can't, how can I show empathy to someone who's pretending? You want me to pretend? I can become a liar too. And so I did the same thing.

I went in the room, hands in my pockets like this. The woman had fake bruises on her face. She was supposed to pretend to be abused. And my first reaction was, how dare you pretend? How dare you mock people who've actually been abused? You're doing a shitty job of it. You're not a great actress. And I'm being judged on how I pretend.

Like this is horrible. Give me a real patient. So did you pass? Well, it didn't matter because it was, right, it was just, we were being used as a trial site. So the next day I get a page, was back when we used to carry those alpha numeric, not even the alpha numeric pages,

just the straight numeric page. Right. And it's the Dean's office. And I'm like, you've got to be freaking kidding me. It's like a month before graduation. I'm like, so I call and it's like, hi, this is Peter or Tia returning a page and they said, oh, Dean So-and-So wants to speak with you

wait a moment on the line. And I'm like, god damn it. So I just get all defensive. So he gets on the phone and he goes, hi Peter. And I'm like, Dr. So-and-So look, before you say it, I just wanna say one thing. This was totally ridiculous. And I go off on like a four minute rant

about how idiotic the whole process was and he goes, he goes, well, look, I just wanna say, I watched it last night and I thought it was hilarious. And I really think you should question whether or not you should be at least incorporating some of that into your career. So I just wanted to call you to say, good job. You know?

And I was like, that is fantastic. That's like the highlight of my medical school. There is hope in the universe, Peter, it's you. I had a similar experience at UCSF when I did a graduation speech that actually launched my whole career as E-Dog MD because I later put it on YouTube. It's in my 1999 UCSF graduation speech. It's there. It's all captioned and everything. And it was, I just went through it as I saw it. And it was all just like, this is bullshit, this is bullshit, this is bullshit,

this is why. This is bullshit. It's about actually connecting with our patients, isn't it? And the majority of the faculty behind me were just like stone-faced for 90% of it and then finally start to crack. And you see Michael Bishop who's like a Nobel Prize when her finally, he's like, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, and actually was lobbying to have my graduation revoked for giving that speech. I mean, so this is the thing, it's a hierarchy. And I can tell you don't like hierarchies so much.

I probably have more respect for it than you actually. Being a surgeon. Yeah, I don't, I don't know. I feel like I'm not as, I don't bristle as much as it is probably some people. I mean, I would say for a surgical resident, I respected it much less than the other residents, and I definitely got into trouble on a few occasions

as a result of it. Yeah, yeah. I've met people who completely have absolutely disregard for any hierarchy, and many of them go on just to the most amazing things. So I always felt like I wish I had less respect for it, but. Well, you know, it's a complex thing

because I think certain personality types don't like to be in the middle or bottom of hierarchies They either want to be on the top or they want to be off the hierarchy It's hard for them to feel like other people are controlling them or they're beholden to others in the higher hierarchy And they either have a tendency to dominate those underneath or to treat them as equals inappropriately in which case the lower down in the hierarchy don't have the competence and what they need is actually To be trained and lifted and supported and And instead, it's like, why aren't you at the level that I'm asking you to be? And so it's interesting.

It becomes tough in the higher echelons of performance and stuff people. I think the problem I had in residency was I really loved hierarchy when I could respect the person I was reporting to. So luckily I did my residency at a hospital where most of the residents were just exceptional. So, for the most part was really easy to respect the hierarchy, but the problem was when I encountered somebody and I didn't think that they were good enough or smart enough

or new enough, I wouldn't hesitate to just steamroll them. And that gets you into a lot of trouble. I saw that in you when you were a medical student. I remember it. It was one of your characteristics that gets you into a lot of trouble. I saw that in you when you were a medical student. I remember it. It was one of your characteristics that I actually respected a lot. Because again, like you said, you kind of described our team pretty well. And the person at the top was fairly narcissistic. The one in the middle was kind of a non-entity.

Then there was me who was the class clown and then there was you. And it speaks to our medical training in general that it really is about kissing the ring of the authority figure. So one day you will be the ring that's kissed. That's the majority of our training. The first two years were fed a bunch of information, 50% of which is wrong, but they don't tell us which 50%. And then the 50% of the residual will be outdated by the time you finish. Exactly. So it's 100% bullshit. And yet we're expected to kind of suck it all in and regurgitate it with respect for this hierarchy. And we don't ask questions. We don't step out of that. And you're right. You have to respect

your authority figures, which is important when you trust and respect them. But when you're questioning things, like, why are we doing this? Why are we giving lay six to this person? Or why? What's going on with this renal failure? Actually, what about the root cause of that? You start asking this question, no, no, no, no, no, that's when I was told, hey, you speak then think you should reverse that. They don't want to hear that from a medical student. And you know, we had the short white coats and everything. You guys said the long white coats. It wasn't as high as I was. It was very unusual. Yeah, I didn't realize how, quote, unquote, special that was until I saw that there were many programs where even the interns were still in short white coats.

And I didn't realize what a big deal that was, like how much obsessing went into the white coat thing. I feel like an idiot even just voicing this right now because I've never thought about this for like 20 years, but what a big deal that white coat is. And I feel bad. Maybe I should be more respectful of the white coat. You know, when I came from UCSF, nobody wore a long white code. It's up for fellows and attendings.

So even the residents wore short white codes. I think Hopkins was that way. They're just starting to change it. When I came to Stanford, I saw you wearing a long white code and my conditioned unconscious wanted to smack me. Like, how? I haven't earned it. You haven't earned it.

I haven't earned the long white code. I'm wearing as R1 as an intern. It's such an interesting process. It's almost militaristic. It's a very military hierarchy. And the question is, is that good? Do we need that? I think some degree of organization hierarchy is important

when people's lives are on the line, same within the military, right? Your friends with Jocco will ink in these guys, I mean, what would he say about this? I don't know. I'd hate to speak for anybody, especially Jocco, but the challenge comes when you have to make a decision that is probably

not the best decision for the patient, but it's the one that's coming down from the person just above you. And I always found the stickiest situations were, and I had an example, and I wanna be very careful, I don't reveal too much, because this was such a vivid example in my residency, but there was a time in my residency when I was an intern and it was a small surgical service so it was me and a chief resident only.

So you didn't have all like the 17 layers. So you basically had attending fellow chief resident intern. So there was only only four people in the chain of command. And there was a situation that was in my mind clearly a case of someone that needed to go to the operating room. I don't think you even needed to be a physician to know that this person needed to go to the operating room. I think if you walked into McDonald's and just pulled 100 people there, 97 would say, yep, that's a surgical case. Yeah, the third would be like, I want extra money. The other three, I missed some finer detail.

So I called the chief resident, and this was a weekend that I was on call, and I said to him, hey, I got this case and, you know, blah, blah, blah, blah, it needs to go to the OR, and he was like, just deal with it yourself. And I said, look, I know you're upset at me. I've already called you twice today. This was 8 p.m. and I had already called him twice on the Sunday.

And he had had to come in both times because of the injuries were so severe that I was calling him about that they had to be taken to the OR. So he'd already been to the OR twice that day. It's a Sunday. He's pissed. It's his day off. So now I'm calling him at 8 p.m. or 8 p.m. to say, this is a surgical case. He's saying, you fix it yourself. I'm saying, look, I technically could address this in the ER, but it's not the

best thing to do. And he was like, stop being such a fucking pussy. So this is your attending. No, no, this was the chief resident. Chief resident. This was the chief resident. Yes. So, again, I don't want to get into the details of it because it could kind of give away the identity of any of the people involved. In the end, I did deal with it in the year. And I dealt with it the best I could. Admitted the patient the next day, everyone's rounding and they see the patient and they're like, God damn, how did this not go to the OR? So what I realized in that moment, and I was very early in my internship,

I mean, days into my internship actually, what I realized was the mistake I made was I didn't call the attending directly. So right above? Yeah, again, it was so obvious that this chief resident was wrong. It's so obvious he was being a lazy sack of shit. So I should have just called the attending. Now at the time, that wouldn't even occur to me. I mean, that's like, you can't break the chain of command.

But I look back at that and I view that as probably, certainly one of probably my five biggest failures in residency was the weakness, the inability to break that chain of command and deal with the consequences of it because there would have been consequences of that. Even though it was the right thing to do, and even though that patient would have got much better care, I would have paid an enormous price for that through the duration of my residency,

at least in that era. And I don't know, I feel like in some ways I was just a coward, or deer and headlights, I just didn't know what to do. So I thought, okay, I'll do the best I can. You know what, deer and headlights, I just didn't know what to do. So I thought, okay, I'll do the best I can. You know what, I want to dig into that because this story is at the center of what we're now calling burnout. And I don't think it's burnout. I think it's moral injury and Talbot and Dean and others have written about this

and stat and other places. You were in a position where all the system was arrayed to make it very difficult for you to do the right thing for the patient You knew it was the right thing you knew the patient needed to have this done and you knew that it would cause serious consequences to you to have it done and you aired on the side of okay Well, maybe the system is this way for a reason and it'll be okay in the morning and it may not have been and Then you had to live with the shame and the guilt of not having done something that was self-destructive, that was not in your best interest to help this other person.

And to this day, I can tell sitting across the table from you that this bothers you deeply, you're saying it's one of five things. This bothered me so much that for at least 12, 15 years after, I would contemplate asking one of my friends who was still at Hopkins, you know, by this point now, a few of my friends who had finished were still attendings at Hopkins. I had contemplated asking them to dig through the medical records to find out what happened to that patient because I couldn't remember the patient's name, but I remembered the date. So I was going to say, hey, go back to this date and look at everyone that came in the

ER on that day. And I will be able to figure out which person is, I want to know what this person is doing today. And I kid you not. This is actually a really funny story. I mean, funny in this one twist. I know you're a huge fan of Dr. Oz, right? Massive, love him.

Yeah. So glad you were on a show, by the way. Right. So I was on that show and a little embarrassed, truthfully, because I felt silly and I didn't think it made sense for me to be on, but nevertheless, I was on. And I didn't know when it actually aired, but when it aired, I heard from the patient's mother, who was also there. And to make it very long, sort of short, it reconnected me with the patient who was doing exceptionally well. And it was, you know, in a way, maybe it's wrong that I could alleviate some of the guilt by knowing that the patient turned out okay, but it was

unbelievable because even this patient said they'd never watched this show before, this Dr. Oz show. They just happened to be in the waiting room, I don't know, getting their car fixed or something, and they saw it on TV and they're like, hey, I know that dude. That patient recognized you across the years. Yeah, this would have been 15 year Delta. And then connected with me through my blog or something like that.

Really, we have to let that sink in. That at the heart of all of this, and you're, you know, listen, you're an amazing scientist, your podcast is unbelievable. Like, I listen to it, I'm enthralled by it because I'm also a huge nerd. But the fact is that was a human connection that you made that also was a victim of a system that was so broken

that it caused you moral distress that lasted for years and was only partially ameliorated by reconnecting with that human at the center of that. Now, let's take that that you suffered and scale it by a thousand times every single day when we have to take care of patients.

We know full well what needs to be done. We know where the fuckups are and where things have gone wrong and where our system has failed. And we have powerless, not only powerless. If we do the right thing, we will lose money, we will lose time with our family, we'll be charting all night, and it still may not work for the patient. Now for my listeners who aren't as familiar with this stuff, help me understand what that means.

So, you trained an internal medicine. When you finished at Stanford, what was the first job you took as an attending? So, I'll be honest with you, about year two of my residency, I wanted to do GI. Because that's always intellectually interested. Your dad is a gastroenterologist. He's actually a primary care doc who also trained in pulmonary. Oh, okay.

But I just, for some reason, I always love GI physiology, love hepatology, I love the way that digestion works and the mind body gut connection, I thought was fascinating. Like I loved irritable bowel syndrome because I thought how interesting that the mind can influence what we sense in our gut when we get butterflies and that kind of thing.

So second year though I did the rotation, had a terrible mentor, it was just scoping routinely doing colonoscopies and EGDs and it was horrible. The idea that that could scale for a career was mind numbing to me. Because when I hear someone saying I want to go into GI, I assume they mean they want to be a, you know, they want to do scopes because that's the most lucrative part of GI, right? But you were more interested in like the medical part of GI. I like the medical part of it. And even hepatology was a little too much, but I wanted to scope that was cool, that was video games and people's buttocks. Awesome. Great. But I like talking

to patients. I like the relationship and I like the physiology of it, talking to people about their issues, because abdominal pain, chronic abdominal pain, constipation, nausea, vomiting, a lot of times, these are deeply connected to the mindset. And so that's what I loved. But then when I saw the scoping part of it, I was like, I hate this.

I hate it. And this is most of how I make a living. It was repetitive, mindless, to me. It didn't sit with me plus. I was starting to get disillusioned in general with medicine because most of what we did seemed like bullshit. Most of what we did, either harm people or just wasn't thought out, you know, it's half baked. And the thing is that causes the kind of moral distress. So I was like, forget it. I was burned out. I was tired. So by third year, I remember my program director had to pull me in and he's like, you're

a bad influence on the interns. It's one thing to be burned out and tired. It's another thing to model that for the younger. It changed me totally. Then I became this great teacher and got focused on that as a way to have self-worth. And what were you doing to be at a bad news sarcasm or like the humor gone too far? Like what was it? The humor got very dark. it became more of a wall than a coping mechanism so it was more like how can I mentally victimize everyone around me by throwing blame to build a wall around myself the fact that

I feel morally bereft doing this job so you know calling patients gomers you know this slang that we're standing for again it stands for get out R. Oh, it comes from the book House of God. Yes. Yes. And so I would use every I haven't heard that in like the longest time because it's a horrible thing. Residents. Yeah, yeah, but we heard it all the time. I just had forgotten what not only to hear it all the time. I had conjugated every form of that verse. So it's like that guy's gomed out. He's he's in status

gomaticus. You know, this guy's preparing to gom. He's like proto gom. He's got serious gomopathy. Like every version of Gomer, I could use. And it came from this black hole in my center where it was like, I'm a bad person, right? I'm a worthless poor, and that's burnout. But it's really moral injury. So because of that, I decided I was to take a,

I told our program director, Kelly Scaff, he knows this story, I have told public, I said, Kelly, I can't was taking, I told our program director, Kelly Scaffy, knows this story, I have told publicly. I said, Kelly, I can't, no, I'm not gonna match, I'm not gonna do a fellowship, and I'm not gonna practice medicine. I'm gonna go into tech, because I'm in the Silicon Valley, I'm gonna work for a couple of startups

and see what happens, and I did that for a year. And in that year, I learned a lot about myself. I learned that without that stimulation of that deep relationship, like money as a stimulus was never going to cut it for me, which I wanted it to, Peter. I wanted to be rich. It couldn't happen. I was doing well. I was moving up in these companies and then I just felt empty. So my buddy, John offered, said, hey, there's this hospitalist gig at Stanford. You should take it. Saw your colleagues from residency. We're doing this cool stuff. It's great. And I said,

I'll try it for a couple of months. I was there for nine years. And that was the first real medical job. I was moonlighting and I loved it, but this was it. And being able to spend time with patients when they were acutely sick in the worst day of their life in the hospital, sitting with them spending time, it was before the EHR, the electronic health record, kind of destroyed our ability to make eye contact. And it was beautiful, man, I kept a diary, because I was weird in those days. I was like 30, and I was like,

this, I'm blessed. Like, who gets to do this? Like, I found my perfect niche. And it lasted probably four years before things started to change. So then what changed four years into that nine-year stint? I think what changed was what's been changing

in medicine across the board, which is the creep of medicine as business, medicine as assembly line, medicine as process to be the creep of medicine as business, medicine as assembly line, medicine as process to be improved, not medicine as deep human relationship that's a sacred calling. So what ended up happening is the EHR goes live, productivity, we start to lose house resident support. So we're more, they're expecting us to just see a bunch of patients to generate revenue.

And it's not so much about teaching, it's not so much about mentorship, it's not so much about a team. What I love about the hospital, you go through, you hey Bob, how you doing social workers there? Case managers there, we know everybody, RT's, and they're all supporting each other. It's not hierarchical, it's like whole-archical, like everybody brings their thing. That started to disappear with the pressure of click, click, click,

then I was going home and charting at home, and then I had my daughter, my first daughter in 2007, and that was a tipping point, where I was like, I'm treating my daughter like, you know, my burnout is expressing in how I'm treating my daughter. And I can't spend time with her, I can't read her stories at night, I'm thinking about clicking these boxes in Epic and I haven't finished this note

and did I remember to check the potassium on that guy and I'm the type of guy who can't just sign it out. I have to like, I own it too much. So it just got horrible. And I started being nasty and like my relationships were suffering and you know. What did your wife think at the time? So she was a radiologist, academic radiologist at Stanford. So she found a path that was really perfect for her introvert, very science-minded, loved the team dynamic of it. She looked at me and was like,

you're in a bad. Did you guys meet at UCSF? We met as Stanford as interns the year that I met you. She did all of medicine and then came to an epiphany. Don't like medicine. Parents were really into medicine, both were medical people. She's like, they didn't see radiology as a real doctor. You know, Chinese parents, it's a lot of pressure.

So she's like, you know what, I'm not gonna specialize in pulmonary critical care. I'm gonna go back and do chest radiology. And Zubin, you're gonna support me, by the way, for four years, if more residency in fellowship. And I was like, all right. And so when that table turned, and I was miserable and depressed,

she was the first to say, you know, because we had gotten this, I mean, that's another story. We started making videos, putting them online and Tony Shea, the CEO of Zapples reached out. But before that, she was like, what can we do for you? Do you want to just stop working? I'll go up to full time, she was 80%.

And you can just stop working. We won't have a ton of money, but we'll, in the Bay Area, you're pouring them out of what you do. And I was like, I don't know, I don't know. And this is how long after O7? This would have been, oh, eight. Okay, so your daughter's, I usually want.

She's one. Yeah. And then by Oh nine, what had happened was I, we went to visit. So Tony Shea went to Harvard with my wife. And Tony Shea built Zappos and then sold it to Amazon for like a billion dollars. And just wrote a book called Delivering Happiness became this national sort of thought leader in this space. We went to visit him for Thanksgiving. He's having a bunch of friends over. So he does this thing that Tony does. You know Tony as well. We all kind of roll in the same circles

and he kind of looks at me and he's like, so are you happy doing what you're doing? As a doctor, it sounds really amazing. And I look at him and I'm like, absolutely not. Absolutely not. And to see you living this life where you're doing what you love and you're financially successful

and you're affecting people's lives and people come up to them in restaurants going you change my life with your book and this not. I'm like, it was a mix of jealousy, like deep jealousy, like how can someone be so connected and me feel so isolated and self hatred? Yeah, because it wasn't the money. You certainly saw money everywhere in the Silicon Valley. I remember one of the things in Tony's book that I liked so much, they paid you to quit after a period of time, right?

Was it three months in? Three months in and they give you 2,500 bucks to just go away. Did you walk away? Yeah, I loved that. And if you walked away, then you weren't really a good fit. They were happy to pay the money. That's a Zappos culture in Tony.

Oh my God. It's amazing. Imagine if we did that in healthcare, give somebody it had to be like $100,000. Okay, quit now. And if you're still with it, it means that you're doing this because there's nothing else in the world you'd rather do.

And that's what I tell medical students, you know, like, whoa, should I go into it? I don't know. Like, is there, if there's anything else you'd rather do, do it first. If there isn't, then this is your path. Because it is hard, but it is a sacred calling, and you'll feel it, and you'll feel it.

So you had that discussion over Thanksgiving with Tony, and then what? I've never been so depressed in my life because I went back to Stanford, it's winter. You know, winter is in medicine wards. Every single old person with pneumonia tries to die in the hospital. It's gloomy, the residents are stressed,

they're midway through. I'm supervising an intern who is a young lady who I remember was such a wonderful human being, but she was stressed and I was stressed and we're looking at each other like, how do we help each other get through this? Because it was just she and I because they peeled back our support from a big team to just one in turn one attending. So I'm a Uber mentor. I'm resident attending, second year, sub-i, everybody in one. I would literally cry in the shower so that the wife wouldn't know that I was crying.

It's funny because I talked about some of this in the TED talk where we met again. So super burned out. But Tony had, and this is why I think it's so important to have mentors that matter. Tony told me, so if you had one thing you could do, that was in that visit. What would you do? And I'm like, dude, I did the speech for graduation. I felt so connected to the audience. I felt like I was revealing truth through humor

that could help motivate people to change stuff. I would do that for a living. I would put these videos on YouTube, which was a new thing, but I can't because I'll lose my job and it's dumb and no one will watch. And he's like, you're wrong. Like look at this guy, Vaynerchuk.

He's like a wine salesman. He made a whole living out of this. Look at this guy, Vaynerchuk, he's like a wine salesman. He made a whole living out of this. Look at this guy who co-founded Dig. What's his name? Kevin Rose. Kevin Rose. Kevin does this show and I watch the show and I'm like, that's funny and awesome.

So part of my depression was, why can't I just get through this inertia to do this thing? And when I finally did, when I put my first video on YouTube on my birthday, basically, in 2000 and- Which one was the first one? The first one was Colin Wars. And it was a parody of me talking about GI through the lens of Luke Skywalker going down the trench. So he's doing a colonoscopy and he's like, stay on target.

I can't hold it, stay on target. You can't do any more good back there, wedge, pull up, pull up. About this whole thing. And it got a bunch of views and people were like, that's nerdy as fuck, I like that. And that's when the depression started to lift and then just on the side as this character Zedog MD, which I created to try to make sure Stanford wouldn't fire me. And the thing is they never even knew

because they weren't on YouTube. And so it's more and more videos and more and then we did one called Manhood in the Mirror, which was our first big music parody. This is the first one I saw, right? And it's good because I'm grabbing my crotch repeatedly, which is important for you to see. Yeah, it's very important.

And it was Michael Jackson's Man in the Mirror, but it was about testicular self-examination. I'm checking album ads in Mirat. I feel my junk full lumps and stuff. And it gets a bunch of views and people are playing it in these like student health clinics, unrepeat, and they're saying, oh, kids are catching early testicular tumors, and I'm like, shit, am I responsible for overdiagnosis?

Now are people having their testicles removed that don't need to, and they all this self-blame again, but it woke me up. So you were still at Stanford when you made that video? Full time. I didn't realize. I thought you had already left by them. No, it's two years at Stanford while making these videos

full time until Tony saw the videos and was like, okay, here's a proposition. Unplugged from that matrix, come to downtown Vegas. We're doing startups here and I'm investing in some things. Do something that's going to transform medicine that's about you and about the community. And that's when we imagine that conversation with my wife. Hey, you told me to follow my dream, honey. So my dream is we quit this beautiful Bay Area lifestyle and we moved to downtown Las Vegas,

which is currently a demilitarized zone for this pipe dream of starting a clinic. And it's a little warmer than Palo Alto in the summer. Vagely. Yeah, vaguely. And very different. And did she bristle? Or was she all in from the most crazy? She was crazy.

I was the one who bristle. I was like, that's dumb. I can't do that. And she was like, listen, this is your chance. You gave me a chance for four years to pursue what I cared about. Now's my chance to pay you back. We'll go. We'll give it a shot. And if it doesn't work, no problem. We'll come back and who cares? And if it does work, then great. So she was the one who pushed me. I mean, without being married to the right person, I think the biggest decision you can make in your life is who you partner with. I agree completely. And my decision to leave medicine, that was just a hard decision to make.

You know, when you're two years left in your 200 year residency, and I was like, yeah, I don't want to do this anymore. But actually, my wife helped me see that because she said, you are so miserable. Why are you so miserable? And I gave her 12 reasons. You know, she sat on it for a few days and then she said, I know you enough. We hadn't been married that long, maybe a year.

And she said, but I know you enough to know that there's only two ways you're going to get better. You either have to fix those 12 things on that list or you have to leave. And I thought about that for a few days, probably for a few months actually, because this would have been the, yeah, August of that year.

So, when did you guys get married? We got married in 04. So this is now summer of 05. So I'm really thinking, this isn't for me, you know, reasons X, Y, and Z, like it would be, if you can, I loved the operating part. It was just, there were too many things about the system I couldn't stand.

So then I came to that really hard decision, but I thought her framework was the right framework, which was, it would be great to stay if I could fix all of these things, but I can't, so I probably need to go. And so that was the decision to go. Now I didn't know what go meant. I didn't know if it meant go into another specialty,

leave medicine altogether, go into the lab full time, and because I had just come back from NIH where I had spent two years in the lab. So all of these options were spinning through my mind, which was, look, maybe I'll just get a PhD and just full time do research or go and do this, or go and do this. I mean, it's funny, I found it recently.

I found the document that I made. This is how nerdy I was. I put a table together in word and I had all of the things that I was considering doing with my life and the pros and the cons and the optionality triggers. And if you do this, it'll cut you out of this, but if you do this, you might be able to then pivot

and do this, like it was this whole thing. Wow, engineer mindset. That's amazing. See, we're so different that way, because I was like, let me throw some feces and see where it sticks. I was sticks there. All right, I'm gonna leave medicine.

So for you, it was thought out, but it was prompted by your wife. In a way, did you feel like you needed permission from your wife? I think so, because people often say to me when they find out I left before finishing at Hopkins, they said, you must have really hated Hopkins. And the answer is not at all.

I freaking loved that place. In many ways, it was, it's hard to say one of the best chapters of my life because I feel like I've been really lucky. I think the only really shitty chapter of my life was college, but medical school was an incredible chapter. Residency was an incredible chapter. Work post residency was, all of these things have been very chapter. You know, work post-residency was,

all of these things have been very enjoyable. So no, the reality of it is like, I had amazing friends there who I am still incredibly close to. Wonderful mentors. Obviously like all hospitals, there are, I think, 20% of the surgeons at Hopkins, you wouldn't let operate on your cat

because they're absolute, I mean, assassins. It's true everywhere. Yeah,ins. It's true everywhere. Yeah, yeah, it's true everywhere. But you also were surrounded by some of the most skilled gifted, remarkable surgeons. And the residents above me, meaning the people that I was trying to emulate these chief residents and senior residents in the fellows,

I mean, oh my God, I mean, some of them were just gods to me. And I still keep in touch with most of them, right? Many of these people who were like, you know My heroes are still my heroes in a way. I actually just ran into one in the vans like very recently She was my fellow on pediatric surgery when I was in intern and she's now you know in attending in pediatric surgery in San Diego And we've come into each other so and she was yeah, vans both Did you have your card?

Because that's important, you don't get a discount on it. I just can never remember it. So I mooch off my wife's phone number every time. That's what I do. Yeah. In a way, I think I needed permission. I think my parents thought it was crazy. Your Egyptian.

Yeah. So, do you have the classic immigrant parents or were they first generation? Yes, no, no, super classic. My mom actually is completely supportive. So whatever I do, my mom is, I literally could be a garbage man, and she would be delighted.

But my father was very upset when I finished engineering, turned down my scholarships to do the PhDs in engineering, and then had to go back and do a post-buck year to go to medical school. He was super upset about that. Right, because you did that post-buck where you got all the pre-rex for medical school. What changed your mind from engineering? It's a tough story to tell.

It's hard for me to get into that. Yeah, it's super emotional. In a future. Maybe. Yeah, when we're both more woke. Yeah. Because it's tough. They're things I won't talk about.

And it's because it's so personal and it's a thing that I'm still working through. We're constantly in this evolving thing. You know, and again, our identity as type A kind of crazy driven people. And you work with like some of the top performers around the world and you do this crazy shit. Like guys, for my fans who don't know Peter, this guy does shit that will blow your mind. Like I don't do any shit. I don't do anything. Like, like, do how many? I have in the past, but I don't do anything.

What's the longest swim you've ever done? Every 25 miles. Oh, just 25. Yeah, but I mean't do anything now. What's the longest swim you've ever done? Every 25 miles. Oh, just 25 miles. Yeah, but I mean, if you dropped me five miles from shore today, I would pretty much die. Yeah, but you know, because you're evolving to something, never in every minute, which we were talking even before the start, just a little bit about

our mutual admiration for Sam Harris and his idea of the self and how it's an evolving transient, almost a loosery thing. So it was our identity. The story we tell about ourselves. Absolutely. So the story of, I'm an engineer, no, I'm a doctor, no, I'm a consultant. What's your story now? I mean, people who have listened to my podcast sort of know this and I've gotten a little

bit of grief for it. If ever given the choice, meaning if I'm at a party or if I'm somewhere where I'm asked what I do, I only have two answers. The first is I'm a shepherd, and the second is I'm a race car driver. And the reason is usually the former nobody really asks you any more questions. Right, I'm a shepherd.

What do you mean? Is this a religious thing? Yeah, yeah, it's like, no, no, no, no, no, no, no, no, no, I tend to sheep, and there are a lot of sheep and saying, do you go, yeah, no, no, no, no, no, no, no, no, no, no, no, no, there's a way to go in, you have to go in, but yeah, and then that's just my way of, like, I don't want to talk about it. And then with the race car thing, at first they think it's sexy, but then I explain that

I'm on the formula 2000, like the formula Renault Circuit, and I can just throw two or three sentences out, and they already, the eyes glaze over, nobody would, like, if you're not doing NASCAR or Formula One, it's not like they have a follow-up question. So it usually just gets me out of having the talk. That's amazing. All I would be doing in that conversation, and we haven't caught up in a long time. Last time I talked to you, you were talking about installing a race car simulator in your house. In fact, I remember it was at that long ago, yeah, I was actually driving back from the track. That's right. Yeah, yeah, yeah. That's right. And you were so, I'd never heard the amount of passion in your voice. You were like, this thing is amazing. It's got all these buttons and like my wife is a little pissed, but the thing is it's like amazing. And you got to you got to try this next time.

And I'm like, who is this guy? So now you're actually driving on these circuits. Yeah, but more importantly, it's just to me, it's like I'm only interested in how well I drive versus myself. Like I'm not, you know, this is not like something that's going to occupy much space in my life beyond just my own obsession with it, like all the other things I obsess over. But the point is, I don't have a narrative. I struggle with all of that stuff. You know, even when my kids are asking me now what I do, like, because my daughter's 10, my son is four and a half, I have a younger son who I was, he doesn't ask me anything.

But yeah, I think they know I'm a doctor. I think they know that that's my job, but they don't have a clue what that means. And I just say, yeah, it means you take care of people and my daughter then asks what kind of doctor are you? And that's where I'm like, yeah, I don't, I mean, you know, I just, I usually change this object. Yeah.

I don't understand. I'm with you know, I just, I usually change this subject. Yeah. I don't understand. I'm with you on that. And you know, for you, I always see you as this kind of oscillating electron probability cloud wave that what you settle on at any minute can be on how you're observing yourself or what you, what you're obsessed about at that moment. And it's always changing.

So when people ask you, tell me your story, tell me you're narrative, it's's almost like when they ask me that, I get a little insulted. I'm like, you can't reduce the cloud that simply. It's more complex than that. But I think that's true for everybody. And then that's why I think, maybe that's why I find that type of question

difficult to answer and frustrating. And I think it's why, like even today I did it. The Uber driver who brought me, I came from a hotel over like even today I did it. The Uber driver who brought me, I came from a hotel over here and not really nice guy. I always love taking Uber in cities that I don't know because really the only two cities I spend, you know, a lot of time in a San Diego and New York

in San Francisco. So if I'm in a city like Vegas, I'd love to like, hey man, where are you from? Did you grow up here? You know, no, he'd been here 14 years, but blah, blah, blah, blah, blah, blah, blah. So I'm asking him like 30 questions. So I now know his life story. And then he turns to me and he's like, what about you, where are you from?

And I'm like, God damn it! How do I get out of this? So I'm like, you know, I'm from San Diego. What are you doing in town, business or work? Now the reality is, I'm kind of here to give this talk, but I was like, I'm just here to see a buddy. Oh, you stay here, remember the weekend? Nope, going home tomorrow. And it was like, you know, and I wasn't rude about it, but I think he could I'm just here to see a buddy. Oh, you stay here, remember the weekend? Nope, going home tomorrow.

And it was like, you know, and I wasn't rude about it, but I think he could tell what this guy's a boring dude. Like, there's nothing else to ask. So I was like, I got to dodge the whole bullet. I do the same thing, because how do you, you have to tell almost like, it's a huge complicated unfolding. And he didn't want that.

I mean, like, there is no circumstance. Like the other place where I will be equally dodgy is at like the parties of the parents at the school where you're with all the other doctors and all that stuff. And this is my favorite thing to do is like, I will spend an entire evening talking to a group of doctors and like learn everything about what they do and manage to not reveal one thing. They will think the entire night, this guy, you know, I'll be dressed like this, and they're all dressed nice, and you know, they will think I'm a shepherd or a race car driver. That is magical. I actually want to hear about what they do. And truthfully, I think it's just selfish. I mean, if I'm going to be brutally honest, you know what it is, I don't learn shit

when I'm talking. Or now, I'm not learning anything. When the other person's talking, I get to learn. And I'm kind of selfish when it comes to desiring knowledge. So I think the real reason I enjoy being in that setting and hearing what is that doctor do and what is she do and what is he do is I'm soaking it up and I don't have to waste any of my time hearing myself say the same stupid thing. And you and I both read this book,

which I have, I just happen to have here, the mind eliminated. I was trying to understand myself better, understand meditation better, stop screwing around, trying to meditate for five years and just being like, I can't seem to get it. I actually think I read that on Sam's recommendation two or three years ago. Oh, really? Yeah. I discovered it just randomly on Amazon, read it and was transformed in my practice. Because it was, do you remember the greatest American hero?

It was a show in the 80s with a guy, this guy Ralph, he's like an insurance broker or something. And he, these aliens come down, find him, give him this suit. That's a Superman-type suit. And he gives him super power. And they give him the, I actually do remember this.

Do you remember this? Yeah. Yeah. I'm walking on air. And they give him the instruction manual to the suit. And they go, here's how you use this shit. And he's like, cool. And he reads it and these bad guys are coming.

So he learns how to shrink himself down. He shrinks himself down with the suit. And then he gets himself grown again, forgets the fucking manual. And it's microscopic now and it's gone. So he has to figure out how to use this powerful suit all by himself for the rest of the season. And that's where it's microscopic now, and it's gone. So he has to figure out how to use this powerful suit all by himself for the rest of the season. And that's where it's fun. Well, that's what it felt like with me for meditation,

trying to understand myself and what is my narrative and who am I and what's going on. You're blindly scraping around, trying a little of Harris's meditation and doing a little headspace and doing, then I got this book and I'm like, it's the goddamn manual for nerds and for type A's who want a process.

And part of what this thing talks about is this submind system. And this idea that our mind is really like a board room where you're projecting stuff on a screen, and that's our conscious awareness. And what's doing the projecting are these subminds. There's a auditory submind, projecting sound, a visual submind, projecting vision, and then there's a narrating submind, projecting sound, a visual submind, projecting vision, and then there's a narrating submind. That ties these things together, integrates them and projects them as this sort of integrated picture.

And that's what tells our story at any given second. I am a race car driver and a shepherd, or I am a former burned out doc who's now trying to transform medicine, which is the lie I'm currently telling myself. And it's created like a beads on a string in these moments, these slices. The liberating thing about that is that at any moment, your next slice could be something completely different.

It's influenced by the momentum of the previous slices, but it is in itself an unknown and anything is possible. So what got you curious to start exploring this? You know what it was? It was moving to Las Vegas from the Bay Area, which was what you're... This would have been 2012. 2012. Now I'm a type A materialistic, high-strung, I need a house, in a car, and keep up with the Joneses, and my career, and so on. That's time conditioned. And I come here where people like Tony Shayer, like, are you happy? Like, are you connected?

There's this thing called community and relationship. I'm like, these people are hippies. They don't know where they go to Burning Man. They have no fucking idea what they're talking about. And then I had an experience. Now, look, I've done psychedelics in college, LSD, Sul-Syben, MDMA, those kind of things. They are transformative drugs,

but when I was dabbling in them in those days, I didn't have an intent to change myself. Something crazy happened. I was up in Tony's place, and he has a friend who will call the sorceress, because that's what she called herself. She has this former fashion designer.

And she's like, hey, we're all hanging out, you want to smoke some weed. And I was like, my, I haven't done this in months and months and months, because I'm an upstanding doctor and a father, and my kids are taking care of right now, everybody's in bed, sure. I ended up smoking a heroic dose, like a Terence McKenna level, heroic dose of weed, because again, low tolerance, etc., and it turns out she is very adept as a guide and had known

me for a few weeks now. And broke, she sat down with me and said, so this is what I see in you. I see a person who's this, this, and this, and this, and this. Now you're here. And you do these videos, but really you're trying to deny that that's an important part of who you are because your identity is a doctor. She goes this whole thing, basically breaks me down, destroys my ego. Everything I thought I was dissolved.

And then she started making... And this is with marijuana. This is just with weed. It's so interesting. I've never liked marijuana. I actually can't stand it. I can't stand the way it makes me feel. So it's hard for me to imagine that that could happen because I don't view it as sort of one of those ego dissolving drugs. I guess for me, I just would always get paranoid, especially if it was Sativa. I mean, that would just make me beyond paranoid.

So this was the most potent Sativa you could imagine. And in my paranoia, which I also get, and I also don't love weed, in my paranoia came this paradoxical dissolution of ego as a protective mechanism. So you might have gone to a place I'd never been to. That's what it was. And I'd never been to. That's what it was. And I'd never been there.

And with this guide, who, you know, she's a big room yoga instructor, she, you know, something very spiritual about her. But in a strange way, I would have thought as woo-woo and forget it crazy, you know, says some very unscientific things, you know. But as a guide for this, triggered me to look at myself and go, what a worthless piece of shit I am. Like what a lying fraud and imposter that I am. And she starts noticing these things and what happened is a protective mechanism to live

with this thing I thought was myself was to dissolve that thing and realize that wasn't really me at all. Like the me is the awareness in which all this arises in moment to moment. And I can be something totally different the next day. And I should have gratitude for all these amazing connections and things that I have. And I tell you and I thought I told her at the time when I was super high, I said, I'm going to forget all this in the morning, but this is transphromatical crying and all this shit. Whoa. And the next morning I woke up and I remembered everything. The transformation was still there. And over the course of weeks I had this clue, my wife was like,

what happened and I told her, I'm like, I've been changed. And she actually went and talked to this lady and was like, yeah, she's got something. And we're both hardcore scientists, skeptics, right? And that changed, it decayed over time, but, and so the ego reasserts itself, but I've never been the same. And that combined with living in the desert of Vegas, which is a blank slate and being told, basically reinvent yourself or go out of business, was a personal awakening for me.

And since then, that got me interested then. And I listened, it sounds cheesy, but I listened to Eckhart Toll's power of now. Just listening to the audio book and listening to his voice, you know, does nothing but now, and the consciousness is to, and I'm like, okay, this is bullshit. And then about 20 minutes into it, I'm like, yeah, no, yeah, this is amazing.

He's got some truth here in all the woo, there's truth. And then I started down this path. I mean, I have found this to be some of the most insightful, difficult material to digest. You know, you and I were joking about this before. A lot of things come easily to me in terms of understanding. I feel very blessed and privileged that whatever subject I needed to learn in school, if I decided I wanted to learn something, I could learn it kind of thing. When it comes to understanding consciousness, when it comes to understanding the nature

of my mind, I feel like a complete moron. And you could argue, well, everybody struggles with that. But it's like, no, no, I feel like I'm three orders of magnitude below the average person in this regard. It's very difficult. And for me, like the biggest breakthroughs have been catching the narrative, catching the self-talk. That's like, that's a huge breakthrough for me. I didn't realize how much I talked to myself. That was a huge breakthrough. And also recognizing the transient nature of emotions. Also just an incredible insight. Very powerful insight for someone who's so prone

to volatile emotions as I am. You know, that's funny, so I just take a personality test. I scored off the charts in volatility and in withdrawal, which is another aspect of neuroticism. And I think, and again, I don't want to, I can't put myself in your mind, but kind of knowing you the way I do, the people who are very good at learning and are very good thinkers have these subminds that are very loud. They're always pitching you ideas. It's like being in an elevator with the most obnoxious fucking startup guy in San the Silicon Valley. Okay, this is the thing, it's gonna be called Dick Lee,

and it's about taking dick picks and really democratizing them, like including vaginas and also balls, because I think balls are important, they're often missed. Anyways, that's my elevator pitch, can I have $20 million? And he gets $20 million.

It's like constantly, along with the self-narrative. So when you say I feel like a moron, I understand exactly what you're saying, because being able to see clearly through the turbulence on the top of the water to the dick at the bottom. Because that's really what it's a big dick with extra hairy balls. That's very hard. So meditation is one way.

Psychedelics are a way to jumpstart it. I know you and Tim talked about this on the show and I don't want to rehash all that, but I want to say that I think you guys are on the exact, all these paths converge. And it seems like pretty smart people are all saying the same thing, which is we need to restart psychedelic research. We need meditation as a crucial tool. I've kind of followed Tim's journey remotely. I've never met him.

But he kind of takes the classic path that a striver type A takes in meditation, which is, first I'm going to use this to help me perform better. Then I'm going to use it to quiet the demons. And I'm going to, and ultimately what me perform better, then I'm going to use it to quiet the demons, and ultimately what it is, you use it to actually understand and appreciate your mind and transform it, so that your day-to-day, actually,

all these defilements, these little voices and the emotional reactivity are uprooted permanently. And in this book, he talks about it, and having those insight experiences, it sounds very esoteric. I found my book very difficult to read, which is not to say it's not well written. I just, I think it again speaks to the problem. I mean, look, I had to read Waking Up by Sam Harris like four times.

I did too. And I think I'm at the point where I understand the first third and the last third. I still don't understand the middle third of the book, Sam. It's just too hard for me. Like I just, I don't have the CPU, I don't have the Neurhunds. There's something that I can't fully the CPU, I don't have the neurons, there's something that I can't fully understand. This is a huge problem.

You know, we talk about the ineffability, the inability to describe these kind of experiences, and it's a huge problem. I found that the mind-aluminative was the closest I got as a rationalist to understanding it, and even then, it's like shooting electrons off something and trying to reconstruct the image that this guy already ineffably feels that you know, he knows it and It's taken me a lot of repetition. I think the point is we can't give up. I still don't entirely understand

Yeah, you brought up swimming earlier. So I learned to swim as an adult so I was about 31 Wow and I decided relatively early in my flailing that like I really want to do this thing. I want to, you know, swim these long marathons. And like the amount that I had to put into doing that, the amount of hours I had to swim to catch up from being, you know, what I called an adult onset swimmer to being able to do this thing was a lot. And I used to sometimes get frustrated like at swim practice because, you know, like I couldn't swim as fast as half the people there.

And, you know, you had to sort of remind yourself, like they've been doing this since they were four. You know, these people have been on swim teams in high school, in, you know, college, blah, blah, blah, you know, there's a song by the Smiths where there's this line where Morris, he says, you just haven't earned it yet, baby. And I just love that line.

It's like, that is my mantra. Like every time I find myself getting sort of frustrated that I'm not good enough at something, I just say, you just haven't earned it yet, baby. You know, you just have, like these people have swam 20 times the number of hours you have. And similarly, when I find myself getting a little frustrated at, you know, my ability to understand consciousness,

and I always think about Sam, because he's just such an amazing teacher. I think, well, dude, you just haven't earned it yet, baby. Like, Sam's been on this journey his whole life. You know, and Sam is probably in a similar boat to us in terms of he's a hyper rationalist. You know, we use this metaphor that John Hight uses the psychologist,

Elfin and writer. So Elfin is our limbic system emotions on conscious, and then our writer is the cortex on top that's conscious. And the thinker and the planner, our writers are hypertrophy. They're super big, but they're still fucking completely beholden to this totally dumb ass elephant that's like, pissed off. Look up something online that backs me up. It's like, well, according to my data, this.

And so Sam had to get through that by long retreats. And what I find is I'm in a position in my life now where I straight necessity to alleviate personal suffering. And that happened in 2012 where I just had this break where suddenly I see things differently. Sometimes it takes that a letting go a relaxing. So something I hear in what you're describing concerns me in the sense that, and again, this is from my own experience, that it's the striving to treat this like a pursuit like swimming or anything that requires racing, that will hinder ultimately.

You'll reach a wall where you can't release until you relax into it and let it go and surrender to it. And it sounds woo-woo, but I think there's something there. So this morning, I do an hour a day now using this. And I know Tim was talking about like 10, 20 minutes a day, and that's great to start. But what I find is there's a therapeutic threshold. And I think it's around an hour, and it's hard to pitch that to people. But once you get into that mold, first you have to set that intention when you sit down, like, this is what I'm doing in this sitting. And the intention creates a momentum of those mind moments that

then drives you into the meditation. So you're not lost. When you get lost and thought you remember the intention and you come back. But at about an hour, you're in a state where the noise actually quits. And when noise appears, you recognize it and you ignore. And you're floating on the breath.

And the body feels like this pulsing wave of energy. And you realize, oh, this is all just experience happening in the present moment. And it's not even, I can't describe it, it's an insight that you have. And then it vanishes about 20 minutes after you're done, where you lose it, you're back in the world. But I'll tell you, if you keep repeating that,

I suspect if we can maintain that even for five minutes a day, it's such a relief in human self. I think the benefits even greater than five minutes a day. I mean, I think, so going back to the example you used about the psychedelics, there's a book that Sam recommended called Altered States, or Altered Trades, I was going to make some.

Yeah, yeah, yeah. The point it makes, now it's a book about meditation and it talks, I think it does a great job explaining that like exercise, the purpose of the hour you spent in the gym this morning was not because there's something particularly insightful about moving a dumbbell from here to here, here to here, here to here, isolating this muscle

and putting this thing on your back and moving it in this direction. In other words, those are simply tools that we're using. There's a state that we create in that hour of exercise, but the goal is to give you traits that last for the other 23 hours. If I would suspect you're getting a hell of a lot more than 20 minutes or five minutes of benefit thereafter, my guess is that kind of a meditative practice is infused into the other 23 hours of the day in how you react.

I mean, I don't even practice that long and I feel the difference. Like I feel infinitely less aggressive. I feel infinitely more empathic. I'm a little jealous actually. And I really feel like I need to up my game. No, I'm not saying that in a competitive way, but like realizing there was,

because I just had this discussion with Kevin Rose the other day. And he said the same thing, which is, you know, he has just totally upped his game, and he's going like 45 minutes a day. And he also mentioned that there's a real threshold you're getting over in terms of the practice and the settling of the mind.

And this is the thing. It is a threshold effect, because something does happen. People who've talked to me, they haven't talked to me in a long time, are like, what happened to you? You're so much nicer. There's something edge that's been taken off. Again, you don't know. One thing that he says in the mind eliminated is that if you practice meditation without somehow applying it in your daily life, it's like a bucket with no bottom, the stuff goes through. It's like a sieve. Whereas if you're starting to collect some of that mindfulness, and mindfulness

is just simply a lack of reactivity being able to go, oh, that's happening. Okay, instead of making A-choice, Tim said it best on your podcast. He said, you become response able. So you're able to actually make a response instead of an autonomic knee jerk to your elephant. All right, we just have to acknowledge we took a P-break. We probably forgot what we were talking about beforehand, and the last thing we were talking about was I was revisiting your dick-bick joke that was making me laugh.

So, what's up? That's right. And I realized I didn't add taint into the mix because the taint is often neglected. You know, we had a joke actually when we were admitting patients, when I was attending at Stanford, the team would come to me and go, yeah, they're trying to, surgeons are trying to admit this gallbladder to us, even though we don't do operations. They're saying it's non-surgical and it's not. I go, you know, this reminds me of when I worked on the Taint Transplant Service.

And they're like, what do you mean? You've never worked on Taint Transplant where you're taking donor taints and you're flying in and you're, you know, homeless guy dies on the street and you take excise the taint, you put it on ice and you fly it off. And I would ask them, I say, listen, is this person in the hospital for anything

other than their taint? If the answer is yes, it doesn't belong on our service. If this is for a taint issue, and a taint issue only, I mean, I'm talking about taint the balls, taint the ass, the space between those two, then it's ours. It's a simple algorithm. And by the way, the graph versus host disease on a taint transplant.

It can be devastating. It's devastating, because both your balls and your ains are affected. And when they both go down, what do you have? Really, can I pitch something to you? Because we were talking about meditation, then I wanna talk about what you do as a doctor and you can ask me anything like it.

But I wanna pitch you this theory of consciousness and reality. And I want you to tell me as a smart person what you think. All right, Dr. Donald Hoffman is a professor of cognitive science and computer science at University of California, Irvine. He was on our show.

He has posited this theory, and it starts with this basic idea, which is, do we see the world as it is? Or are we seeing some fabrication that isn't even close to reality? And he actually was able to look at this evolutionarily. He studies visual perception and how people actually perceive stuff. And what he determined through lots of different studies and also different approaches in different fields was that organisms, that sea reality as it actually is, go extinct. So if you see the matrix, as zeros and ones, you go extinct.

And the reason is it takes a lot of energy to actually see reality in all its complexity. And so the second proposition is, well, then maybe we just see part of reality, but it's still real. It's just not all of reality. And that's what most visual scientists propose. What he proposes is, based on his cognitive models and his computer models and his simulations, is that organisms that see any aspect of reality as it is go extinct in just a few generations, whereas organisms that see reality as a fitness icon designed to help them reproduce thrive.

So in other words, there is no bottle of water here as such. There's no water, there's no atoms, there's no paper, there's none of that. This is a graphical user interface that I as a human have evolved to see to help me survive. I see something wet that I know that if I drink it, I will not die. So we have this shorthand hack in how we see the world. And over and over and over he gives examples of insects who will go extinct having sex with a beer bottle because it's perfectly hacked

their interface to look like a female insect. And these male insects in Australia, these beetles, will have sex with this bottle to the exclusion of beautiful females nearby because it is so perfect. This has been hacked and advertising with humans to make things look hyper appealing. Any McDonald's ad where they're opening the burger and you see the juicy cheese and all that. By the way, the vegans hate us, don't they? All that that's designed to hack our interface.

And his theory is the interface theory of perception that every species sees reality through a series of evolved hacks that allow us to reproduce. And so here's the punch line of that. What is reality? Is there a reality? And what he argues is yes, there is. There is an objective reality. It's not we're all not just making this up. Our visual cortex isn't just constructing it. It's not something where, and he's looked at, you know, the number of neurons

in the visual cortex is way more than it takes to reconstruct an image, but just enough to construct an image. So we are constructing the world second to second in our minds every day. But the question is based on what? And if you look, he then digs into quantum mechanics and I read his manuscript of the book that he hasn't released yet, in quantum mechanics, they've pretty clearly established that there is no such thing as local realism. In other words, something doesn't exist until it's interacting with a conscious observer. It's a probability wave. So the moon maybe doesn't exist until it's interacting with a conscious observer. It's a probability wave. So the moon maybe doesn't exist

until conscious entities interface with it. But what is it that we're interfacing with? And this is what, when he described this in a TED talk, and then I read his stuff and I had him on the show, I was convinced it felt intuitively correct to me. I want to see how you feel. You may say it's bullshit. The world is actually nothing but consciousness

subdivided into things he calls conscious agents, which are little subdivisions of consciousness that sum up and break down kind of the way you can have a one bit conscious agent. And all conscious agent is it's able to it's a simple mathematical function and he has the formulas to kind of show this how they interact with each other and how they sum. The smallest one bit conscious agent is a plank length thing. The smallest thing you can imagine that can have three things. It can perceive, it can decide, and it can act. And the currency of reality is experience.

It's conscious experience. From the tiniest levels all the way down, all the way to the largest structures that we have. And so when we try to explain the consciousness, the hard problem of consciousness, how does the brain, how does this three pounds of wet goo create the experience of me seeing Peter in his cool racing hat with his kind of sexy stubble, which I wish I had, yeah, it's an icon, but I like it.

I'm gonna call it mycon, because I want it. How does it create that experience, the smell of baking, you know, bread? And the answer is we've been going about it wrong. We have to invoke a miracle in our current understanding. How do we go from atoms, neurons, to experience? Well, at some point there's a jump that no one has been able to explain.

You can wave hands. Yep. What he's saying is, how about you start with the miracle, which is everything is awareness and consciousness, and matter and neurons are icons that we use in a species specific way to understand this vast network of social, the social network of consciousness interacting with itself. So when I see Peter, I see a sexy dude, but what is really there on your insight is this vast realm of experience and perception and awareness and thought and emotion that I don't see.

What I see is my species specific hack that allows me to get through the world, allows me to reproduce, allows me to stay alive, and allows me to survive in a way because we don't have enough processing power to see what I really think is there, which is this incredibly complex series of nested consciousness all-interacting. And when you talk about books like this where they talk about subminds and meditation, what you're doing is you're taking your highest instantiation, which is the kind of aggregate of all these subminds, and you're looking and listening at those interconnected consciousnesses interacting with each other, and you're also connecting to maybe the deeper connection between all of us as a higher consciousness.

Sounds like woo, but in his formulas, he actually shows how these things work mathematically, and actually the formula reduces to the Heisenberg, sort of formula for electron probability cloud, so it's really quite fascinating. Can it be tested experimentally? Right. So this is what he's working on now. You can compute our model this stuff. And the problem is, it's as valid as any other model

because it's hard to test. So the question is, how do you test that we're all awareness interacting with awareness? Yeah, there's a famous, actually, I don't remember which physicist it was. I don't think it was Fermi, but a very famous physicist one said, all models are wrong, some are useful. That's right.

And he himself says, this is probably only partially correct. Because the idea is then, well, why would evolution even happen? If conscious agents just exist and they're outside of time and space, it's really just an important piece of this. So we're wondering about time and space, and are they real, are they an actual thing? No, they are a species-specific data compression algorithm that allow us to make sense of this social network

and allow us to survive. So space and time are different for you and me. Well, we're similar because we have the same species, as presumably, although you're probably more evolved than me. But like a dog or a cat or a fruit fly are all awareness interacting with other awareness, but the way they see the world in space and time is a totally different construct. And so all of it is constructed, which transforms in my mind, let's say it's true, and we'll talk about how we can test it, because I think we should brainstorm

ways to test it, but I think it transforms how you think about mental illness. So what is mental illness? But in our reductionist, materialist viewpoint, which we're very good as doctors at thinking, because we've been conditioned to think that, and I think there's a lot of truth. The way we do medicine now is we are really good at moving the icons around on the desktop. We know that a serotonin icon,

when put into a human icons bloodstream, does something to a subjective description of experience from that human subject in terms of depression. But what is really happening? We're like monkeys moving these icons around, but what's the transistors and the electrons that actually make it up? If the serotonin molecule is really a conscious agent, that's the sum of little conscious agents, and it's interacting with our conscious agent, that re-shifts how we think about how these medicines work,

how the mind, body, connection actually. What if that's not correct? What if the serotonin agent doesn't have the ability to perceive? So if serotonin is actually electrons, if electrons are materially real. Yeah, what if serotonin is simply nothing more than atoms with all of its constituent elements, right?

Electrons, protons, neutrons. So if that's true, then it negates the entire model because it says something is materially real. This model says there is nothing real beyond awareness itself, and it creates reality on icons that allow it to evolve. And now this is difficult stuff to grasp as scientists, which both of us are, you're much more than me, because it goes against everything we train, which is big bang happened somehow matter organized into complex structures that through which consciousness emerged. We're saying consciousness was and subdivided into these smaller agents that combined into bigger agents and evolve over time into complex agents like ourselves that interact with other agents and social networks

that probably form higher levels of consciousness. So you could actually posit what is God, but all these conscious agents at its highest instantiation in a way that it knows more than almost anything because it's a sum of all these agents. Now, how do you test it? So if serotonin is a molecule, then yes, our reductionist approach is right, and we should continue to hammer at it. If it's wrong, we should still hammer at the reductionist approach because we're moving icons. So, as Hoffman says, he says, just because the desktop trash icon on my computer desktop isn't literally a trash icon, and I'm not dragging real documents into it, that doesn't mean

I drag my life's work into it and hit delete. Just because I don't take it literally doesn't mean I don't take it seriously. So yeah, we take our icon seriously. We should know all about them, but we're going to hit a wall. And I think we're getting there in our understanding. Because until we understand what is the fundamental nature of reality, we're not going to be able to manipulate it in a way that reduces suffering, which I think is what we're trying to do, right? When you talk about health span, you're talking about the longest possible life with the most enjoyment or happiness or fulfillment or whatever their individual's goal is. And to me, that's like a lack of suffering.

No one wants to live to suffer unless you're a BDSM bondage person. Even that's not suffering because it's actually pleasure for them. So suffering is a mental construct. Pain is eternal, suffering is optional because it's how we frame it. What do you think? I don't know. It's hard for me to actually internalize that because, I mean, letting go of subatomic structures is sort of not being real. That would just require a lot more understanding on my part. Let me say this. Subatomic structures are absolutely real as icons. So in other words,

they mean something. They're an image. Yeah, I think trying to imagine that they have their own state of consciousness is You know, it's not for me to understand. It's not even that. So okay, let me let me dig into that a little bit because this is something that I have to think about a lot That's a dualist belief. So in other words The subitomic structure electron is an electron with some awareness. That's a belief called dualism. It means that there is matter and there's consciousness and they're related. What Hoffman's saying, what I think I intuit from this is, and I could absolutely be wrong, and people get violently disagreeable to this idea,

there's no electron at all. Electron is a conscious agent that we see as electron through our species specific interface. It's how we've evolved to see the world. We see it as, and we don't ever see electrons. We use equipment to intuit them. But then how would we explain physical experiments that have independently validated the same construct. Meaning. So for example, when Newton came along, he was the first to define a set of physical laws. And they held pretty well until the early part of the 20th century, when at one layer below

the Newtonian understanding, there was a new layer of physical laws that had to be described. Many of these laws have been independently validated. And I would think that if it was all a hack, meaning if we were all creating our own construct, our own icons, it strikes me as improbable that we would be converging on the same descriptions, the same experimental identifications. This is a great way to think about it. And here's how I would think about that. We have our hack, but it's based on reality. And reality is these conscious agents exchanging experience

with each other. We see it as the laws of physics. We see it as an electron binding to this and this chemical reaction happening. And of course, it will be validated because it's actually happening in the sense that these agents are behaving relationally to each other in predictable, precise ways that we can measure and science can quantify. But wait, but why would the electrons, the protons behave in a predictable way when you

and I can't behave in a predictable way? Because we don't behave predictably, Peter, because we are complex instantiations of multiple conscious agents that emerge a very high level of consciousness. So part of the reason you have these voices that are telling you you're an asshole, and I have them, is that we have,

that are unconscious to us, agents that are making decisions in the background, that are feeding it up to our higher instantiation. It's very unpredictable. It's a complex system. The simplest systems, in other words, one bit, two bit, twelve bit, a hundred bit conscious agents behave predictably because they have three actions perceived as side act.

It might be that the one bit conscious agent can only have two perceptions, two actions. And so it sums up scientifically, mathematically, as absolute predictability. But wait a second, if you collapse that to one and one, you could have a reductionist world. If you had no choice, if all of the sub particles had no choice, right, it would become a semantic game. Well, if none of the particles had a choice, meaning you were, you always knew how they were going to behave. Right, right, right. Well, then you have, it's the same as being materialist. It's saying they have no consciousness.

So that's right. The definition of this is they have choice. And here's something that's even more interesting. Yeah, which again, I just can't, so probably, realistically, that just strikes me as impossible. Yeah. Right? Because you couldn't have the order that we have in the universe

if there was any choice to be made at that level. Again, I'm saying this as a guy who's bullshitting because he's hearing about this for the first time, but that's my initial reaction is I don't understand how you could preserve any order in the universe if there was any choice to be made in that regard. Yeah, so what's interesting is when you look at actual quantum mechanics, there is uncertainty at the quantum level. There is uncertainty. But there is a predictability function. Yeah, but exactly. It's defined by a probability function.

Right. But it collapses to something that's known once it's observed. Correct. So what is observation, but two conscious agents interacting and exchanging experience that then allows this particular conscious agent to settle into a particular choice? So to me, it's not exclusive of that having choice at the smallest level. Now again, this is the simplest of choices. Yeah, exactly.

And one thing you said was interesting to me because I was struggling with this, which was, how can if we all see things differently as a hack, how can there be reality? How can there be objective, predictable, scientifically valid reality? Well, look at it this way. So he gives the example, which I think is very powerful of synestheats. So people have synesthesia, which is they experience the world very differently. They smell colors, or they hear sites, and you see colors when you hear sounds. And he gives examples of a guy who, anytime he tastes mint in his hand, he feels a basket

of ivy. And it turns out that guy is a synestheat. So his interface is a mutation. Something has changed in the way. How do you know that without functional MRI or is that the way that one can validate that? He's actually done some of that on these guys. It's interesting.

And the parts of the brain that light up with touch, light up when he's actually thinking about mint or something. So you've basically just, you've disaligned if for lack of a better word, the relationship between the external and internal sensory. The cortex is basically been remapped. There's some remapping. Now, I would argue that the cortex is an icon we use to actually

consciousness interacting with itself, but imagine that person now is a mutation of some kind that interfaces with the world differently because he can feel mint. It turns out he's a glorious chef. So he has a career as a professional chef because he's able to take flavors and tactfully feel them. And to him, it's real. That's interesting. It's like a basket, he's putting his hand in basket of ivy.

When he tastes something else, I forgot what it was. He would make a horrible surgeon. I mean, could you imagine how he could taste all of those body parts to be able to, because you know, you rely on your feelings. It's like a chilled monkey brains, Dr. Jones. It's true. So a surgeon would go extinct, having that skill,

but a chef would evolve. Now imagine evolution starts to put pressures on us where only the best chefs get laid and have sex and reproduce. Now that becomes the default. But see, to me, that is totally explainable through Darwinian biology. Right. That is completely understandable. through Darwinian biology. Right.

That is completely understandable. So Darwin is essential for this theory as well. You have to, in fact, the core universal principles of Darwinism have nothing to do with DNA and molecules. They have to do with, is something heritable? Is there evolutionary pressure on it? And those sort of things. And that works just as well with conscious agents as it does with material stuff.

So conscious agents can evolve over time to have perceptions that actually allow them to succeed in this social network where they're competing. But I mean, and again, forgive me for just not having a god damn clue what you're talking about. Why is it that if that bottle is an icon, you can't make it lift up off the table by thinking about it? Because in the social network of conscious agents that happen to be this way, that is not a perceptual decision or an action. That's why I can't you override it. Well, there are rules between how these things actually interact.

In other words, it's not a free-for-all. It's not magical thinking. It's not like, well, just because everything's aware and it's I create, like Deepak Chopra. He'll say something like, everything is consciousness. And so you can secrete, which is my way of using secret as a verb. You can secrete success and happiness and all that.

Well, that's not true. That's magical thinking. What we're saying is no. Have you seen the big Lebowski? Dude. Dude, the dude abys. There are rules, dude. Okay, this isn't fucking numb.

All right. There are rules. And the rules are these things behave just like that. You know, one of the worst parts about trying to be health conscious is that you can't drink white russians as liberally as the big Lebowski. Who says so? You say so. I mean, the Kaluah is just, if you want to proper, I mean, you could drink a Caucasian.

Yes. Right. Half and half. Yeah. Which is a little cleaner. But if you want to do it right, you got to have the Kaluha in it. And between the vodka, the Kaluha and the cream. It's just, it's the alcohol.

But I've never craved a drink. I enjoy alcohol, but I've never craved it until the first time I saw the big Lebowski, which was, got 25 years ago. I'm in the same boat. And I was like, I want to have one of those drinks. And I need to grow a mustache because I need to be able to lick that off.

So good. Oh, I just love it. So much. We should have white Russians. And that gets me this thing. Guys, could you, is there any way you could fire for a white Russian right now? Two white Russians.

Throw a black Russian in, too, just to the heck of it. We want to be equitable. And one Caucasian. And one Caucasian. And one Caucasian. We initially reconnected over your work on nutrition and diet, and we had a patient and common and so on and so forth. And you did a bunch of testing on me that really transformed how I think and know about myself.

For example, I dabbled in ketosis. Yeah, I also dabbled in pacifism. Not in numb. I dabbled in ketosis as well for probably eight months. You were in it for three years with one day exception, I understand. And I learned a lot because I learned that I make these very small dense lipid particles that didn't seem healthy.

And we ended up going to mediterranean, I did a lot better. But the idea that a white Russian would do, I couldn't do it, it was devastating to me. So it wasn't sustainable. How do you think about nutrition now? Because you have the patient panel, you're a functional medicine doc

which I want to talk about as well. I see, I see. I see a little squirm. Yeah, I don't know what to say. I don't even know what functional medicine is. I mean, I know what the definition is, but like, I don't know what I do. I don't know anything.

I mean, I know what I know, but I don't know how to put a label on it, and I don't know what I'm, all I'm interested in, I can define my objective, I can define I know, but I don't know how to put a label on it. I don't know what I'm interested in. I can define my objective. I can define the strategy and I can define the tactics. But other than that, I can't actually take an existing description and apply it to it. But the objective, which is the easiest part to state, is I want to figure out a way,

and I'll just use myself as an example, but I obviously would apply this to every patient. I want to figure out a way to live longer than I am otherwise on a trajectory to live, which means I have to delay the onset of the things that will kill me. And I want to improve the quality of my life, which I define rather simply as having three legs. One leg being cognition, the second leg being everything that has to do with the exoskeleton of my body. So the maintenance of muscle mass, the ability to move, maintain mobility, stability, which I actually think is much more important than mobility, but gets no attention I can explain in a moment.

Freedom from pain, sexual function, all of the things that people are age take for granted, but you stop taking for granted when you are in your 80s, in your 90s. Before we got started, we were looking at pictures of our kids playing instruments and stuff like that. I mean, because we're gunners, man. Well, I was your kid. I was your kid at the drummer. Oh, it was pretty awesome, man.

Well, mine's a virtuoso violinist. How about you? Well, you know. But if you think about the way you were able to interact with your kids in your 40s, and now imagine, would you be able to reproduce that in your 80s? And so a lot of stuff you took for granted, right? Like, could you lay down on the floor, play blocks or dolls or whatever, and stand up easily

or is that like a debilitating activity? I mean, if your grand kid or great-grand kid came running towards you, could you dip down into a goblet squat position and pick up a little 30-pound terror. So that sort of all is encompassing this physical part. And then the third piece, which I don't have a great name for it or anything, and it's by far the hardest to impact as a physician, because I think the first two are a little bit more within the tools that we can apply.

The third piece is this ability to be happy, as nebulous as that is, and to have what I describe as borrowing from a friend of mine, Paul Conti, who's always explains what you know Paul. Yeah. Yeah, is just to have the highest degree of distress tolerance possible. And of course, mindfulness and meditation becomes the single most important tool to impact that.

But there are other parts of that as well, social support, sense of purpose, all these other things. And as you alluded to earlier, most people, if you took those things away from them, they wouldn't wanna live one more minute. And there are exceptions to that rule. I mean, you look at Stephen Hawking, he had one of those three completely taken away,

yet for all indications lived a completely fulfilling life, and I'm sure wanted every additional day of life he could have had. But for many people, they want all of those things, especially if they at some point in time have had all of those things. So I guess the only way I describe myself, and this is why I generally like to be referred to as a shepherd or a FR2000 race car driver, is I'm a doc who's obsessed with that problem. And I have to say, having experienced what you do from both a clinician as a patient side,

seeing you with a patient and with me, you have a gift for this. This is something that very few people I've seen in medicine do, which is you look at the patient as a unique individual, you educate them in a way that sometimes is hard to understand actually. The same way when I'm talking about consciousness, we're all struggling with it. Sometimes some of the concepts that you talk about are so intuitive to us, but our patients look at us like we're crazy. But even then, this idea that you can optimize a particular regimen to the goals of that unique patient is the foundation of what we call Health 3.0, which we tried in our clinic turntable health, and it is

the same idea. And if we had clinicians like you surrounded with a team, could you do it all yourself or do you have a team? Oh, no, no, I have a monstrosity of a team actually. Tell me about your team. Yeah so I have two soon to be three people who are basically interacting with the patients on all of the logistics of what we do. We have a dietitian soon to be another probably we need two health coach dietitians. What we're realizing is that the hard part is not, I mean, it is hard to figure out what is the optimal way for a person to eat, but there is a finite number of iterations you can make until you start to converge on it.

So that's what we call the efficacy problem. By far, the harder problem is the effectiveness problem. I'm a walking experiment of somebody who knows exactly what he functions best on. Problem is I just don't want to do it. So I'm one of those guys who actually did incredibly well on the ketogenic diet. I mean, everything couldn't have gone any better. Now, whether I should have been on it indefinitely or cycled it or whatever, we don't know the

answer to that question, the point is I just didn't want to be on a ketogenic diet. I mean, I missed too many things. So now I take a totally different approach. I have a different framework around nutrition entirely that starts at one end with the sad, the standard American diet, and at the other end ends with a complete caloric restriction. So water only, which obviously you can't do indefinitely, you should cycle that. And then in between, there are three other steps. And it's one thing to figure out how to optimize a person based on how they cycle between those layers But you know like I said the harder part is figuring out how to make that the default as opposed to something you have to work into

You know, I'm influenced a lot by Dick Taylor's work in Nudge, which is The easier you can make something for someone the easier it's going to be to do and just figure out a way to make them opt out of Good behaviors rather than opt in to good behaviors. Nudge is very similar to Switch, which is by the Heath Brothers based on this elephant rider motif from John Hyde as well. And it's the same thing. You create a path for the elephant rider walk that is default good. You motivate the elephant by making them feel something like they want to change or they

want to do this. And then you gently direct the rider, the rationalist on how to make that change. And you know, when I talk publicly to, I talk about this as a model of how we can do Health 3.0 to influence change in our patient. I remember what you were asking us to do was very hard. You have to be motivated to want to do it. We happen to be. But let me ask a question, like, are fat people fat because they just don't have the willpower that it's their fault that they're fat? Or is it that we just haven't cracked the hack for how to motivate people, make the system by default better,

and find their optimal plan for them. I mean, it's such a complicated question. There's something called the Dunning Kruger effect. I don't know if you're familiar with it. Oh, but anti-vaxxers love this, because they know a little, and they think they know it. Yeah, but yeah.

Can we come back to Vax? Absolutely. Oh, can we? Yeah. I actually lost a patient over this once. Lost not died. Lost left. Lost left.

Yeah. A patient of mine had some questions about not wanting to get his kids vaccinated and came to me, assuming that I would agree with him that he should not have his kids vaccinated. And I said, nope, you absolutely should get your kids vaccinated. And I said, look, here's the one deviation I made from the protocol. We waited six months to do the first panel

instead of doing them on the first day, but that was no rhyme or reason. That was just my intuition said, give the little bastards a break for six months. But yeah, I can't imagine any reason why you wouldn't want to vaccinate your children. And he went loco. He was like, I expected more from you.

I can't believe, blah, blah, I mean, he was pissed. That was it. Like, he left, I mean, he stopped. He didn't want to ever see me again. So as someone who dabbles in the anti-vax space a little bit, to the point where people are banging on this door, shouting obscenities at me during a live show with Paul Offett, I will say this, what you triggered was that person's elephant. So their unconscious was triggered in a way where their entire conception of the world,

their ideas of liberty versus justice versus care versus harm, this moral palette that John Hight talks about, which we can talk about more later, but this idea that vaccines are a violation of the sanctity of the body, so you're putting toxins in the body, and the idea that he probably went to you thinking you were a little bit off the grid that you're looking at the unique person, therefore you're not going to swallow the dogma, right? But the truth is what he didn't realize is no, you swallow what works, and the things that have been shown to work are, in fact, vaccines, and not a whole lot of other stuff until you really look at it. And you look at supplements, you look at a lot of things,

Peter, like stuff that would give standard American doctors, or also sad, so you have the standard American diet and the standard American doctor, or sad, the hives, because you have taken yourself self-experiment with tons of supplements and you've drawn blood a million times, and you've done, you have a quantified person because you care about finding out truth for patients and also for yourself.

But this idea that you triggered that person in a way that they made a moral judgment about you that was so far off their moral compass that they couldn't tolerate stomach the idea of seeing you until we recognize how people work. We'll never be able to connect with antivacers that way because we can't imagine why people would think that way. And it's one thing to understand them. It's another thing to condone delusional and dangerous with the anti-vaxxers that way, because we can't imagine why people would think that way.

And it's one thing to understand them. It's another thing to condone delusional and dangerous thinking in public forums, like running into a theater and yelling fire. That's what the hard core professional anti-vaxxers do, and our platform has a zero quarter for that. Now I just banned them, I ridiculed them, I shamed them, I dropped F-bombs on them, I will never stop until these professional anti-vaxxers are stopped. However, the mother on the fence, the person who's like been conditioned by this stuff on I will never stop until these professional anti-vaxxers are stopped.

However, the mother on the fence, the person who's like, been conditioned by this stuff on the internet, that's where it's obligated on us to be patient. But I think that's what happened with your patient. Well, what's interesting is I'm not particularly equipped to delve into that. So I remember this discussion, because my next step was, and it's been so long ago,

God, I don't even, I don't even remember this, but I think, I mean, I don't remember all the details, but I remember saying to him, look, there was this one paper that got made this an issue, but you know it was retracted, right? Like, you know that it wasn't retracted because the calculations were wrong, it was retracted because it was fraud.

It's great fraud. And do you realize that all of this sort of propaganda you're buying into emanated from something fraudulent? Which with I think a bit more of an intellectual approach, I don't think I had the resourcefulness or the insight at the time to take an emotional approach. Emotional might be the wrong word, but less of a, let me just beat you down with more facts

and explain to you why this is right. So my guess is he was pissed not only in the fact that I was obviously a not outside the box thinker, but maybe on some level he was just pissed that, you know, I probably talked to him like an idiot. I was dismissive of him, right? You really put your finger on something that we do in medicine a lot, and I'm guilty of it. And that is speaking all to writer, trying give them data when we haven't motivated elephant or understood elephant

and unconscious motivation. And this guy, what I've started doing is sitting down and going, yeah, so why, why do vaccines bother you? Let's just take Wakefield and his study out of the equation. What is it about, about them that really bothers you? Well, they're forced on me. I don't like the idea of toxins in my body, or I don't trust the government. I don't trust big pharma. And I'm like, you know what? I don't either. I wouldn't let government run healthcare.

I don't want fully socialized medicine. I think that's crazy. But I do think that the government does a lot of things that are good and things are much more complex. But let's talk about ways that maybe we can come to it understand, because we both want what's right for the kid. It's very hard though, because we get our own emotional. I get so angry, man.

I've gotten triggered the point where I go on these exploitive, laced rants on my show. And you know what, here's the thing, Peter, you know this as well as I. It will get a shit ton of views. When I lose my shit and I'm like, fuck these anivaxes and everything they end there, everything about them. And it will go crazy because doctors will be like,

that's what I've been wanting to say forever, because my elephant is conditioned a certain way, which is caraviruses arm. I want these children to live and not die of preventable disease. When you see a case of measles, you see whooping cough in the hospital, it will devastate you. And when we're showing each other pictures of our kids, like imagine one of our kids getting measles and you didn't vaccinate them. How am I going to feel about you as a person as a doctor? So that kind of thing, it's easy and it's seductive. I like to think of the emperor and his robes going, yes, unleash your anger and you will replace your father by my side.

And just beams of dark force energy coming out. But the truth is that is not going to influence those people. And I've had to struggle with this because my platform reached a lot of people, and I get a lot of criticism on both sides of how you're being too much of a dick or you're not being enough of a dick. And it's like the truth is nuance and people hate nuance.

And you know, they hate it. And that's the thing about you, I remember, you used to get really pissed when people would be like, so what are you eating now? What's your diet? And you're like, it changes. It's not, my diet isn't your diet. And then you would say the diet. And then in the comments, there'd be people like, I thought

you were about ketones, man, you're a fraud. How dare you eat a molecule of carbohydrate? And they're super triggered because for them, this nutrition is a religion. And I've experienced that. We did a show about that documentary, What the Health? Have you heard about this thing? Yeah, I've heard about it. I've been seeing it. It says a bunch of docs there spouting vegan propaganda, cherry picking studies and saying,

this is the only diet. There's a thing, I have no problem with vegan diet. The thing is, it's not the only thing. Well, that's, you know, the funny thing, it's when you bring that up, because that's the point I try to make is, any diet that you do that's different from the sad, if you compare it to the sad is amazing.

You can't do worse than the sad. The standard American diet. You can't accept eating more of it. If you're over here on the left side of my framework, you're eating a standard American diet, which is this incredibly perfectly engineered ratio of just the right amount of refined carbohydrates, the right amount of sugars, the right amount of fats, it's like you couldn't come up with a better way to kill someone than that diet. And I'm not really into the conspiracy theory that that's deliberate.

I mean, I think the harm is absolutely not an intended consequence. It's the palatability. It's the shelf life. It's the cost. it's the all of these other things is the intended thing It's basically driven by profitability. I mean, let's just call us pay to spade as an unfortunate consequence The drug kills the user and that tends to be the case with good drugs You know eventually cigarettes are gonna kill you if you drink too much. It's gonna kill you if you eat too much sad It's gonna kill you so you're starting out here in sad land. And then most people only realize one box on the framework, which is called dietary restriction, which is when you restrict certain elements of what you can eat. Less sad. Well, it's, yeah, but it's, it's take something out of sad or reduce some element within sad.

So you don't restrict when you eat, you don't restrict how much you eat, you just restrict certain elements of it. So it's an ad-libitum diet that contains something or that is absent something in the sad. Got it. So a keto diet is a great example of dietary restriction, as is a paleo diet, as is a Mediterranean diet, as is a vegan diet, as is a vegetarian diet. These are all, they're all, so, so you think of all

of the diets that people are out there talking about. They're basically talking about one little cluster of the state space in nutrition, which is dietary restriction. No one's talked about it. Time restricted feeding, hypochaloric feeding, caloric restriction. So all of these guys are trying to nuke each other saying, my diet's the best. No, my diet's the best. My diet's the best. But what they're forgetting is they're all comparing it to sad. Right.

And guess what, you're all right. All of your diets are better than sad. I mean, that's like saying, like my pancakes taste better than that dog shit over there. Yeah, I bet your pancakes will taste better than that dog shit too. How dare you? My pancakes taste vastly worse than dog shit. By the way, that's a bumper sticker. My diet's better than sad. Like too. How dare you, my pancakes taste vastly worse than dog shit.

By the way, that's a bumper sticker, my diet's better than sad. Like, yes, it is. So they're all at this reference point that's dumb. All of them contain products. And it's relevant, it's just like there's too much focus on this whole thing. And so when people say to me,

like, do you think a paleo diet's better than a vegan diet or vice versa? It's kind of like an irrelevant question to me, truthfully. Like, if the alternative, if you're asking me, my choice is, you know, I'm going vegan or I'm going back to my standard American diet, I'm like, you better stay vegan. Yeah. Right? Yeah.

Please, don't ever deviate from this one thing if it's keeping you away from being on the standard American diet. Yeah. Well, you know, and for me, going from ketosis into the kind of of Mediterranean with intermittent fasting to now a feeding window of like once a day That I finally found a sweet spot where it's not only good for me in other words I feel better my labs are good, but I can do it and I enjoy that meal so much and it allows me to be with my family during the meal We eat together and I cheat on the weekend because I'm with my family. So it worked for me personally society that I think obesity is something

that's gonna take a multi-pronged approach and fat-shaming, I did a video where it was a short rant and it was called, it's your fault your kid is obese. And my take was this, and I love your opinion on this. So I said, listen, yeah, there are social determinants of health, yeah, food deserts exist, yeah, it's hard to afford good food. But if your kid absent a medical cause is obese,

it is fucking your fault. It is entirely your fault as a parent because you control what goes in that child's mouth. I'm talking about young kids. And they don't make decisions. They'll throw fit and stuff. And yeah, you can negotiate with them. But if you're giving them a soda or a big thing

orange juice, something like that. You gotta understand, you're just giving them a load of sugar, they're drinking their calories. And then they're obese. That is on you. You need to educate yourself. You need to understand these simple things. And a ton of people were like, yeah,

it's finally some doctor says what we're thinking. But then a lot of people push back in there like, sometimes this is fully systemic. And you're asking somebody who has poor education to do this stuff. And what were you stand on? am I wrong am I crazy? I mean truthfully I don't spend much time thinking about this problem at all anymore it has been probably three years since this was something that was in my crosshairs and as is often my want

When I'm laser focused on something it is generally to the exclusion of almost everything else So while I think that what you're describing from an end point is imminently relevant, I don't have the data to speak to it. My intuition is that it is probably not as extreme as you are stating it. I think I have over the years become more and more empathic might be the wrong word, but maybe it is the right word. Probably just a little, you know, I look at my family, for example, right? So my father knows everything I've ever thought, taught, described. My father will not for the life of him take one bit of advice from me, medically or dietarily. Is it because he's not intelligent enough to know?

Is it because he can't afford to eat the way I suggest he would eat? No. There's some other reason there, and I don't know what it is, but I also don't know that it's his fault. I don't know how to think of it in those terms. It's certainly vexing to me,

and it's probably one of the sort of few triggers that still, I have to be very conscious of not getting upset in that setting, but I just don't know. So in the example you gave, you take those parents that are giving their kids whatever. I mean, the kids still drink regular soda. Is that still, or has that been generally curbed out of system? No, they still drink regular soda and not only that. or has that been generally curbed out of system? No, they still drink regular soda, and not only that. It's on the decline, isn't it?

There are kids in this town that put, the parents put Dr. Pepper fully sugared in a bottle and give it to the kid thinking it'll keep them quiet or it's healthy in some way. So, I mean, I guess to me, it's just hard for me to say that that parent is at fault because they're not playing with the same template that you or I are playing with.

So again, if I were obsessed with this problem, I would solely be interested in changing the environment. So what is it that's making you put diet pepper in that bottle? Is it because it's cheaper? Is it because it's there? Is it because I had better shelf life? Is it because it tastes better?

And it shuts the kid up. Like, I want to understand why it's the diet pepper. And I want to figure out how it is. You can put something that's not diet pepper in there that would still check what I consider these four boxes of the default food environment. That's a nanny state Peter. People don't want you taxing sugar or preventing it from being. And again, I don't know that taxing is the right way to do it. I mean, I you know one of the things that I had thought a lot about was an experiment that never got off the ground. So when I was still involved in this world,

I used to have these sort of thought experiments and occasionally some of them become interesting ideas for actual experiments. I think this would have been one, but it would have been prohibitively expensive and I think logistically quite challenging. But it was to basically take two areas that were in reasonable proximity and similar to each other

that were both quote unquote foods, and do an experiment. So in the control group, you would give them an amount of money that was going to allow them to sort of buy whatever they want, but you wouldn't change the food environment or anything like that. So you just poured more fuel on whatever fire was there. And in the treatment group, and you, by the way, have to do this as a crossover.

So it's not a random assignment. You have to cross them over. In the treatment group, you would do a whole bunch of other stuff, which is you teach them how to cook, you give them the money, and oh, by the way, then you go into, this is the really hard part of the experiment. You go into the stores where they will buy all of their food, and you price, switch everything, position, switch, everything, and see if, switch everything, position, switch everything, and see if you can create a new default. So the cocoa puffs are no longer $2.99,

they're like $12.99, but the eggs and the avocado, and maybe the steel cut oats, like those are now super cheap. And by the way, they're the ones that are sitting in the front of the store with like the buy two for one right now, but the cocoa puffs, you can still buy them.

They're just four times more, and you gotta frickin' find them, and you gotta ask Sally where they are, and Sally probably won't even remember where they are, and they might not even be in stock. So it's like you totally changed the food environment, and the fantasy I had was you ran these one year in parallel, and then you crossed them over.

And see, this is why it's so fucking hard to study nutrition, because that's what you would have to do. Yeah, and I had done the math on how much this was gonna cost. I mean, there was a day when I used to think about this stuff so often that I sort of had what a budget for this would be. And it was in the grand scheme of things not outrageous. I mean, it would be sort of 120th of the cost of developing a new drug, but still, you know,

in the tens of millions of dollars. So we'll never do it because prevention, proactivity, looking at root causes, not something we do in American medicine. And when you were talking about giving people the tools, education, et cetera, teaching them to cook, that's what we did at Turntable. So we had a teaching kitchen in our facility. We had health coaches that would teach, you know, Winnie the Pooh, how to cook, and if we would desert on a budget without honey.

And it worked. So these patients transformed their lives and they would say, well,, Winnie the Pooh, how to cook, and a food desert on a budget without honey. And it worked. So these patients transformed their lives, and they would say, well, I really like the health coach, and I felt accountable to them, and they felt like they cared about me, and I didn't want to let either one of us down. And so this motivation component, the education component, and then going to the supermarket, what the coaches would do, look at their shopping list and go, yeah, you're fucking this up. So here's a simple thing, you know, shopping the periphery of the supermarket, what the coaches would do, look at their shopping list and go, yeah, you're fucking this up. So here's a simple thing, shopping the periphery of the supermarket, et cetera.

All these little hacks. So it got to the heart of this issue of, first of all, patients need to feel like we actually care and they're being held accountable to some degree because we function in that way. If we're just left to our own device, like you and your dad,

like your dad's like, I'm not gonna listen to my son about this shit. And that's how my dad is the same thing. I can give him advice about whatever. There's an emotional component too, but humans are humans and we're driven by these unconscious urges and processes and until we are able to understand them, we can't hack them. And since it's all conscious, it's anyways, and I've it managed. Let me ask you a question though, relating to this, free will.

Do you think it's a real thing? Do you think humans actually make these choices? Oh boy. I mean, I would say this. If you asked me this question two years ago, I would have said absolutely 100% on the free will train all day long. So people have free will, yeah. Oh, woo, woo, woo, woo, free will all day.

I am now in a gray area where I'm starting to begin to understand the counter argument. What I love about the counter argument is it's another great empathogen. That's... You know how much easier it is to go through life when you stop being a pompous piece of shit who thinks you're so good because of your own free will. You just nailed what I was going to say, which is empathogen, which is an amazing word, something that generates empathy. When I came to the conclusion that free will was largely an illusion, but I have some nuance to that. But it was Sam Harris's book, Free Will.

And this idea that these thoughts and impulses bubble up from dark spaces that we cannot nail down, I made a decision. I made the decision. First of all, the state of I is a bit of an illusion, but let's say there is an I, a little guy behind our head pulling levers, how did he come to that choice? Well, bubbled up from unconscious processes that we don't understand, states and causes and conditions. And so as a result, when somebody does something dumb, in a way, they could never have acted otherwise.

The same person molecule for molecule could not have acted otherwise. And that's a tremendous impatagen because it means instead of judging them and getting angry, you can say, let's see if we can perturb this neuronal storm to spin in a slightly more productive way for what their goals are.

And to clarify, I think one thing that someone listening to this might get confused by is that's not to say that there are consequences for the choices that are made. So if your absence of free will enabled you to decide you wanted to take a drink, you know, have a couple of white Russians and drive home and in the process you hit somebody, okay, maybe that, you know, maybe you didn't choose to do that

or choose to make all of the decisions, the bad decisions that led you there, but there will be consequences for those actions. Yes, absolutely. And this is what people who say, you know, you don't think they're free will then, the whole criminal justice is involved. Exactly. They're sort of confusing and confounding to issues. They are because you murder someone.

You made a choice to do it. You made a choice. Well, I wasn't free will. That's my argument. You're on our show. You're going to jail forever. Why? Because we need to make sure that others who also don't have free will have their subminds condition

that if you commit murder, you go to jail forever or you die depending on what state you're in and whatever your beliefs are in the death penalty. And so as a result, that deterrent reconditions the unconscious that then allows different decisions to be made. So my feeling on free will is that it's actually much more nuanced. These subminds actually have their own free will and they feed it up and it's conditioned by our downward input. So what comes out is a consensus decision.

And so in a way, yes, we are kind of in charge. Who we decide to be around. If I hang out with Peter or T, I'm going to be better for it. If I hang out with Charles Manson, I'm probably going to come with some shitty stupid ideas. If I fall into a Facebook hole where all I'm looking at is alt left or alt right or alt center, I'm going to miss, I'm going to be conditioned in a way that may be malproductive. So those things matter. There are consequences.

We should hold them. So when I do the show about blaming, I say it's your fault that your kid is obese. My secret reason for doing that is not that I actually think they're to blame. It's that somebody will watch that and go, I never, wait, what? I've been giving Dr. Pepper and the thing.

Like, it's my fault. What do you mean? And they, and they just something clicks and they go, wait, so that I'm not supposed to do that. Okay, I'm going to, I'm going to do something different. So it's a way of influencing you now. It may not work. So blame may not work. There's some data that it doesn't. And in looking at hospital errors, just culture is one of these, like blame-free kind of scenarios. And there's some data that people will hide and they won't come out and admit errors if they fear retribution. Whereas in an environment where we're trying to make the system better, it could change. So again, it's like gaming this bigger system. Totally unrelated. In medicine, did you guys do M&M all the time?

Okay. I was the presenting party in M&M at least once. And that's morbidity and mortality around. Yeah, yeah, yeah. So it's really funny. I remember the first, this is totally off topic, but just what you said about the coming out, one of the things I miss the most about being in an academic medical center is M&M. So the more British and more tally conference. So, I'm as well just explain, and I assume it's the same in surgery as it is in medicine.

What we would do is every Tuesday morning at 6am, there was no exception to this rule. There was nothing that would get in the way of this conference. All of the surgeons, the residents, the fellows, the attendings, everybody would meet in a room, and all of the complications, so the morbidities, that pertinent the morbidities, and then all of the deaths, the mortalities, would be presented. And it was a very unemotional conference. So I would stand up there, and I would say, Mr. Smith, I was a 47-year-old man who

came to the emergency room on such and such a day presenting of left lower quadrant pain. We suspected diverticulosis, blah, blah, blah, blah, blah, blah, blah, took him to the OR, did this, and then, oh, and by the way, he had a pulmonary embolism and died six days later. Okay. And so you just unemotionally present the facts and then comes the process. Okay, let's start with the basics. Was he on sub-Q Hepparin? Was he up-walking? Did he have a hyper-quagulable state?

Did you do this? Did you do this? Did you do this? And I've never been afraid of speaking in public with maybe one exception. That was a very difficult conference to present at. But by the time you were presenting, i.e. by the time you were senior enough to be the one to stand up there and present, you had seen the beauty of it and the benefit of it, which is it hurts. There's no denying it.

It's a rectal exam without any lubrication. But there's benefit. You see this. And so I remember when I left medicine, the first place I went to was to work at this consulting for a McKinsey and company, which I loved, you know, another exceptional fun chapter in my life. But I remember like, naively asking at one point, I'm like, why don't these companies do M&M? And everyone's like, what do you mean, they eat M&M's all the time? And I'm like, oh, no, no, sorry. I mean, morbidity and more telling like, why is it that there't a post hoc analysis of everything that goes wrong in a totally unemotional way that just, and the reason M&M works is it's completely closed. There is no legal recourse. So there's no hiding. Nobody who's not a part of surgery is allowed in that room. And that's sort of what enables it to be that way, which I

mean, look, if you're the, you know, if you're running a publicly traded company, you don't have that luxury. And I had the same experience with M&M. It was this horrible, painfully going up thing on this patient died because of a mistake that was made here and then having to go through that. And everybody looking at you and being like, so what you did this, did you think about this? I did, but I decided this. Do you feel like that was a correct decision?

Well, obviously not. But coming out just like, okay, first of all, I'm glad that that I was able to talk about this because you don't think I've been beating myself up about this. I'm just a second year resident. This is devastating to me. I went into this to help people. My biggest fear is hurting people and I hurt someone. And you come out so much stronger for it, even though you've been put through this ringer. And we, you're right, we don't do that in another way. It's a blame culture. Like, you get fired if you screw up in a lot of businesses.

In the hospital, nurses often get fired if they make mistakes. And the truth is it ought to be a no blame culture. What was going on in that PIXIS dispensing system that allowed that medicine to be dispensed, even though you erroneously typed it in wrong, and it was a paralyzing agent instead of a sedative. And the person died under torture in the CT scanner and you didn't check on them because

there was no protocol saying they had to be monitored. Well, we need to fix that. Was there malicious intent? Was there recklessness? Was there substance abuse on the part of the nurse of the doctor? No. Well, now we need to talk about how can we prevent this from happening and what is accountability? What does it mean?

In the setting of maybe free will not being entirely a real thing, but at the same time, us having to behave like it is or else people won't, it won't condition people to do the right thing. I love how we turn free will into M&M. I never get to talk about M&M. This is why you and me need to do a show that no one will listen to. It's just you and me about stuff we care about, you know? Having been through it all, what do you care about Peter?

Like what are you interested in these days? What's driving you these days? And how can my experience, because what I've done is so different as well, and I can't categorize it. When people ask me, I want them just to stop talking, because I'm like, I don't wanna tell you this. Yeah, you have a harder story.

I don't know that it's harder. It's just, it's more complicated in there. I don't know why I say, I'm a professional clown, because that's what my dad says. So you become a professional clown, huh? At least you're putting some non on the table. Because otherwise it's just, fuck off, fuck you. It is wasting.

You went to all the medical school and now what are you doing? You're just, you know, jacking off on this camera. He doesn't even know what that means. He just hears me say it and he's like, oh, you're jacking off. I'm like, don't say that. In mixed company, it's not something. So, you know, you're jacking off. I'm like, don't say that. In mixed company, it's not something. So, you know, you're spending your time

but you're between San Diego and New York, you're doing all this cool stuff, you're talking with like really smart people on your podcast. What's driving you right now? Personally or professionally, because there's a bit of a divide. I wanna go personally, actually. Okay, let's go professional first.

I would say professionally, I am really, really obsessed with the question of what is the appropriate dose of caloric restriction and the frequency and of the molecules that mimic that. So when you start to think about metformin, rapamycin, especially, and complete caloric restriction. So I've really lost interest in much of the junior stuff that gets close to there. So I sort of view that as filler when you're not fasting. Okay, let me interrupt for a second

for my medical audience. A lot of them are gonna have no fucking clue what you just said. So rapamycin, metformin caloric restriction, operating on the principle that a lot of studies in animals, mammals show that some form of caloric restriction increases longevity through a series of mechanisms. And there are molecules and receptors

that might mimic or be at least partially responsible for the action of this caloric restriction in terms of promoting longevity. Rapa Mison is one metformin, might be another. Yes. Sorry, I just wanted to make sure I understood because I am dumb about this stuff. Yeah, yeah, no, thank you for clarifying that.

So molecules like met Foreman, which have a net effective activating an enzyme called AMP kinase, which is a nutrient sensing enzyme, it mimics something that you see when you're being deprived of calories. Conversely, rapamycin inhibits something called the mechanistic target of rapamycin. They got very creative on the naming man.

M-tore. M-tore would be a great superhero. Sounds like a he-man bad guy. Absolutely. Skeletor. It should have been an ex-man. It should have been. So, rapamycin inhibits that m-tore, which is sort of the central nutrient sensor for amino

acids. So, again, when you inhibit m-tore, you are mimicking deprivation of amino acids. And then, of course, there's just the old fashioned way to do it, which is just don't have anything but water. And that seems to work really well, provided you do it in short enough periods of time. I mean, if you do it indefinitely, you arrive at a state called malnutrition and you die. But the problem is we don't have a clue what the optimal dose is. So if you treat caloric restriction like a drug, meaning don't eat for this long a period of time and then repeat that at this frequency, we don't know the answer to that question. Furthermore, we don't know, like, do you need to go all the way?

Could you just eat 500 calories a day for a certain period of time and repeat that at a certain frequency. So you pretty quickly realize that it becomes an infinite problem. You have the number of calories you consume, somewhere from zero to something not too big, the composition of those calories, if it's anything but zero, the duration at which you're exposed to that, and the frequency with which you repeat it. And then by the way, if you want to add a fourth variable, since we're talking quantum physics, add that whole three layer three space onto the what you consume when you're not doing that.

The problem becomes ridiculous and it's unsolvable. That's an unsolvable problem. So what do you do when you're an engineer and you have an unsolvable problem? You take a guess at states that would be discrete enough that they're not too close to each other that they should overlap that much and you would test them. So you would ask the question, well, if caloric restriction and orrapamysin and or metformin extend life, what would be some of the readout states of that? So my obsession professionally is understanding

those readout states and basically collaborating with and facilitating the funding of research to answer those questions. So there will be assays that need to be created to measure the readout states of that, including things like autophagy. So autophagy, as the name suggests, autofagy, self-eating. That is generally regarded as probably the most important, though not the only mechanistic

change that occurs under caloric restriction and administration of rapamycin. Undertaking this line of research, as you said, is very complex. And what you're ultimately trying to figure out is, really, what is the best mix of variables? Yeah, because I have a fasting routine that I literally pulled out of my ass. And I have patients that are doing slightly different ones or the same ones. And I have patients that aren't fasting at all

because it's still a bit scary. And in the end, I just sort of want to be able to give a dose response. I want to be able to say to a patient, look, if you want to go all in, this would be as reasonable or as aggressive a protocol as you might want to take. But look, you could get 50% of the benefit of that doing this and you could get 20% of the benefit doing this.

And if you stack this with this, you can do x, y, and z. So I have spent years experimenting on myself with this stuff, but the measurement tools that I have are too blunt to actually make any reasonable inference. So you need a better study. I need much better tools to measure what we care about. So that's your passion now, and you also treat patients trying to help them. Are you using these medications on patients?

Metformin, yes, rapamycin, no. Right, because rapamycin is a transplant rejection drug. Yes. Now, rapamycin gets a bit of a bad rap. It's a much safer drug than people realize. Like, I would be less afraid of a patient taking rapamycin than cyprophloxicin. Oh, well, yeah, exactly. At the right dose. Yeah, right. Exactly. And at the right frequency. I mean, I wouldn't want a patient taking rapAPA miceen at the frequency that we gave it to, a kidney transplant patient, but we certainly know enough now, based on all of the literature out there,

including literature in humans, dogs, et cetera, that RAPA miceen given at certain doses, at certain frequencies actually enhances the immune system and improves many metrics of physiology. So if you talk about giving R wrap of my SNET that dose versus giving, you know, CIPRO for a bad UTI, I'll take wrap up all day long. I mean, given how small my interaction is with patients,

because I have so few of them, the fact that I've already known to patients who in the course of their life have had tendon injuries during the course of fluoroquinealones, I've become sort of paranoid about these antibiotics, which might be an overreaction, by the way. I'm not sure it is, man, because we used to give them out like candy.

It was a moxie, sippro era when I was training, and everybody with pneumonia got that because it covered all kinds of shit. And then essentially, we didn't see a lot of tendons stuff. It might be it was seen as an outpatient. Well, it's just about to say, the research I've looked into this is, you have about a six-month window of

susceptibility to tangent injury following Flora Quinnalon. What we saw more often was a higher incidence of C. Diff C. Diff is still in a bowler infection in fact I had a picture. Have you done any songs on C. Diff? Yes. It's called Dawn of the Diff and I took a lot of rap a mice and saw a Cabusta rap about yeah, it was really dumb. It was one of our early songs, but it was all about how people will come asking with intent for a cold antibiotics and go away with a debilitating bowel infection that could be fatal. And out of the patient who died of it,

coated in the CT scanner and had a huge paraclonic abscess from CDIF. And I remember telling his son who was a marathon runner that his dad had died. I was in the ICU and it was one of the most, I'll never forget it because the whole thing was ayatrogenic. I mean, it was caused by...

One error after another. One error after another. And this is one thing I want to say because I think your listeners in particular, they're not all doctors and medical people, they may be scientists or people who care about this stuff. You don't understand how fucked up and terrible the hospital is as a place to be safe and taken care of.

It is a disastrous zone of chaos, of infection, of errors, of poor system design, of lack of coordination, and of expense that doesn't need to be done. And until we feel that emotionally in our elephant, we're going to continue to perpetuate a broken system. We have to wake up and realize, even maybe we need AI to help coordinate our care. Maybe we need better technology.

Maybe we need better processes. But none of it's happening because our incentives are still fee-for-service, which is we get paid to do things to people. And in a hospital, you can do a shit ton to people. And a hospital gets paid. Nobody's incentive eyes to make it safer, even though we all have a story of someone who we love or we took care of who died because of a medical error. We got injured because of a medical error.

So to me, this has become a recent passion. So when I hear you talk about rapamycin, I get excited because maybe we can keep people out of the hospital through the select. Yeah, I think the thing about rapid mice and it's so exciting is it doesn't just increase lifespan. I mean, if that's all it did, it wouldn't be that interesting because the US healthcare system is pretty good at increasing lifespan in the presence of deteriorating health span.

We can torture you in the ICU for years. We can keep you alive for an extra year if you're aorta ruptures if we're really willing to go all in. Heck, mow. Yeah, exactly. Yeah. Yeah. But it's the increase in health span that comes with it.

Or stated more accurately, it's the reduction in the rate of health span decline. That's interesting because it's always going to decline. You're never going to be able to do it 90 what you did at third. That's right. That's right. My intention is to sort of understand what the 20 requirements are to be a kick-ass 100-year-old. what the 20 requirements are to be a kick ass 100 year old. So consider like a new Olympic sport

is the Centenary in Decathlon. So you figure out what all those metrics are and then engineer your way back to what you need to be able to do at 40, 50, 60, 70, 80 to hit that target. So that's the second professional problem I'm obsessed with. So the first one is this whole thing around developing finer tools to probe the molecular places where we're going to see readout states on caloric restriction,

rapamycin, metformin, other agents that are CR mimetics, meaning drugs that mimic caloric restriction. And then the second completely independent obsession is codifying what does the perfect training routine look like that makes me at a hundred the thing I have in my mind. In other words, that's why I don't actually care if I can swim 25 miles today. I don't care if I can ride my bike 200 miles. I don't care if I can deadlift 500 pounds anymore. None of those things matter to me anymore.

Not that they weren't interesting and valuable and beneficial at one point in my life, but I don't think they matter enough to this centenary and de-cathlon. That makes a lot of sense and it kind of brings it back to what your goals are and how you're changing over time and we all are. That's the thing people expect something static of human beings. They expect us to be the same person we were here and here and here and here. And I think for me, that's very uncomfortable, because I think we evolve over time and are interested in evolving. I think medicine as an entity is a complex evolving organism.

We treat it like some easy system or something we can game or something. It's not. Do you have any thoughts on what you would do if you had a magic wand? How would you reform health care from a payment model? Have you ever thought about that stuff? I have, actually, but not in a very long time.

I think my answers are conceptually quite simple, but practically almost impossible. So I'll start with a story, and I've actually given a talk on this one. Before we were shooting this breeze here, I was explaining how much I hate giving talks. But one of the talks I gave was actually on this particular issue. It's the only time I've ever spoken about it

It's like a hundred years ago, but I started with this example So I had a friend who's an ex-pats who's an American but living in Saudi Arabia But he would always spend like June, July, August, September back in DC because you know, obviously it's pretty hot in Riyadh those that time of the year and I remember him saying that I don't even know how this came up It just like in the conversation that he left the air conditioning on for those four months. And he just said it like in a matter of passing, I was like, well, what do you mean you leave the air conditioning on for four months? He's like, well, like if you didn't leave the air

conditioning on, when you come back in October, like it's going to be 120 degrees in your apartment. And I was like, yeah, but you'll turn the AC on. And in like three hours, it'll be 75 degrees. He's like, yeah, but that would take like three hours of being like balls hot. And I was like, dude, I'm struggling to understand the logic here. He goes, oh, you don't understand.

Like we don't pay for our energy in Saudi Arabia. I forget what the number was. It cost like $2 a month to keep my air conditioning on the whole summer. So for me, spending eight bucks or 19 bucks whatever it was to keep my air conditioning on all summers totally worthwhile. And so we can listen to that in the United States

and we can laugh our asses off at how ridiculous that is and oh, those stupid governments subsidizing their people and that's the root of all evil in the Middle East and blah, blah, blah, blah, blah. And it's like, hey, dude, get off your high horse and take a look at the US healthcare system. It's a long story, but I basically got a bunch of data to plot out what the P&L looked like of the US healthcare system. Which turned out to be much harder than I expected. This took all of my McKinsey Ninja skills to get these data.

And if you plotted basically where the dollars come in and who makes the decisions on where the dollars get spent, guess what, we're in Saudi Arabia, brother. The people who are driving the cost are not bearing the cost. And so it's not that dissimilar from you going to the Lexus dealer and knowing that you only have to pay 9% of the cost of whatever car you get. Do you really think that the parking lot

that I'm looking at now would look as it does if people were only on the hook for 9% of the car that they got? No. So fundamentally, if you to fix the cost issue, you must be able to couple decision-making to spend. You can't have those uncoupled, and they're currently uncoupled. But the other thing that is worth mentioning, and I'll get off my soapbox on health care,

is there are two other legs of health care that often get confused with the third. So you have cost, you have access, and you have quality. And you don't get to move one without the others coming along. So you can't fix one independently. So the other thing that sort of frustrates me when people talk about healthcare, which is why I never talk about it. I view it like religion and politics.

I just, I've decided I don't give a shit at all. I don't care what anybody thinks. I don't want anybody to know what I think, although you've asked and you're stuck hearing what I think. But what bothers me is that when people talk about this, they talk about those three things like their independent variables. Whereas the moment you decide, well, Canada's got the best healthcare system in the world because of X, Y, and Z. It's like, no, no, no, that's actually not correct. You have to understand what Canada has optimized for. Canada has optimized for cost. They've optimized for quality to some extent,

and they've optimized for access, but not in the immediate sense. So the difference is in Canada, it's cheaper, and you have X, Y, and Z, but like if you want to go and, you know, like things that you and I would take for granted, like if you tore your ACL or suspected you tore your ACL, you would have an MRI within 24 hours here. That's not going to happen in Canada unless you have the money to cross the border and get it done in the United States. You could easily wait six months for an MRI there. Access to physicians, I mean, the stories are horrible

and I know this because my whole family's still there. So it's not just like I'm sort of making this stuff up. I mean, I'm seeing what they're going through. And yet there are still things that are amazing in Canada. Like when my father had an enormous operation there, I was totally impressed with his care. I mean, it was as good as care he would have received at a great US hospital and it didn't cost a penny.

And that blows my mind. Because you don't need these sort of nonsense internal accounting system that we have in US hospitals where like the cup that you collect your urine in is 78 bucks. And you know, like that bag of IV saline over there is 100 bucks and all this kind of nonsense. So the short answer is, if I get a wave a magic wand on this system, as much as I hate to say it on some level, you have to have at least a blanket called a single-payer

system. I do believe that if you truly try to individually privatize this thing, you cannot get that silly D-couple out. The second thing, and this is also very unpopular to say, is I do think we as patients need more skin in the game. Now, of course, under the current pricing regime, that would be impossible, right? You couldn't allow patients to be exposed to more than the 9% that we're already exposed to, and it's probably higher by now, by the way, those are old data. You would probably know what the current exposure is, but because the prices are so inflated and so nonsensical, and as you probably know, I mean, you obviously know this, but maybe the

listeners don't. I mean, medical cost is the leading cause of personal bankruptcy. So the answer isn't, patients need to spend more. They just need to own a greater share of the cost, which really means the total cost can't be a bullshit scam, which is sort of what it is right now. So as interesting and important as all of that stuff is, I never think about it. I love it. Yeah, here's my solution to this very complex problem and I don't think about it at all. You know what's funny? Everything you just said, I've been batting around this

quite a bit because part of what I try to do. I have a solution that I'm going to pitch you real quick. I think it fulfills most of what you're saying because our plans again converge like many things. It's strange when people think about these things independently and they converge. We've never talked about this. So my plan for fixing healthcare is this. First of all, you need to put patients in the game and the way you do that

is you give them a personal health account up to about $2,500. If you're very poor, that can be subsidized by the government. What do you use that for? You use that for primary care services or out of pocket expenses. So it's used or lose it? Well, it's used it, or maybe it grows, maybe you keep it.

But it has to be used within healthcare. So there's no incentive to not spend it. Exactly. You want to use it in healthcare. And the thing is, you want to use it for primary care. And the way you do primary care right is the way we did turntable health, which is a flat membership fee

for an unlimited all you can treat access to a relationship driven preventative minded team-based health care. That's technology enabled, but not enslaved. That's evidence informed, but not evidence in slave. You can look at the unique patient. You're not subject to metrics beyond the patient having outcomes that matter to them.

Because otherwise, they will take their money and they will, they'll take their personal health account and they'll go somewhere else. So it's people competing with each other based on what they're providing to the patient. So you would be on that plan, they would use the money to pay you, et cetera. Once they reach that $2,500,

then it gets into deductible space. So at this point, if you're a rich person, that deductible may be $7,500 or whatever it is for your family, which it is now. So it's like that now. If you're poor, it might be subsidized by either your employer or by the government to some degree, but your skin is still somewhat in the game. And so you're paying for that. Now, once you reach the deductible, that's where the catastrophic Medicare kicks in. That is Medicare for all, but not in the single pay or sense. It doesn't pay for everything. It's not like carte blanche fee for service, you get whatever you want.

It's a catastrophic wrap around, if you go to the hospital, it will cover it after you paid your ductble, after you use your personal health account. And it's given out in the administered in the same way that Medicare advantages. In other words, different entities compete to be the most efficient with that money. So in other words, if a hospital system can actually keep you out of the hospital, it doesn't spend all the money,

it gets to keep the shared savings, something like that. So you have businesses competing, you have the government covering everybody, nobody falls through the cracks, hospitals compete, doctors compete, but everybody gets to practice the way they want, you get to choose your doctor and their skin in the game, and it doesn't bankrupt the country because you need maybe another 6% tax and it's equitable but not completely unfair.

And I think that's how you do it, but the center of it is prevention primary care is the engine that drives it. And that also ameliorates burnout. And then you focus on technology that actually enables that. Quality science that actually enables that. And if you discover that, you know, there's a particular dosing of rapamycin and you have a clinic that does that, you're going to win the competition game and your science will disseminate and then other people steal it and elevate the game.

So that's my theory. I mean, it's very interesting. Obviously, I think a lot of that makes sense. The one thing that is very challenging in these systems, which are, because there's a portion of what you're describing is almost capitated. Yes, right. The challenge of these systems is, and this is why, as much as I would love to say, this should all be done privately without the government, I think the one advantage the government has

going for it, if it knows how to play its cards right, which unfortunately it doesn't always, is it owns the patient life forever and therefore it is truly incentivized to participate in a capitated way. The challenge of privatizing this is the median tenure of a patient with a payer, be it an insurance company or their employee employer, is in the neighborhood of what four or five years. Maybe less than that. Maybe less than that. Yeah, maybe less than that.

So, if you have pre-diabetes right now, the cost to normalize, in fact, if you are a newly diagnosed type 2 diabetic today, or you have naffled e today, and I know I only own your life for three or four more years, I have zero incentive to spend one penny because the macrovascular and microvascular diseases that are going to destroy your life in 20 years, I'm gonna be so long gone, I won't even know you,

I won't even remember your name. And actually this is a central piece of this, which is in this country, we medicalize our social problems. So diabetes to a large extent, you know, when these very high utilizers is a social problem, it's poverty, it's lack of job security, it's inability to excite it because they're danger in the community

of these kind of things, it's adverse childhood experiences. So as a result, if you start shunting money from healthcare into those social services like every other industrialized country does, you can actually squeeze down the overall cost. So that may emulatorate some of this, but that has to be, but that would have to be done centralized.

There is no way any entity but the government is going to do that. I agree. I agree with you. I think that's the role for government. And people will disagree. The hard-core libertarians will disagree. I don't care. Well, here's the funny thing.

I consider myself, again, libertarian is such a broad term that it doesn't mean much because you have such extremes on that, but I actually found Michael Lewis's book, The Fifth Risk, to be quite interesting. I'll check it out. I knew about half of it quite well. I actually knew a lot about what the DOE does and what the USDA does,

but I didn't have much of a sense of what the Department of Commerce does. And his book is a very depressing book, so I don't want to get into the politics of the book. But absent all of the politics, if nothing else, whatever your political views are, is simply an exercise in civics to understand what your government does.

Because we have a lot of examples of what they do poorly. I mean, and I'm as guilty of that as anybody. I get to rattle off a hundred things that they are mindlessly incompetent at. I think Lewis does a great job explaining things that they are competent at. And in fact, so competent at

that we don't realize how many close calls we have. Right. And he does that through going through what Ag does, energy does, commerce does. It's a very quick read. I think I read it in a day and a half. It was a hard time putting it down. It was so good.

A day and a half of busy work, I would. Yeah, yeah. I mean, this is why the center probably holds the truth for in most cases. That's where I am, too. I think government has a role. Listen, people will say, oh, get government out of healthcare. We can't have them in healthcare.

They're already 50% of healthcare, Medicare, Medicaid, and all this chip. They are a huge bear. Yeah, at least 50, right? Yeah, yeah. So at least 50. So think of VA, think about that. So now you're like, okay, well how can we optimize them?

And don't let them break stuff that they have no business in, but then have them do what they really do well. And I think that some of that social support is, I mean, we do well. We don't have the political on this country, I think, to come together on that. But if we did, we'd stop putting the moral distress on us as caregivers because we feel terrible.

We can't, it's a hamster wheel. You know, when I go around at the county, I did this week, every single patient there doesn't need to be there. They're all preventable, it's all social determinants, it's substance abuse, it's adverse childhood experiences, people who were abused sexually and otherwise, and that manifests as adult chronic disease.

We know this, so this is a thing. I wanna say one thing, because I think my followers and yours will wanna know how you're not scalable as a doctor. You do amazing things. How are people gonna find doctors like you that think so differently in our treating people in a way that is trying to maximize these outcomes

that you talk about? I mean, I think there are already sort of organizations that organize around this through functional medicine and things like that. I'm not being facetious. I probably get 250 emails a day. Now, obviously a number of those are directly work related, you know,

patients, colleagues, whatever. But a very high number of those, which unfortunately I just can't respond to for the most part, are, you know, through the blog or through the podcast or something saying, hey, you know, Peter, I live in St. Louis and I've been listening to your podcast or reading this and I'm interested in the way you're thinking about metabolism or this or that or the other thing. My doctor kind of rejects everything you're talking about as I have 12 minutes to see him and like it's basically refilling my blood pressure medication and that's it. Is there a doc in St. Louis that you know that you like?

And so the answer to these questions is inevitably and invariably always I don't. I just you know I don't know. Once in a blue moon I get asked that question and the person is asking it from a place that I know, and I'm like, great, I used to always tell people about you in Vegas until they couldn't come and see you. So what we're actually doing is creating a doctor database on our site. And we're making it a pain in the ass for the doctors to fill out because I want them to do some work, right? So it's like, you got to come to the site, you got to answer a lot of questions and really get into the weeds on like like how much time do you spend each month learning about this subject or that subject or this subject.

What is your process of reeducation? What is your philosophy on medicine? Because I think in about 2500 words or less and maybe we allocated a thousand words or whatever. I don't remember what it was, but we gave quite a bit of room for people to basically explain how they think about medicine, because even though I can't do it in 30 seconds, if given three minutes, I could probably provide a reasonable overview. And then the goal is to basically figure out a way to get that to be a critical mass such that it now becomes just a sort of directory for patients. So I can someone can say, if my zip code is this, boom, pull up all doctors within 20 miles and then they'll be able to go and then read about those people. And obviously, it's impossible for me to vet these physicians. So that this in no way,

shape or form means like I'm putting an endorsement on this person. Chris Cresser has done a bit of that through his work through he can at least vouch for you know so and so's taken this course. But my hope is that given the hurdle of how much work goes into that it's not just someone mindlessly saying I'm a doc, I want another you know portal of referral. If it streamlines the process for patients by 50% it's still valuable. I think it could be more valuable than that. How can my fans help with this? These are all healthcare people, activists, patients.

They should just go and sign up. So if you go to peteratiaemd.com, I don't look at my website enough to know, but I'm sure that somewhere on there, it is physician network or something like that. It's not a porn site, so you have no business on it. Pretty much, yeah. That's my criteria usually.

We've touched on this briefly, but I don't think we've done it justice, which is your music videos are at once both incredibly funny and actually at times incredibly touching. Some of them are very moving and they're always entertaining. So rather than me try to describe six of your favorite videos, we're just going to link to all of them in our show notes so that people can see them. But every time I've asked you about it, either your modesty just downplays your process or you really are a savant.

But I don't know how you actually do that. So can you just pick one and explain how you go from, there's a very popular song out there to, I have an idea that I would like to parody, to I write the lyrics to I make this video. You talk about that as though, like the same way I talk about making scrambled eggs. Yeah, it requires a little bit of work, you know, you don't wanna get the shell in the bowl.

So you want to inside the Dr. Studio with ZedogamDeez, you want to get into how I do this in essentially because- Exactly. Exactly. So much of it is like a creative process. Like for example, when I see what you do and the way you dissect a paper or the way you think about science, it's inexplicable to me because my mind works very differently. The way that I think about something,

let's use an example of, there's a song I did called Ain't the Way to Die. Yes, which is one of the, I would say three of yours that I actually find very touching because as funny as it is, if you've been there and seen it, it's a tearjerker. And I'm sure we'll link to it so people can see it.

The idea was everything we do is try to be mission driven. So the why of what we're doing. And sometimes that's unconscious. We don't consciously go, oh, what are we doing? This video is, it's more like, what's the message we're trying to get? Now, when I was working full time at Stanford, one of the most painful things I saw was that people suffered and were tortured at the end of life because nobody had the balls to have a conversation and say, what is it you want when this happens?

And be very specific. Like talk to your loved ones. The loved ones will say, he never talked about it. He said, he didn't balls to have a conversation and say, what is it you want when this happens? And be very specific. Like talk to your loved ones. The loved ones will say, he never talked about it. He said he didn't want to be a vegetable. Or the loved ones three states away and needs to come before any decisions are made, but they won't come for weeks because they think it's not urgent. But this person is on a ventilator, paralyzed, partially sedated, probably suffering, and didn't know that this was even a possibility.

So it starts from that emotional place of, what do we want to do with this thing? Then you start to think, I want to do a song about this, what would be a fit for this? And this is kind of a bit of science. You're trying to fit this sort of peg in the right hole and figuring out what's the right emotional valence, what's the right lyrical structure, and you're going through, you're maybe going through Spotify, flicking through, and then you see, and I saw Eminem, I'm like, I like Eminem. I mean, he's one of those guys that you can listen to,

you don't love it, but it's so clever, you just go, that's clever, I admire that. But he did that piece with Rihanna about domestic abuse. You know, just gonna stand there and watch me burn. And you're like, that hits you right in the elephant, right in the emotional unconscious. Okay, we can motivate the elephant, and then later we'll think about the writer,

how we direct them. So that made me feel something. It's about domestic abuse. Isn't domestic abuse the same as the institutional abuse that happens to our patients when we don't have this conversation? And then I really felt it. I was like, yeah, listen to the lyrics going, it writes itself. Then I sit down and I go through the lyrics and I create a spreadsheet. So this is a kind of a Peter O'Hall approach. I did not expect this.

Yeah, this is where my scientist inside me comes up and I go, okay, these two actually, so they'll sometimes help me with lyrics. They didn't help with this one, but my friend Harry did. He's a pediatrician. Well, they didn't get me a white rush, either, and I'm still a little... Because they're a little vex. They're pieces of shit. Faded black. Oh, he faded me to black.

I see he faded Peter to black, because Peter wants his white rush, and instead he got blacked out, which is another consequence of white rush. The dock him, the nice thing about it, like a Google spreadsheet is, you have all the original lyrics here. And so this is the problem with, you know, you get to all these emails, I get you get any emails. And they're all like, you should do a parody of OPP, but make it about ECG. You down with ECG? Yeah, you know, me, I'm like, look, that's dumb. It has no point. And they often get the meter wrong. So they're saying, here are my lyrics and the meter is totally off. Well, we were talking earlier,

we were looking at awesome vids of your daughters playing the violin. Are you musically trained? So this is the funny thing. When I was in high school, we were talking about identity in self-hatred. I wanted to fit in. I was a short little kid with a funny last name who was kind of chubby. So I always struggled with way to unhealthy relationship with food to this day.

But if somehow managed to do okay, the way I got by was I would try to find these crutches to help me fit in socially in the Central Valley of California, which is all white or all Hispanic. And here I am, this like, Zerastrian Persian weird person. I had an afro at that time, which I've seen photos. You've seen photos. I used to pray and I'm not even religious.

I used to pray for my hair to fall out because I hated my hair so much. And when it did, I was like, why God, why I was kidding. So awkward kids, so I picked up guitar as a way to try to impress ladies. Because I was like, you know what, everybody, you know, more than words, which I eventually did a parody of, by the way, call more than words about HPV.

But the weird thing is I fell in love with the instrument because I always love music and weird-al was always like a weird, because I was a nerd, I loved weird-al, and so I was just in love with this concept of parody. So I picked up a guitar, learned guitar, then I went to UC Berkeley and had this delusion that I was gonna be a rock star. So I felt like,

because Berkeley is, I mean, generally going to the best school in the state, but it's an obvious linear pathway to being a rock star. It's a one-to-one correlation. You're a scientist, but you're asking these questions? Yeah, for me, it was like, no brainer. I'll go to Berkeley just to please my parents because they want me to go to a real school and it's not Stanford. So I don't have to spend all the tuition because my dad was like, I do know what? Berkeley is just as good and cheaper. I'm

like, it's actually not that. Here's the secret. It's really cushy. Okay. It's really cushy. So all that being said, I minored in music and I majored in molecular biology because I was like premed with the hedge that I'm the rock star. I like it. And increasingly it became clear that I didn't have this thing called talent.

I didn't have enough drive and talent and ambition in that line of intelligence music to be famous. There were so many kids that were so much better than me and I knew it. And the thing is rather than beat myself up about it, I'm like cool, I'll be a doctor who plays guitar on the side. And that's what ended up happening. And so I

actually made it, I did ethno musicology. So it was like studying like the music of Indonesian, all these different musical forms. And it turned out that was the perfect conditioning of my subminds, these little conscious agents, to later in my depths of burnout, all this music came back out. And the weird al component came through. So here I am as a professional weird al now. I'm going, okay, here's my spreadsheet. On the left, I have the original lyrics to Eminem in their structure and the right, I have a blank space. I come up with the title and then I reach out to my friend Devon Moore, who's our audio engineer, who's just a genius. He's like a professional musician and he just, we met in Vegas and he's like, this is how we do

things. I want to do your stuff because you suck at producing the songs because I was doing it on Garage Man. So he creates the backing track and he did that in that case. He sends me the track, then I have the feel of it. Then I'll sit there with the original listen to it and I'll just start coming up with lyrics. In my mind, I may have some notes. I needed to hit this point and this point and this point. And then I'll brainstorm and usually this happens, my creative process is I get on a treadmill or a stairmaster where I run, and that silences the monkey mind on top so that the unconscious, which has been processing the stuff in the background, starts to bubble up these ideas. So these little clever phrases or little things that I remember from the ICU or a case that

I remember, bubbles up and then I start to put it into the structure. So from open creativity to codified structure with parameters. So the nice thing is there's a parameter, there's a structure in the song already that I can't violate. So that bit of constraint allows me actually to excel at what I do. I need that constraint. If it's just open, I will fuck it up because there's too much possibility and I'll mentally masturbate for hours and it won't come out. So having that constraints helpful, then I put it in thing, then I show it to friends, then I go back, and then this is the thing.

The rewriting process of lyrics is even more important than the initial writing. So it's going back and that one word is just emotionally wrong or it feels musically wrong, and you tweak it, and tweak it, and tweak it, and get a source out. You go to rhyme zone, and you find better rhymes, and then you hone it. And when it's done, then I go into that studio, which is right there, which I won't say

the name of it because it uses the R word, but it has Tartus in it. It looks like a Tartus from Dr. Who, but it's not okay. It's a developmentally delayed Tartus. And I record it. And then Devon mixes it and then we put it out. Okay, so put some time on that for me. From the moment you picked the Eminem song, what was the length of time from the idea,

I wanna do a song on this topic to choosing the song, a prox. A couple days. I wanna do the topic. Often it is. Okay, and then from the moment you pick the song to strip the lyrics out, make the spread sheet, do the runs, write the song, is how long?

lyrics out, make the spread she do the runs, write the song is how long? In this case it was about one or two weeks. In the shortest case it's a day, I do it right then, and I have friends and they help me in the team here, Tom and Logan. If it in the longest it's been a month where I'm just pounding my head on the shit and there's no time for anyone. And do you ever in that process say I picked the wrong song, I gotta go back? Yes. Our history is littered with half completed projects where there's actually a track

and it's just dump for example we were going to do Amy Winehouse rehab about skilled nursing homes. Oh interesting. I try to make me go to rehab. I won't go go go yes I fell bad but I got 12 cats at home, home, home, the little old lady who won't go to sniff. That was dumb. And the more we tried to make it work, the less happy we were. Now then we may come back to it, but yeah, so sometimes we just fail. But ain't the way to die, it just kind of started to happen. Oh, yeah, that's, that's a...

And the more we realize we got the sense, if you know that sense of moral elevation, you get in your chest where you feel something hit and it raises you in this way where you feel it expand. It sounds very woo-woo, but it's a real human since John Hyte and others have talked about the sense of moral elevation. Like, I've done something here. I've tapped into some ethos that will help people. And recording a song like that is done in one day?

It depends. So that one we did over a couple of days, I went to Devon's studio actually and we just kept banging it out. And he would coach me to sit there in there in the engineer space and be like, you know what, I'm not feeling anything with that. Try it maybe this way and then we'll do like 30 takes. Oh my God. And then he'll be like,

that's it, I got goosebumps, that's it, that's it, right? How does one do that? Like if you said to me, can you repeat something six times? Like I wouldn't, this is the thing that's always amazed me about acting. I don't think I've appreciated it as much about singing,

but, you know, if you've ever been on a set to actually watch a movie being made, and there's like a list actors there, which I've had the privilege of doing once or twice, I'm amazed that, first of all, an entire day of shooting produces 60 to 90 seconds worth of a movie. That's how many times things are being done over and over and over again. And it's to watch the actors and actresses show up with the same level of emotion, the same emphasis, correcting maybe whatever the director says to correct. I'm like,

well, that's another great reason why I could never have done that for a living. And these are professionals that are really good at that. Now see, I'm an unscrained amateur. I like comb myself with Pro Am. Cause you know, it's one of those things where I get paid a little bit here and there with ads and stuff, but really I'm just, you know, it's for the love of the game. But the truth is, it's a craft for me and the finished product matters so deeply to me

that I cannot put out a stinky piece of shit. I've done it and I've regretted it. And sometimes I put something I think is good and retrospective, I think it's crap. Sometimes I think it's something that's crap and it turns out being great. But ain't the way to die was one of these things so I can't fuck this up.

So you do, in 2030 takes. And you'll see is they're all sitting there in logic. That's the program we use and you just take, take, take, take, take. And what we'll do then is we'll comp sometimes. We'll say let's take the best of this first verse. Yeah. Best of that. And some people think that's cheating,

but that's how most people do it now. I didn't realize that would be thought of as cheating. So some of the purists in the old school musicians say, well, no, you just got to go on and sing it live. And that's how you do it. But that's not how anybody does it now. Because you are trying to produce the best piece of art you can.

And what's fascinating, actually, Peter is, again, I'm not a trained musician. I don't sing. I don't rap. It's something that I had to figure out. I used to be really bad, and Devon would tell me, you really suck. Like it takes 30 takes just to get it to sound good. Have you thought about taking voice lessons?

And I'm like, don't insult me, dude. What's up? You can't train a voice. That's bullshit. You have to, it's stupid. And then I went and got voice lessons. There's just a few lessons, and then these CDs that I kept doing. And this is a thing, man, the voice, like anything, is a performance instrument, it's a muscle.

And the vocal cords get stronger, your control gets better, your breath control gets better. So the way you breathe for singing is so different than the way you would normally talk or anything. And that helps when you do speaking because you don't get horse, you warm up right, you project better. So I'm a tiny little person who can project is damn voice.

Yeah, but you also, as a rosterine, you come from the lineage of the greatest singer of all time. We are the champions. Exactly. Freddie Mercury. Oh, God. And Zubin Mehta, who I was named after as conductor, it's a musical lineage.

Are people, my people call it Maze. Peter Athea, do you remember that commercial? It was an old Missola commercial in the A.E. It was that they had a Native American guy in the head dress. Oh, he's sitting in a boat and he's eating corn and he's like, my people call it Maze. And it was like, Mozo, ho-la, corn goodness.

Anyway, so I trained my voice. And so now I have to do less takes and I'm able to go live. So even though we do this art where we're cutting it up in the studio, when I have to perform the way to die live, which I do 50 times a year when I do my live shows. Oh really? Yeah, so I do that one, I do seven years. I could do about 20,000 times. Oh, so you're hitting on all the killers.

Like, seven years is, I think the most touching of them all. Seven years in my favor. And Tom was the genius behind how to Tom and Logan back there. Genius of how to cinematographize that and the emotion of it. We're sitting in the edit, speaking of that. So the edit, there's... Those were your kids and those are my kids. That's your my clinic It's my family. It's my wife. It's my dad So it was a personal thing and we're sitting in the edit on the apex where that you're pushing in on my daughter

And it's like you know soon I'm a 60 years old and it's all emotional piece and we didn't feel it We didn't feel it. We didn't feel it and then we're like it, and then we're like, how about this? Trim that. One microsecond here, all of us are crying. Wow. We're like, okay, that's it. Hit send, that's the thing. That's the process. And it's the same with the musical piece.

So then, once you do it, you may craft this thing here, but when you go and do it live, it takes on a whole new persona, because you have this input, and you're doing it in one take, and that's where I think the real artistry starts to try try to how I'm calling it artistry is I'm a fucking professional clown. But it feels like that on stage because you're seeing the synchronization of the audience with the message people are crying, you're feeling this energy and afterwards they'll tell you this is how you made me feel during that and I'm a 20 year veteran I'm a 30 year nurse or I'm a 40 year RT or whatever it is and that's what really gets you. So all of that is for this. That's the process. Then we'll put it out.

Then we'll brainstorm the video. Then we'll go beg our hospital to let us shoot. Extras are all real medical people. Nobody's paid. We'll go and do it. We'll rent the equipment. We'll get the crew and we'll do it. And how long does it take you to shoot,

say those two videos there? It's like a day. Yeah. Because we don't have a choice. Because we're operating in a real hospital with real patients running around. So we have to go to a wing where maybe they're not on overflow right now, so we can do it

and they're kind enough to let us do it. And then maybe they'll kick us out because they have a - You have extended the invitation to me so many times to be in a video. I just, I gotta take you up on one of these. I'll be the guy that just like walks by and no one will even see me. We're doing a parody of the Bear Naked Ladies one week.

I don't know if I sent it to you. You remember that song? It's been one week. No, hang on as I, you don't realize this. I went to high school with the bare naked ladies. Fuck you. Yeah. Their dad was our guidance counselor. The Kreegan brothers, right? Andrew and Jim. No, he was our guidance counselor. Oh my God. Yeah. So I saw them in 1991 and Berkeley in a small little club before they were famous and I was like, these guys are gods. You know, this is me and great non-baby. Yeah. This. Oh my God. And notice it's grade nine,

not ninth grade. No, because it's Canada. It's can it grade nine yeah so i always love the bear naked ladies one week wasn't my favorite song but i i wanted to do a tribute for foreign medical graduates from india and south asia like my parents but we were doctors and i'm like one seek we'll make it about doctors and so this is one where it just right Tom. We were just like Here the lyrics. It took a second. It was like there's this one seek in the doctor's lounge a punjavi guy Who's name no one can pronounce for James and emergency saying get that condolga away from Dr. Mukherjee and when the rap comes up It was like you know Tika masala the desi chicken you have a drumstick Your heart stops ticking of watching Bollywood with no lights on.

Check out Amir Khan. He does a slow-mo running this one, like Bobby Jindal, I'm trying to act white. He's not just staying right, because I always drive Camry. So we're shooting that in Texas next month. So you should come and be in Victoria, Texas, this tiny town on the coast about an hour from Austin.

I know you have homey's in Austin Yeah, I got really flying into Austin. We're renting all the equipment. We're going to this cardiology clinic that this Indian doctor couple runs They heard the song. They're like we want to be in it, okay? But I've heard and so we're gonna shoot it there. So you should come and be an extra on that All right, well when we're off mic, I'll ask you for the details so that we don't let all the fans in the world know where we're gonna be That's a great idea. Yeah, we don't want the anti-vaxxers to show up. To these poor people's clinic. Oh, that would be terrible.

So that's more or less the process. Well, I got to say, I mean, if nothing comes of this discussion other than a set of people who are not familiar with you, I.e. a subset of people who listen to me who don't yet know who you are, figure out who you are. That's worth everything. In fact, I almost feel bad that we took up all this time because what I could have just done is said, today's podcast is going to be really short. It's just going to be me telling you go check out all of Zubin's stuff because that's effectively the most important piece of this to me. Well, that's effectively what I'm going to tell my followers, which is Peter Atia is doing brilliant work in the space

that nobody else is doing and the people that are collaborating with them are amazing and you need to check him out. And also, he's my homey from way back. And we don't give an F about a damn thing. That's one thing that separates us from some other so-called doctors. All right. Am I right? Brother, it has been a lot of fun.

This has been long overdue. By about two decades. Yeah, I think. So it has been a lot of fun. This has been long overdue. By about two decades, I think. Yeah. So it's been a real pleasure, Peter. Thanks so much. Thanks for hosting me, guys. This is the fact that you didn't bring me a white Russian. I still love you over there.

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