Latest / The LIVING Room Podcast | Inside The WNDR Lab / The World's 'Most Measured Man' Stanford scientist on the future of Genomics and Wearables

Transcript

The World's 'Most Measured Man' Stanford scientist on the future of Genomics and Wearables · The LIVING Room Podcast | Inside The WNDR Lab

0:00
SPEAKER_00: Medicine's most measured man.
0:02
SPEAKER_05: Measuring people while they're healthy and then taking corrective action while they're healthy.
0:06
SPEAKER_05: It's empowering.
0:06
SPEAKER_05: Yeah.
0:07
SPEAKER_05: Almost impossible to cure a disease when it's a very late stage.
0:10
SPEAKER_00: Especially when the diagnosis and treatment are so broadly applied to everyone.
0:14
SPEAKER_05: And from this group of 109 people, 49 had a major health discovery.
0:19
SPEAKER_05: So having that information is very valuable.
0:21
SPEAKER_05: And I think the deep data dives, like is done here, is very, very powerful because it really does give many more pieces of the puzzle of what your health looks like and how it's shifting.
0:31
SPEAKER_05: I figured out my Lyme disease from a smartwatch because my heart rate jumped up and my blood oxygen dropped.
0:36
SPEAKER_05: Well, there's 12% of the US population is diabetic.
0:39
SPEAKER_05: 20% don't know it.
0:41
SPEAKER_05: Right.
0:41
SPEAKER_05: And 40% are pre-diabetic.
0:44
SPEAKER_05: Physicians were mad at me.
0:45
SPEAKER_05: I even had one yell at me and said, you should not be doing this.
0:48
SPEAKER_05: You are going to make everybody in the hypochondriage unit cost millions of dollars.
0:51
SPEAKER_05: This is not right.
0:52
SPEAKER_05: We did it anyway.
0:53
SPEAKER_05: I think the baseline is very, very important.
0:55
SPEAKER_05: You can track people's trajectory and then again optimize them.
0:59
SPEAKER_05: In some cases, it turned out to be life-saving.
1:01
SPEAKER_05: One person had a heart defect.
1:02
SPEAKER_05: We picked that up from his genome sequence.
1:04
SPEAKER_00: If I had$1,000 to spend on tracking, managing my health, what would you spend it on?
1:10
SPEAKER_05: Number one.
1:27
SPEAKER_00: I want to start by referencing the fact that if someone Googles your name, it comes up with a statement, Medicine's Most Measured Man.
1:37
SPEAKER_00: And I know this because I just did it.
1:39
SPEAKER_00: Can you explain how that has come about?
1:43
SPEAKER_05: Sure.
1:44
SPEAKER_05: Well, we've done big data research for a long time now, initially studying biological problems.
1:50
SPEAKER_05: And then 17 years ago, I moved to Stanford and wanted to move into healthcare.
1:55
SPEAKER_05: And very quickly you realize that our healthcare system's broken.
1:59
SPEAKER_05: We practice sick care rather than health care, meaning we keep people alive rather than healthy.
2:05
SPEAKER_05: And as a consequence, you know, people live the last decade of their life with chronic diseases, usually pretty unhealthy.
2:11
SPEAKER_05: And so we were thinking about it and said we need to apply these big data issues to medicine.
2:17
SPEAKER_05: But then even looking at more, uh, when you think about how we practice healthcare, that's also broken.
2:23
SPEAKER_05: You typically go to a physician's office, always in an inconvenient time.
2:28
SPEAKER_05: Uh when you're there, they don't make very many measurements.
2:30
SPEAKER_05: That's where the big data comes in.
2:33
SPEAKER_05: Um they, you know, the whole process is very antiquated and it's very low-tech.
2:39
SPEAKER_05: And so um we wanted to change all that.
2:41
SPEAKER_05: And so basically, when I moved to Sanford, we set up this idea of doing deep data profiling.
2:47
SPEAKER_05: Um, and I was a guinea pig.
2:49
SPEAKER_05: I thought we should do it on me first just to see what it takes, uh, get all this going and get the technology up and running.
2:56
SPEAKER_05: Genome sequencing had just come out then.
2:58
SPEAKER_05: It was all brand new.
3:00
SPEAKER_05: And we had methods for analyzing literally tens of thousands, if not more, molecules out of blood and urine and even poop, uh the microbiomes.
3:09
SPEAKER_00: Nice.
3:10
SPEAKER_05: So we basically did just that.
3:12
SPEAKER_05: We started um uh essentially collecting blood, urine, and stool initially from me, and then later from a small group of people, about 109.
3:21
SPEAKER_05: And we would then measure as many molecules as possible.
3:25
SPEAKER_05: Wow, the blood, uh their RNA, their metabolites, their proteins, their lipids, so all these different molecules.
3:31
SPEAKER_05: And now the microbiome we would basically sequence and see what species are there.
3:36
SPEAKER_05: Uh, and even though a lot of this is exploratory, it wasn't clear, it still isn't 100% clear how the microbiome affects your health.
3:44
SPEAKER_05: We know it's important and we know some things about it.
3:47
SPEAKER_05: There's a lot more to discover.
3:48
SPEAKER_05: Yeah.
3:49
SPEAKER_05: But that was the idea: get this going, get it rolling.
3:52
SPEAKER_05: And very quickly, we discovered that data was very useful.
3:56
SPEAKER_05: Me, I discovered my diabetes.
3:57
SPEAKER_05: It was the risk was predictive for my genome sequence.
4:01
SPEAKER_05: Uh, we discovered my Lyme disease through careful monitoring and several other things as time has gone on.
4:06
SPEAKER_05: And from this group of 109 people, 49 had a major health discovery, meaning we caught someone with early lymphoma, two people with pre-cancers, one which later turned to aggressive cancer, two people with serious heart issues.
4:20
SPEAKER_05: And the less, first of all, they were all found pre-symptomatically, meaning people had no idea this was going on.
4:26
SPEAKER_05: So we picked these things up.
4:28
SPEAKER_05: Uh, and then in the case of pre-cancer, we used more monitoring than on that person.
4:33
SPEAKER_05: We called it one turned to aggressive cancer.
4:35
SPEAKER_05: So um it's turned out to be very, very powerful.
4:38
SPEAKER_05: And the other lesson that was learned was no one technology did this.
4:41
SPEAKER_05: Sometimes the genome sequencing predicted people's risk.
4:44
SPEAKER_05: Like someone had a bracket mutation, someone had a heart defect that we figured out from the genome sequence.
4:49
SPEAKER_05: We still had a mutation, said something may not be right here.
4:52
SPEAKER_05: They did a follow-up, sure enough, they had a heart problem.
4:54
SPEAKER_05: Young guy, too.
4:55
SPEAKER_05: Uh, he's on medication now.
4:57
SPEAKER_05: So, this the power of data is that you can, if you dive in deeply while they're healthy, you can get a good profile on what their health should be.
5:05
SPEAKER_05: Upstream of disease, known upstream of disease, yeah.
5:07
SPEAKER_05: And then take corrective action uh, or minimally at least do more careful monitoring.
5:12
SPEAKER_02: Yeah.
5:13
SPEAKER_05: And that's how it all rolled out.
5:15
SPEAKER_05: And so the werewolves came on a few years into this project.
5:18
SPEAKER_05: They were fitness trackers.
5:19
SPEAKER_05: We said, these are pretty powerful health monitors.
5:21
SPEAKER_05: Why don't we put them on our cohort?
5:23
SPEAKER_05: And right away we can tell when people are getting infectious disease, respiratory viral infections.
5:28
SPEAKER_05: Uh, my case, Lyme disease.
5:30
SPEAKER_05: I figured out my Lyme disease from a smartwatch because my heart rate jumped up and my blood oxygen dropped.
5:34
SPEAKER_05: You can measure all this with a smartwatch.
5:36
SPEAKER_05: It's pretty powerful.
5:38
SPEAKER_05: It's very sensitive, it's more sensitive than the COVID tests, actually.
5:41
SPEAKER_05: Now, it's not as specific, just to warn you.
5:44
SPEAKER_05: Uh so we set up an alerting system.
5:46
SPEAKER_05: We published the first part of this before the COVID pandemic, 2017.
5:50
SPEAKER_05: And then the pandemic hit in spring 2020.
5:54
SPEAKER_05: And uh, we quickly, you know, set up a COVID detection test that where you got red alerts.
5:59
SPEAKER_05: But it measures more than COVID.
6:01
SPEAKER_05: It measures a shift from your baseline, and that's the lesson.
6:04
SPEAKER_05: So it'll pick up mental health stress, things like that.
6:06
SPEAKER_05: In fact, that's the number one trigger of red alerts.
6:09
SPEAKER_05: That's the alerting system we set up.
6:10
SPEAKER_00: So it would notify you when you went out of range for one of the basically, yeah.
6:16
SPEAKER_05: So it's tracking your baseline in a circadian fashion, because these things normally fluctuate through the day anyway, and you just normalize relative to that, meaning you look at your reference relative to your baseline.
6:29
SPEAKER_05: And sure enough, if you're up, if you're out of range too high too long, something's off.
6:34
SPEAKER_01: Yeah.
6:34
SPEAKER_05: And you're either mentally or physically stressed.
6:37
SPEAKER_05: And so we know in the future with some additional kinds of data, we can distinguish you know, workplace stress, which is the one number one trigger of red alerts, yeah, from say a respiratory viral infection.
6:48
SPEAKER_05: The older watches didn't have that, but the newer watches, they'll measure respiration, all these things that can distinguish those.
6:55
SPEAKER_00: It must have been, it must be so remarkable to see how quickly that has changed over time.
7:00
SPEAKER_00: I mean, this was 17 years ago you started.
7:02
SPEAKER_05: Uh when I, yeah, when we started the big data approach in general, the wearable is more like about 12 or 13, I think.
7:09
SPEAKER_00: So you must have had to determine yourselves what data mattered and why it mattered as well.
7:14
SPEAKER_05: As part of what we did, we collected as much data as possible.
7:17
SPEAKER_05: We weren't sure which data types would be most valuable.
7:21
SPEAKER_05: Um, you know, everybody's pushing on the genome sequence because that was something that was just coming out that people could do, and that is valuable, don't get me wrong, predicting your genetic risk.
7:30
SPEAKER_05: But it turns out we think that the proteomics, meaning measure of all proteins and metabolomics, measure of all your metabolites, are quite powerful, in fact, for predicting uh disease risk, but also for seeing how you age, it turns out.
7:44
SPEAKER_00: There's hey, on that note, sorry to interrupt you there, but I think for the audience, it would be good to get an understanding of what what are multiomics because I think everyone will have heard that at some point.
7:56
SPEAKER_00: Sure.
7:57
SPEAKER_00: And maybe felt like they should be doing a test.
7:59
SPEAKER_00: Can you maybe at a high level just explain what that even means?
8:03
SPEAKER_05: Sure.
8:04
SPEAKER_05: So your genome is your collection of your genes.
8:07
SPEAKER_05: It's your DNA sequence, basically.
8:10
SPEAKER_05: And then there's something called your your transcriptome.
8:13
SPEAKER_05: That's a measure of all your transcripts or RNA.
8:15
SPEAKER_05: So your genes make RNA, which in turn mates protein, which in turn mates metabolites.
8:20
SPEAKER_05: Yeah.
8:20
SPEAKER_05: Although some metabolites you get by eating.
8:22
unknown: Yeah.
8:23
SPEAKER_05: So some you make, some you ingest, and others you breathe and things.
8:27
SPEAKER_05: Those are sometimes that's good, sometimes that's bad.
8:29
SPEAKER_02: Yeah.
8:30
SPEAKER_05: Um, so the um anyway, the the when we measure the ohms, if you will, we'll take blood and we'll measure all the RNA that comes from the genes and then the proteins that get made.
8:43
SPEAKER_05: So for example, and it turns out that when your organ systems are are failing or aging more perhaps faster than they might be, they release cells dye, and they actually release some of these components into the blood.
8:55
SPEAKER_05: We can pick that up.
8:57
SPEAKER_05: And so we can actually track people's health to some extent.
9:01
SPEAKER_05: That's how we found some of these things that were, you know, again, we call them outliers, these these proteins or metabolites.
9:08
SPEAKER_05: Your metab your metabolome is your collection of metabolites, your proteomes, your collection of proteins.
9:14
SPEAKER_05: And so we we can measure all these and we see when things are off.
9:18
SPEAKER_05: And that can give you clues as to what organ systems are off, and it can also give us clues, as I was mentioning, to aging.
9:25
SPEAKER_05: So it turns out we all age differently.
9:27
SPEAKER_05: So when we did these profiles, we actually tracked this and we would see that, well, some people there are pathways that were changing where there are cardio hypertrophic signaling pathways.
9:36
SPEAKER_05: Basically, their heart cardiovascular disease systems were changing.
9:41
SPEAKER_05: And for other people, it might be their kidney, and for other people, it'd be their immune system.
9:46
SPEAKER_05: Others say oxidative stress.
9:48
SPEAKER_05: It could be any one of those things or combinations thereof.
9:50
SPEAKER_05: You can have multiple things happening.
9:52
SPEAKER_05: And so we could pick this up in the blood and see we call them agites, what people's aging patterns are across their different systems.
10:01
SPEAKER_05: Yeah, basically.
10:02
SPEAKER_05: So if you're a uh kidney ager, there'll be certain markers that'll show up in the blood.
10:07
SPEAKER_05: If it's oxidative stress, there'll be other markers and so on, an immune system.
10:11
SPEAKER_05: And so we pick all this up.
10:13
SPEAKER_05: And these days with AI, you can take your data as well as the data that's in the scientific literature, yeah, and combine them and basically make very specific recommendations, not just exercise more, eat better, but they give you things that you should eat that you may not have even thought of or heard of.
10:32
SPEAKER_05: In fact, that's happened for me where it said these things I had to look up, and sure enough, uh I tried them.
10:37
SPEAKER_05: And 95% of people who do these tests, they basically improve their markers when they uh get these recommendations.
10:44
SPEAKER_05: So we think this information is powerful.
10:46
SPEAKER_00: Yeah.
10:46
SPEAKER_00: We do, we do also when we do these tests, and you know, I built this with you, in fact.
10:50
SPEAKER_05: Yeah, that's right.
10:51
SPEAKER_05: One of the companies re-founded, yeah, yeah.
10:54
SPEAKER_00: Um, and I think, and I've spoken about this on the part in past episodes.
11:00
SPEAKER_00: I love that we're getting higher resolution on our own biology because that is what gives us agency, right?
11:05
SPEAKER_05: Absolutely.
11:06
SPEAKER_05: It's empowering, yeah.
11:07
SPEAKER_05: And I think that's the power of measuring people while they're healthy, yeah.
11:11
SPEAKER_05: And then taking corrective action while they're healthy.
11:14
SPEAKER_05: It's almost impossible to cure a disease when it's very late stage.
11:17
SPEAKER_00: Yeah, especially when the diagnosis and treatment are so broadly applied to everyone.
11:23
SPEAKER_00: Yeah.
11:23
SPEAKER_00: Right?
11:23
SPEAKER_00: You know, if if we one size fits all.
11:25
SPEAKER_00: Yeah, if we age at different rates across different systems of our biology, it's very difficult to say.
11:30
SPEAKER_00: Yeah, one size doesn't fit all.
11:32
SPEAKER_05: Yeah, and we know that treatments aren't the same for different people, and how you best keep people healthy, people's reaction to food, all very personal.
11:40
SPEAKER_00: And you don't know what you don't know, right?
11:42
SPEAKER_00: And so I think that knowledge is power, and having that knowledge is powerful.
11:46
SPEAKER_00: And so, would I be right in saying that, you know, when we are healthy, if we have access and the resources to take these tests, we are effectively getting more pieces of the puzzle so we can get a much clearer picture of our health, such that uh not only if something goes wrong, we can take uh higher resolution action, but also we can make sure things continue to go right and even better than right, maybe.
12:10
SPEAKER_05: Yeah, no, we uh many people they call them optimizers, they're always trying to perfect their health to some extent.
12:17
SPEAKER_05: I am.
12:18
SPEAKER_05: Um and but I think we all should be taking more charge of health because nobody's gonna understand your health better than you.
12:25
SPEAKER_05: Yeah, the physician has 15 minutes to be with you in a doctor's office, and that's not enough time to learn all your background and then relay.
12:34
SPEAKER_05: I mean, it does give some useful information, but it's not what like what you could do, especially with these devices now, the wearables and other things.
12:43
SPEAKER_05: You can bring in this information, track it yourself.
12:46
SPEAKER_05: It the platforms aren't as user-friendly as they could be, and I but I think that'll come.
12:51
SPEAKER_05: This whole area is so new, it's just it's yeah, it's the beginning.
12:55
SPEAKER_00: It feels like it's moving very quickly, right?
12:57
SPEAKER_00: Very quickly.
12:57
SPEAKER_00: Even if I think back five years or so, you know, we weren't standing behind that data as much as we do now, right?
13:05
SPEAKER_05: Yeah.
13:05
SPEAKER_05: So I think people now trust the Apple Watch and uh and and Fitbit and all these things.
13:10
SPEAKER_05: Um the resting heart rate, heart rate variability are pretty act accurate.
13:15
SPEAKER_05: Um and they're good enough to see when things are off.
13:18
SPEAKER_05: So having that information is very valuable.
13:21
SPEAKER_05: Uh, and I think the deep data dives, like is done here, is very, very powerful because um it really does give many more pieces of the puzzle what your health looks like and how it's shifting.
13:33
SPEAKER_05: And so I think that we just should all have that information.
13:38
SPEAKER_05: Uh, I'm also a big fan of whole body MRIs and their, you know, other equivalents being done here.
13:43
SPEAKER_05: Uh and they're powerful because they give you a baseline.
13:47
SPEAKER_05: Now, if you ask any physician today, should you do whole body MRI?
13:50
SPEAKER_05: Nearly 100% of the time they'll say, absolutely not.
13:54
SPEAKER_05: Because they're afraid you're going to find nodules.
13:56
SPEAKER_05: And everybody has them, and they're correct.
13:58
SPEAKER_05: Everybody has nodules, yeah.
13:59
SPEAKER_05: But that's not the point.
14:01
SPEAKER_05: The point is, do you have any growing nodules?
14:03
SPEAKER_05: Yeah.
14:03
SPEAKER_05: And that you get from the longitudinal measurement.
14:06
SPEAKER_05: So we should all be measuring ourselves over time.
14:09
SPEAKER_00: So you think with that kind of screening, the value is the value builds as you get more data points.
14:15
SPEAKER_05: It does.
14:15
SPEAKER_05: And the key is, and in fact, so again, I'm affiliated with another company called QBio that does whole body MRI.
14:23
SPEAKER_05: And they have already discovered early pancreatic cancer, which is almost never discovered early, early ovarian cancer, all kinds of things for people who are supposedly healthy.
14:32
SPEAKER_05: They caught before they had symptoms.
14:34
SPEAKER_03: Yeah.
14:34
SPEAKER_05: And then you can again act early.
14:37
SPEAKER_05: The and the reverse is actually horrible.
14:40
SPEAKER_05: If you get cancer today and they catch it and then they operate on it and they go back and do whole body MRI, they're going to find those nodules.
14:48
SPEAKER_05: Right.
14:49
SPEAKER_05: If you don't have a baseline, there's no way to know if you're cancer and metastasize or if in fact they were there to begin with.
14:57
SPEAKER_02: Right.
14:57
SPEAKER_05: So many cases happen actually happened to a friend of mine who actually wound up with um, yeah, basically uh couldn't move his arm one day, woke up Thanksgiving, couldn't move his arm, and turns out had a big tumor on his spine.
15:10
SPEAKER_05: So the operator got it out, and then a month later we went back for a whole body MRI, and they found three more nodules on a spine, and they didn't know if they were there to begin with or if it metastasized.
15:21
SPEAKER_05: So they had to basically treat them as though they were metastatic.
15:24
SPEAKER_00: Right.
15:25
SPEAKER_00: And so and that and that could have been avoided if he had known that they were there previously.
15:31
SPEAKER_05: Yeah, so so I think the baseline is very, very important.
15:34
SPEAKER_05: Yeah.
15:34
SPEAKER_00: I guess I guess the one pushback though is when they do find things that aren't dangerous that people like there is an anxiety.
15:41
SPEAKER_05: You want to caution people on this.
15:42
SPEAKER_05: So you want to say, um, look, everybody has nodules.
15:46
SPEAKER_05: You're gonna have nodules.
15:47
SPEAKER_05: I have nine of them.
15:47
SPEAKER_05: I've done 23 whole body MRIs in the 23.
15:51
SPEAKER_05: Yeah, in the last nine and a half years.
15:53
SPEAKER_05: And I have nine nodules.
15:54
SPEAKER_00: That's crazy.
15:55
SPEAKER_05: That's no, but I'm happy to say none of them are growing.
15:57
SPEAKER_05: But there's a rationale behind this because I would argue we don't even know how often we should be measuring.
16:03
SPEAKER_02: Right.
16:03
SPEAKER_02: Yeah, yeah.
16:04
SPEAKER_05: But uh, you know, if you get an aggressive cancer, it can go from zero to full-blown, you know, death in three months if it's super aggressive.
16:12
SPEAKER_05: That's rare, but it does happen.
16:14
SPEAKER_05: So, one reason for doing this is to try and get a sense of how often we should be measuring people.
16:20
SPEAKER_05: Uh, we're kind of, in that case, I might argue it's a little bit overmeasurement, but the argument is that we can then downsample to see, you know, how often do events really occur.
16:30
SPEAKER_05: And for me, I've had several events over the years, and and I'm learning, you know, that, but it it is stochastic for any individual.
16:39
SPEAKER_05: But I think if we can aggregate all these individual cases, yeah, and then that might give us at least some general guidance of how often you should get measured.
16:48
SPEAKER_05: But now in today's world, right, people when they're healthy, they never get measured.
16:52
SPEAKER_05: Well, and they only go in when they're sick, like every two years or something.
16:55
SPEAKER_05: And that's just not a good way to keep people healthy.
16:57
SPEAKER_00: Do you think these uh the and I assume the answer is yes, but do you think the technology uh becomes A, you know, more accurate over time because we do still see false positives and false negatives with these with these technologies, and B, like more comfortable.
17:12
SPEAKER_00: You know, I I I've done one, um, I've done two, in fact, and I didn't love it.
17:18
SPEAKER_00: Uh I must admit, you know, I'm very fidgety as you as you well know.
17:22
SPEAKER_00: But um, you know, it's I think they're like 60 minutes, right?
17:25
SPEAKER_05: But there are there are well originally they're yeah, more like an hour 40 minutes, hour 30 minutes to get a high resolution one.
17:31
SPEAKER_00: Yeah.
17:32
SPEAKER_05: QBio can do it about 35, 40 minutes because they have some new algorithms to be able to do this more efficiently.
17:38
SPEAKER_05: In the future, they'll probably be 15 minutes.
17:40
SPEAKER_00: That'd be nice.
17:41
SPEAKER_05: Yeah, so then you you'll fidget.
17:43
SPEAKER_05: Well, hopefully you can sit not fidget for 50 minutes.
17:46
SPEAKER_00: But do you think alongside that we'll we'll lose some of the um false positives?
17:52
SPEAKER_00: Or that always be a thing?
17:53
SPEAKER_05: Maybe.
17:54
SPEAKER_05: I think still it's the it's the delta that counts.
17:57
SPEAKER_05: I think people don't delta meaning the change.
18:00
SPEAKER_05: Yeah.
18:00
SPEAKER_05: And I don't think people realize this your health almost entirely depends on your value relative to population averages, going back to something we talked about earlier.
18:10
SPEAKER_05: And that's how physicians act.
18:12
SPEAKER_05: They don't even often look at the older data.
18:15
SPEAKER_05: And I think the delta is way more important because you can be in a normal range uh and then have your value jump double, even in some cases, depends on the measurement, and still be in the normal range.
18:28
SPEAKER_05: And the physician will say nothing to you because you're in a normal range.
18:31
SPEAKER_00: Because you're still normal relative to normative data.
18:33
SPEAKER_05: But if you doubled and you've been, you know, very consistent baseline, you doubled something happened.
18:39
SPEAKER_05: And maybe it's trivial, maybe it's not.
18:41
SPEAKER_05: But why don't you go get it checked again then?
18:43
SPEAKER_05: And that happened for one of the individuals in our study, he came up to me and said, Mike, nobody say anything.
18:48
SPEAKER_05: Yet I noticed my certain it was a liver enzyme doubled in value.
18:52
SPEAKER_05: I said, Well, just go get another test.
18:54
SPEAKER_05: And sure enough, then it went, then it went out of range.
18:56
SPEAKER_00: Right, yeah.
18:56
SPEAKER_05: So it's a trajectory that mattered.
18:59
SPEAKER_05: So I don't and we don't bring that in in medicine.
19:01
SPEAKER_05: That's it.
19:02
SPEAKER_05: So that's why I think we need these longitudinal measurements, like you guys do here.
19:06
SPEAKER_05: Yeah.
19:07
SPEAKER_05: Which I it's it's just very, very important.
19:09
SPEAKER_00: Personalized medicine, right?
19:10
SPEAKER_00: Right.
19:11
SPEAKER_00: Hyperpersonalized, yeah.
19:12
SPEAKER_05: So you can track people's trajectory and then again optimize them, uh, I would argue.
19:18
SPEAKER_05: Um, yeah.
19:19
SPEAKER_00: Will these things become considerably cheaper?
19:21
SPEAKER_00: I think a big pushback for a lot of people is just cost.
19:24
SPEAKER_00: And I don't mean cost just to do the thing.
19:27
SPEAKER_00: I mean in the US especially, you know, cost when you find something, right?
19:33
SPEAKER_00: Actually treating the thing.
19:34
SPEAKER_00: And I know, I know, and I know you uh you're of the mindset, which I I agree with, that you'd rather know.
19:40
SPEAKER_00: Yeah.
19:40
SPEAKER_00: Um, but you know, people is tough out there.
19:44
SPEAKER_05: Yeah, I'm okay.
19:45
SPEAKER_05: The the cost of the test will go down.
19:47
SPEAKER_05: Like genome sequencing, right?
19:49
SPEAKER_05: The first one cost a million bucks.
19:51
SPEAKER_01: Yeah.
19:51
SPEAKER_05: Um, the first personal one, um, the reference costs more.
19:55
SPEAKER_05: Hundreds of millions, right?
19:56
SPEAKER_05: Yeah.
19:56
SPEAKER_05: To actually discover.
19:59
SPEAKER_05: Um, and so the cost will go down.
20:01
SPEAKER_05: Now you can get a genome with some amount of interpretation for$500.
20:05
SPEAKER_02: Yeah.
20:06
SPEAKER_02: Yeah.
20:06
SPEAKER_02: In a few hours, in fact.
20:07
SPEAKER_05: It'll in fact go down.
20:09
SPEAKER_05: Yeah, even further.
20:10
SPEAKER_05: And so that'll be true of all these things.
20:12
SPEAKER_05: The technology, it's clunky and it gets better over time.
20:17
SPEAKER_05: Um, and then the follow-up tests, uh, they're not as expensive as people anticipate.
20:22
SPEAKER_05: When we started sequencing healthy people's genomes, um, physicians were mad at me.
20:28
SPEAKER_05: I even had one yell at me and said, You should not be doing this.
20:30
SPEAKER_05: You are gonna make everybody in the hypochondria is gonna cost millions of dollars.
20:34
SPEAKER_05: This is not right.
20:35
SPEAKER_05: So, of course, we did it anyway.
20:37
SPEAKER_05: Um, because uh we knew it was important.
20:39
SPEAKER_05: Now most of them have warmed up to it.
20:41
SPEAKER_05: Sure.
20:41
SPEAKER_05: Uh, because there is value there.
20:43
SPEAKER_05: Imagine you do see a bracket mutation.
20:46
SPEAKER_05: So you want somebody to be, you know, you checking your your breasts, whether you're male or female, yeah, more if um you have a bracket mutation.
20:55
SPEAKER_05: And there are other cases like that.
20:57
SPEAKER_05: In fact, I think in the first 70, we had 12 individuals who had an they called them actionable mutations, had a mutation in their DNA that you would increase your screening for.
21:07
SPEAKER_05: In some cases, it turned out to be life-saving.
21:09
SPEAKER_05: One person had a heart defect.
21:10
SPEAKER_05: We picked that up from his genome sequence, actually.
21:13
SPEAKER_05: Uh, and he's on medication now, young guy.
21:15
SPEAKER_03: Wow.
21:16
SPEAKER_05: Uh, another one had um mutations said they're at risk for cancer cancer.
21:20
SPEAKER_05: They did a whole body MRI, and sure enough, they had early thyroid cancer, and that was removed, and they kept most of their thyroid.
21:26
SPEAKER_05: Again, caught early.
21:28
SPEAKER_05: So, this stuff can be, we think, very powerful.
21:31
SPEAKER_05: You know, nobody wants to hear the bad news you have a brack mutation.
21:34
SPEAKER_05: On the other hand, it's kind of important to know you have a brack mutation so you can get screened for it.
21:39
SPEAKER_05: So I think this is this is the power of all this.
21:43
SPEAKER_00: Do would you say there are a selection of tests that everyone should do?
21:48
SPEAKER_00: And and would you say you should do them earlier rather than later?
21:52
SPEAKER_05: Yeah, I would argue everyone should get a baseline.
21:54
SPEAKER_05: Uh, and it's true that the probability of diseases is lower when you're younger.
21:59
SPEAKER_05: Yeah.
22:00
SPEAKER_05: But I think you want to get uh an early baseline what that number should be.
22:03
SPEAKER_05: I don't know, but I I say at least in your twenties, if not before, and then periodically throughout, your genome's not going to change too much, so that's fine.
22:13
SPEAKER_05: Just do that once.
22:14
SPEAKER_05: Uh, and then get some of these other measurements periodically to see if anything is going off.
22:19
SPEAKER_00: What would those other measurements be?
22:22
SPEAKER_05: Well, be things in general have to be met actionable.
22:26
SPEAKER_02: Yeah.
22:27
SPEAKER_05: So they would many of them are just deeper medical tests than we do now.
22:30
SPEAKER_05: It's pretty trivial what they measure in a typical medical exam.
22:34
SPEAKER_02: Yeah.
22:34
SPEAKER_05: As you know, the exam you guys run here and and and many other concierge services, it's much more deluxe.
22:40
SPEAKER_05: And some of that stuff I would argue is pretty important.
22:42
SPEAKER_05: Hormone levels, things like this.
22:44
SPEAKER_05: Oxidative stress measures are almost never picked up in a standard exam, but they get an immune system marker.
22:51
SPEAKER_05: There's only one, and it's a really crude one that's measured in a typical exam.
22:55
SPEAKER_02: Yeah.
22:55
SPEAKER_05: But, you know, places like Wonder Health and others actually measure more, and that gives quite valuable information.
23:02
SPEAKER_05: Yeah, so I think there's a, you know, there's for me, uh, the minimum would be probably 140, 150 uh biochemical measurements.
23:11
SPEAKER_05: I'm a big believer in the wearables, as you know, because resting heart rate, heart rate variability, and they're only going to get better in the future.
23:18
SPEAKER_05: Uh, they can pick up all kinds of things, certainly AFib, uh, which is, you know, can lead to heart failure.
23:25
SPEAKER_05: Um, they pick up, we showed infectious disease, including Lyme disease.
23:29
SPEAKER_05: Um, yeah, and the one perhaps the most powerful monitor these days are continuous glucose monitors.
23:35
SPEAKER_02: Yeah.
23:36
SPEAKER_05: We're big fans of those.
23:37
SPEAKER_05: I think everyone should wear one of those.
23:39
SPEAKER_05: And why do I say that?
23:40
SPEAKER_05: Well, there's 12% of the US population is diabetic, 20% don't know it.
23:47
SPEAKER_00: 20% of the 12%.
23:49
SPEAKER_05: Yes.
23:49
SPEAKER_05: Right.
23:50
SPEAKER_05: And 40% are pre-diabetic.
23:52
SPEAKER_05: Yeah, it's crazy.
23:53
SPEAKER_05: Nearly all of them are going to become diabetic.
23:56
SPEAKER_05: Um, and 80% of them don't know it.
23:59
SPEAKER_05: So half the population, more than half, is either diabetic or pre-diabetic and on its way to becoming diabetic.
24:06
SPEAKER_05: And yet, and it's getting those numbers are getting worse.
24:09
SPEAKER_05: Wow.
24:10
SPEAKER_05: We're not, and we we don't do anything about it because the food out there is terrible, right?
24:14
SPEAKER_05: All this processed food, we're trained since we're little to eat this garbage.
24:19
SPEAKER_05: And so we've got to shit solve that problem, or health problems are going to magnify.
24:24
SPEAKER_00: And so it is solvable, right?
24:27
SPEAKER_00: For the 40% at least.
24:28
SPEAKER_05: It is.
24:29
SPEAKER_05: So you should be able to, um, and even for diabetics, uh change of lifestyle.
24:34
SPEAKER_05: Some people have been able to reverse their losing weight or exercising more.
24:38
SPEAKER_05: Um, and what's powerful about the continuous glucose monitor is you can see in real time what's going on.
24:44
SPEAKER_05: And it turns out that everybody, well, by real time, I should let me back up.
24:48
SPEAKER_05: Glucose monitors measure glucose every five minutes.
24:51
SPEAKER_01: Yeah.
24:51
SPEAKER_05: And if you eat a sugary drink, it'll send you your glucose through the roof.
24:56
SPEAKER_05: Um, and but what's interesting is that everybody reacts to food differently.
25:00
SPEAKER_05: And this is a big part of our work.
25:02
SPEAKER_05: Uh, and another group in Israel had found the same thing that you know, some people will spike their glucose if they eat a banana, others pasta, others potatoes.
25:11
SPEAKER_05: Nearly everybody to white rice.
25:12
SPEAKER_05: White rice is worse than ice cream, actually, for most people.
25:15
SPEAKER_02: Agreed.
25:16
SPEAKER_05: So um, anyway, um, and so if you wear one of these monitors, you'll never eat the same uh way again.
25:23
SPEAKER_05: And I mean that in a good way.
25:24
SPEAKER_05: You'll see what spikes you, what doesn't.
25:26
SPEAKER_05: You just eat the things that don't spike your glucose, and that's much healthier for you.
25:31
SPEAKER_05: We've taken this a step further.
25:32
SPEAKER_05: We can actually subtype people's glucose dysregulation, meaning some people, this gets a little technical, some people are muscle insules, meaning their muscle doesn't respond to insulin.
25:42
SPEAKER_05: Some people have a beta cell defect, insulin doesn't get out of pancreas.
25:46
SPEAKER_05: Other people have hepatic insulin resistance, their liver.
25:50
SPEAKER_01: Yeah.
25:50
SPEAKER_05: And the GLPs are very famous these days.
25:53
SPEAKER_05: And uh that's they're called incrediins, and some people have defects in those.
25:57
SPEAKER_05: And just from the shape of a glucose curve with AI, we can now tell for some of those subtypes, the two most common ones, muscle insular resistant beta cell defects, what your defect is.
26:09
SPEAKER_05: And you might say, so what?
26:10
SPEAKER_05: Why do I care about that?
26:11
SPEAKER_05: Well, your subtype determines what foods you'll spike to.
26:15
SPEAKER_05: Right.
26:16
SPEAKER_05: So if you're muscle insulin resistant, you'll spike to potatoes and the pasta, but not if you're insulin sensitive.
26:23
SPEAKER_05: Say if you're a beta cell defect, you'll spike to um potatoes as well.
26:27
SPEAKER_00: And are you wearing one right now?
26:30
SPEAKER_05: I'm not for technical reasons.
26:32
SPEAKER_05: Uh I have to offload some data uh elsewhere, but I normally wear them, wearing them from decades now.
26:38
SPEAKER_05: But uh again, they're very, very powerful.
26:41
SPEAKER_05: And um, I wear them a lot, as you might imagine.
26:45
SPEAKER_00: And um that doesn't surprise me, Mike.
26:48
SPEAKER_05: Yeah.
26:48
SPEAKER_05: Uh they're they're just um yeah, and everybody wears these things.
26:53
SPEAKER_05: I have yet another company.
26:55
SPEAKER_05: Uh they wear this, people wear this, and they instantly improve their eating habits and they lose weight, even though that wasn't the objective, but they improve their time and range.
27:04
SPEAKER_00: Can I ask you a question?
27:06
SPEAKER_00: Over the 10 years that you've been wearing one, has that information changed?
27:11
SPEAKER_00: And what I mean is have the have the foods that cause those spikes changed over time?
27:17
SPEAKER_05: This is a great question.
27:18
SPEAKER_05: And the answer is I I believe a a little bit, not so much for me.
27:22
SPEAKER_05: So I should back up a little bit and say, most people won't guess this, but I'm a type 2 diabetic because I'm pretty thin.
27:28
SPEAKER_05: Um, and I've never been overweight.
27:30
SPEAKER_05: Um, so in my case, I have a beta cell defect.
27:34
SPEAKER_05: I have a very specific kind, and I don't then certain foods spike me and others don't.
27:42
SPEAKER_05: And so um, with the beta cell defect, it's a little more constant.
27:46
SPEAKER_00: Right.
27:47
SPEAKER_05: But for other people, I do think, and we're running studies to look at this, it's a great question.
27:52
SPEAKER_05: Uh, some people, most people are musclen's resistant, and then gradually over time, they start becoming accumulate some beta cell defect.
28:01
SPEAKER_05: Yeah, many people are mixed, by the way.
28:03
SPEAKER_05: Um, and so um I I think there is some shifting going on.
28:07
SPEAKER_05: How much that is, I don't know.
28:10
SPEAKER_00: The reason I ask is that um I feel like uh the big pushback against tracking a lot of these things is that it's kind of frictious, it's like effort, right?
28:22
SPEAKER_00: And and I'm I'm very bullish on using uh wearables and tracking but sporadically, right?
28:30
SPEAKER_00: Like so I don't wear a a wearable.
28:32
SPEAKER_00: Um I notice that.
28:34
SPEAKER_00: Yeah.
28:34
SPEAKER_00: Um and it's not because I don't think that they are valuable, I do, and we often we give wearables to our our members and like we encourage tracking.
28:42
SPEAKER_00: It's just that for me, for my personality, um I find that it can be a little anxiety-inducing in that let's take sleep, for example.
28:53
SPEAKER_00: Often I'll sleep seemingly well, then I will look at the data and it'll be like you really should feel like shit, and then I then I just do, right?
29:01
SPEAKER_00: Or or I'll be thinking throughout the day, I I'm more exhausted than I would have otherwise been.
29:06
SPEAKER_00: Um, I think there's a term sleep is a tricky one.
29:09
SPEAKER_00: Yeah.
29:10
SPEAKER_05: Yeah, psychosomatic.
29:11
SPEAKER_05: So the um, so for sleep, there's now a study out there from one of my colleagues at Stanford that shows depending on what people tell you, determines how you'll feel.
29:21
SPEAKER_05: That's exactly what you're saying.
29:23
SPEAKER_05: Yeah, so regardless of what the score is, if the if somebody tells you sleep score was great, people function well.
29:29
SPEAKER_05: If they tell you it's bad, they function poorly.
29:32
SPEAKER_05: So I think that one's heavily influenced.
29:34
SPEAKER_05: I think the other one's a little less.
29:35
SPEAKER_05: So I'm I'm a and I do think sleep, it's probably one of the areas we're most vulnerable.
29:40
SPEAKER_05: It's my number one deficit.
29:41
SPEAKER_05: I don't I don't do that very well.
29:43
SPEAKER_00: But I think CGM, the continuous glucose monitor, I've seen people get exceptional value from doing it for two weeks twice a year, or like, yeah, yeah, I think it could be like that.
29:56
SPEAKER_05: Now, I think the heart monitoring, I think ultimately we are gonna want constant, and maybe what you need is a as an implantable when they come out in the future.
30:04
SPEAKER_05: They're not there yet.
30:05
SPEAKER_05: Or some people wear rings because they don't like watches.
30:08
SPEAKER_05: And I I do agree you have to find what information you want coming back to you.
30:13
SPEAKER_05: And uh, we need to be able to set the settings right.
30:15
SPEAKER_05: I think you should still be wearing those, but probably have a dashboard that you only look at that when you think you need it, or a red alert goes off when say something serious like that.
30:27
SPEAKER_00: You can't not look.
30:28
SPEAKER_00: Yeah, I see.
30:30
SPEAKER_00: I'm too I want to I want to know because I want to know if it's good as well, because then I'll feel even better.
30:35
SPEAKER_00: Yeah.
30:35
SPEAKER_05: Well, I think most people train themselves to some extent.
30:38
SPEAKER_05: You know, when the fitness track was first came out, and there's studies to show the same people wore them, you know, three months and they threw them in the drawer because they knew their patterns.
30:47
SPEAKER_05: But we're in a different world now where these are health monitors and they really just like your car, you don't drive your car around without a dashboard.
30:54
SPEAKER_05: Yeah, I feel like we need the same thing for our health.
30:57
SPEAKER_05: And so they and they are powerful, and and I do think they can be life-saving, uh, like the AFib and cases like that.
31:04
SPEAKER_05: And when you when you're off, and I think you know, mental health is very poorly studied in today's world.
31:12
SPEAKER_05: And there aren't good biomarkers, and digital ones are going to be the future for sure.
31:16
SPEAKER_00: Um I want to add just a cat just a caveat to my own point, is when I have worn them with some degree of consistency, I have improved my health, right?
31:26
SPEAKER_00: Objectively.
31:27
SPEAKER_00: And so they do work.
31:28
SPEAKER_00: So you have a counter-argument even on yourself.
31:30
SPEAKER_00: Yeah, it's more of a me problem than anything else.
31:32
SPEAKER_05: No, I think you have to find the right balance.
31:34
SPEAKER_05: And it's true, you don't want people waking up every morning, am I gonna get breast cancer?
31:38
SPEAKER_05: I'm gonna get breast, right?
31:39
SPEAKER_05: If if they have certain information about markers, but you might want that information to go to the physician so that they say, Well, while you're here, let's do a breast exam for you.
31:48
SPEAKER_02: Yeah.
31:49
SPEAKER_05: So someone else can be looking after you.
31:52
SPEAKER_05: And I think as we hit an older and older population, um, you know, we're all gonna be looking after our parents a lot more.
32:00
SPEAKER_05: I remember um, you know, my mom would live by herself, and uh, you know, when she got old up to 90, um, she would, and and she was known to have like um dizziness.
32:13
SPEAKER_05: And and um every now and then she forgot to put the hook back on the phone.
32:17
SPEAKER_05: So, you know, and I'm one of six kids, so somebody would not be able to get a hold of mom.
32:23
SPEAKER_02: Yeah, yeah.
32:23
SPEAKER_05: So they, you know, had to call the front desk and say, Do you mind checking on my mother?
32:28
SPEAKER_05: And if she just had a smartwatch on her, we'd say, Oh no, she's fine, I'll be to find it.
32:33
SPEAKER_05: So there are time, so I think for caregivers and you know, elderly, there's a lot of value to having these things.
32:40
SPEAKER_02: Yeah.
32:40
SPEAKER_05: And I'll give you one other, maybe counterexample or consistent example with what I just said.
32:46
SPEAKER_05: There's a person in my lab, he's totally in this data monitoring stuff.
32:49
SPEAKER_05: So he has smartwatch and his aura rang, and he was 76-year-old.
32:54
SPEAKER_05: Great guy.
32:54
SPEAKER_05: If you look at this guy, he's thin, energetic, and uh he ran on the Peloton quite frequently.
32:59
SPEAKER_05: And one day after writing on this Peloton, he died like right after.
33:05
SPEAKER_05: So his wife, knowing how much we like data and how much he liked data, said he'd want us to share this with, so she did.
33:12
SPEAKER_05: So we looked at his watch data and his Warring data, and sure enough, about four and a half months before he died, there was a step function change, meaning his resting heart rate went up, his heart rate variability dropped, his sleep uh shifted.
33:29
SPEAKER_05: I can't remember if it was longer or short, I think longer, his gait, which you can get from a watch, also shifted.
33:35
SPEAKER_05: And there were two other things.
33:36
SPEAKER_05: And if you looked at the data, it's very clear something happened then that was going on.
33:41
SPEAKER_05: So he and so the data were there, but there was no system to relay it back to him, right?
33:48
SPEAKER_05: To say, hey, something's off with you.
33:50
SPEAKER_05: The check engine light, something's off with you.
33:52
SPEAKER_05: You should go get this checked out.
33:55
SPEAKER_05: And first of all, yeah, and so happens the time he died was the time he ran one of the hardest runs on his Peloton.
34:04
SPEAKER_05: So somebody might have also said, well, maybe you should back off a little bit, yeah, or or go on some medications or what have you.
34:11
SPEAKER_05: But of course, you know, this is you know, backstreet coaching here, um, but on 2020 hindsight.
34:18
SPEAKER_05: So anyway, I I do think they could be powerful, and people have discovered their aphibs from them.
34:23
SPEAKER_05: But it's true, you don't want to turn everybody into hypochondic, so you have to adjust it for the person.
34:28
SPEAKER_05: You know, my Apple Watch, I I hate it buzzing at me all the time.
34:31
SPEAKER_05: I turned all that stuff off.
34:32
SPEAKER_00: How many wearables have you got on right now?
34:34
SPEAKER_05: Yeah, so I have my um four smart watches, two rings.
34:38
SPEAKER_05: Um, I even have an exposometer.
34:41
SPEAKER_05: I must left it downstairs.
34:42
SPEAKER_05: Um, and I have hearing aids, which are also pretty powerful.
34:46
SPEAKER_05: They can measure physiology, but more importantly, they measure how much um we're running a study around the socialization I do because it turns out that's a pretty important health parameter, too.
34:58
SPEAKER_05: You may know people live in the blue zones, they're active, they tend not to eat ultra-processed food.
35:04
SPEAKER_05: So it doesn't always have to be vegetarian, but it's Mediterranean or what have you.
35:08
SPEAKER_05: And they also have great social networks.
35:10
SPEAKER_02: Yeah.
35:10
SPEAKER_05: And so my guess is they sleep well too, but uh that those studies are as well run.
35:15
SPEAKER_02: Yeah.
35:16
SPEAKER_05: So I think so.
35:17
SPEAKER_05: We're writing studies, see just you know, how much socialization people should you do?
35:21
SPEAKER_05: How much is it just you sitting there listening versus you participating?
35:27
SPEAKER_05: How are you?
35:27
SPEAKER_05: My guess is a combination of both would be useful.
35:30
SPEAKER_05: How are they measuring that?
35:31
SPEAKER_05: Well, it can capture the kinds of sounds that comes, it's not recording your conversation precise.
35:36
SPEAKER_05: So don't worry.
35:38
SPEAKER_05: I'm not breaking your privacy here.
35:41
SPEAKER_05: It captures, yeah, this conversation and then how much I'm talking, which is a lot more than you right now, but uh yeah, it's how much you're talking and then how much you know conversation time I'm having during the day.
35:53
SPEAKER_05: And we'll correlate that with longevity and other health measures like cognition, which is one of the number one things people worry about as they get older.
36:01
SPEAKER_05: And uh, yeah, you guys have a ton of great tests, it looks like.
36:05
SPEAKER_05: So um I think um, yeah, that's very powerful.
36:09
SPEAKER_05: And so maybe we will be saying, well, you should be, you know, in conversation with your colleagues, uh, you know, two hours a day or more cats.
36:20
SPEAKER_05: Yeah, yeah.
36:21
SPEAKER_05: No, I do think actually these kinds of engagements are are very, you know, they're they're very stimulating.
36:27
SPEAKER_05: I always learn stuff.
36:28
SPEAKER_00: Yeah, we had Bob Waldinger on recently um talking about social isolation.
36:33
SPEAKER_00: I think it's just one of the most, if not the most powerful methods.
36:36
SPEAKER_00: Yeah, it's probably one of the most undervalued.
36:38
SPEAKER_00: Undervalued, yeah.
36:39
SPEAKER_00: Yeah, for sure.
36:40
SPEAKER_00: So, Mike, given that, two questions.
36:45
SPEAKER_00: Why, why wear all of them?
36:47
SPEAKER_00: Um, and second, lead there's really a leading question as to what why is there not just one wearable to rule them all?
36:54
SPEAKER_00: Because that would feel like less friction for all of us.
36:57
SPEAKER_05: Right.
36:58
SPEAKER_05: Well, for one thing, uh I'm it's a scientist of me.
37:01
SPEAKER_05: The average person doesn't need all these.
37:03
SPEAKER_05: Yeah, I wear them all because they're measuring different things and they're at different resolution.
37:07
SPEAKER_05: So the Apple Watch is higher resolution, uh, for example, um, but it takes longer to charge.
37:14
SPEAKER_00: So you wind up with more missing data.
37:16
SPEAKER_00: What do you mean by resolution?
37:18
SPEAKER_00: The data is more accurate.
37:20
SPEAKER_05: Yeah, well, and it's yeah, yes, in the sense, so it's making many, many more measurements per second.
37:25
SPEAKER_05: And in general, they're all pretty good for resting things, but when you run hard, the Apple Watch actually can capture that much better than the other devices because it's sampling more frequency, so it can capture all this better.
37:41
SPEAKER_05: But and and so that's nice if you want to capture, you know, how often you're hitting your maximum heart rate, you won't get that from the Fitbit as well or the others because it doesn't capture as well.
37:53
SPEAKER_05: But on the other hand, the Fitbit, because you throw it in the and you try, I charge it while I go in the shower and it lasts seven days.
38:01
SPEAKER_02: Yeah.
38:01
SPEAKER_05: So I'm never missing any data.
38:03
SPEAKER_05: And that's powerful when you're doing sort of health monitoring.
38:06
SPEAKER_02: Yeah.
38:06
SPEAKER_05: So there's a balance, and I'm we're trying to figure out what is the optimal resolution.
38:11
SPEAKER_05: Like when I got COVID, I was wearing all four of these.
38:13
SPEAKER_05: We're still sorting this out, but what is the optimal resolution I should be using because I have all the different devices.
38:20
SPEAKER_01: Yeah.
38:20
SPEAKER_05: And which parameters are most or best for predicting health?
38:25
SPEAKER_05: In the end, I'm quite certain resting and heart rate, heart rate variability.
38:28
SPEAKER_05: They vary for the kind of illness you're trying to detect.
38:31
SPEAKER_05: Uh, we think breathing has value, obviously, for respiratory viral infections, um, and SBO2 as well.
38:37
SPEAKER_05: So they and and skin temperature, but believe it or not, you know, the way we met tell if you're sick now, put a thermometer in your mouth.
38:44
SPEAKER_02: Yeah.
38:44
SPEAKER_05: It's a 300-year-old concept, fails half the time for COVID.
38:48
SPEAKER_05: There's lots of presymptomatic things.
38:50
SPEAKER_05: Your resting heart rate's a way better measure and heart rate variability.
38:54
SPEAKER_00: I think step count as well is valuable for people because it is, yeah.
38:58
SPEAKER_05: No, that's a great indicator of health.
39:00
SPEAKER_05: Absolutely.
39:00
SPEAKER_05: The functional assays, which again, I guess Wonder Health does a lot of these, are very powerful because at the end of the day, that's what it comes down to.
39:09
SPEAKER_05: How well are you functioning?
39:10
SPEAKER_05: Not just what are your biomarkers.
39:12
SPEAKER_05: Biomarkers are great because they're ways of quantifying function, and they're also ways of you know tracking things in quantitative fashion.
39:20
SPEAKER_05: Some of these functional assays are tougher.
39:22
SPEAKER_02: Yeah.
39:23
SPEAKER_05: Um, but their functional ones are what counts at the end of the day.
39:26
SPEAKER_05: You want to see how your cognition's going, your psychological, your locomotion.
39:31
SPEAKER_00: Yeah, they're tough as well because the almost the more functional the test, the less date, the less normative data there is.
39:37
SPEAKER_00: So it's hard to try.
39:38
SPEAKER_00: It's often you versus you, right?
39:39
SPEAKER_05: Like yeah, that's right.
39:40
SPEAKER_05: Um you asked two parts of that question.
39:43
SPEAKER_05: I forgot what the second one was.
39:45
SPEAKER_00: I asked why we couldn't just have one.
39:47
SPEAKER_00: Oh, yeah.
39:48
SPEAKER_05: So I think that they will all be one on one.
39:50
SPEAKER_00: You think it will?
39:51
SPEAKER_05: They will.
39:51
SPEAKER_05: And even glucose measurements, which now is a separate patch.
39:55
SPEAKER_05: There are companies working on on watch versions of this.
39:59
SPEAKER_05: And and you can actually predict your glucose.
40:02
SPEAKER_05: One of my other companies, January I, does this pretty well from just the smartwatch heart rate data?
40:07
SPEAKER_05: It's not as good as a CGM.
40:09
SPEAKER_02: Yeah.
40:09
SPEAKER_05: But in the future, they'll measure CGM from smartwatches, too.
40:13
SPEAKER_05: So I think they all will roll into one.
40:16
SPEAKER_05: Right now, it's early days, but and I think that's just one form of what should show up on your dashboard, these kinds of measurements.
40:23
SPEAKER_05: I'm a big believer in this remote sampling, as you know, where you give little drops of blood, and I have a company measure 650 metabolites that's used here.
40:31
SPEAKER_01: Yep.
40:32
SPEAKER_05: Uh, and they can profile um yeah, uh, all these categories, the oxidative stress, they can track your aging and your agio type.
40:41
SPEAKER_05: So, and again, it's this information is very powerful.
40:45
SPEAKER_05: And so instead of going to physician every two years when you're ill, you can do 90% of your health measurements at home.
40:52
SPEAKER_05: I think in the future, we'll be doing smart watches, visual exams, like face, you know, recognition and voice recognition.
41:00
SPEAKER_00: Which has come a long way recently.
41:02
SPEAKER_05: It is, and and these days, you may know from retinal scans, um, you can measure not only something like 20 some eye ill eye diseases, but also at least 13 other sorts of things, cardiovascular health, uh, diabetes, all kinds of things, even Parkinson's from a retinal scan, and that'll be done.
41:23
SPEAKER_05: So I think the future will be primarily a digital exam that you can do.
41:27
SPEAKER_05: Some parts will be due routinely when you wake up and look in a mirror.
41:31
SPEAKER_01: Yeah.
41:31
SPEAKER_05: And some parts will be done just episodically, but way more than, you know, maybe it's weekly, maybe it's monthly, where you get a little prick of blood, it gets mailed in, yeah, and back comes your report.
41:42
SPEAKER_05: And that won't make doctors go away.
41:44
SPEAKER_05: It'll just help the doctors.
41:45
SPEAKER_05: They can spend more time thinking about integrating all this data.
41:49
SPEAKER_05: And you'll still need whole body MRIs and some of the things that you know uh you would want to do here, the DEXs and things that that are some of the stuff going on here.
41:58
SPEAKER_05: We still want all that stuff as well to supplement this other information, but you can capture a lot of the health just from this remote monitoring, I think.
42:08
SPEAKER_00: And that and and I think going one step further, I think we would love that to mean that we have to monitor it ourselves less.
42:18
SPEAKER_00: I I mean, I certainly would.
42:19
SPEAKER_00: Like if that if it would, if that could then remove friction and actually filter out the noise and just tell you what I should do right now in this moment.
42:27
SPEAKER_00: Like a real-time health recommendation is really what I think we all kind of want.
42:32
SPEAKER_05: And I think we're heading there.
42:33
SPEAKER_05: It's just that you know, it's new days and things are clunky and stuff.
42:37
SPEAKER_05: But whole body MRIs, I I can argue the physician's the exact opposite.
42:41
SPEAKER_05: The of uh they they don't like it because of the nodules and people are gonna freak out.
42:46
SPEAKER_05: But actually, for many people, it's reassuring.
42:48
SPEAKER_05: They get the whole body MRI, they know a cancer type's running in their family, they do this and they say, Oh, I don't have that.
42:55
SPEAKER_05: That's great.
42:56
SPEAKER_05: So it can actually see you have to learn how you have to educate people.
43:00
SPEAKER_05: No, it's not about the nodules, it's that has to be a growing nodule that counts.
43:05
SPEAKER_02: Yeah.
43:05
SPEAKER_05: And so, and to some extent, then you have to educate the physicians.
43:09
SPEAKER_05: But we're in a world where right everybody, first thing they do when something goes wrong, uh, is they look it up on Claude or ChatGTP or one of these things, and I do that too.
43:19
SPEAKER_05: Um, and um that's how the world's gonna work.
43:23
SPEAKER_05: So you want to give as much information as possible into this.
43:26
SPEAKER_05: So, as you know, I recently hurt my back.
43:29
SPEAKER_02: Yeah.
43:29
SPEAKER_05: And um, you know, the typical medical system, I wanted to get the only way I could get this looked at is went to the emergency room.
43:39
SPEAKER_05: They couldn't squeeze me in because it wasn't dying.
43:41
SPEAKER_05: Uh, so I had to come back the next day because of uh other appointments, and I hear it was my back is killing me.
43:48
SPEAKER_05: And in the end, uh I they gave me an x ray, which is insufficient to do what I wanted.
43:52
SPEAKER_05: But luckily, I had my whole body MRI from two weeks earlier.
43:56
SPEAKER_05: We can look back and say, yeah, it was a little bit compressed.
43:58
SPEAKER_05: I'll bet this is what's going on.
44:00
SPEAKER_05: Because when you have a back pain, you're not under.
44:02
SPEAKER_05: And I was feeling mine in my legs actually.
44:04
SPEAKER_05: I wasn't feeling it in the back because it's pinching on my motor neurons.
44:08
SPEAKER_05: So I was kind of confused, right?
44:10
SPEAKER_05: What do I know about this stuff?
44:11
SPEAKER_05: Nothing.
44:12
SPEAKER_05: Um, and so I'm here I am with these leg things.
44:14
SPEAKER_05: I'm thinking, what's going on?
44:16
SPEAKER_05: So I, you know, called up and I looked back at the exam.
44:18
SPEAKER_05: Yeah, it's a little bit narrowed there.
44:20
SPEAKER_05: Uh, and the it's called L4, L5, these two vertebrae, uh, narrowed and then pinch your motor neurons.
44:27
SPEAKER_05: And and in the end, that was mostly right, actually.
44:31
SPEAKER_05: There's a also protrusion.
44:33
SPEAKER_05: So, anyway, um, but so Claude gave me a lot of the answer, along with having baseline data, is very powerful, actually.
44:41
SPEAKER_05: And I think this is how we can operate for lots of things in the future.
44:45
SPEAKER_00: Just put like playing devil's advocate on two points, because I think I should.
44:49
SPEAKER_00: Um, one is there are a lot of examples though, where Claude or ChatGPT will give a compelling answer, but it's not grounded in any kind of evidence.
45:00
SPEAKER_00: And I think if you're not that well versed in how to determine the difference, that can be kind of dangerous.
45:07
SPEAKER_05: Yeah, I would argue that you got to view these things as check engine lights.
45:11
SPEAKER_05: They give you, you know, signs go happen, signs go off like for the wearables.
45:17
SPEAKER_05: And then you do need a more in-depth thing.
45:19
SPEAKER_05: And Claude can give you a preliminary thing.
45:21
SPEAKER_05: You're right, you shouldn't rely entirely on Claude.
45:24
SPEAKER_05: If I did that, I wouldn't have done anything.
45:26
SPEAKER_05: We've just done the physical therapy, which would have been off.
45:29
SPEAKER_05: And uh it was partly right, but wasn't ideal.
45:33
SPEAKER_05: Um, and so it's not again, we're not at a point we're ready to replace the the medical system, but I would argue we're at a point where we want a physician to be using AI.
45:44
SPEAKER_05: Yeah.
45:44
SPEAKER_05: We'd rather have a physician who uses AI than one who doesn't.
45:48
SPEAKER_00: I guess as well, that is inherently kind of the problem is that when we do have a problem, it's so hard to get it fixed.
45:54
SPEAKER_00: Yeah.
45:55
SPEAKER_05: Or like it's not afforded.
45:57
SPEAKER_05: Why is it you wait for these things anyway?
45:59
SPEAKER_05: If why is there always a line in the emergency room?
46:02
SPEAKER_05: Why what you always know?
46:04
SPEAKER_05: Oh, people said, Oh, it's always busy Monday morning.
46:07
SPEAKER_05: Why don't we staff it?
46:09
SPEAKER_05: What's going on here?
46:10
SPEAKER_05: It's a service industry.
46:11
SPEAKER_05: Why isn't better staffed?
46:13
SPEAKER_05: So I agree.
46:14
SPEAKER_05: I think we should be resources, right?
46:16
SPEAKER_00: Like I think Well, but you yeah, we should but maybe that's what AI really helps with, right?
46:22
SPEAKER_00: Like if it can help the physicians, you know, who are trying to help.
46:26
SPEAKER_05: Well, we'll already they don't spend as much time writing up the reports because that's a cell record and they get a digested summary that they added.
46:34
SPEAKER_02: Yeah.
46:35
SPEAKER_05: So instead of a in a half hour point, which is typical in medicine, they get 15 minutes with you normally.
46:41
SPEAKER_05: They used to spend uh, you know, say 10 or 5 to 10 on the write-up, and the nurse came in for five to ten making the first measurements.
46:50
SPEAKER_05: So um now, first of all, I think those first measurements, most of them should be done before you even walk in that room.
46:56
SPEAKER_05: They're not, but they should be.
46:57
SPEAKER_02: Yeah.
46:58
SPEAKER_05: Uh, where all the questionnaires and things like when does this all first happen?
47:02
SPEAKER_00: Yeah.
47:03
SPEAKER_05: Well, you look at the watch, you know exactly when it happened.
47:05
SPEAKER_05: Yeah, um, you just look back at that.
47:07
SPEAKER_00: Isn't that the most annoying thing about going to a clinic or seeing a doctor is filling out for them before anything?
47:12
SPEAKER_05: And all the stuff you can fill.
47:14
SPEAKER_05: Uh luckily at Stanford, we do fill out a lot ahead of time.
47:17
SPEAKER_05: That helps.
47:17
SPEAKER_05: But there's still a whole bunch they take that, they don't actually they repeat it.
47:21
SPEAKER_05: You have to repeat a lot of it.
47:22
SPEAKER_05: Yes.
47:23
SPEAKER_05: Even though I said, well, I just filled it out this morning, but here it is again.
47:26
SPEAKER_05: Yeah, why are you here?
47:27
SPEAKER_00: You're like, yeah, I just told you.
47:28
SPEAKER_05: Yeah.
47:29
SPEAKER_05: So uh yeah, back on your question.
47:32
SPEAKER_05: I again, I think you got to use these as facilitating monitoring your health and not as the absolute value.
47:40
SPEAKER_05: Medicine today is pretty tough, right?
47:42
SPEAKER_05: Doctors can't figure out, especially I mentioned the back problem.
47:46
SPEAKER_05: I mean, I went to a number of people and got lots of different comments on that.
47:50
SPEAKER_03: Yeah.
47:51
SPEAKER_05: And um, in the end, actually, the high-resolution whole body, uh not whole but uh resolution in the area really said what exactly what was going on.
47:59
SPEAKER_05: Yeah, how to fix that, of course, is tricky.
48:02
SPEAKER_05: But anyway, we um yeah, I think doctors were quite flawed right now as well.
48:08
SPEAKER_05: So uh so you can pick on AI as being flawed, but I think in fact, there are studies that show doctors have a certain accuracy, AI is better, and AI plus doctors is worse.
48:20
SPEAKER_05: That was um some original studies.
48:22
SPEAKER_05: Now, I don't think that's quite true.
48:24
SPEAKER_05: Some of that was on simulated exams, but uh I think most of us would like to think that AI plus doctors is better.
48:31
SPEAKER_00: I guess either way, the more data you have on your own biology, the better, right?
48:37
SPEAKER_00: So we I think so.
48:38
SPEAKER_05: And I'll give you another example.
48:39
SPEAKER_05: We um, in fact, here's this is really unchanged world.
48:43
SPEAKER_05: We are running some classes, a lot of fun, uh, on vibe coding, you know, where you can basically instant code by loading what you want to do.
48:51
SPEAKER_05: Yeah.
48:51
SPEAKER_05: And longevity.
48:52
SPEAKER_05: We're running classes, uh, venture capitalists and I are doing this for fun.
48:56
SPEAKER_05: And we had people take these classes, and for fun, he just he just made one on supplements and said, All right, here's the supplements I'm taking.
49:04
SPEAKER_05: Do any of them interact with one another?
49:06
SPEAKER_05: So he uploads them, and it turns out he's taking magnesium and zinc.
49:10
SPEAKER_05: And uh the algorithm he wrote basically spit out and said, Well, you should take them six hours apart because they use the same transporter.
49:19
SPEAKER_05: So no um physician, there's no way any physician's possibly gonna know that, right?
49:26
SPEAKER_05: The AI scoured the literature, found uh you know this paper, and you know, gave the reference.
49:32
SPEAKER_05: We looked it up, sure enough to write, that magnesium and zinc have to get in the cells the same way through this transporter.
49:39
SPEAKER_05: So you're better separating them so they can get into the cells.
49:42
SPEAKER_05: Where you put them together, they just compete.
49:44
SPEAKER_05: So this is where AI can pull together a vast resource of information to better manage your health.
49:52
SPEAKER_05: And by the way, if I'm allowed to make a plug, this is totally not for profit.
49:55
SPEAKER_05: But we set up a supplement website because supplements is a very messy business.
50:00
SPEAKER_02: Sure.
50:00
SPEAKER_05: Some of it's great, some of it's hogwash, and there aren't great studies out there.
50:04
SPEAKER_05: So we set up a supplement encyclopedia called MySuppla Hub.
50:09
SPEAKER_05: And we're trying to get people to use it and talk about their experience with supplements because we want to take the top ones people are using, the ones that sound interesting, and run proper studies.
50:19
SPEAKER_02: Sure.
50:20
SPEAKER_05: And the idea there then is just to do what I just said, get real information around supplements so we can know.
50:25
SPEAKER_05: Like there are good ones now around vitamin D3 and a few others that with thousands of people, these really do help you.
50:32
SPEAKER_05: B12 is another one, but there's a lot of them that are just you know, and there are thousands of them now.
50:39
SPEAKER_05: It's a and it's a bil it's a 30 billion, some something like that dollar industry.
50:43
SPEAKER_05: It's huge.
50:44
SPEAKER_05: So I think it's one, it's an area that needs some cleaning up.
50:48
SPEAKER_00: Yeah.
50:48
SPEAKER_05: So anyway, we just launched that.
50:50
SPEAKER_00: Well, what about we'll add that into the show notes, Mike?
50:53
SPEAKER_05: That'd be great.
50:53
SPEAKER_00: Don't let me forget that.
50:54
SPEAKER_05: All right, umprofit, total research.
50:58
SPEAKER_00: Yeah, no, it's not I'm I'm gonna use it.
51:00
SPEAKER_00: So going back to just quickly before I forget the wearables themselves, and you know, you've got a number on, and I think it's clear why, you know, some are better at measuring things than others.
51:13
SPEAKER_00: One thing that troubles me a little is all of them say they're great at measuring everything.
51:20
SPEAKER_00: Yeah, and so you know, if I and and and often they will give you a composite metric score based on the that data, right?
51:29
SPEAKER_00: So like dress.
51:31
SPEAKER_00: Yeah, so well uh even even a composite of of all of the different subdomains, so like a uh biological age, for example, nearly all of these platforms have their own composite metric, which I don't believe we should be hanging our hat on right now, because you you know, as a great example, you need different ones to tell you different things.
51:55
SPEAKER_05: Yeah, uh you have to measure them.
51:57
SPEAKER_05: I mean, we're a scientific lab, that's what we do.
51:59
SPEAKER_05: Yeah, so the wrestling high rate, high rate variability are pretty good.
52:02
SPEAKER_05: Those are, and you know, we can argue they're off two beats per minute.
52:06
SPEAKER_00: That's still valuable, right?
52:08
SPEAKER_05: Yeah, yeah.
52:09
SPEAKER_05: Um they're not off by a factor of two or even 30%.
52:13
SPEAKER_05: They're they're pretty good.
52:15
SPEAKER_05: So I think the basics they're pretty good at, but skin temperatures, some devices are good, some aren't so good.
52:21
SPEAKER_05: So we're kind of evaluating all that, but the average person would know, because you're right, every device manufacturer says we're great at all these things.
52:29
SPEAKER_05: Yeah, and blood pressure, some of them are good, some aren't.
52:32
SPEAKER_05: Blood pressure is very tricky to measure.
52:34
SPEAKER_00: Sleep is the same.
52:35
SPEAKER_00: Sleep we can get.
52:36
SPEAKER_00: Sleep is the software.
52:37
SPEAKER_05: Yeah, it turns out the aura ring is probably the best for that.
52:40
SPEAKER_05: The ring is better, but it's not as good for the other metrics, yeah.
52:44
SPEAKER_05: So um, yeah, because it's not as high resolution, doesn't have as good a battery, so it can't measure as much.
52:51
SPEAKER_02: Right.
52:51
SPEAKER_05: So, anyway, um, yeah, but this is all gonna sort its early days, that's how I look at it.
52:57
SPEAKER_05: It'll sort itself out.
52:59
SPEAKER_05: And then, you know, some people just hate watches, so they're I'd rather they wear a ring than nothing.
53:03
SPEAKER_05: Yeah, and some people um they don't they don't like rings for whatever reasons.
53:08
SPEAKER_05: For me, I have very few phobias.
53:10
SPEAKER_05: One is that I don't like it if I can't get my ring off.
53:13
SPEAKER_05: So I wear them a little loose, which means I lose them.
53:17
SPEAKER_05: I remember carving pumpkins once and uh it was all done.
53:20
SPEAKER_05: It was like, where did my ring?
53:21
SPEAKER_05: Where'd my aura ring go?
53:23
SPEAKER_05: Well, it was thrown out in the trash.
53:25
SPEAKER_05: I never did find that one.
53:26
SPEAKER_00: How how many how many aura rings have you bought, do you think?
53:28
SPEAKER_05: Oh, this is my fifth one.
53:30
SPEAKER_00: Yeah, I've I've bought a few.
53:31
SPEAKER_05: Yeah.
53:32
SPEAKER_05: Um, but and it it's just because of that phobia about site.
53:37
SPEAKER_05: Yeah.
53:38
SPEAKER_05: Yeah.
53:38
SPEAKER_05: Only I only lost once on I lost once on gardening, yeah.
53:42
SPEAKER_05: Somehow, yeah.
53:42
SPEAKER_00: I think like that's the the it's not troubling.
53:46
SPEAKER_00: I think that I think we're we have more agency than ever, and it's only getting better.
53:50
SPEAKER_05: I think that's the key.
53:51
SPEAKER_05: And you have to learn how how to live with it.
53:54
SPEAKER_05: And and I think we need to have ways of you could self-regulate how the data coming back to you.
54:00
SPEAKER_05: Like, I don't that you can work with.
54:03
SPEAKER_05: Maybe it should be a weekly summary.
54:05
SPEAKER_05: Yeah.
54:05
SPEAKER_05: In your case, I don't know what the answer is, but it should.
54:08
SPEAKER_05: I think these things should all be personally controlled.
54:11
SPEAKER_05: I think the data in general should go to your physician if you're willing to share it, as I think you should be, because they could track some of the stuff, AFib.
54:19
SPEAKER_05: La AFib kinds of things, they don't, you know, they don't happen continuously.
54:24
SPEAKER_05: They're they're episodic through periods.
54:26
SPEAKER_05: And you actually have to wear something continuously for a few weeks to pick that kind of stuff up.
54:32
SPEAKER_00: I think I want all of the data and I want to be told when there's a red flag.
54:37
SPEAKER_00: Yeah, I want all of the upside, Mike, but I don't want to have to wear anything or charge it or be you need the implantable then.
54:44
SPEAKER_05: Yeah, I need an implant.
54:45
SPEAKER_00: Or maybe a shirt or something that has yeah, there are some on that note.
54:49
SPEAKER_00: I think another sort of thing that people might have reservations about with you know, now wearables, but in the future implants is is privacy.
54:57
SPEAKER_00: And like yeah, what can you can you speak to that?
55:01
SPEAKER_00: And and yeah, is that something we should be concerned about or not?
55:04
SPEAKER_05: Well, I have a both a flip answer and perhaps a less flip one.
55:08
SPEAKER_05: The flip answer is privacy, get over it.
55:10
SPEAKER_05: Nothing's private.
55:11
SPEAKER_05: You have street cameras on every corner, you have credit cards, nobody operates in this world without a credit card, which has a lot of personal, a lot of private data.
55:22
SPEAKER_05: And yet we do that because nobody's gonna walk around with bags of cash.
55:26
SPEAKER_05: You just it's just not practical.
55:28
SPEAKER_02: Yeah.
55:28
SPEAKER_05: So we've learned to do it for a variety of reasons.
55:33
SPEAKER_05: And I would argue health monitoring, yes, there is a potential for loss there.
55:38
SPEAKER_05: Uh, but the value by catching disease early outweighs the loss.
55:42
SPEAKER_05: Right, yeah, yeah.
55:43
SPEAKER_05: And by sharing data, hopefully we can build better algorithms.
55:46
SPEAKER_05: So you don't have those false positives that scare you and that kind of thing.
55:51
SPEAKER_05: So, and I and we will get there with more data.
55:54
SPEAKER_05: Uh, I would also argue that um, you know, in the issue of privacy, it's yeah, it um if you should be in charge of your own data, first of all, you should get to control it.
56:08
SPEAKER_05: But I still think it's um um it's more valuable to have this than not.
56:14
SPEAKER_00: Yeah.
56:15
SPEAKER_00: Are we in control of it if we wear one of these popular wearables?
56:19
SPEAKER_05: Maybe not as much as you think, because you know, data uh companies can control this, like Fitbit and stuff that they collect all your data.
56:26
SPEAKER_05: This relates to somebody said maybe earlier too, they often just save the daily summaries, like the that sort of thing.
56:33
SPEAKER_05: And for researchers, we want the hourly or second data so we can build better algorithms.
56:38
SPEAKER_05: But anyway, they do um save your data.
56:41
SPEAKER_05: And there's a you know, famous case of 23andMe when they were going bankrupt and somebody's gonna buy them out, all this data was gonna go outside of their control.
56:51
SPEAKER_05: Yeah, and so I think we need protections for that sort of thing.
56:55
SPEAKER_05: I remember the other thing I was gonna say, which is I think, you know, this is the Pollyannish of me speaking, but um, I think everyone's entitled to some minimal level of healthcare.
57:06
SPEAKER_05: So you shouldn't be discriminated by sharing your data or by having wearables, right?
57:11
SPEAKER_05: You in fact, you should be rewarded for it.
57:13
SPEAKER_05: If you wear a smartwatch, you'll take better care of yourself.
57:16
SPEAKER_05: So you should get a discount on your plans and your insurance.
57:19
SPEAKER_05: I would argue the same for your genome sequence.
57:21
SPEAKER_05: You should get a discount because you'll see what you're it's for.
57:24
SPEAKER_05: You'll get measured for those things more than you would if you hadn't done that.
57:28
SPEAKER_05: Like recipe.
57:28
SPEAKER_00: But would then they not punish the people that are at high school.
57:31
SPEAKER_05: Well, that's what I would argue that we should then have laws in place.
57:35
SPEAKER_05: Right.
57:35
SPEAKER_05: So you can't be, you know, again, I think the I'd like to think we're in a wealthy society.
57:41
SPEAKER_05: Yeah.
57:41
SPEAKER_05: In a wealthy society, we owe a minimum level of health care to our citizens.
57:45
SPEAKER_00: And that's just how I believe there are companies doing this now as well, rewarding like giving wearables as a one I know.
57:53
SPEAKER_05: You may know some others, is John Hancock has a vitality system for life insurance.
57:58
SPEAKER_05: And there the financial incentives are aligned because if people live longer, they make more money.
58:04
SPEAKER_05: So they give people points for wearables.
58:06
SPEAKER_05: That's something they should do for genome sequence.
58:08
SPEAKER_00: Yeah, because again, they will increase in productivity, less sick days.
58:12
SPEAKER_05: But we don't have the financial incentives aligned right now with our sick care system.
58:16
SPEAKER_00: Yeah, right.
58:16
SPEAKER_05: Nobody pays to keep you healthy.
58:19
SPEAKER_05: We need to get employers involved, but you should get again a discount.
58:23
SPEAKER_05: It's only two things that motivate people money and family.
58:26
SPEAKER_01: Yeah.
58:26
SPEAKER_05: You know, people are pretty good about taking care of their family members.
58:29
SPEAKER_05: I'm a yeah, so if you can get them involved, uh people taking care of their parents.
58:34
SPEAKER_05: Yeah.
58:34
SPEAKER_02: Yeah.
58:36
SPEAKER_02: Huh.
58:36
SPEAKER_05: So anyway, I think we need to get the incentives aligned.
58:40
SPEAKER_05: How do you know the problem with today's healthcare system is that um people only stay with the provider an average of 18 months.
58:48
SPEAKER_00: Right.
58:49
SPEAKER_05: So why would I dump a lot of money into you when 18 months later you're gonna be with somebody else, right?
58:53
SPEAKER_05: It's a poor investment.
58:55
SPEAKER_05: So the technology gets cheaper, it pays to.
58:58
SPEAKER_05: And if it's cheap enough, then you can also say, look, we offer this great plan.
59:02
SPEAKER_05: If you have a wearable, we can help monitor your health, this kind of thing.
59:06
SPEAKER_05: So I think there are ways to do it.
59:08
SPEAKER_05: Uh but the cheap stuff will move in.
59:10
SPEAKER_00: How do you incentivize people to be more proactive upstream of these things, right?
59:17
SPEAKER_00: Because you know, we've certainly noticed this as well, that you know, there's a reason why even a preventative MRI, any kind of preventive screening, I can understand why people would feel an urgency to go and do those things because they think there might be something that I don't know about that's killing me.
59:35
SPEAKER_00: Right.
59:36
SPEAKER_04: Right.
59:36
SPEAKER_00: Whereas if we look at the you know, robust evidence that we have for prevention of disease and illness is far upstream of screening, even right, right?
59:44
SPEAKER_00: And so how do we get people to how do we create urgency to do the things to stop you getting sick in the first place?
59:52
SPEAKER_05: I think we need to um get better education right from day zero.
59:57
SPEAKER_05: Uh also, if you think about the way our system's set up, I and I've learned about this recently in schools, right?
1:00:02
SPEAKER_05: They kids sit all day, go out of recess once, but otherwise they're mostly sitting around, which is not so good for your health.
1:00:09
SPEAKER_05: Yeah.
1:00:09
SPEAKER_05: Uh we're not built to be sitters.
1:00:12
SPEAKER_05: Um, and so we really need to build that into the system.
1:00:16
SPEAKER_05: So we should have breaks at the end of a session where students sit up and jumpy jacket, I don't know what they do, something like that.
1:00:25
SPEAKER_05: That would little habits that you could start from very early age.
1:00:29
SPEAKER_05: And likewise, how about getting rid of a lot of this stuff?
1:00:32
SPEAKER_05: And I used to be opposed, because I'm a libertarian, to sugar taxes, but uh now I'm not so sure.
1:00:39
SPEAKER_05: I've heard they don't work, but they will at some point.
1:00:42
SPEAKER_05: I mean, food has gotten expensive now.
1:00:45
SPEAKER_05: And if you do have a tax on sugary things, because ultimately somebody does pay for that later when their health breaks down, yeah, it's going to show up and be very expensive.
1:00:56
SPEAKER_05: At some level, then I feel like um maybe maybe that's a way to go.
1:01:01
SPEAKER_05: We we need to incentivize healthy eating.
1:01:04
SPEAKER_05: And though activity, I think, is easy now with the wearables for incentivization.
1:01:09
SPEAKER_03: Yeah.
1:01:09
SPEAKER_05: But for the the food one, that's trickier.
1:01:12
SPEAKER_05: How do we but I think again you could incentivize if you wear a CGM once a year or twice a year, we'll give you a discount because you'll probably eat better.
1:01:22
SPEAKER_05: And so so that one you could do.
1:01:24
SPEAKER_05: That you will eat better.
1:01:26
SPEAKER_05: Um, the other ones, and and there's ways to tell.
1:01:28
SPEAKER_05: If you put somebody puts a smartwatch or a CGM on a dog, you'll figure it out.
1:01:33
SPEAKER_05: Um, they don't behave the same.
1:01:34
SPEAKER_05: So, anyway, we could we can handle that.
1:01:37
SPEAKER_00: Which they do now, by the way.
1:01:38
SPEAKER_05: Yeah, so so but food diet in general, it is tricky.
1:01:42
SPEAKER_05: We need better rewards.
1:01:43
SPEAKER_05: I think we need better education of the parents, which then trickles to the kids.
1:01:48
SPEAKER_05: It's going the opposite direction these days.
1:01:50
SPEAKER_05: Again, obesity diabetes, but dramatically on the rise.
1:01:54
SPEAKER_05: Unbelievable.
1:01:55
SPEAKER_00: Yeah.
1:01:56
SPEAKER_00: Or or and or we make food that are better for you more affordable.
1:02:01
SPEAKER_05: Yeah, that would be fantastic.
1:02:03
SPEAKER_05: Yeah.
1:02:04
SPEAKER_05: Because it is And it doesn't have to be, yeah, I think that's true.
1:02:08
SPEAKER_05: And but some healthy foods aren't that expensive, but we haven't got them integrated properly again into people's habits.
1:02:16
SPEAKER_00: I think it's this that it is then convenience on top of in a you know, like you you could sure you could say if you were to prep meals for a week for your family and buy in bulk and then cook it all and then you know, store it, then it's going to be cheaper.
1:02:32
SPEAKER_00: But that's not how life works for some people, you know.
1:02:34
SPEAKER_00: Yeah, when we're talking about it.
1:02:35
SPEAKER_05: Some of these federal programs are trying to incentivize that way, yeah.
1:02:39
SPEAKER_05: But even, you know, place you think would know better at diabetes meetings, which I sometimes attend, they have muffins there.
1:02:45
SPEAKER_05: I mean, yeah, it's crazy.
1:02:47
SPEAKER_00: It's crazy.
1:02:47
SPEAKER_00: Yeah, yeah.
1:02:48
SPEAKER_00: Most health um conferences you'll find the same thing.
1:02:52
SPEAKER_00: Yeah, like because it's cheaper, yeah, more convenient.
1:02:56
SPEAKER_05: Every now and then you'll go to one which has like the perfect food.
1:02:59
SPEAKER_05: It's amazing.
1:02:59
SPEAKER_05: Yeah, the expensive ones.
1:03:00
SPEAKER_05: So we need to get yeah, they are, but we need that's where we need to head to.
1:03:04
SPEAKER_05: We need to find, I don't think everything has to be expensive to be eat, live and eat healthy.
1:03:09
SPEAKER_05: Certainly the activity stuff can easily be done cheap.
1:03:13
SPEAKER_05: The the eating, I think we could get more healthy foods, inexpensive healthy foods, and the people again, but it would be a matter of good habit forming.
1:03:23
SPEAKER_00: Mike, let's get practical.
1:03:25
SPEAKER_00: Let's talk about some sure real practical takeaways with people.
1:03:29
SPEAKER_00: Um, we had a listener write in a question.
1:03:33
SPEAKER_00: Let's call her Lizzie.
1:03:34
SPEAKER_00: Um, and she asked, if I had$1,000 to spend on tracking managing my health, what would you spend it on?
1:03:43
SPEAKER_05: Number one CGM.
1:03:45
SPEAKER_05: Uh, and this you'll get all under thousand.
1:03:48
SPEAKER_05: And of course, a wearable.
1:03:49
SPEAKER_05: Find one that's right.
1:03:50
SPEAKER_00: What's your what's your one wearable that you picked?
1:03:52
SPEAKER_05: Well, I I get one that lasts again, that's easy to charge because I think missing data is not so great.
1:03:58
SPEAKER_05: So uh, of course, there's um Fitbit, there's um uh Garmin, they're both easy to charge.
1:04:04
SPEAKER_05: And of course, I have a company called Sensomics.
1:04:06
SPEAKER_02: Yeah.
1:04:07
SPEAKER_05: So they're all pretty good.
1:04:09
SPEAKER_05: Um and while you still have money left over, what else should you do?
1:04:14
SPEAKER_05: I think we'll be moving into some of this micro sampling monitoring, but um I think people can still go to their physician checkups because they're usually subsidized, right?
1:04:25
SPEAKER_05: They they just pay a visit fee.
1:04:27
SPEAKER_05: And for most people that should be once a year, and probably the frequency would increase as you get older because the probability of something going off.
1:04:36
SPEAKER_05: But um yeah, what point well I I'd I'd start in the teens uh for at least a baseline and gradually increase you know the number of visits.
1:04:47
SPEAKER_05: Um so I I think yeah, visit would be a good thing.
1:04:50
SPEAKER_05: Whole body MRI is out of your a thousand dollar range, but uh and then but the standard things to do are the ones I mentioned earlier, activity and people who live in the blue zones.
1:05:00
SPEAKER_05: So it's not all weightlifting.
1:05:02
SPEAKER_05: I do think strength training is important, by the way.
1:05:04
SPEAKER_05: Um as a weightlifter, do I hurt my back?
1:05:06
SPEAKER_05: Although I still do some, believe it or not.
1:05:08
SPEAKER_05: Um the uh yeah, the ones that don't affect my back.
1:05:12
SPEAKER_02: Sure.
1:05:12
SPEAKER_05: Um, and um anyway, most people don't do there's a lot of runners out there, but I think there should be more strength training.
1:05:19
SPEAKER_05: Great.
1:05:20
SPEAKER_05: And that stuff doesn't cost anything.
1:05:22
SPEAKER_05: Um, so we need that.
1:05:24
SPEAKER_05: We need to avoid ultra-processed foods.
1:05:26
SPEAKER_05: I don't know if there's a way to lock fridges or something like that.
1:05:30
SPEAKER_05: Probably could set up automated systems for that.
1:05:33
SPEAKER_05: Uh what else?
1:05:34
SPEAKER_05: And we mentioned the communication, you know.
1:05:36
SPEAKER_00: Wait, an automated fridge locker.
1:05:39
SPEAKER_00: Yeah.
1:05:39
SPEAKER_00: I love that.
1:05:40
SPEAKER_00: Yeah.
1:05:40
SPEAKER_00: I need I I don't know if you do this, but I will.
1:05:43
SPEAKER_05: Yeah, maybe you have someone put all the bad foods, first of all, throw them out.
1:05:48
SPEAKER_05: But if you can't throw them all out, put them in one section that gets only unlocked once a week or something like that.
1:05:54
SPEAKER_05: I don't know, making this up as I go along.
1:05:56
SPEAKER_05: Yeah.
1:05:57
SPEAKER_05: But I think um, yeah, if people are overeating, You could certainly set up a timed future freezer, that's for sure, and have this all wired to your watch.
1:06:05
SPEAKER_00: We've just got ourselves a new startup.
1:06:07
SPEAKER_00: Yeah, there you go.
1:06:08
SPEAKER_05: Um, yeah.
1:06:09
SPEAKER_05: But you have to that that's why you need the implantable though, because if the watch will just take the watch off.
1:06:13
SPEAKER_00: Have one that shocks me when I go to the fridge.
1:06:15
SPEAKER_05: Yeah, there you go.
1:06:18
SPEAKER_00: So you mentioned something there that I wanted to just touch on.
1:06:21
SPEAKER_05: Or maybe here's that, you know, you if you got your 10,000 steps, and then you can do an extra visit to the fridge.
1:06:27
SPEAKER_00: Yeah.
1:06:28
SPEAKER_05: See the reward systems actually.
1:06:30
SPEAKER_00: Long-term sustainable habits, right?
1:06:32
SPEAKER_05: Yeah, basically.
1:06:33
SPEAKER_05: Probably exercising every day, getting your heart rate up to a certain number.
1:06:36
SPEAKER_00: Um, just going back quickly to something you mentioned about starting in your teens.
1:06:41
SPEAKER_00: If any listeners have teenage children right now, you think they should be wearing wearables?
1:06:47
SPEAKER_05: I think so.
1:06:48
SPEAKER_05: My daughter does it.
1:06:49
SPEAKER_05: Um yeah.
1:06:51
SPEAKER_05: I didn't force her to.
1:06:53
SPEAKER_05: She I have two daughters, one does, one doesn't.
1:06:55
SPEAKER_00: I bet there's loads lying around the house as well.
1:06:57
SPEAKER_05: Uh well, they are, but you know, we want to get the latest ones on.
1:07:01
SPEAKER_00: Yeah.
1:07:01
SPEAKER_05: So um, and and I I think she likes wearing it.
1:07:06
SPEAKER_05: Um, and part of it's for the things you were just saying about she does check if you know, these days if you think you're off on something, your heart rate's up, and you even if you sort of feel what am I coming down with something?
1:07:19
SPEAKER_05: You can actually check your watch and look at the record yourself, even with that alerting system.
1:07:24
SPEAKER_05: Say, yeah, I am my heart rate is up.
1:07:25
SPEAKER_05: Something is off.
1:07:27
SPEAKER_00: Are there any wearables that don't have mobile apps?
1:07:30
SPEAKER_00: The reason I ask that is like I'm just thinking now out loud, I'd kind of like one that I couldn't check on an app on my phone.
1:07:37
SPEAKER_05: Yeah.
1:07:37
SPEAKER_00: So maybe it's you need to be closer to it.
1:07:40
SPEAKER_05: Yeah, get it blinded.
1:07:41
SPEAKER_05: It has to use your phone to pull in the data.
1:07:44
SPEAKER_05: Um, I mean, I guess it could do it through the cloud, but usually they Bluetooth onto your phone.
1:07:50
SPEAKER_05: And then you would just have the dashboard set up in a way that presumably this could be done, but isn't done.
1:07:55
SPEAKER_02: Yeah.
1:07:56
SPEAKER_05: Because most people like to probably do daily checks.
1:07:59
SPEAKER_02: Yeah.
1:07:59
SPEAKER_05: I myself only check every few days in spite of all my because I know my habits pretty well.
1:08:04
SPEAKER_05: Yeah.
1:08:05
SPEAKER_05: But if I sense anything's off, I will do a check.
1:08:07
SPEAKER_00: Well, I do think that's an incredibly important point you make as well, that you get you start to get better intuition because of the data, right?
1:08:16
SPEAKER_00: So when you learn when you start to learn about yourself more, and I think in many ways is one of the reasons I don't use them as frequently as I maybe should, is that you know, I feel like I've probably need it for the exogenous thing, like uh if you get a viral infection and things.
1:08:30
SPEAKER_05: But these things, and and again, as you get older, the probability of you having a heart issue does go up.
1:08:35
SPEAKER_02: Yeah.
1:08:36
SPEAKER_05: You know, you think about half the people in the US die of cardiovascular disease.
1:08:40
SPEAKER_05: And we don't do very active health monitoring on those folks, right?
1:08:44
SPEAKER_05: Very little, usually after the fact, just like the person who died on the treadmill.
1:08:50
SPEAKER_05: Yeah.
1:08:50
SPEAKER_05: So we really should be doing a lot more there with biochemical and wearable markers, in my opinion.
1:08:56
SPEAKER_00: So on the flip side then, you think you know, anyone with, you know, and a lot of people listening will have aging parents who haven't grown up having access to these things, they didn't exist.
1:09:07
SPEAKER_00: You know, what would be the pitch to to say to my my parents to wear one?
1:09:11
SPEAKER_00: In fact, I don't think either of my parents do wear one.
1:09:13
SPEAKER_00: And so they will be listening now, hopefully.
1:09:15
SPEAKER_00: So they should.
1:09:16
SPEAKER_05: The pitch is we want to keep you happy and help piece and have fun with your grandkids.
1:09:22
SPEAKER_05: And so if you wear one of these things, personal probably help you, but maybe share the information with your you know, sounds good.
1:09:31
SPEAKER_05: Yeah, and you know, have this happens naturally anyway.
1:09:34
SPEAKER_01: Yeah.
1:09:35
SPEAKER_05: Uh, I don't know about you if your parents are still alive, but you know, again, when my parents got older, I had this family of six, and um I was probably not the best one in doing this.
1:09:45
SPEAKER_05: The ones who live closer tend to take more responsibility, but they were always, you know, checking up, and um, and I think the watch would have gone a long ways and and helping alleviate a lot of issues.
1:09:56
SPEAKER_05: Yeah.
1:09:57
SPEAKER_00: So maybe that's a good gift.
1:09:59
SPEAKER_05: It is, I think so.
1:10:00
SPEAKER_00: Because I I I bet there are, you know, I bet most of our parents wouldn't go out and buy one like proactive about it.
1:10:07
SPEAKER_05: So we might just go in and help them set it up.
1:10:10
SPEAKER_05: Yeah.
1:10:10
SPEAKER_05: Download the app, put the watch on, show them how to charge it, and then off they go.
1:10:15
SPEAKER_00: Yeah.
1:10:16
SPEAKER_05: Then it just runs in the background, just like your car.
1:10:20
SPEAKER_00: Can we can I ask you uh a question about misinformation?
1:10:24
SPEAKER_00: You have so much information, so much data that you've collected over the years, you must have seen the sort of pendulum of evidence swing both ways for a bunch of different tools and technologies.
1:10:36
SPEAKER_00: Is there anything that you are seeing online in the press, in the media, that you would wish people would stop paying attention to?
1:10:44
SPEAKER_05: Um it's a good question.
1:10:47
SPEAKER_05: I think more in the other direction, like people like physicians not liking whole body MRIs or genome sequence.
1:10:54
SPEAKER_05: They don't like the wearables because a lot of people do have some alerting system that they come in with this thing, hey, my watch tells me this.
1:11:03
SPEAKER_00: Right.
1:11:03
SPEAKER_05: Uh and I do think those things are valuable.
1:11:06
SPEAKER_05: So I I'd like to see some of this good stuff get incorporated.
1:11:10
SPEAKER_05: Uh, what's bad that's out there?
1:11:12
SPEAKER_05: I I think um taking control of your own health, even you you mentioned earlier, AI is not perfectly accurate, nor is a physician.
1:11:22
SPEAKER_05: And I would encourage people to take responsibility for their own health.
1:11:27
SPEAKER_05: I think the supplement data is it's in flux.
1:11:32
SPEAKER_05: Some stuff's good, some stuff there's no evidence for.
1:11:36
SPEAKER_05: And some there tends to be small studies, so you're not quite as sure yet.
1:11:41
SPEAKER_05: Um, I don't know, there's a lot of things out there to be sorted out.
1:11:44
SPEAKER_00: Yeah, there's a lot of unanswered questions, right?
1:11:46
SPEAKER_05: Yeah, there are.
1:11:47
SPEAKER_05: And I, you know, there's certain areas that what what I think is fascinating, some fields like traditional Chinese medicine uh that I now follow quite a bit, and also I follow an Indian version of this called Arivea, um, where they have other things they bring in, like in body composition, things like this.
1:12:07
SPEAKER_05: And I think there's something to some of these things, but how to incorporate it, I don't know yet.
1:12:13
SPEAKER_05: But they certainly have a lot of interesting remedies out there for diabetes and things like this that I suspect are pretty effective and they're not yet brought in.
1:12:22
SPEAKER_05: So then it adds to this mystique and you know, lack of clarity what is good and what is not good.
1:12:28
SPEAKER_05: But acupuncture is a good example.
1:12:29
SPEAKER_05: I think acupuncture is very well accepted for pain.
1:12:32
SPEAKER_02: Yeah.
1:12:33
SPEAKER_05: Uh I, you know, I did this for uh hypertension.
1:12:37
SPEAKER_05: I did it just because I was on sabbatical, and my gracious host said, Mike, why don't you try acupuncture?
1:12:43
SPEAKER_05: And I'm borderline hypertensive.
1:12:45
SPEAKER_05: Some people say I would I am.
1:12:46
SPEAKER_05: For me, it worked great.
1:12:47
SPEAKER_05: I actually I'm a great.
1:12:49
SPEAKER_00: You showed me the dates, right?
1:12:50
SPEAKER_05: Oh, it's unbelievable.
1:12:51
SPEAKER_05: I went from I used to be in like the low 140s over, say, 82, and I went right away to 117, 119 over um about uh what was it?
1:13:01
SPEAKER_05: It was uh I think 69.
1:13:04
SPEAKER_05: So and then it got even better as you do multiple treatments.
1:13:07
SPEAKER_05: So so it's so for me it worked, but it only it doesn't work for everyone.
1:13:10
SPEAKER_05: Back to personalization, apparently it works for 70% of people.
1:13:14
SPEAKER_05: So that one's now semi-accept, but then there's a whole bunch of other acupunctures out there, not clear.
1:13:20
SPEAKER_05: It's kind of like supplements.
1:13:21
SPEAKER_05: Do they work?
1:13:21
SPEAKER_05: Do they not work?
1:13:22
SPEAKER_00: Yeah, it's the challenge, right?
1:13:24
SPEAKER_00: Because there are there are so many things that both feel and sound promising, and the science hasn't yet caught up, or the data hasn't yet caught up.
1:13:35
SPEAKER_00: Yeah.
1:13:35
SPEAKER_00: Can you do you have some top examples of that?
1:13:39
SPEAKER_00: The the the one I think, and you correct me if I'm wrong, where I I think it's incredibly promising.
1:13:45
SPEAKER_00: I think we can capture lots of data, but we still don't really know what to do with it as the microbiome.
1:13:50
SPEAKER_00: Like I think there are dozens of microbiome companies now, but really what are they telling you to do other than take a pre and probiotic and change your nutrition?
1:13:58
SPEAKER_05: Like, yeah, we wrestle with that one all the time on the micro.
1:14:01
SPEAKER_05: I lab does a lot of microbiome research, but it is really research.
1:14:05
SPEAKER_00: I am optimistic about it, by the way.
1:14:06
SPEAKER_05: Yeah, no, it's very clear that the microbiome's been linked to every disease and condition you can think of.
1:14:13
SPEAKER_05: I think the reason it's complicated is because it's communities and people treat them like individual strains.
1:14:18
SPEAKER_00: Right, yeah.
1:14:19
SPEAKER_05: So it's a community you have, not black and bacillus and bifido.
1:14:23
SPEAKER_05: Those are important as part of the community.
1:14:25
SPEAKER_05: And so that has not all been figured out, but will be with AI.
1:14:28
SPEAKER_05: And yeah, the whole actionability, but I think it also comes back to the personalization of the person.
1:14:34
SPEAKER_05: Like I'm a great responder to acupuncture, but other people aren't.
1:14:38
SPEAKER_05: And it probably has something to do with how I'm wired relative to other people.
1:14:42
SPEAKER_05: And I think that's true of food.
1:14:45
SPEAKER_05: Your microbiome gets established in the first three years of life.
1:14:48
SPEAKER_05: So it does a lot of your immune system because you're getting infected with things, you're eating food, everybody's exposure is different in that first three years.
1:14:57
SPEAKER_05: 70% of your immune cells are in your gut, so you're tuning your immune system in very personal ways early on.
1:15:05
SPEAKER_02: Yeah.
1:15:05
SPEAKER_05: And so the net result is people all come out very different.
1:15:09
SPEAKER_05: And I think that's a major component of our health from the microbiome, from other situations, stress, things like this.
1:15:16
SPEAKER_05: And so I think back to this baseline, if we know what your baseline is, we have one study where we see that people are under stress respond favorably to certain conditions, whereas others don't.
1:15:29
SPEAKER_05: But if you do the population as a whole, you'd scratch your head and say, what's going on here?
1:15:33
SPEAKER_02: Yeah.
1:15:33
SPEAKER_05: Uh this condition doesn't work.
1:15:35
SPEAKER_05: It's kind of like borderline.
1:15:37
SPEAKER_05: But once you segregate out the responders and the non-responders, oh well, yeah, this does work for that kind of a person.
1:15:45
SPEAKER_05: And it comes back to like I was saying about the diabetes, that you know, if you're musclins resistant, you'll be a potato spiker.
1:15:52
SPEAKER_05: We can also show you can mitigate those spikes.
1:15:55
SPEAKER_05: Another general lesson for the listeners here.
1:15:58
SPEAKER_05: If you're um you've been told since you're little, or should have been, that you should eat your salad before your french fries and potatoes, starchy things.
1:16:06
SPEAKER_05: And some do, some don't, you should do it as a general, but it it also depends on your diabetes subtype.
1:16:13
SPEAKER_05: So if your muscle's resistant, it doesn't work to eat um uh fat and so back up.
1:16:22
SPEAKER_05: Protein and fiber, and to some extent fat will suppress those spikes.
1:16:27
SPEAKER_05: Yeah.
1:16:27
SPEAKER_05: And if your muscle's resistant, it doesn't work.
1:16:30
SPEAKER_05: Same with the beta cell defect.
1:16:32
SPEAKER_05: So the kind of subtype you are determines not only what you'll spike to, but how to mitigate those spikes.
1:16:40
SPEAKER_05: And this is why we're complex, you know, it's annoying, isn't it?
1:16:45
SPEAKER_00: It's annoying, yeah.
1:16:46
SPEAKER_05: And so we're all different.
1:16:47
SPEAKER_05: And that's why these monitors are gonna help us personalize it.
1:16:50
SPEAKER_00: And from from what I'm hearing, you know, we are that there is we are capturing so much more data now that that will become the resolution will get higher and the efficacy of the the internal.
1:17:02
SPEAKER_05: And you're gonna know your baseline in so many different ways.
1:17:04
SPEAKER_05: Yeah.
1:17:05
SPEAKER_05: From the wearables, from the retinal scans, all these things, that it will help track you.
1:17:10
SPEAKER_00: Can I ask you a question about women's health?
1:17:13
SPEAKER_00: Because you know, you mentioned a moment ago, you know, what works for me doesn't necessarily work for you.
1:17:19
SPEAKER_00: And I suspect that like things would change throughout different parts of your cycle, and then that that would give different data, which would then recommend different intervention.
1:17:29
SPEAKER_00: Are there any good women's health wearables that are in who's leading the field there at the moment?
1:17:33
SPEAKER_00: Do you know?
1:17:34
SPEAKER_05: Well, most of the wearables have they you can tell someone's menstrual cycle from the wearable data.
1:17:41
SPEAKER_02: Yeah.
1:17:41
SPEAKER_05: Because the heart rate changes, the temperature changes, about a degree and a half between menstruation time and uh other times.
1:17:50
SPEAKER_05: And um, yeah, so there are shifts, heart rate variability shifts.
1:17:55
SPEAKER_05: Um, all these things um do, and and most devices will pick that up, but although the ones who are running serious studies that I can tell are Fitbit, Apple, and Aura, um, fairly large studies.
1:18:07
SPEAKER_05: I think the area that's very understudied is menopause.
1:18:11
SPEAKER_05: Uh and and it's a very important area.
1:18:14
SPEAKER_05: You know, it used to be hormone replacement therapy was in, then it was out.
1:18:18
SPEAKER_05: They it had to do with the studies were, I think, misinterpreted.
1:18:22
SPEAKER_05: Uh, they thought hormone replacement led to increase in cancer.
1:18:26
SPEAKER_02: Yep, yep.
1:18:26
SPEAKER_05: But now it's back in.
1:18:27
SPEAKER_05: In fact, it's highly recommended.
1:18:30
SPEAKER_05: And so um, anyway, there's all kinds of biological changes when women hit menopause, perimenopause, and menopause.
1:18:38
SPEAKER_05: So I think we need to understand that better so we can make appropriate recommendations for women.
1:18:44
SPEAKER_05: And during, yeah, I would say even during healthy women's cycles who are cycling normally.
1:18:50
SPEAKER_05: Well, first of all, there are plenty of women who aren't cycling normally.
1:18:53
SPEAKER_05: What's going on there and what's triggering that?
1:18:55
SPEAKER_05: That you can to some extent decipher with wearables, we think.
1:18:59
SPEAKER_05: Uh, and then for um just during the cycle, maybe we could optimize people better about when they would should be doing certain tasks, perhaps.
1:19:12
SPEAKER_02: Yeah, yeah.
1:19:12
SPEAKER_05: Uh, when are they better to handle certain things versus others?
1:19:15
SPEAKER_00: Not to say you'd ever completely avoid things based on your cycle, but if you want to optimize, you might just do just yeah, for creativity or physicality or yeah, yeah, endurance, yeah, yeah, emotional regulation.
1:19:28
SPEAKER_00: I think that there's good knowledge is power, right?
1:19:30
SPEAKER_00: And we can figure it out now.
1:19:32
SPEAKER_05: Yeah.
1:19:32
SPEAKER_00: Huh.
1:19:33
SPEAKER_05: And I have another saying, you can never have too much information.
1:19:36
SPEAKER_00: Do you believe that?
1:19:37
SPEAKER_05: Yeah, I totally do.
1:19:39
SPEAKER_00: Well, clearly.
1:19:41
SPEAKER_05: I've never regretted pulling in any information.
1:19:44
SPEAKER_00: No, but do you think that's because of the way that you're I'm hardwired to be able to handle the information.
1:19:49
SPEAKER_05: Yeah.
1:19:50
SPEAKER_05: Not everyone is, I get it.
1:19:51
SPEAKER_05: You know what, again, you want don't want people psychologically stressing, getting information, they can't that won't that you know impacts their functioning lives.
1:20:00
SPEAKER_01: Yeah.
1:20:00
SPEAKER_05: Again, you don't want someone waking up every morning, am I gonna get breast cancer?
1:20:04
SPEAKER_05: I'm gonna get breast cancer.
1:20:05
SPEAKER_01: Yeah.
1:20:05
SPEAKER_05: So if you're that kind of person, but the decision, as tricky as it might be, the decision rests with the person.
1:20:11
SPEAKER_05: Yes, doesn't rest with the physician, doesn't rest with the insurer, it should really come down to the person.
1:20:16
SPEAKER_00: Yeah, and I and I also think there's no right or wrong answer.
1:20:19
SPEAKER_00: Um, because you know, some people will find that anxiety inducing, and some people will find that it sucks the fun out of life a little bit, right?
1:20:28
SPEAKER_00: And you know, given how much data we have on social connection and you know, joy and happiness and optimism, that might impact them in the wrong way, right?
1:20:39
SPEAKER_05: Yeah, I s suspect that's unlikely, but yeah, I worry more about the people who are more introvert who don't get out enough.
1:20:47
SPEAKER_00: But do you not think um, do you not think that like being uh I and I say this because I it happens to me I I and I mentioned it before we started recording, that I feel like at times I've become a bit of a slave to technology.
1:21:03
SPEAKER_00: And so if I'm then required to monitor data about my health on the screen, I'm just spending more time on my screen.
1:21:10
SPEAKER_05: Yeah, that's not so good.
1:21:12
SPEAKER_00: And and I do think that sucks the fun out of life a little bit.
1:21:15
SPEAKER_00: That's what I am really looking forward to, and this is why I'm so bullish about it.
1:21:18
SPEAKER_05: We need a way where it just shows up on your bathroom mirror in the morning.
1:21:21
SPEAKER_00: Yeah, and that that's coming.
1:21:22
SPEAKER_05: That'll be once a day, yeah.
1:21:24
SPEAKER_05: Absolutely.
1:21:24
SPEAKER_05: Yeah.
1:21:25
SPEAKER_05: So yeah, we need to figure out a way to control it to you can best manage information.
1:21:31
SPEAKER_00: And I think because it's so valuable, we are being a good idea.
1:21:38
SPEAKER_05: Yeah, or once a week.
1:21:40
SPEAKER_05: So I think the user should be in charge of that.
1:21:43
SPEAKER_00: But are there any things that you're seeing, um, you know, everyone wants a slice of this pie commercially now, right?
1:21:50
SPEAKER_00: Every there are I'm we're seeing new technologies and tools every day.
1:21:54
SPEAKER_05: Oh, yeah.
1:21:54
SPEAKER_00: Um, are there any like domains in which you're seeing them being released where you think that the science is nowhere near caught up?
1:22:01
SPEAKER_00: So you you're like, I don't think this is actually valuable yet.
1:22:04
SPEAKER_05: Um, I mean, I do spot claims time to time of things I question, yeah.
1:22:09
SPEAKER_05: Um then tell us.
1:22:11
SPEAKER_05: It's all kinds of things.
1:22:12
SPEAKER_05: No, I want to watch a little bit, but the yeah, uh yeah.
1:22:17
SPEAKER_05: I mean, the supplement business is notorious.
1:22:19
SPEAKER_05: I'll stay with that.
1:22:20
SPEAKER_05: That's everyone knows that.
1:22:21
SPEAKER_05: Um, this is great for you.
1:22:23
SPEAKER_05: And again, it may be great for certain people.
1:22:25
SPEAKER_05: Uh do you take supplements?
1:22:27
SPEAKER_05: I take a ton.
1:22:28
SPEAKER_05: Uh it's I'm pretty sure it's up on my website.
1:22:30
SPEAKER_05: If not, I'll make sure it is.
1:22:32
SPEAKER_05: Happy to give it to you.
1:22:33
SPEAKER_05: You can you can put it up on your website if you want, Chris.
1:22:35
SPEAKER_05: Um, yeah, I take about 10 or so.
1:22:38
SPEAKER_05: I have certain medications for my diabetes.
1:22:41
SPEAKER_05: Uh, like I take they're called SGLT2 inhibitors, and I'm on the GLPs, although they got me too thin.
1:22:47
SPEAKER_05: I'm actually looking a little unhealthy.
1:22:49
SPEAKER_05: Uh, so I backed off to doing it one-third the dose.
1:22:52
SPEAKER_05: I can do it every third week instead of every week.
1:22:55
SPEAKER_05: Oh, and I'm on the minimal dose.
1:22:56
SPEAKER_05: Uh, but I also have better eating habits now, which is helping with some of that.
1:23:00
SPEAKER_05: But um, but yeah, I take antioxidants.
1:23:04
SPEAKER_05: That's a classic case where it's very clear antioxidants in food.
1:23:08
SPEAKER_05: If you eat foods with antioxidants, people have longer lifespan, lower cardiovascular disease, all these good things.
1:23:15
SPEAKER_05: But there's very few studies showing antioxidants as a supplement, like coenzyme Q will do what I just said.
1:23:22
SPEAKER_00: Right.
1:23:23
SPEAKER_05: So that's where, well, it hasn't been shown, but the food does it, so it's very likely right.
1:23:30
SPEAKER_05: So I tend to err, like if I'm a betting guy, I'd bet that they're gonna be good.
1:23:34
SPEAKER_05: So I take my coenzyme Q.
1:23:36
SPEAKER_05: Uh, so anyway, yeah.
1:23:37
SPEAKER_00: Uh feels like the risk reward is appropriate.
1:23:40
SPEAKER_05: Yeah, exactly.
1:23:41
SPEAKER_05: So I take all I take beetroot extract.
1:23:44
SPEAKER_05: That's one most people may not think of as much, uh, because um that makes nitric oxide, which is good for your endothelial cells and your microvascular system, which is both good for your brain and your whole cardiovascular system.
1:23:57
SPEAKER_05: So I take that one, I take vitamin D3, fish oil, the whole bunch of protein.
1:24:02
SPEAKER_05: Yeah.
1:24:03
SPEAKER_05: Yeah, time to time.
1:24:05
SPEAKER_05: But one minus is I have a big tub there and everything else I got in these pills, I'm always in a rush in the morning.
1:24:11
SPEAKER_05: So I grab my and I I do have plenty of I work out normally.
1:24:15
SPEAKER_05: I work out lifting weights, and then I take my protein uh right after that.
1:24:20
SPEAKER_05: But I yeah, so I I probably should get the pills, but they probably don't I probably have to pop five pills or whatever the number is.
1:24:27
SPEAKER_05: Uh so every now and then I I do take some creatine, but not not as regularly as I should.
1:24:33
SPEAKER_05: Yeah, but uh yeah, I I take another packet of supplements.
1:24:37
SPEAKER_05: I it's a new one that seems quite good from yet another company uh that I'm involved in.
1:24:42
SPEAKER_05: But um anyway, yeah.
1:24:44
SPEAKER_05: So um oh and I take magnesium, and there are many different forms of magnesium out there.
1:24:49
SPEAKER_05: I take two of them.
1:24:50
SPEAKER_05: Uh glycinate, which helps you sleep, and three and eight, which is supposed to be good for the brain.
1:24:54
SPEAKER_05: And um, and also helps you sleep, has magnesium there.
1:24:57
SPEAKER_05: Yeah, so I take both of them.
1:24:59
SPEAKER_05: I'll put them up on my website now.
1:25:01
SPEAKER_00: Yeah, well, let's add that to the show notes too.
1:25:03
SPEAKER_05: Yeah, there you go.
1:25:04
SPEAKER_05: Yeah, yeah.
1:25:05
SPEAKER_00: Mike, what would you say your biggest vice is?
1:25:07
SPEAKER_05: Oh, it's sleep.
1:25:08
SPEAKER_05: I don't sleep well enough.
1:25:10
SPEAKER_05: I had been getting about four and a half hours of sleep at night.
1:25:13
SPEAKER_05: Uh, I wake up in the middle of the night, do my email, go back to sleep.
1:25:17
SPEAKER_05: It it's pretty fragment, so not so good.
1:25:19
SPEAKER_05: So I've been trying to get out of that, at least on uh work, do my email to um try and sleep better through night.
1:25:26
SPEAKER_05: So lately I've been getting about six hours, so that's getting better.
1:25:30
SPEAKER_05: I'm trying to push it up to seven.
1:25:32
SPEAKER_05: So I'm not there yet.
1:25:34
SPEAKER_05: Um, and I don't get it every night because of I have a big thing due that day.
1:25:38
SPEAKER_05: I wake up in the middle of the night and then I I can either worry about not getting done or just do it then.
1:25:44
SPEAKER_05: Yeah, then I go back to sleep better.
1:25:45
SPEAKER_05: So I've but that's not that common, but does happen.
1:25:48
SPEAKER_00: Are you an early bird?
1:25:50
SPEAKER_05: Um I get up at six, sometimes before.
1:25:53
SPEAKER_05: Okay.
1:25:53
SPEAKER_05: Yeah.
1:25:54
SPEAKER_05: All right.
1:25:54
SPEAKER_05: I didn't use it that way.
1:25:56
SPEAKER_05: When I was in college and as a professor, I get up at noon.
1:25:58
SPEAKER_05: Yeah.
1:25:59
SPEAKER_05: Like typical yeah, standard.
1:26:01
SPEAKER_00: Yeah.
1:26:02
SPEAKER_00: What um looking forward ten years from now, what excites you most about the field that you're researching?
1:26:12
SPEAKER_05: Well, in my dream world, everyone will have their genome sequence, ideally before birth for the newborns coming along.
1:26:19
SPEAKER_05: They will be wearing some sort of measurable device implantable um smartwatch ring, and they'll look in the mirror and they'll have a and and they'll say, Good morning, Chris, or something new, or can talk to themselves.
1:26:34
SPEAKER_05: And that combination will give you 90% of what you need for health information.
1:26:38
SPEAKER_05: And if we can get a high enough resolution, maybe get a retinal scan from that, or maybe you have to hold your phone to it, uh, either every day, once a week.
1:26:48
SPEAKER_05: And then it's gonna integrate all the information you've been doing, right?
1:26:51
SPEAKER_05: What you've been doing, you were out drinking too much last night, you probably know it anyway, but maybe it's gonna show that data too.
1:26:57
SPEAKER_05: That's the power of data.
1:26:59
SPEAKER_05: Yeah, the CGMs, it shows you drink a McDonald's shake and wear a CGM, you see what it's doing to you.
1:27:05
SPEAKER_05: Your sugar goes through the roof.
1:27:08
SPEAKER_05: And I think if we can get that kind of resolution back to people, that will also be impactful for them better manage their health.
1:27:14
SPEAKER_05: So, and then yeah, they will, and there'll be incentives for them being active, either running or lifting weights, ideally a combination of both.
1:27:23
SPEAKER_05: Uh, at least some strength training, which I think is underrepresented now.
1:27:27
SPEAKER_05: Yeah, and have good social networks.
1:27:30
SPEAKER_05: And then my world, people live long, healthy lives and then pass away when the time comes.
1:27:36
SPEAKER_05: Now, I do think that's a whole different podcast.
1:27:39
SPEAKER_05: I think we should be able to engineer people to live forever.
1:27:42
SPEAKER_05: But we can't do that now.
1:27:44
SPEAKER_05: But it's the kind of thing that is it's an engineering problem, but it's a different podcast, that's for sure.
1:27:50
SPEAKER_00: How far away do you think that is?
1:27:52
SPEAKER_05: I don't know.
1:27:53
SPEAKER_05: I think it'll be happen stepwise.
1:27:54
SPEAKER_05: Like I think your mitochondriate damage as you get older.
1:27:57
SPEAKER_05: I'm sure you're doing podcasts on that.
1:27:59
SPEAKER_02: Yeah.
1:28:00
SPEAKER_05: And then and you can swap mitochondria out.
1:28:02
SPEAKER_05: So that's kind of on the edge now, meaning companies are out there uh that are doing mitochondrial transfer.
1:28:09
SPEAKER_05: And and it happens naturally in our cells.
1:28:12
SPEAKER_05: The other thing you need to do is get rid of your senescent cells.
1:28:15
SPEAKER_05: And there are companies out there that have good, they're looking very promising for doing that.
1:28:20
SPEAKER_05: Or sorry, synolytics.
1:28:22
SPEAKER_05: Um, because they damage your surrounding cells, cause a lot of inflammation.
1:28:26
SPEAKER_05: The tricky one is replacing your stem cells, particularly in your brain.
1:28:30
SPEAKER_05: And that's gonna be a lot of thought and a lot of effort, and we're not there yet.
1:28:36
SPEAKER_05: So when is all this gonna happen?
1:28:37
SPEAKER_05: It it's almost impossible to predict the space as you know it.
1:28:40
SPEAKER_05: Yeah.
1:28:41
SPEAKER_05: Move so fast.
1:28:42
SPEAKER_05: And um, every time you think you have a solution, there can be a problem, like sure, maybe you'll replace your stem cells, but now you cause cancer.
1:28:49
SPEAKER_01: Yeah, yeah.
1:28:50
SPEAKER_05: So you gotta watch.
1:28:51
SPEAKER_05: So safety is important.
1:28:52
SPEAKER_05: Yeah, but I think some of the stuff is easy, the synellitics and the um mitochondria, but the the swapping, the regenerating your stem cells.
1:29:01
SPEAKER_00: Yeah.
1:29:02
SPEAKER_00: Yeah.
1:29:02
SPEAKER_00: No, no, I I've changed my perspective to be much more bullish on that conceptually, at least, given what I've seen.
1:29:08
SPEAKER_05: Well, I think people born today, the it's highly probable minimally they're gonna live to be a hundred.
1:29:13
SPEAKER_00: Yeah.
1:29:13
SPEAKER_05: Uh unless, you know, they get hit by a bus or something, yeah.
1:29:16
SPEAKER_05: Some sarcastic event.
1:29:18
SPEAKER_05: But you know, there's a decent chance they will be able to live forever.
1:29:24
unknown: Right?
1:29:26
SPEAKER_00: When you go back to the first day of your career, would you have ever thought that you'd be saying that out loud?
1:29:33
SPEAKER_05: No.
1:29:35
SPEAKER_05: It wasn't on my radar, so I think it was something I thought about.
1:29:38
SPEAKER_05: I wasn't I didn't even think about longevity at all until it goes back to the beginning of our conversation.
1:29:44
SPEAKER_05: We're doing all this big data research, and I did want to apply it to human health.
1:29:48
SPEAKER_05: And then when I moved to Stanford and got my you know, medical exam, like you do when you sign up at a new health plan, I realize how Byzantine this was.
1:29:58
SPEAKER_05: It's like it's time.
1:30:00
SPEAKER_05: We talked about a lot previously.
1:30:02
SPEAKER_05: So uh, and I I think that's what got me thinking seriously about this.
1:30:07
SPEAKER_05: Kind of interesting too, because the longevity field was generally filled with people who study mechanisms of aging, not really solving it.
1:30:15
SPEAKER_05: And people in the health span field, which is kind of what else I view myself, which you know, we do research, don't get me wrong, we discovered all kinds of fun stuff, but we when we apply it, we are trying to apply it and keep people healthy.
1:30:28
SPEAKER_05: And now the field's emerging, which is kind of fun.
1:30:31
SPEAKER_05: Yeah.
1:30:31
SPEAKER_05: Um, so yeah, I I I think it it's and things, as you point out, they're moving at such a rapid pace that it's fun.
1:30:40
SPEAKER_05: And and I think also people have the mindset, well, they they do all over the all over the country, but especially when you're in the Bay Area, people really like to solve problems.
1:30:50
SPEAKER_05: Yeah.
1:30:50
SPEAKER_05: They don't want to just learn about the problem.
1:30:53
SPEAKER_05: They're they're that they start companies with the idea we're gonna solve these unsolvable problems.
1:30:58
SPEAKER_05: Yeah.
1:30:59
SPEAKER_05: And they often do.
1:31:00
SPEAKER_05: Longevity has really taken, you know, that that whole spirit.
1:31:05
SPEAKER_05: Um, there's a whole bunch of longevity.
1:31:07
SPEAKER_05: Now everybody calls themselves a longevity company.
1:31:10
SPEAKER_05: Some probably are, some probably aren't.
1:31:11
SPEAKER_05: Yeah.
1:31:12
SPEAKER_05: Many are just help.
1:31:13
SPEAKER_05: Nothing wrong with that.
1:31:14
SPEAKER_00: Yeah.
1:31:15
SPEAKER_00: Yeah.
1:31:16
SPEAKER_00: You it must have been exciting for you to see that shift, right?
1:31:20
SPEAKER_00: Like I think back 10 years we weren't even using that word.
1:31:24
SPEAKER_05: Yeah, no, that's right.
1:31:25
SPEAKER_05: Yeah, it's it's been fun.
1:31:27
SPEAKER_00: Yeah.
1:31:27
SPEAKER_05: And it's fun just hearing all the ideas, some of which are you know, you raise your eyebrows to, you know, cryo preservation.
1:31:35
SPEAKER_05: So there are companies that will freeze people who die.
1:31:39
SPEAKER_00: There's some that will just freeze your head, I've I've seen.
1:31:42
SPEAKER_00: Yeah, well, it's cheaper that way.
1:31:43
SPEAKER_00: Yeah.
1:31:44
SPEAKER_00: The budget version.
1:31:46
SPEAKER_05: I don't know what to say about that.
1:31:47
SPEAKER_05: Uh you're gonna have to rewire your head back on her.
1:31:50
SPEAKER_05: Maybe they're hoping to transplant your brain.
1:31:52
SPEAKER_00: Yeah.
1:31:53
SPEAKER_05: Yeah.
1:31:53
SPEAKER_05: And then, of course, there's at least one I know that's talking about, yeah, trying to upload your your neural information.
1:32:00
SPEAKER_00: Without going on a crazy tangent, I think that the you know, the 3D organ printing piece will already is starting to.
1:32:10
SPEAKER_00: People are working on it.
1:32:11
SPEAKER_05: It's tricky.
1:32:12
SPEAKER_05: It's not I don't know anyone who's made a functioning organ yet, but um I think the liver's been done.
1:32:18
SPEAKER_05: Yeah, I guess that would be easier.
1:32:20
SPEAKER_05: Um the yeah, the heart, you know, obviously there's a shortage of transplant patients.
1:32:27
SPEAKER_05: So it's a good one.
1:32:28
SPEAKER_05: Um the brain would be tough, right?
1:32:32
SPEAKER_05: Yeah, primates first.
1:32:33
SPEAKER_05: Yeah, brain will be very tough.
1:32:36
SPEAKER_05: Um, yeah, I we'll see.
1:32:39
SPEAKER_02: Yeah.
1:32:40
SPEAKER_05: I think things like the you know, the uterus will come out pretty early compared.
1:32:46
SPEAKER_05: And as you say, I I I don't think I knew the liver was out there, but liver cells you kind of regenerate, they divide on their own to some extent once a year.
1:32:55
SPEAKER_00: The organoids are doable, yeah.
1:32:57
SPEAKER_05: Organoids for sure.
1:32:58
SPEAKER_05: Yeah, and then essentially these organs are trying to get all the different cell types in the organoid, in the organoid in a proper way.
1:33:06
SPEAKER_00: Yeah, systemically that's buried.
1:33:08
SPEAKER_05: Yeah, so so it it's doable.
1:33:10
SPEAKER_05: It had for a while.
1:33:11
SPEAKER_05: Nobody could get the vascular, you know, all these organs have blood vessels in them.
1:33:16
SPEAKER_05: So you've got to get the vascular system impregnated in this thing and just right.
1:33:21
SPEAKER_05: And and nobody could do that for a while.
1:33:23
SPEAKER_05: Now people are setting up these cold culture systems that can do this.
1:33:28
SPEAKER_05: It's it's damn.
1:33:29
SPEAKER_00: What a time to be alive.
1:33:30
SPEAKER_05: It is gonna be amazing.
1:33:32
SPEAKER_00: Mike, what would you say?
1:33:35
SPEAKER_00: I mean, do we have any data on how wearing these are impacting us with regards to radiation or EMFs?
1:33:42
SPEAKER_00: Like I think there's a lot of scaremongering going on, and I can't see much or any data on that.
1:33:48
SPEAKER_05: Uh, the studies I've seen about EMF, like power lines of these things, have all been negative.
1:33:54
SPEAKER_05: Right.
1:33:54
SPEAKER_05: There's no evidence that they cause issues.
1:33:57
SPEAKER_00: Okay, we can move straight on from that then.
1:33:59
SPEAKER_05: I believe so.
1:34:00
SPEAKER_00: Okay.
1:34:00
SPEAKER_00: Mike, if you had unlimited funding, resources, access to the other world's best scientists, what one question would you want to answer?
1:34:10
SPEAKER_05: Well, probably have several.
1:34:12
SPEAKER_05: Uh, I always I do debate what makes us human.
1:34:15
SPEAKER_05: Um, I think that's interesting.
1:34:18
SPEAKER_05: Um, I I personally believe most people will want to.
1:34:22
SPEAKER_05: If you ask people, do you want to live forever?
1:34:26
SPEAKER_05: Most people will say no, actually.
1:34:29
SPEAKER_05: Surprises me.
1:34:30
SPEAKER_05: Uh, but my own view is that when they're that's talking about myth, but my own view is if you ask anybody who's healthy, are you ready to go yet?
1:34:38
SPEAKER_05: The answer is never, no.
1:34:40
SPEAKER_02: Yeah.
1:34:40
SPEAKER_05: But if their health starts declining, then they're ready to go.
1:34:43
SPEAKER_02: Yeah.
1:34:44
SPEAKER_00: So I think, yeah, how do we get people to, I guess, embrace that's such a good way of framing it because I agree, I agree with both of those statements.
1:34:58
SPEAKER_00: Yeah.
1:34:58
SPEAKER_00: Are you ready if you're in good health?
1:35:01
SPEAKER_00: They want to keep going.
1:35:02
SPEAKER_05: Who doesn't want to be with their grandkids even when they're 90, right?
1:35:05
SPEAKER_05: Uh everyone I know does.
1:35:06
SPEAKER_03: Yeah.
1:35:07
SPEAKER_05: But I, you know, and sometimes health can be mental health.
1:35:11
SPEAKER_05: Um, because I think some people, all their friends have passed away.
1:35:15
SPEAKER_02: Yeah, true.
1:35:16
SPEAKER_05: And then they're feeling lonely and things.
1:35:18
SPEAKER_05: And so I think we will need this comes back to the socialization.
1:35:22
SPEAKER_05: We'll need new kinds of networks and families if we want people to stay again healthy for as long as possible, both mentally and physically.
1:35:32
SPEAKER_05: So um, yeah, I sure wish I knew how the brain worked.
1:35:37
SPEAKER_05: That's yeah, that would be a good area too.
1:35:39
SPEAKER_05: I could probably ask a thousand questions there, yeah.
1:35:42
SPEAKER_00: What what is something that you were really certain about that you got wrong?
1:35:47
SPEAKER_05: Well, I probably sound like a politician, like I'm never wrong, but I am wrong uh a number of times.
1:35:54
SPEAKER_05: But um what conceptually do we get wrong?
1:35:58
SPEAKER_05: Well, I never thought I'd be doing the work I'm doing now.
1:36:00
SPEAKER_05: I guess some kind of go with the flow kind of person.
1:36:04
SPEAKER_02: Yeah.
1:36:04
SPEAKER_05: And maybe this will talk more about science than non-science, but I'm a believer in science.
1:36:11
SPEAKER_05: You have to reinvent yourself your entire career because science changes, just like the longevity field's changing so fast.
1:36:18
SPEAKER_05: I don't know what's going to be hot and exciting 15 years from now, probably even 10 years from now.
1:36:24
SPEAKER_05: And so you always have to reinvent yourself.
1:36:26
SPEAKER_05: So I try and keep an open mind looking for things.
1:36:29
SPEAKER_05: I think one area I thought I thought we'd be able to sequence a genome in about 15 minutes by now.
1:36:36
SPEAKER_05: Um, so I overestimated that one.
1:36:38
SPEAKER_05: But these technologies are hard to predict.
1:36:40
SPEAKER_05: It takes about a day.
1:36:42
SPEAKER_05: Um, so I I thought we'd be able to move faster.
1:36:46
SPEAKER_05: Um, although there's a company that'll do in less than a day soon that's emerging.
1:36:51
SPEAKER_05: So um, yeah, so there's one, I guess I got wrong.
1:36:55
SPEAKER_05: I'm sure there are many more.
1:36:56
SPEAKER_05: I probably thought some data types be more valuable than other data types.
1:37:01
SPEAKER_05: Um yeah.
1:37:02
SPEAKER_00: Can I ask you something that might sound really naive?
1:37:04
SPEAKER_05: Okay.
1:37:04
SPEAKER_00: Um you know, uh with the gene editing, gene sequencing.
1:37:09
SPEAKER_05: Yeah.
1:37:10
SPEAKER_00: I often read headlines that sound incredibly promising and hopeful.
1:37:15
SPEAKER_00: You know, I've seen, you know, with um, I think it's cerebral palsy, maybe, or I might have got that wrong.
1:37:24
SPEAKER_00: Or Down syndrome or a combination of different ailments that they could switch, uh switch off a gene to stop a um a baby developing that in the first place.
1:37:35
SPEAKER_00: Is that true?
1:37:36
SPEAKER_00: And also if that's the case, what stopping us from being able to switch something like Ape OE4 to ApoE2?
1:37:44
SPEAKER_00: Or like what what's you know, why can't we do that?
1:37:47
SPEAKER_05: Yeah, well, the brain is a trickier for one thing.
1:37:50
SPEAKER_05: Yeah.
1:37:51
SPEAKER_05: So that is true.
1:37:53
SPEAKER_05: You picked a good area.
1:37:54
SPEAKER_05: I probably would have expected gene um therapy to be further than it was.
1:37:59
SPEAKER_05: There's been setbacks for a variety of reasons.
1:38:01
SPEAKER_05: Some of people not being quite as responsible, some of that, like when they did the first case where they're trying to fix kids without an immune system, there's a clear gene that was mutated, and they tried adding that back and everything, this is of course gonna work.
1:38:16
SPEAKER_05: This is great.
1:38:17
SPEAKER_02: Yeah.
1:38:17
SPEAKER_05: And then suddenly it turns out, well, those genes tended to land in front of a cancer promoter, so they wound up causing cancer.
1:38:26
SPEAKER_05: So, yes, they got cured for the immune system, but then I think at least half, not the majority, wound up getting cancer.
1:38:33
SPEAKER_05: So then you had to know, well, now we have to add a step in to screen and remove those.
1:38:38
SPEAKER_01: Yeah.
1:38:38
SPEAKER_05: So there's some unit science, and and I think people misinterpret what that means.
1:38:43
SPEAKER_05: If it's science, we don't know the answer.
1:38:45
SPEAKER_05: That's why we do what we do.
1:38:46
SPEAKER_02: Yeah.
1:38:47
SPEAKER_05: And so you have to do all these things, try them, see what works.
1:38:50
SPEAKER_05: Uh, if we had the answer, be no point doing it.
1:38:54
SPEAKER_05: So, so anyway, we we yeah, uh, I guess that's a big issue.
1:38:59
SPEAKER_05: I think I think I would have expected to be further, but on the other hand, it's hard to know what you don't know.
1:39:04
SPEAKER_05: Yeah.
1:39:05
SPEAKER_05: Um, and so I think some areas we should be further on in gene, and it's now emerging.
1:39:11
SPEAKER_05: The brain knows tricky because it and it comes down to exactly what you're trying to fix and how much of the cells do you have to fix?
1:39:17
SPEAKER_01: Right, yeah.
1:39:18
SPEAKER_05: You have to fix 100% of the cells, forget it.
1:39:20
SPEAKER_05: It's just about impossible.
1:39:22
SPEAKER_05: It's 20%.
1:39:22
SPEAKER_05: Well, you have a decent shot.
1:39:24
SPEAKER_05: Like for Parkinson's, if you can, I forgot what the number is, might be 20%.
1:39:29
SPEAKER_05: That may be uh don't quote me on that.
1:39:31
SPEAKER_05: Okay, but it may be good enough to um, you don't have to get them all though.
1:39:36
SPEAKER_05: Good enough to get, you know, your dopamine neurons fire there and firing.
1:39:41
SPEAKER_05: And yeah, and there are some new technologies that are called ASOs, antisens oligos, that they're kind of like gene therapy, but they're not you're not adding a whole gene, you're adding something that modulates a gene.
1:39:53
SPEAKER_05: And that's being used in a number of neurological diseases, and and in some cases has had success.
1:39:59
SPEAKER_05: They kind of have to roll out in the extreme cases initially, right?
1:40:03
SPEAKER_05: Yeah, because it's not clear they're safe or not.
1:40:06
SPEAKER_05: And extreme case meaning people who are enforcement in trouble.
1:40:10
SPEAKER_05: Yeah.
1:40:10
SPEAKER_05: And so they try them, and and occasionally some of the stuff works.
1:40:14
SPEAKER_05: So there's a few neurological conditions where ASOs have now been successful.
1:40:19
SPEAKER_05: So people are heading in that direction.
1:40:22
SPEAKER_05: And I'm aware of other cases where people are trying to solve a um a child that was born with the um uh a mutation, and and that should lead to lethality.
1:40:33
SPEAKER_05: And the uh uh people are working on trying to fix that child.
1:40:37
SPEAKER_05: So that stuff does happen.
1:40:38
SPEAKER_05: There's a group here in Boston, sorry, a group in Boston um that's uh um Robert Green, who does what they call baby seek, they sequence newborns to look for you know conditions.
1:40:50
SPEAKER_05: And and you know, occasionally they do have things, some of it's actionable, and you can take action sit by simple mechanism, some of it not so actionable, meaning it's nothing you do about it.
1:41:01
SPEAKER_00: Right.
1:41:01
SPEAKER_00: Do you think these things would move quicker if we had a lot more funding?
1:41:04
SPEAKER_00: I know it's a challenging environment right now.
1:41:07
SPEAKER_05: Yeah, it absolutely.
1:41:08
SPEAKER_05: I mean, that's what's generally holding back science, and funding for the most creative, cutting-edge stuff in particular is always lacking.
1:41:16
SPEAKER_05: Yeah.
1:41:17
SPEAKER_05: And it's it's understandable, it's a nature system.
1:41:20
SPEAKER_05: NAH does a great job.
1:41:21
SPEAKER_05: They're the biggest funder of science in this country, and they, you know, but they they have review and they tend to fund things that by consensus are viewed as you know, great science.
1:41:35
SPEAKER_05: But consensus is not always the best way to come up with the very best stuff.
1:41:39
SPEAKER_02: Sure, yeah.
1:41:40
SPEAKER_05: Because uh it means a group of people had to agree that this is the best thing, and generally that's not the most creative science.
1:41:47
SPEAKER_05: Sure.
1:41:47
SPEAKER_05: Trying to disprove a hyper.
1:41:48
SPEAKER_05: By definition, yeah.
1:41:50
SPEAKER_05: In fact, one reason, and uh early on I pushed this, but I'm a believer in discovery-based science, and that's why I like big data and genomics.
1:41:59
SPEAKER_05: So, discovery-based science means you can collect data and let the data tell you what's going on.
1:42:05
SPEAKER_05: Traditionally, science has been hypothesis-based.
1:42:08
SPEAKER_05: You think of an idea and you test it.
1:42:11
SPEAKER_05: And I always said, well, by definition, that's not the most creative science, because if you thought of it, it couldn't have been totally unexpected.
1:42:19
SPEAKER_05: And the biggest discoveries in science are things like penicillin, which right came out of a mold.
1:42:25
SPEAKER_05: Uh, there was uh, this gets technical, RNA as an enzyme, very field-changing.
1:42:31
SPEAKER_05: People didn't realize at the time.
1:42:33
SPEAKER_05: That was an observation uh that came out because again, people didn't know, but they saw this thing that looked weird, and then they pursued it.
1:42:42
SPEAKER_05: So, by so the the ability to collect data the way we do now lets us discover new things people couldn't imagine before.
1:42:50
SPEAKER_05: And that's what I like about we're in a system where you can not only collect but analyze data at a level that's never been possible before.
1:42:57
SPEAKER_02: Yeah.
1:42:57
SPEAKER_05: So I think we're just at a golden age.
1:43:00
SPEAKER_05: I agree, maybe a platinum age where we can just change the world, and this is really going to impact our health.
1:43:06
SPEAKER_05: And so, yeah, resources are the only thing holding us back.
1:43:10
SPEAKER_05: And I think it's good to fund both academic science.
1:43:12
SPEAKER_05: You need academic science is the basic discovery.
1:43:16
SPEAKER_05: And then it's good to fund all these startups that can translate this stuff that can then get it out to the world.
1:43:22
SPEAKER_05: And then once you know, people show this stuff works, then everybody gets access, at least that's the hope.
1:43:28
SPEAKER_00: Well, I think that's been so inspiring from getting to know you is that you you are bridging that gap.
1:43:34
SPEAKER_05: We're trying.
1:43:35
SPEAKER_00: Yeah.
1:43:35
SPEAKER_00: Yeah.
1:43:35
SPEAKER_05: Um, which is we spun off a lot of companies over the years, yeah.
1:43:38
SPEAKER_00: Yeah, it's remarkable how you find the time, to be honest.
1:43:41
SPEAKER_00: I love what I do.
1:43:42
SPEAKER_00: Yeah.
1:43:42
SPEAKER_00: I'm gonna ask you one more question because I'm mindful of your time um with all of these various different commitments.
1:43:48
SPEAKER_00: Um, if if there's two more.
1:43:51
SPEAKER_00: There's one more and then just a request.
1:43:54
SPEAKER_00: If someone were to tune into this episode for the last 60 seconds, what would you want the takeaway to be?
1:44:01
SPEAKER_05: Take control of your own health.
1:44:04
SPEAKER_05: And we now have the systems to do it with wearables, with data collection.
1:44:08
SPEAKER_05: Um, yeah.
1:44:09
SPEAKER_05: So I that's the number one thing.
1:44:11
SPEAKER_05: And there's also some simple things we talked about through the show about what they can do right now to impact their health.
1:44:17
SPEAKER_05: But no one's gonna know your health better than you.
1:44:20
SPEAKER_00: Yeah.
1:44:20
SPEAKER_00: Lean in.
1:44:21
SPEAKER_05: Lean in.
1:44:22
SPEAKER_00: Okay.
1:44:23
SPEAKER_00: Mike, where can people find more information on what you do and the different various companies that you're working with?
1:44:30
SPEAKER_05: Yeah, visit our website.
1:44:31
SPEAKER_05: You can reach out.
1:44:32
SPEAKER_05: Uh, so there's a Snyder Lab website.
1:44:34
SPEAKER_05: If you look up Michael Snyder Lab, you'll find it.
1:44:37
SPEAKER_05: A lot of our studies are there.
1:44:38
SPEAKER_05: Some of them you have to be in the Bay Area, some you can participate in remotely.
1:44:42
SPEAKER_05: Um, I give a number of podcasts and talks of varying, you know, um, accessibility, meaning some are more technical and some less.
1:44:52
SPEAKER_05: So feel free to take a look at those.
1:44:54
SPEAKER_05: I just gave a TED talk recently, very short talk uh on on the wearables, actually.
1:45:00
SPEAKER_05: So, and then had an NPR follow-up on on wearables and things.
1:45:05
SPEAKER_05: So, so those are some of the places, and I'm pretty easy to find on the internet.
1:45:09
SPEAKER_00: Yeah, we'll we'll we'll add all of those to the show notes.
1:45:12
SPEAKER_00: Terrific, Mike.
1:45:15
SPEAKER_00: It's always a pleasure talking to you.
1:45:17
SPEAKER_00: And I want to say a lot of fun for me.
1:45:18
SPEAKER_00: No, this is great.
1:45:20
SPEAKER_00: I want to say thank you as well, specifically for all of your help over the last three, nearly four years now.
1:45:27
SPEAKER_05: I love what you built, it paid off.
1:45:29
SPEAKER_05: Yeah, I think your vision, I wasn't 100% sure when you and Kim were telling me about you know what's gonna come out of this thing.
1:45:38
SPEAKER_05: I got part of it, but I think the degree, and I keep saying, Well, I think I might be conflicted.
1:45:42
SPEAKER_05: No, no, no, you're not conflicted.
1:45:44
SPEAKER_05: You said the same.
1:45:45
SPEAKER_05: And uh, and I see, no, absolutely not.
1:45:48
SPEAKER_05: It feeds right into what you guys can do, it's pretty cool.
1:45:51
SPEAKER_05: Yeah, and I love what you build, it's beautiful.
1:45:53
SPEAKER_05: Yeah, I'm excited.
1:45:54
SPEAKER_05: It really is.