Transcript
00:00:00 We have two tubes that are right next to each other
00:00:02 in the throat.
00:00:03 One is for food, drink, saliva, mucus, snot,
00:00:06 whatever you’re gonna swallow.
00:00:08 All of that stuff must go down the esophagus,
00:00:10 the food tube, and end up in the stomach.
00:00:12 And right next to the esophagus, millimeters away,
00:00:15 is the windpipe or the trachea,
00:00:17 which goes down to the lungs.
00:00:18 Throat, heart, feces, genitals.
00:00:21 Every organ from moment to moment keeps us alive
00:00:24 and ensures our survival.
00:00:25 The genitals are, in a way, the opposite.
00:00:27 How would you improve the penis and the vagina?
00:00:33 The following is a conversation with Jonathan Reisman,
00:00:36 a physician and writer of The Unseen Body,
00:00:40 a doctor’s journey through the hidden wonders
00:00:42 of human anatomy.
00:00:44 He has practiced medicine in some of the world’s
00:00:46 most remote places, including the Alaskan
00:00:49 and Russian Arctic, Antarctica,
00:00:52 and the Himalayan mountains of Nepal.
00:00:56 This is the Lex Friedman podcast.
00:00:58 To support it, please check out our sponsors
00:01:00 in the description.
00:01:02 And now, dear friends, here’s Jonathan Reisman.
00:01:06 You wrote a book called Unseen Body,
00:01:09 all about the human body, the messy, the weird,
00:01:12 the beautiful, and the fascinating details.
00:01:15 So, from an evolutionary perspective,
00:01:18 are most parts of the human body a feature or a bug?
00:01:21 Is it like the optimal solution
00:01:24 or just a duct tape solution?
00:01:26 Great question.
00:01:27 I think that most of the time,
00:01:29 the way the body works is the best solution.
00:01:32 I haven’t seen many alternatives, so it’s hard to compare.
00:01:35 But I think, you know, there’s some parts of the body
00:01:38 that make more sense than others.
00:01:40 You know, the way our hands work, for instance.
00:01:43 You know, the muscles are up in the forearm
00:01:45 and then the tendons kind of come down
00:01:47 like strings on a puppet.
00:01:48 And just the dexterity it gives our hands
00:01:50 is just really amazing.
00:01:52 And it’s hard to imagine a better tool
00:01:55 than the human hand to do everything from, you know,
00:01:57 hold things to play piano
00:01:59 and do a million other daily activities that we do.
00:02:03 One thing I talk about in the book,
00:02:05 there’s some other body parts that seem to be lacking
00:02:07 that kind of brilliant design, such as the throat,
00:02:11 you know, where the food, drink are swallowed
00:02:15 and air is inhaled, and they kind of,
00:02:17 those two paths come within millimeters of each other.
00:02:19 And you slip up once, you laugh while eating,
00:02:22 or you speak while trying to swallow and you die
00:02:25 from choking.
00:02:26 So it seems less than optimal,
00:02:28 though I’m not sure it could be better
00:02:30 from the way we’re kind of formed in the womb
00:02:33 as a beginning as this tiny little tube.
00:02:35 I don’t think it could have been done any better
00:02:37 or there’s any other way to do it,
00:02:39 but it is an unfortunate thing that, you know,
00:02:41 does lead to some problems.
00:02:42 So the hand, if I could just link on that for a second,
00:02:46 you talk about the wisdom of a design in the book.
00:02:50 What are the important things about the hand?
00:02:52 It seems like very useful for many things
00:02:55 and it seems to be quite effective.
00:02:57 A lot of people think the thumb is foundational
00:03:01 to the human civilization.
00:03:05 Is there any truth to that?
00:03:07 I think that is true.
00:03:08 Actually, one of the ways in which the importance
00:03:10 of individual fingers comes to attention
00:03:13 is when people have severe injuries to their fingers.
00:03:15 For instance, I have a story in the book
00:03:18 about a guy whose thumb is nearly ripped off
00:03:21 by his dog’s leash.
00:03:23 And, you know, when plastic surgeons
00:03:26 who are often the ones to repair that,
00:03:27 sometimes it’s orthopedic surgeons,
00:03:29 they will debate, you know,
00:03:31 how important is it to save this finger
00:03:33 or how important is it to save, you know,
00:03:36 let’s say the kind of tip,
00:03:38 the one third, the tip one third of one of your fingers.
00:03:41 You know, it depends on the length that you’ll lose.
00:03:43 It depends on which finger.
00:03:44 And so the thumb really is the most crucial,
00:03:47 just, you know, for your occupation in most cases
00:03:50 to just daily life and your ability to get around
00:03:54 and take care of yourself and others.
00:03:55 So, you know, there’ll be more,
00:03:57 they’re willing to go further, do more surgeries,
00:03:59 more aggressive therapy to save a thumb, let’s say,
00:04:03 than, you know, the tip of your pinky finger.
00:04:05 So in that way, I do think the thumb, you know,
00:04:07 does seem like the most important in many ways.
00:04:09 It’s nice that there’s backups.
00:04:11 I wonder if that’s part of the future
00:04:13 or is it just the symmetry that nature produces?
00:04:15 You think the two hands is like,
00:04:18 is it about the symmetry or is it about backup?
00:04:21 We’d be much less formidable hunters, gatherers,
00:04:25 survivors in any way if we only had one hand.
00:04:29 So I think that is important to have two
00:04:32 so we can, you know, even everything from kind of
00:04:34 spearing an animal to firing a bow and arrow
00:04:36 to butchering an animal.
00:04:37 You really need two hands to do it very effectively.
00:04:40 But can you do a better job with three?
00:04:43 Great question.
00:04:44 And we’ll never know, perhaps.
00:04:48 You tweeted, now I’m gonna analyze your tweets
00:04:51 like it’s Shakespeare sometimes.
00:04:54 You tweeted that, quote, millions of years
00:04:56 of sex and death design the human body.
00:05:00 It’s like poetry.
00:05:01 Are those two basic activities basically summarize
00:05:05 everything that resulted in humans on Earth?
00:05:09 So like, is that a good summary of the evolutionary process
00:05:13 that led to this conscious intelligent being,
00:05:16 is death and sex?
00:05:19 In a way, yeah.
00:05:20 So sex is how more of us get made, obviously.
00:05:23 And death is how we get weeded out
00:05:25 or the gene pool gets weeded out
00:05:27 and certain genes survive and others don’t.
00:05:30 And, you know, the age at which we die,
00:05:33 whether it’s before we’ve, you know,
00:05:35 had sex and reproduced ourselves is a big factor
00:05:38 and who survives, who doesn’t, who passes on their genes
00:05:41 and what the future of the body looks like.
00:05:43 You know, who lived and who died
00:05:46 before they were able to be at reproductive age
00:05:48 a million years ago was pretty important
00:05:50 in what we look like now.
00:05:52 And perhaps how we have sex and die now
00:05:55 will determine what we’re shaped like
00:05:58 unless technology has an even bigger role in that,
00:06:00 you know, a million years from now.
00:06:01 So you think that’s fundamental
00:06:02 to like if there’s alien civilizations out there
00:06:05 that have the same order of magnitude
00:06:07 of intelligence or greater,
00:06:09 do you think that we will see something like sex
00:06:12 and something like death?
00:06:13 So the reproducing and this selection process
00:06:18 plus the weeding out of the old to make room for the new,
00:06:23 is that kind of foundational to life?
00:06:25 I would think so.
00:06:26 I mean, it sure seems to be on earth,
00:06:27 you know, perhaps in some distant future
00:06:29 when medicine is nearing, you know, perfection
00:06:33 and people can live a really long time.
00:06:35 Maybe we won’t even need to reproduce as much
00:06:39 or something like that, you know,
00:06:41 it’s hard to even know what life will be like
00:06:43 in the distant future.
00:06:44 But I would guess that any alien civilization
00:06:46 will have the same dependence on who has sex and who dies.
00:06:50 Well, that’s the problem with immortality.
00:06:51 How are we going to clear out the old
00:06:55 to make room for the new, which is kind of a,
00:07:00 it’s like a framework of adaptability
00:07:03 to changing environments.
00:07:04 So as long as the environment is changing,
00:07:06 and it seems to always be,
00:07:09 because the entirety of the earth system
00:07:11 is a complex system, it seems like you have to adapt.
00:07:14 And to adapt, you have to kill off the stubborn old ideas.
00:07:19 And unless there’s a way to like not become stubborn and old,
00:07:23 but it feels like the nature of wisdom is stubborn and old.
00:07:30 Like that’s what wisdom is.
00:07:32 It’s like the lessons of life,
00:07:34 the lessons of experience solidified.
00:07:37 And the solidification is the thing
00:07:39 that actually prevents you from reinventing yourself
00:07:43 to adapt to the new changing conditions.
00:07:47 But then again, why not have that both of those modes?
00:07:49 Like have two minds and one person,
00:07:51 one immortal person that like in the morning,
00:07:55 they act like a teenager,
00:07:56 in the evening they act like a old wise man.
00:07:59 That’s possible.
00:08:00 So you see, you can imagine within one mind both modes,
00:08:07 but those are required.
00:08:08 You have to have the ability
00:08:11 to completely reinvent yourself,
00:08:13 which is what death does in an ugly way,
00:08:18 or a beautiful way, depending on your perspective,
00:08:20 depending whether you take the human perspective
00:08:22 or the human, the nature’s perspective.
00:08:25 And then you have to have the selection.
00:08:27 So competition, so sexual selection.
00:08:30 It’s an interesting, interesting little planet we got.
00:08:33 What’s the weirdest part, function, concept, idea
00:08:37 about the human body to you?
00:08:38 We’ll talk about fascinating details,
00:08:40 but I should say for people that should read your book,
00:08:46 they will come face to face with the fact
00:08:48 that you do not shy away from the weird
00:08:51 and the wonderful of the human body.
00:08:53 It’s like, it’s fun, but it’s honest.
00:08:57 So given that, sorry to make you pick one of your children,
00:09:03 but what’s the weirdest one, would you say?
00:09:06 The weirdest body part.
00:09:09 Or concept or function.
00:09:12 So the chapters, you divide it up kind of into parts,
00:09:16 but there could be a thread that connects all of them,
00:09:19 the weirdness, maybe, or maybe the texture of the substance.
00:09:23 It could be the liquids, the solids, I don’t know.
00:09:26 Definitely every body part and bodily fluid
00:09:29 has their own kind of both gross and fascinating aspects.
00:09:33 That’s probably why I’m a generalist as a doctor
00:09:36 and couldn’t just, as you said, pick one of my children,
00:09:38 become a specialist, because I like them all.
00:09:42 I feel like one of the strangest concepts
00:09:44 about the human body is that kind of the aspects of it
00:09:49 that are the most universal, that we all do,
00:09:51 are the most taboo socially.
00:09:54 I wouldn’t have expected that if I had, you know,
00:09:56 just looked from the outside, like what we do
00:09:58 in the bathroom, what we do in the bedroom,
00:10:00 what we do to our own genitals, what we do to our,
00:10:04 you know, quote unquote, private parts, they’re private,
00:10:07 even though it’s sort of the thing that we all have
00:10:10 in common is the most we try to hide from other people
00:10:13 and don’t talk about in polite company.
00:10:15 I mean, it makes sense as a human living in this society,
00:10:17 but from the outside, it sort of might be surprising.
00:10:20 How do you make sense of that if you put on
00:10:21 your Sigmund Freud hat?
00:10:23 The thing we all do, why do we make that a taboo thing?
00:10:28 Is it because we like taboos?
00:10:30 Maybe we get off, or maybe our kinks as humans
00:10:35 is to have taboos, and it’s kind of efficient
00:10:38 to have taboos about the things that everybody does.
00:10:41 Like, you can make walking taboo or something, I don’t know.
00:10:45 But just, maybe that’s what we love,
00:10:48 that’s what’s exciting to us, is the forbidden.
00:10:52 I think, yes, society loves rules, for sure.
00:10:54 They love, some societies more than others.
00:10:57 You know, they love controlling how you think
00:11:00 and what you do in public versus in private.
00:11:02 You know, there’s a lot of societies where, for instance,
00:11:05 parents have sex in front of children.
00:11:08 Not, you know, for instance, like in traditional
00:11:10 Inupiat Eskimo societies, that was sort of normal.
00:11:14 I mean, but what are you gonna do,
00:11:15 go outside in the middle of the winter in the Arctic
00:11:17 and do it out there?
00:11:18 Of course not.
00:11:19 So, you know, there’s different taboos
00:11:22 in different societies.
00:11:23 Some taboos make perfect sense.
00:11:25 Some taboos are even public health measures,
00:11:28 you know, like, as I talk in the book about in India,
00:11:32 where they, you know, the hands are symmetric, as you said,
00:11:35 but in Indian culture, and the left hand is taboo,
00:11:38 and the right hand is what you use for shaking hands,
00:11:41 for eating, for other things, and the left hand
00:11:44 is the dirty hand that you use for wiping your own bottom.
00:11:47 You know, that’s the toilet paper is your left hand.
00:11:49 So, while the body is anatomically symmetric,
00:11:52 the taboo creates this pretty intense asymmetry.
00:11:56 But for a good reason, you know,
00:11:57 yet you probably shouldn’t be shaking hands
00:11:58 with other people with the same hand that you use
00:12:01 to kind of clean your bottom.
00:12:02 So in that sense, it makes sense.
00:12:05 Yeah, maybe the roots of it makes sense,
00:12:07 but the way it propagates, especially as the times change,
00:12:10 might not, because you can wash your hands.
00:12:14 But the taboo remains.
00:12:16 Right, society is very slow to change.
00:12:19 What is the most fascinating part, function,
00:12:21 or concept in the human body?
00:12:23 So, you know, something that fills you with awe.
00:12:30 I guess the most obvious one is the brain,
00:12:32 partly because it’s so, you know, sort of poorly understood,
00:12:36 though we understand more than we ever have in the past.
00:12:39 There’s still so much that we don’t understand
00:12:41 about how the lump of matter in our skulls
00:12:44 kind of creates this subjective experience
00:12:46 that we all kind of understand quite viscerally.
00:12:50 That’s an easy one.
00:12:51 I would say the kidneys are an underappreciated organ.
00:12:55 The way they tinker with the bloodstream,
00:12:58 raise levels of this, lower levels of that,
00:13:01 kind of our entire lives from inside the womb until we die
00:13:05 is just really incredible.
00:13:07 And when you look at how much energy
00:13:09 different organs consume,
00:13:10 the brain and the kidneys are two of the biggest ones,
00:13:13 because the brain obviously in us is always active,
00:13:16 and controlling parts of the body,
00:13:17 but the kidneys are just consuming a ton of energy
00:13:21 to do what they do.
00:13:21 They’re kind of the unsung hero of the body,
00:13:24 relegated to the back of the abdomen,
00:13:26 like some forgotten organ, but they are great.
00:13:28 I did consider being a nephrologist,
00:13:29 which is a kidney specialist,
00:13:31 because I was so taken with the kidneys,
00:13:33 but decided I like all the organs,
00:13:35 so couldn’t pick just one.
00:13:37 So your book is ordered in a particular way.
00:13:40 It’s throat, heart, feces, genitals, liver, pineal gland,
00:13:47 brain, skin, urine, fat, lungs, eyes, mucus,
00:13:54 fingers and toes, and blood.
00:13:57 All right.
00:13:59 First of all, great chapter titles.
00:14:03 Is there a reason for this ordering, or is it all madness?
00:14:06 There’s a few different reasons that went into it.
00:14:09 I did wanna start with the throat for the reason
00:14:13 that it kind of presents the topic of death,
00:14:18 which is sort of obviously very important
00:14:20 in the training of a physician, in the career of physician.
00:14:23 It’s a big part of what I deal with.
00:14:25 On the first day of medical school,
00:14:27 we started the dissection of a cadaver
00:14:30 in the class called anatomy lab.
00:14:32 And so in a way, we were kind of thrown right in there
00:14:34 in the beginning, like this is the end of the human story.
00:14:38 Understand this, and then we sort of backed up
00:14:40 to the beginning with embryology and reproduction and stuff.
00:14:43 So it’s kind of like we got, and I got thrown into that
00:14:47 right away, right in the beginning,
00:14:48 kind of like here’s a dead body.
00:14:50 Now start cutting it apart and learn the name
00:14:52 and function of absolutely every bit of flesh.
00:14:54 How did that change you, that first experience
00:14:58 with the cold honesty of human biology?
00:15:01 Right, that’s exactly what it was,
00:15:02 is cold honesty about kind of the story
00:15:05 of each individual human body.
00:15:06 It has an end, and that’s it.
00:15:09 I think that, well, actually before the end
00:15:12 of that first day, so what we did on that first day
00:15:14 was study the superficial muscles of the back,
00:15:16 like the lats or latissimus dorsi and some other muscles.
00:15:19 We cut through the skin of the back.
00:15:21 My cadaver was laying face down on this metal gurney.
00:15:24 We pulled back the kind of plastic sheets
00:15:25 that would keep him moist for the next four months
00:15:28 as we dissected him, cut through the skin on his back,
00:15:31 and then started dissecting through the superficial muscles
00:15:33 of the back.
00:15:34 And that was really all we saw that first day.
00:15:36 We didn’t get any deeper, didn’t enter the abdominal
00:15:38 or chest cavity to see internal organs,
00:15:41 but I was so fascinated with this sort of
00:15:44 behind the scenes look at how things work in the body,
00:15:48 how you move your arms, how you arch your back.
00:15:50 You know, these are the muscles that do it
00:15:52 that I decided I wanted to donate my own body
00:15:54 for the same purpose.
00:15:56 So I made that decision literally
00:15:57 before the end of that first day of class,
00:16:00 and I’m still sticking to it.
00:16:02 So someday there’ll be a medical student
00:16:05 that can watch and listen to this podcast
00:16:09 while dissecting your body.
00:16:11 It could happen.
00:16:12 They might not know that that person
00:16:13 they’re listening to on the podcast
00:16:15 will be the carcass in front of them,
00:16:17 but we never learned anything.
00:16:18 The universe will know.
00:16:20 The universe will know.
00:16:21 And they will acknowledge the irony or the humor,
00:16:24 the absurdity of that.
00:16:26 The universe will chuckle,
00:16:27 but the medical student won’t know
00:16:29 because they never, as I did not,
00:16:31 learn any personal information about the person,
00:16:35 only what I could glean from looking inside them,
00:16:37 which actually tells you quite a bit.
00:16:39 I knew he was a smoker.
00:16:40 I knew he had coronary artery disease.
00:16:41 You know, you get a window into,
00:16:44 I knew he was overweight.
00:16:45 You get a window into people’s lives
00:16:46 just by looking in their bodies after death.
00:16:49 Other cadavers in the lab, not my own,
00:16:53 or I shared one with three other students,
00:16:55 but other cadavers, some had metal joints,
00:16:58 like a knee replacement.
00:17:00 Some had a kidney missing.
00:17:01 So they probably,
00:17:02 and we could tell it was surgically removed,
00:17:04 not that he was born with one.
00:17:07 And we could tell that he probably had a kidney tumor
00:17:08 or cancer that was removed.
00:17:10 So you do get an insight into people’s lives
00:17:12 from picking them apart after they’re dead,
00:17:16 but you don’t know their name
00:17:17 or what podcast they’ve been on.
00:17:19 So as the book title says, Unseen Body,
00:17:23 so it tells some kind of story of your life.
00:17:27 So it does capture the decisions you’ve made in your life,
00:17:30 the things you’ve done,
00:17:32 that might be kind of secret to that person
00:17:37 and maybe to a few others that knew him or her well.
00:17:41 It’s so fascinating.
00:17:42 So what kind of things can it reveal?
00:17:46 Like what kind of choices in terms of the injuries,
00:17:49 the catastrophic events,
00:17:53 the lifestyle choices of smoking and diet
00:17:56 and all those kinds of things?
00:17:57 What can you see?
00:17:59 What kind of history can you see about the human before you?
00:18:03 So all those things you mentioned are things you can see.
00:18:06 Take the skin, for example, right?
00:18:08 Most things that happen to us leave a mark,
00:18:11 as I say, kind of a story written in the language of scar
00:18:15 where it tells you injuries you’ve had.
00:18:16 And same thing with animals.
00:18:19 I’ve seen deer hides that have marks
00:18:21 that look like they’re made by maybe a barbed wire fence,
00:18:23 something like that.
00:18:24 You can tell, sometimes it’s conjecture,
00:18:27 but you can sort of imagine what might’ve happened
00:18:30 to cause that.
00:18:30 Perhaps two bucks were fighting
00:18:32 and one got injured with an antler.
00:18:34 And the same with humans.
00:18:36 I have scars on my body,
00:18:37 and when I notice them, I remember what happened.
00:18:40 I got a big cut on my hand when I was 13,
00:18:44 and it’s still there,
00:18:45 and I remember what happened every time I look at it.
00:18:48 And so in that way, only I might know that story,
00:18:52 but other people, when they dissect me
00:18:54 and notice the same scars,
00:18:56 they can kind of, it can fire their imagination
00:18:58 as my cadaver, you know, did for me.
00:19:00 They know that there is a story there.
00:19:02 That’s such an interesting way
00:19:03 that the skin does tell a story,
00:19:07 both tattoos and scars.
00:19:09 Right.
00:19:10 Some of the fun you’ve had
00:19:12 and some of the damage you’ve done.
00:19:14 Right.
00:19:14 And even when I evaluate a patient,
00:19:16 I can use scars to help me make medical decisions.
00:19:20 So for instance, someone that comes in with abdominal pain
00:19:22 into the emergency room,
00:19:24 you can see scars on their abdomen
00:19:26 that tell you about, you know,
00:19:27 the past kind of activities of a surgeon, perhaps.
00:19:30 I know, I recognize the scars that are left
00:19:33 when someone has their gallbladder removed,
00:19:35 the scars when someone has their appendix removed,
00:19:37 maybe when someone’s had a hysterectomy,
00:19:38 and that can tell you what it might be or what it isn’t.
00:19:42 You know, if someone doesn’t have an appendix,
00:19:43 their abdominal pain’s not appendicitis, end of story.
00:19:46 So in that way, I’m sort of looking at these,
00:19:49 the tracks or the footprints of past surgeries
00:19:52 to tell me what might and might not be the cause
00:19:55 of this patient’s abdominal pain,
00:19:56 which is kind of my main job in the ER
00:19:58 is figuring out what’s causing it and to help them.
00:20:01 Is there ways to get more data about the human body
00:20:05 as we look into the future of medicine biology
00:20:08 that will be helpful to fill in some of the gaps
00:20:11 of the story?
00:20:12 So, you know, you have companies,
00:20:17 you have research that looks at, you know,
00:20:20 collection of blood over long periods of time
00:20:23 to see sort of, you know, paint the picture
00:20:26 of what’s happening in your body,
00:20:28 mostly to help with lifestyle decisions,
00:20:29 but also just, you know, to anticipate things
00:20:33 that can go wrong and all that kind of stuff.
00:20:35 Is there, can you just speak to a greater digital world
00:20:40 that we’re stepping in,
00:20:40 how that can help tell a richer story?
00:20:45 I certainly think that we have more data
00:20:48 than we know what to do with right now,
00:20:50 especially with kind of direct to consumer medical devices,
00:20:54 you know, smartwatches, et cetera,
00:20:55 that are just collecting these reams of data.
00:20:58 I have not seen them put to,
00:21:01 I think the eventual use that they will.
00:21:04 I think that the potential is sort of just, you know,
00:21:08 unimaginable and I hope we’re heading into a new age
00:21:11 where, you know, you can determine, for instance,
00:21:14 is a person gonna have more of the dangerous side effects
00:21:17 to a drug based on their genetics
00:21:19 or are they gonna tolerate one drug better than the other,
00:21:22 you know, based on their genetics?
00:21:24 And we are slowly moving into that age
00:21:27 and especially the age of kind of
00:21:29 completely synthesizing drugs in the lab,
00:21:34 you know, much like, for instance,
00:21:36 some of the COVID vaccines actually,
00:21:38 like Moderna never had the virus in their lab.
00:21:41 They made that vaccine completely
00:21:42 without ever having the virus themselves
00:21:44 just by having the genome, which is sort of astounding.
00:21:46 And there’s a lot of potential going forward, you know,
00:21:49 based on that technology and some others.
00:21:51 Well, I didn’t know that.
00:21:52 So they basically, it’s all in the computer,
00:21:53 it’s computational.
00:21:54 Right, you have the genetic code,
00:21:56 you have tremendous power,
00:21:57 even if you don’t have the organism itself.
00:21:59 What do you make of Elizabeth Holmes and efforts like that?
00:22:04 First of all, I’m a curious,
00:22:11 I’m drawn to the darkness in human nature
00:22:16 because that somehow reveals
00:22:20 the full spectrum of what humans could be.
00:22:23 So there’s a lot of sort of controversial thoughts
00:22:25 about who she is and her efforts and so on.
00:22:28 I think you may have even tweeted about it,
00:22:30 but I’ve read a lot of your tweets, so I’m now forgetting.
00:22:33 But what do you make of her and both those efforts
00:22:37 and the charlatans that sort of snake oil salesmen
00:22:42 that promise those efforts to do more
00:22:49 than they currently can?
00:22:51 I think that her, you know, that goal that she had
00:22:55 that she created Theranos to try to achieve,
00:22:58 to use less blood in tests is a very worthy goal
00:23:01 and a huge frontier that we have not achieved
00:23:04 and that I hope we will achieve.
00:23:06 So I understand why, you know,
00:23:09 someone describes what a huge step forward that would be
00:23:12 and it would be indeed.
00:23:13 I understand why people put a ton of money behind it.
00:23:15 Can you describe what was the promise?
00:23:17 What are we even talking about with Theranos,
00:23:20 just for people who don’t know?
00:23:22 So Theranos is a company that was basically started
00:23:25 to revolutionize the way medical blood tests are done,
00:23:29 both to use a whole lot less blood in doing it.
00:23:33 You know, if anyone’s ever been to the doctor
00:23:34 and had five to 10 tubes of blood removed from them,
00:23:37 it can be quite surprising how much they take out.
00:23:41 And it’s, you know, that’s the limitation of our technology
00:23:45 that we need those volumes of blood
00:23:46 to run all the tests that we want to.
00:23:47 And so the promise of Theranos was that perhaps
00:23:50 with a single drop of blood, we would be able to know
00:23:53 as much about the person’s, the condition of their body
00:23:57 without drawing all that blood and thereby, you know,
00:24:00 there would be these devices she was gonna create
00:24:02 that would sort of do it.
00:24:03 You put a drop of blood in and it spits out everything
00:24:05 you ever wanted to know about what’s in your bloodstream.
00:24:07 And in a way that would make it so much easier,
00:24:09 you know, it could be, you could have one in your home
00:24:11 theoretically, and you, I don’t know why you’d wonder
00:24:14 what your potassium level is on any given day,
00:24:16 but you could check if you wanted to.
00:24:19 And so that goal is very worthy.
00:24:21 You know, I put that goal up there with the frontier
00:24:25 of making painkillers that are as good as opioids
00:24:27 without the addictive quality.
00:24:28 You know, that would be such a huge revolution
00:24:30 if we did have that in medicine.
00:24:32 But, and particularly for me,
00:24:34 cause I trained in both pediatrics and internal medicine.
00:24:37 So I learned to care for both children and adults.
00:24:40 In children, we do draw much less blood.
00:24:42 They have a much lower blood volume.
00:24:43 And we use these tiny little tubes to draw their blood.
00:24:47 And we seemingly get equivalent information
00:24:50 out of the larger tubes we draw from adults.
00:24:52 And I’m still unclear to be honest,
00:24:53 why we can’t draw that little amount of blood from adults.
00:24:56 It seems technically possible.
00:24:58 I don’t know what the barriers are.
00:24:59 I’m sure there are, or else we’d be doing it.
00:25:02 But I do think that that is a very important goal.
00:25:04 And if Theranos had done it,
00:25:06 it would have really revolutionized the practice of medicine.
00:25:09 So to return to that cadaver,
00:25:13 that first day when you got to meet with the dead,
00:25:18 with a human body that’s no longer living.
00:25:21 So how quickly did it take for you to get used to sort of,
00:25:27 you said, looking at the surface muscles of the back?
00:25:31 I mean, that can be overwhelming as a thought.
00:25:34 And people listening to this that have never dissected
00:25:37 anything might be overwhelmed by that thought.
00:25:40 So like, how quickly were you able to get used
00:25:43 to the brutal honesty of the biology before you?
00:25:48 For me, it did not take long at all.
00:25:50 I guess I’ve never been a squeamish person.
00:25:53 So for me, it was kind of riveting and fascinating
00:25:55 right from the first moment.
00:25:56 But I do know some of my fellow classmates
00:26:00 did have some trouble with it.
00:26:01 Some of them I heard had nightmares in the first few weeks
00:26:05 of anatomy lab.
00:26:08 But then everyone, as far as I know, got used to it.
00:26:10 And that was also actually a big lesson for me
00:26:13 that it’s pretty amazing what people can get used to
00:26:15 in their daily lives.
00:26:16 And I kind of extrapolated that to people living through war
00:26:20 and through just terrible situations
00:26:23 and living under oppressive regimes.
00:26:26 And it really is amazing what people can get used to,
00:26:30 almost anything.
00:26:31 Well, you know, in war, people often come back
00:26:35 and they have nightmares.
00:26:37 They suffer through it.
00:26:38 There’s PTSD.
00:26:39 There’s a lot of complicated feelings with that.
00:26:43 Are echoes of those same complicated feelings possible
00:26:47 in the case of training to be and becoming a doctor?
00:26:51 That’s a good point.
00:26:52 Yeah, I think sometimes, just as a barbed wire fence
00:26:56 can leave a scar on your skin,
00:26:58 emotional, psychological experiences
00:27:01 can leave a mark on your brain or your memory.
00:27:03 And I think that that definitely could be a problem
00:27:09 in medical training.
00:27:10 You do see a lot of things that are very shocking,
00:27:14 very repulsive, things that you’d never forget.
00:27:17 I know one of those students that had nightmares initially
00:27:20 went on to be a surgeon.
00:27:21 So I imagine she’s not having the PTSD
00:27:23 of kind of seeing inside her first dead body
00:27:25 because she sees inside them all day, every day now.
00:27:28 But I’m sure it could.
00:27:30 You know, we go on to see so many kind of grosser
00:27:34 or more shocking things in medical training
00:27:37 through medical school and then by working
00:27:38 with actual living patients,
00:27:40 not just dead and embalmed bodies.
00:27:43 So I do think that things can leave a mark,
00:27:46 but I don’t think that initial cadaver
00:27:48 would be the most traumatic.
00:27:51 Yeah, but maybe some of that trauma,
00:27:54 the demons make you a better surgeon,
00:27:56 just like some of your own psychological trauma
00:28:00 might make you a better psychiatrist.
00:28:03 Returning to the ordering, is it order or is it chaos
00:28:07 to the ordering of the chapters from throat and heart
00:28:12 and feces and genitals all the way
00:28:14 to fingers and toes and blood?
00:28:16 So I did mention that, you know,
00:28:18 throat was the first one because I kind of wanted
00:28:20 to throw the reader right into the brutal honesty of death.
00:28:24 And I followed it up with feces as the third chapter
00:28:27 and in a way, partly to also throw them right
00:28:30 into the deep end of how I like discussing parts
00:28:33 of the body and revealing their gross
00:28:36 and fascinating aspects.
00:28:37 So I didn’t want to hide anything.
00:28:39 You know, when you train to be a doctor,
00:28:41 everything is on the table, literally in the cadaver lab,
00:28:44 but also just, you know, you deal with blood
00:28:46 and piss and vomit and feces.
00:28:48 And that’s kind of the medium of your craft.
00:28:51 And yes, the medium of the craft, that’s right.
00:28:55 Like if you’re a painter, this is the paint.
00:29:00 Exactly.
00:29:01 And then you have to create a masterpiece with it.
00:29:04 Like almost like a dance because there’s multiple painters.
00:29:06 One of the painters is the biology.
00:29:08 So let’s return to throat.
00:29:10 You mentioned it’s a weird one.
00:29:12 So first of all, a friend of mine said,
00:29:14 I just see humans as like a bunch of holes
00:29:19 that just walk around.
00:29:24 Not untrue.
00:29:25 It’s a funny way to look at humans.
00:29:27 So we have ears, we have nose, we have mouth,
00:29:31 we have the sexual holes, vagina, penis.
00:29:36 And then, you know, what’s the medical term
00:29:40 for your asshole?
00:29:42 Anus.
00:29:43 Anus, thank you.
00:29:45 This is a very technical discussion.
00:29:47 The rectum’s further in, don’t confuse the two.
00:29:49 Oh, that’s very important.
00:29:51 Is there a difference between throat and mouth?
00:29:54 By the way, so when you say throat,
00:29:56 are we talking about when that hole actually becomes tubular?
00:30:00 The throat I would count as just sort of the very back
00:30:03 of the back of the mouth, where the nose also comes down
00:30:07 and meets it, where the tonsils are and the uvula.
00:30:11 But you’re right that we are a bunch of holes.
00:30:13 But more accurately, we’re a tube, right?
00:30:15 We start in the womb as kind of this microscopic little disc,
00:30:18 almost like a flatbread.
00:30:21 And then we roll almost like a burrito into this tube.
00:30:25 And we’re a simple microscopic tube.
00:30:27 And from there, we grow into this bigger and bigger tube
00:30:30 and we become more complicated.
00:30:32 And each end of the tube does split into various holes.
00:30:35 So all the holes you mentioned at the front end of the tube,
00:30:37 the front end of our body, right?
00:30:38 It splits into the nose, the mouth, the ears, the sinuses,
00:30:42 the tube to the lungs, which is the windpipe,
00:30:46 the tube down to the stomach, which is the esophagus.
00:30:48 And then the other end of the tube splits as well.
00:30:51 Men end up with two holes and women end up with three holes.
00:30:56 The urethra, the vagina, and the anus, and men.
00:30:59 The urethra and kind of the reproductive system,
00:31:02 they share a hole.
00:31:03 So I’m learning a lot today.
00:31:05 It really is incredible that you start from a sperm and an egg
00:31:10 and you have some DNA information.
00:31:12 And from that, the building project begins.
00:31:15 And then what that leads to is like pizza dough
00:31:20 and then you roll it into a tube.
00:31:24 And that tube then eventually sort of becomes
00:31:29 more and more complicated and gets eyes and a brain
00:31:34 and then can create a Twitter account.
00:31:38 So it’s really incredible that we’re just a fancy tube.
00:31:43 Right, we are.
00:31:44 And we sprout eyes and a brain and a sense of smell
00:31:48 and taste pretty much to regulate what comes in
00:31:50 the front of the tube.
00:31:52 We don’t wanna eat anything dangerous or poisonous.
00:31:55 We wanna choose what we eat, even choose who we kiss.
00:31:58 Well, we seem to be motivated by what comes out
00:32:01 of the tube as well in part.
00:32:04 That’s not just output, it’s a feedback mechanism seemingly.
00:32:07 Like we’re also monitoring the functioning of the output.
00:32:11 We’re not just obsessed about the input.
00:32:14 We’re very obsessed with the output.
00:32:15 You’re absolutely right about that.
00:32:17 People have medical complaints about their output
00:32:21 very often that are, I never cease to be surprised
00:32:24 by a new kind of complaint or observation about the output.
00:32:28 I think people have gone to wars over the output
00:32:32 and maybe sometimes the lack of the output
00:32:35 or the desire for output for the particular other humans
00:32:39 that you fancy, the brain and the eyes that sprouted
00:32:44 somehow convinced the rest of the body
00:32:48 that this one particular other tube is fanciful.
00:32:51 So you’re going to go to major wars
00:32:53 and lead global suffering because of the fancy
00:32:57 and the desire for additional output with the other tube.
00:33:01 Okay, so on the throat, that part of the tube,
00:33:09 is it, you said the design is not,
00:33:13 you could have thought of maybe a little bit better options
00:33:16 because it’s too multifunctional.
00:33:18 Is that, can you sort of elaborate
00:33:20 on the multifunctional nature of this part?
00:33:23 Are a lot of parts of the human body multifunctional
00:33:26 or do you find that more specialization
00:33:29 is going to get the job done better?
00:33:32 There is a lot of organs, for instance,
00:33:34 do have multiple functions.
00:33:35 The pancreas is like two organs in one.
00:33:39 One secretes hormones like insulin into the bloodstream
00:33:42 and the other aspect of it secretes digestive enzymes
00:33:45 into the gut to help you digest and absorb food.
00:33:49 The liver is like 15 organs in one.
00:33:51 It’s just amazing how many different things it does.
00:33:53 But the throat, so basically the problem with the throat
00:33:57 is as I said, we have two tubes
00:33:59 that are right next to each other in the throat.
00:34:01 One is for food, drink, saliva, mucus, snot,
00:34:05 whatever you’re gonna swallow,
00:34:07 all of that stuff must go down the esophagus,
00:34:09 the food tube and end up in the stomach.
00:34:11 And right next to the esophagus millimeters away
00:34:14 is the windpipe or the trachea,
00:34:16 which goes down to the lungs.
00:34:18 And your throat does these daily gymnastics
00:34:21 to keep everything but air out of the windpipe
00:34:26 because you slip up once and you can die.
00:34:30 You can choke, you laugh or speak while eating
00:34:32 and it’s curtains, unfortunately.
00:34:35 So it seems like every aspect of the body
00:34:37 when I was learning about it in med school
00:34:38 seemed so brilliant and so perfectly designed
00:34:42 by evolution or whoever you might think designed it
00:34:46 to favor survival, to enhance life,
00:34:51 but the throat seemed the opposite.
00:34:53 It seemed set up almost for failure.
00:34:56 And we developed all these mechanisms as a compensation.
00:35:00 We have the gag reflex whenever food or something
00:35:04 is headed towards your air pipe, your windpipe
00:35:07 or down to your lungs,
00:35:08 your throat has this sort of like rejection of it.
00:35:10 It pushes it away in a gag reflex.
00:35:13 At the same time, we have a cough,
00:35:14 which is something our body does
00:35:16 when something inappropriate does get down the windpipe.
00:35:19 When we get a little food down the wrong pipe,
00:35:22 we end up coughing and the coughing does
00:35:24 usually flush it out and get rid of it.
00:35:27 We even have something called the mucus elevator
00:35:29 in our lungs, which is this constant flow of mucus
00:35:33 up the airways, up to the trachea, dragging with it
00:35:36 all kinds of particulates that we’ve inhaled
00:35:38 and perhaps some food that went down the wrong pipe
00:35:41 and drags it up into the throat and we swallow it
00:35:44 kind of unconsciously all day, every day is the truth.
00:35:47 Even the mechanism of swallowing is super complicated.
00:35:50 It uses a number of cranial nerves.
00:35:52 It uses over 15 different muscles.
00:35:55 It’s this coordinated act to keep food out of the airway.
00:36:00 You can see someone’s Adam’s apple in their neck
00:36:02 kind of jump upward when they swallow,
00:36:05 which helps lift the airway up against the epiglottis,
00:36:09 which plugs it closed and allows food or swallow drink
00:36:13 to kind of skirt just past it.
00:36:15 But every time we swallow, those things do come
00:36:17 within millimeters of going down the wrong pipe
00:36:19 and it’s just thanks to these kind of compensations,
00:36:22 these adaptations we have to the danger of the throat
00:36:25 that keeps us alive.
00:36:27 As I actually took a sip of water,
00:36:30 it’s kind of, it makes you appreciate
00:36:34 the wonderful machinery of it all.
00:36:36 By the way, we have pulled up your Instagram
00:36:39 that people should follow.
00:36:41 You have a post about the throat
00:36:44 and just showing so many different components
00:36:47 from the tongue to the trachea, the esophagus,
00:36:52 just the entire machinery of it all.
00:36:56 The teeth for the chewing, it’s so interesting.
00:37:00 And so a lot of the structure of this,
00:37:02 the anatomy and the physiology,
00:37:05 does it echo other mammals?
00:37:07 Are we just basically borrowing a lot of stuff
00:37:11 from evolution and maybe making small adjustments
00:37:14 maybe due to the fact that we’re not using our mouth
00:37:17 to murder things as other predators might?
00:37:22 We use our thumbs.
00:37:23 Exactly, we have hands, we don’t need to bite them.
00:37:26 Yeah, there’s a lot of overlap between different animals
00:37:29 which I find very comforting and fascinating.
00:37:32 Someone asked me, is there any animal
00:37:34 in which the throat is better designed?
00:37:36 And my first thought was whales
00:37:38 because the blowhole’s kind of up on the top of their head.
00:37:40 So I was thinking, oh, maybe they are more separate.
00:37:44 But when I looked into it, actually no,
00:37:46 the paths do come very close, just like in us.
00:37:48 And I saw a paper about some new discovered organ
00:37:53 that actually helps keep food and drink
00:37:55 out of the airway in whales
00:37:56 that they hadn’t ever noticed before.
00:37:58 So it’s a different mechanism,
00:37:59 but the same kind of basic problem is that
00:38:02 we’re tubes and the air tube and food tube
00:38:05 are right next to each other.
00:38:06 How well do we understand,
00:38:07 so just even linger on this little part,
00:38:10 is there still mysteries about the complexity
00:38:13 of the system?
00:38:13 You mentioned just even for swallowing
00:38:16 all these parts in the brain that are responsible
00:38:18 and all the different things that have to,
00:38:20 like an orchestra play together.
00:38:22 Do we have a good sense from both a medical perspective
00:38:26 and a biology perspective or is there still mysteries?
00:38:29 There’s definitely still mysteries.
00:38:30 We understand a lot about, for instance,
00:38:32 how the swallowing mechanism is coordinated
00:38:35 in the brainstem,
00:38:37 sometimes using some higher levels of the brain,
00:38:40 but it is a very thoughtless thing
00:38:42 as you mentioned when you drank the water.
00:38:44 It’s not something we have to think about, thankfully,
00:38:45 or we’d be thinking about it all day.
00:38:49 There’s a lot we don’t understand
00:38:50 about the basic mechanisms,
00:38:51 perhaps about how the nerves fire
00:38:53 and how they kind of coordinate on the microscopic level,
00:38:58 how ions rush into and out of nerve cells
00:39:01 to kind of create that electrical signal,
00:39:03 but we sure understand a heck of a lot
00:39:05 and it’s very fascinating.
00:39:07 So, moving on to chapter two and we’ll jump around.
00:39:12 And you actually said the liver does a lot of things.
00:39:17 I also saw you retweet something
00:39:21 where it said, you know,
00:39:23 showing that the liver is bigger than the heart,
00:39:25 which is the body or the universe’s way of saying
00:39:28 you should drink more and care less,
00:39:31 which is a good line.
00:39:32 So, you give props, like you said, to the kidney,
00:39:37 to the liver, to the maybe, to the organs,
00:39:40 to the parts that don’t often get as much credit
00:39:44 as they deserve, but let us go for time to the human heart.
00:39:50 We get chest pain.
00:39:52 We talk about it when we talk about love for some reason.
00:39:55 Why do we talk about the heart when we talk about love?
00:39:58 There sometimes can actually be
00:40:00 some chest pain involved in love.
00:40:01 I remember when I was a med student,
00:40:03 I was very smitten with another medical student
00:40:06 who was totally brilliant and beautiful.
00:40:09 And it actually does cause
00:40:10 this kind of burning in your chest.
00:40:12 I don’t know what that is.
00:40:13 I don’t think it’s from the heart itself.
00:40:16 I don’t know if it was like acid reflux
00:40:17 because I was so nervous.
00:40:18 I’m not really sure,
00:40:20 but I definitely felt something in my chest
00:40:22 whenever I saw her.
00:40:23 I don’t know what that is,
00:40:24 but you could see why someone might think,
00:40:26 oh, you know, maybe it is your heart.
00:40:28 That’s kind of the most prominent organ in your chest.
00:40:30 When people come to the ER with chest pain,
00:40:32 the big question is, is it my heart?
00:40:33 And that’s my main job is figuring out if it is or not.
00:40:36 So I could see why.
00:40:39 The way ancients saw the functions of different organs
00:40:42 is fascinating, but often hard to explain.
00:40:46 Would it be fair to say
00:40:48 that if you look at the entirety of human history,
00:40:51 the way most people die has to do with the heart?
00:40:55 Well, like in America today,
00:40:58 cardiovascular disease and coronary artery disease
00:41:01 is one of the most common,
00:41:02 perhaps the most common cause of death.
00:41:04 You know, 100 years ago, 200 years ago,
00:41:07 it was probably not.
00:41:08 People were not living as long
00:41:09 and people were dying of infections
00:41:11 that we tend to die less of these days.
00:41:14 Sure, that’s true, but in terms of things to stab,
00:41:18 so I’m trying to sort of introspect
00:41:20 like why talk about the heart and love?
00:41:24 My thought would be that it’s because
00:41:28 the heart was seen as the most important organism.
00:41:31 It would be like the origin of life comes from the heart.
00:41:35 The originator of life and the way you figure that out
00:41:38 from sort of an ancient perspective
00:41:40 is when you stab things,
00:41:43 what is likely to lead to issues?
00:41:46 It’s like, it’s possible to imagine
00:41:48 that the brain is not as special as we might think
00:41:50 from when you don’t understand modern biology
00:41:54 or physiology or neuroscience, all those kinds of things,
00:41:58 especially because pain, you know, it’s painless too,
00:42:02 if you stab it, the brain, I mean.
00:42:07 Yeah, anyway, so that’s really interesting.
00:42:09 I’m sure there’s a kind of a poetic answer to
00:42:13 maybe the way people wrote about it,
00:42:15 but what to you is the wisdom in the design of the heart?
00:42:20 I mean, the main function of the heart basically
00:42:22 is to push blood through the cardiovascular system,
00:42:25 through the branching blood vessels
00:42:27 to feed every cell in the body.
00:42:30 You know, when I believe our ancestors
00:42:32 started off as single celled organisms
00:42:34 floating in some ancient brew,
00:42:37 and they were surrounded by the medium
00:42:39 that would bring them all the nutrients they needed,
00:42:41 so there’s no issues there.
00:42:42 And then once you start getting multicellular organisms,
00:42:45 the kind of that are thicker and the ones on the inside
00:42:47 aren’t in contact with that sort of nutritious brew
00:42:50 that they’re growing in,
00:42:52 you kind of need a way to distribute those nutrients
00:42:54 to every cell, and so that’s what the heart
00:42:56 and the branching vascular tree do.
00:42:58 So the heart, you know, it’s the biggest disconnect
00:43:02 between how the organs talked about in poetry
00:43:04 and through history versus its actual function
00:43:06 is probably the heart,
00:43:07 because we ascribe all these things like love and passion
00:43:11 and life itself sometimes to the heart,
00:43:13 but actually it’s just a simple mechanical pump,
00:43:15 you know, that’s all it is.
00:43:17 I don’t wanna downplay it, it’s amazing,
00:43:18 but you know, it just pushes.
00:43:20 It fills with blood and then squeezes it,
00:43:22 fills with blood and squeezes it,
00:43:23 and just that squeezing, that pushing,
00:43:25 creates the blood pressure that you need
00:43:27 to get blood to every cell in your body,
00:43:29 especially when you’re standing upright
00:43:31 to get blood to your brain,
00:43:32 you need a certain amount of pressure to get it up there.
00:43:35 Isn’t it amazing to you how much volume of blood
00:43:39 just gets pushed through by this pump?
00:43:42 Absolutely, they say every red blood cell
00:43:45 takes about five minutes to circulate
00:43:47 and come back to the heart,
00:43:48 and that circulation kind of starts in the womb
00:43:52 and continues kind of until the moment that we die,
00:43:55 but the volume is tremendous,
00:43:56 and it can never take a break, basically.
00:44:00 And it’s sort of propagating all kinds of stuff
00:44:03 throughout the body, it’s a delivery mechanism,
00:44:06 blood for all kinds of good stuff and bad stuff,
00:44:09 nutrition, drugs, all that.
00:44:13 Right, medications too.
00:44:15 Medications, such a fascinating design.
00:44:19 And it also takes the waste away,
00:44:21 it kind of brings the nutritious stuff,
00:44:22 brings the nutrients, especially oxygen,
00:44:24 but many other things, and then it also,
00:44:26 as it passes the cell, takes the cell’s waste,
00:44:29 so it’s sort of the fresh water
00:44:30 and the sewage system in one.
00:44:33 So about blood, what do you use fascinating about blood?
00:44:38 So we talk about the pump that spreads the blood,
00:44:41 but the blood itself.
00:44:43 Right, so the blood itself is sort of,
00:44:44 I mean, it’s the most important bodily fluid, of course.
00:44:48 From moment to moment, every cell in the body
00:44:50 needs a flow of blood to bring it,
00:44:54 most importantly, oxygen, but also, again,
00:44:56 all the other nutrients and to take away waste,
00:44:57 and if that stops for even a few moments,
00:45:00 you can be in big trouble.
00:45:02 So blood is sort of the most important medium.
00:45:05 It’s also, doctors use it to kind of evaluate the body.
00:45:09 It does have this kind of all seeing quality to it,
00:45:12 where we can evaluate organs through the blood.
00:45:16 I can tell you about your liver, your heart, your kidney
00:45:18 just by taking a sample of your blood.
00:45:21 So it’s sort of like this crystal ball in a way,
00:45:23 and we use it kind of all the time
00:45:26 to assess someone’s health, to assess their disease.
00:45:29 Is it also the attack vector for diseases,
00:45:34 for bacteria, for viruses and all that kind of stuff?
00:45:37 So viruses seem to attack either the throat,
00:45:40 maybe you can correct me,
00:45:41 but they seem to attack different parts of the body,
00:45:44 depending on how easy it is to access
00:45:46 and how easy it is to get in deep,
00:45:50 depending on what you prefer.
00:45:52 If you want to do a little bit of hard work,
00:45:54 but you get in deep,
00:45:55 or you don’t want to do the hard work,
00:45:58 but you don’t get in deep,
00:45:59 those are the choices viruses have.
00:46:01 But is blood one of the sort of attack vectors?
00:46:04 What’s like, if you were trying to break into the human body,
00:46:07 like a parasite, a virus, a bacteria, how would you do it?
00:46:13 Like what would be the attack vectors you would explore?
00:46:16 Right, so you got to look for the body’s weaknesses,
00:46:18 of course, you know, we have inherent weaknesses,
00:46:21 for instance, like our respiratory tract,
00:46:22 we have to breathe,
00:46:23 we have to get air in from the outside.
00:46:26 And so that’s one of the entries into the body.
00:46:28 And so, you know, when we inhale,
00:46:30 let’s say a poisonous gas, you know,
00:46:32 it’s an easy way in, you have to breathe,
00:46:34 can’t hold your breath very long,
00:46:35 but, you know, air in our lungs is still kind of contiguous
00:46:39 with the external atmosphere,
00:46:41 it’s not really inside the body until it does cross
00:46:44 across the lining of the alveoli into the blood,
00:46:47 as you said, that’s when it really gets inside.
00:46:49 And the other besides the respiratory tract,
00:46:51 the gastrointestinal tract is another way,
00:46:53 kind of a chink in the armor,
00:46:55 you know, we have to eat, we have to drink,
00:46:57 and therefore we’re taking the external world
00:46:59 into ourselves, into our gut,
00:47:01 in order to extract from it what we need
00:47:03 and let the rest kind of flow out.
00:47:05 So those two, the gastrointestinal and respiratory tract,
00:47:08 you know, there’s a reason that, you know,
00:47:09 respiratory tract infections
00:47:11 and gastrointestinal infections are kind of the most common
00:47:14 that afflict us because those are the ways in to the body.
00:47:17 So I would definitely pick one of those,
00:47:20 not just be a lazy cold in the nose,
00:47:22 but really a more aggressive pneumonia down deep
00:47:24 in the lungs and get across that barrier into the blood.
00:47:27 But also the whole sex thing that humans do.
00:47:32 So speaking of which, let us go for time
00:47:36 to the genitals chapter.
00:47:38 So what are genitals?
00:47:41 I think I’ve heard of those.
00:47:43 I think I’ve read about a penis and a vagina.
00:47:45 Can you explain to me how those work?
00:47:48 Just asking for a friend,
00:47:50 but also what do you use fascinating about it
00:47:54 and maybe what’s misunderstood or little known about them?
00:47:58 Sure, so they’re very unique organs, I would say.
00:48:03 One of the things that I like to point out is that,
00:48:06 you know, while every organ from moment to moment
00:48:08 keeps us alive and ensures our survival,
00:48:10 the genitals are in a way the opposite.
00:48:12 You know, we don’t need them from moment to moment.
00:48:15 You don’t even have to use them at all.
00:48:17 And in fact, they often make us do stupid things
00:48:20 that are the opposite of kind of enhancing survival.
00:48:23 So, and they, you know, they’ve affected the brain
00:48:26 and you can become sort of focused and nuts
00:48:29 based on those desires that kind of stem from the genitals.
00:48:31 So they can be dangerous organs too.
00:48:34 But you know, I mean, sexual dimorphism
00:48:36 helps with genetic variability,
00:48:39 as it does in so many other organisms.
00:48:41 You know, you take two people
00:48:42 and mix them together, their genetics,
00:48:44 you just get a lot more variation
00:48:46 and more opportunities to try different genetic codes
00:48:50 and see what’ll enhance survival
00:48:52 as we talked about sex and death.
00:48:54 I talk about in the book, a lot of,
00:48:55 for instance, the female genital tract,
00:48:57 how the uterus is very unusual
00:49:00 because, you know, it doesn’t even sort of wake up
00:49:02 and start doing its thing until the second decade of life.
00:49:05 You know, it’s even though babies,
00:49:09 female babies are born with all of the eggs
00:49:12 they’ll ever have in their ovaries already.
00:49:14 They’re just sort of in this stasis
00:49:15 until they start waking up kind of once a month.
00:49:18 And it’s this cycle, you know,
00:49:20 there’s so much in our bodies that are cyclical and rhythmic,
00:49:23 the heartbeat, the breathing, but menstruation
00:49:26 is kind of a very strange rhythm
00:49:28 that takes over a decade to start.
00:49:31 And only, you know, the rhythm beats once a month,
00:49:34 which is very slow compared
00:49:35 to every other rhythm of the body.
00:49:37 The other unusual thing is, you know, in medicine,
00:49:40 when rhythms of the body cease, when they stop,
00:49:43 those are emergencies, right?
00:49:44 When your heart stops, that’s a cardiac arrest.
00:49:47 You need CPR, maybe an electric shock to restart it.
00:49:50 When your breathing stops, you know,
00:49:51 you need a breathing machine to breathe for you
00:49:53 or something to reverse whatever might be causing
00:49:56 the suppression of your breathing.
00:49:58 But when menstruation stops,
00:49:59 it’s the point of menstruation in the first place.
00:50:03 The whole reason that the uterus grows a lining
00:50:06 and sheds it each month is to one day, you know,
00:50:09 get fertile, the ovum to get fertilized
00:50:11 and for it to implant in the lining,
00:50:13 and then the rhythm ceases.
00:50:14 And that’s obviously not a medical emergency,
00:50:16 unlike most other rhythms, you know, cessations,
00:50:19 it’s the point of the whole thing in the first place.
00:50:21 So these particular penis and vagina are that whole thing,
00:50:25 the uterus, whatever.
00:50:26 Am I not using the wrong terms?
00:50:28 I don’t know.
00:50:29 I’ll just keep saying.
00:50:31 You use those terms.
00:50:32 There’s more technical, there’s parts, various, various parts.
00:50:35 In medical school, you learn every bump
00:50:38 and, you know, every little part of every little organ
00:50:41 including the genitals, so.
00:50:43 I never really thought of it this way, as you said,
00:50:47 is that most organs are kind of full time employees.
00:50:51 Like 24 seven, they’re doing something.
00:50:54 And then there’s some organs,
00:50:57 penis, vagina being representative of this,
00:51:00 they’re not functioning all the time.
00:51:03 They’re only functioning every once in a while
00:51:05 and then get us to do stupid stuff or awesome stuff
00:51:08 and all that kind of stuff.
00:51:09 But they’re not essential for human survival
00:51:11 on a second by second basis.
00:51:14 And that the whole cyclical nature of the human body,
00:51:18 how many other cycles are on a monthly basis?
00:51:20 Like that far apart.
00:51:23 That’s a fascinating design
00:51:25 that the human body would do that
00:51:27 and wouldn’t start until the second decade of life.
00:51:32 It’s almost like, what do I want to say?
00:51:35 There’s some kind of meta planning going on.
00:51:39 Like this is the optimal solution
00:51:41 for the sexual selection mechanism
00:51:44 among like somewhat intelligent species.
00:51:48 Like it’s useful to after the brain has developed
00:51:53 sufficiently long to now be making
00:51:57 sexual selection decisions.
00:51:58 Like you need time for this computer,
00:52:01 this really powerful computer to load in the info.
00:52:05 Interesting.
00:52:06 You also need the body to develop.
00:52:08 A child simply isn’t big enough
00:52:10 to be pregnant and deliver another baby.
00:52:14 I wonder if there’s animals in which this happens
00:52:16 at a much more accelerated pace in different stages.
00:52:19 Definitely, especially certain kinds of insects,
00:52:21 like Drosophila, a lot of the fruit fly,
00:52:25 a lot of experiments are done on
00:52:26 because their life cycle is so rapid.
00:52:28 A lot of kind of insects and other creatures
00:52:31 are almost ready to mate as soon as they’re born.
00:52:34 Not us.
00:52:35 Not us.
00:52:36 Is there any improvements to the design?
00:52:42 So a lot of people are very interested
00:52:45 in these particular body parts.
00:52:47 If you were to sort of step back
00:52:49 as a geneticist, biological designer,
00:52:52 or maybe a computer scientist, computer engineer
00:52:55 trying to build human 2.0 or maybe a robot,
00:53:00 how would you improve the penis and the vagina?
00:53:05 Well, the penis for starters,
00:53:06 I mean, let’s also discuss the testicles.
00:53:09 They’re very important too.
00:53:10 I mean.
00:53:11 Okay, so they’re fragile and they’re important
00:53:14 and yet they’re hanging off the body in danger basically.
00:53:18 So does that make sense?
00:53:20 You know, they begin in the womb,
00:53:22 they begin inside the abdomen and they slowly descend
00:53:25 and sometimes before birth,
00:53:26 sometimes in the first year of life, sometimes never,
00:53:29 they pop out of the body and end up hanging in the scrotum.
00:53:32 There’s a reason because the chemical reactions
00:53:35 that create sperm function best
00:53:37 at a few degrees cooler than body temperature.
00:53:40 And so that’s why you might notice in the warm weather,
00:53:44 they might hang further down and in the cold weather,
00:53:47 they scrunch themselves up to get closer to the body
00:53:50 to maintain that ideal temperature a few degrees cooler.
00:53:55 So it’s hard, you know,
00:53:56 if you could create a sperm production mechanism
00:53:58 that did not rely on that lower temperature,
00:54:00 that would be great.
00:54:00 Keep them inside the body protected like the ovaries are.
00:54:04 Oh, then you wouldn’t rely on the lower temperature.
00:54:07 I thought you meant create some kind of weird internal
00:54:10 cooling mechanism.
00:54:11 No, well, I guess that would be one solution,
00:54:14 but just maybe a different type of chemical reaction
00:54:17 or, you know, would not be reliant
00:54:19 on the lower temperature, let’s say.
00:54:21 You know, it’d be great to design a spermatogenesis
00:54:25 or a sperm production process that would function best
00:54:28 at body temperature and then we can keep
00:54:30 those delicate organs inside the body
00:54:32 and not have them hanging out in danger.
00:54:35 Or maybe the argument for this design
00:54:37 is maybe it’s nice to put them in danger
00:54:42 so you are constantly concerned about it.
00:54:46 Could be, maybe that’s beneficial for male psychology,
00:54:49 I’m not really sure.
00:54:50 There’s a psychological element here
00:54:51 about the evolution that could be.
00:54:53 So that’s the testicles.
00:54:56 Penis?
00:54:58 A better way to do it, you know?
00:55:00 I mean, it’s pretty good as it is.
00:55:03 You know, it kind of, when it’s time for it to work,
00:55:05 it grows and stiffens and when it’s time for it not to work,
00:55:08 it kind of shrinks and hangs out.
00:55:12 Saw this on a Seinfeld episode, so I know how it works.
00:55:17 Shrinkage.
00:55:18 Yeah, that was a good one.
00:55:19 But you know, that’s also a bit unique,
00:55:22 I suppose, that the way it has this erectile tissue.
00:55:26 Actually, they’re similar in the mouth
00:55:29 of certain baleen whales, there’s a certain similar
00:55:32 kind of erectile tissue that helps cool them off
00:55:37 because they have so much blubber
00:55:39 and create so much heat in moving around and feeding
00:55:42 that they have actually a similar,
00:55:44 similar to the penis organ in their mouth
00:55:45 that helps cool their bodies, because it’s a big problem.
00:55:48 They have to store all that blubber for fuel,
00:55:51 but it makes them too hot, so as a compensation,
00:55:53 they have this kind of erectile organ in their mouth.
00:55:55 Okay.
00:55:57 What about vagina?
00:55:59 You know, the fact that miscarriages sometimes happen
00:56:02 because of sexually transmitted diseases,
00:56:05 because of trauma, you know, it’d be great
00:56:08 if the uterus where the growing fetus is
00:56:11 is sort of even more protected from those things.
00:56:15 You know, I guess that’s a side effect of the fact
00:56:18 that people still have sex when they’re pregnant
00:56:20 or still, you know, exposed to injury.
00:56:23 If there was a way to make it more protected,
00:56:25 perhaps that would be even better.
00:56:27 I did see an article recently about artificial wombs,
00:56:30 which are rapidly becoming a reality,
00:56:33 and in animal studies, they’re able to prolong
00:56:36 the gestation of a fetus by a month in an artificial womb.
00:56:40 Can you explain the artificial aspect
00:56:42 of the artificial womb?
00:56:43 Sure, it’s, I believe it acts almost
00:56:46 like a heart lung bypass machine,
00:56:49 so when someone’s getting like bypass surgery,
00:56:51 their heart is stopped, literally they throw ice
00:56:54 in the chest and they give a potassium infusion
00:56:58 through the blood, which stops the heart,
00:57:01 but the blood is run through a machine
00:57:04 that basically does the work of the heart
00:57:07 and lungs together, gets oxygen into the blood
00:57:09 and then pushes it back into the body.
00:57:11 So I believe it’s a sort of similar mechanism
00:57:14 to keep blood and nutrition flowing to this fetus,
00:57:18 and so it’s just not inside the body of a parent,
00:57:20 it’s in some kind of other device,
00:57:23 but I think that science is gonna rapidly improve.
00:57:27 One benefit is, you know, babies are born premature,
00:57:29 and while, you know, neonatology is able
00:57:33 to continuously kind of lower the age of viability
00:57:36 through better technology and understanding
00:57:38 how, what you can, medicines and other things
00:57:40 you can do to premature babies when they’re born,
00:57:42 you know, ideally, if let’s say premature labor begins,
00:57:46 you can’t stop it, that baby’s coming out one way
00:57:49 or the other, if you could just then stick it
00:57:50 into an artificial womb where it can continue
00:57:52 its development, that would save a whole host
00:57:55 of problems, often those babies born very early
00:57:57 suffer from damage to various organs,
00:58:00 including the brain, you know, for the rest of their life,
00:58:02 so that could be a very important technology.
00:58:04 So some aspects of the human body,
00:58:07 we can develop technologies that outsource them,
00:58:10 sort of offload some of the stress
00:58:16 and the workload from the human body to do it elsewhere.
00:58:19 Like dialysis does that for kidneys, you know,
00:58:21 people can live decades without kidneys
00:58:25 as long as they get dialysis, which does the work for them.
00:58:29 Not every organ can do that, for instance,
00:58:31 the liver, there’s no dialysis version for the liver,
00:58:34 like if your liver fails, you need a liver transplant
00:58:36 and that’s the only thing that’s gonna do it for you.
00:58:40 So that’s the world’s first artificial womb for humans
00:58:45 and we’re looking at a picture of what looks like
00:58:48 gigantic balloons.
00:58:50 Matrix, here we come.
00:58:51 This is very matrixy.
00:58:53 How are they floating?
00:58:55 What are we even looking at?
00:58:57 There’s giant red spheres.
00:59:00 This really looks like the matrix.
00:59:03 I wonder where it’s from,
00:59:04 so there seems to be a paper on this too.
00:59:07 I don’t know too much about it, but I did see that there,
00:59:10 it’s advancing very rapidly.
00:59:12 The world’s first artificial womb for humans.
00:59:14 Scientists in the Netherlands say they’re within 10 years
00:59:18 of developing an artificial womb
00:59:20 that could save the lives of premature babies.
00:59:22 Premature birth before 37 weeks is globally
00:59:25 the biggest cause of death among newborns,
00:59:27 but the development also raises ethical questions
00:59:31 about the future of baby making and so on and so forth.
00:59:36 Wow, we’re going to be facing a lot of ethical questions
00:59:41 as we start to mess with human biology.
00:59:45 In an effort to help human biology,
00:59:50 we might start to mess with it.
00:59:52 That’s going to be very interesting.
00:59:54 Let’s take steps towards the matrix.
01:00:01 All right, what about the neighbors, poop, feces?
01:00:07 There seems to be a lot of interesting stories
01:00:11 in that particular output as well.
01:00:16 What to you is fascinating?
01:00:20 What to you maybe is misunderstood
01:00:26 or little known about poop?
01:00:30 Well, it’s hilarious, for one thing, that we do it.
01:00:35 The word is great as well.
01:00:36 There’s so many different words.
01:00:38 I do, when I’m talking to the parents
01:00:40 of pediatric patients, I use the word poop.
01:00:42 I don’t often, when I’m talking to adult patients,
01:00:44 try to choose a more mature word.
01:00:47 But poop is amazing.
01:00:49 I mean, I guess it’s sort of the dirtiest, the most vile,
01:00:55 the most hated aspect of our bodies.
01:00:57 It’s the grossest, we don’t want to think about it,
01:01:00 talk about it, have it anywhere near our food
01:01:04 or in social interactions with good reason.
01:01:08 I mentioned gastrointestinal infections
01:01:10 are one of the most common infections
01:01:11 the human body suffers from.
01:01:13 And the way they spread from person to person,
01:01:17 grossly enough, is referred to as the fecal oral route,
01:01:20 which means a bit of someone’s stool
01:01:22 is getting into your, you’re swallowing it,
01:01:25 through water supply.
01:01:27 For instance, diarrhea is actually quite
01:01:29 a brilliant mechanism of these microbes, right?
01:01:32 If you, let’s say you’re in the intestine of one person,
01:01:35 your goal is to get into the intestines of another person.
01:01:38 Brilliant to just trick their intestines
01:01:41 into secreting all this fluid into the intestines
01:01:45 to increase the volume of stool and its runniness
01:01:47 so that when they do poop, it gets into the water supply
01:01:50 and then everyone else kind of ends up
01:01:51 getting infected as well.
01:01:52 Wow, that’s brilliant.
01:01:54 Just the same way like tuberculosis or coronavirus
01:01:57 kind of infects your lungs and makes you cough
01:02:00 and you send it out into the air
01:02:01 and it ends up in other people’s lungs.
01:02:02 And that’s all evolution.
01:02:04 Yeah, it’s brilliant.
01:02:06 So diarrhea is intelligent, is a big takeaway lesson.
01:02:11 It’s one of the most intelligent things we can do
01:02:14 as an entirety of an organism,
01:02:15 not just the particular cognitive organism,
01:02:17 but there’s, we’re made up of bacteria and viruses
01:02:22 and there’s a lot of visitors and so on.
01:02:24 As the entirety of the system,
01:02:25 diarrhea is one of our better accomplishments.
01:02:28 It’s fascinating.
01:02:30 Well, I wonder, why is poop funny?
01:02:34 I think a lot of that is socially constructed,
01:02:37 just how it’s sort of supposed to be hidden away
01:02:39 yet something we always do,
01:02:41 something we chuckle about as children.
01:02:43 But even in healthcare,
01:02:45 it becomes this big topic of conversation
01:02:48 because you end up talking about it constantly.
01:02:50 Like in the ER, people come in,
01:02:53 they’re complete strangers.
01:02:55 Sometimes like a nice old lady who resembles my grandmother
01:02:58 and all of a sudden I have to ask her all about
01:03:00 what’s happening in the bathroom.
01:03:01 Like, is she straining?
01:03:03 What color is it?
01:03:04 What’s the consistency?
01:03:07 Does it float on top of the water more than it should?
01:03:10 Is it hard to flush?
01:03:11 I mean, there’s a million different questions you learn
01:03:13 as a medical student and you’re like this poop detective
01:03:17 when people come in with issues.
01:03:19 And so it’s funny, I guess,
01:03:22 in the exam room with the doctor patient relationship,
01:03:25 there’s sort of no barriers.
01:03:26 You talk about everything
01:03:27 and you’re talking about the most intimate details
01:03:29 of a person’s life,
01:03:31 even though you just met them a second ago.
01:03:33 It’s so different than normal social interactions.
01:03:36 Yet there is this social aspect.
01:03:38 A lot of what I do is social.
01:03:40 It seems like doctors, what they do is mostly scientific,
01:03:43 but actually it’s just relating to another person
01:03:46 and you have to maintain your professional demeanor
01:03:49 and this normal human level interaction,
01:03:51 even though you’re talking about poop.
01:03:54 And that’s a skill, that’s an art and a science.
01:03:57 Well, okay, actually I wanna linger on that
01:03:59 because I’m a fan of just diving into conversations
01:04:03 right away with strangers, just getting no small talk.
01:04:08 And this is the ultimate, I don’t know if it’s the ultimate,
01:04:12 but it’s one version of no small talk.
01:04:14 You get right to the point.
01:04:18 That’s really powerful from a psychology perspective.
01:04:21 You’re a kind of therapist
01:04:22 or you have the power to be a therapist.
01:04:26 I don’t mean just about the medical condition of the body,
01:04:28 but the psychological.
01:04:30 There’s so much fear connected to this concern.
01:04:35 Also, self doubt, insecurities,
01:04:42 even sort of existential thoughts about your mortality,
01:04:46 all of those things are right there in the room.
01:04:50 So I think one way doctors deal with that
01:04:52 is they kind of have this cold way about them.
01:04:54 They almost have like dual mode.
01:04:56 One is like, I’m going to be friendly on the surface
01:05:00 and cold about the brutal honesty of the biology.
01:05:05 But I wonder if there’s like a skillful middle ground,
01:05:11 this dangerous place where you can help people
01:05:15 deal with their psychological insecurities,
01:05:18 concerns, fears, all those kinds of things.
01:05:21 Is that just really tough to do?
01:05:23 Yeah, it’s a huge part of being a doctor
01:05:25 is dealing with the psychological aspects
01:05:28 of whatever’s going on with the patient’s body.
01:05:30 I mean, in the ER, you deal with psychiatric emergencies
01:05:32 kind of left and right more than ever these days.
01:05:35 And that’s a huge issue,
01:05:37 not to mention sort of drug use, alcohol related stuff,
01:05:41 that gets into sort of psychology
01:05:43 and the human love of intoxicants
01:05:45 and changing the brain’s chemistry and habit, of course,
01:05:49 we’re creatures of habit and that plays in as well.
01:05:51 I mean, a big part of, for instance, pediatrics
01:05:54 is reassuring parents and kind of convincing them,
01:05:59 giving them the confidence that what’s going on
01:06:01 with their child is not serious, will go away on its own,
01:06:03 does not need any particular intervention.
01:06:06 And, but adults too, reassurance is a huge part of the game.
01:06:12 Yeah, in the ER, you see humanity at its most raw.
01:06:17 I feel like you get this tremendous insight into people,
01:06:20 how they live, what they worry about,
01:06:22 what they think about, how their body works
01:06:24 and also how their mind works
01:06:25 that you almost don’t see anywhere else.
01:06:28 It’s a really interesting place to work.
01:06:30 And also the way our society is shaped,
01:06:32 the ER is where people go for almost everything.
01:06:35 When they’re suicidal, they come to the ER.
01:06:37 When they’re too high on drugs to walk, they come to the ER.
01:06:40 Children who have been abused, sexually abused,
01:06:42 physically abused, come to the ER for us to investigate.
01:06:45 It’s sort of like the all purpose waste bin
01:06:48 for the dregs of society, what people do to themselves
01:06:51 and what they do to other people.
01:06:53 You mentioned you’re interested in the darkness of humanity
01:06:55 and made me think of the ER where you really see
01:06:58 what human life is like in the ER.
01:07:02 Okay, you tweet about, you write about,
01:07:04 you think about the emergency room ER.
01:07:07 That’s really fascinating.
01:07:10 Just the little window you give to that world
01:07:13 is fascinating.
01:07:16 What lessons about humanity do you draw
01:07:20 from this place where you’re so near to death?
01:07:24 There’s so much chaos.
01:07:26 There’s so much variety of what’s wrong.
01:07:29 So little information or the urgent nature
01:07:34 of the information inflows such that you can’t really reason
01:07:39 sort of thoroughly and deeply and collect all the data,
01:07:41 all those kinds of things.
01:07:42 You have to act fast and then everybody’s freaking out.
01:07:45 Can you just speak to the human condition
01:07:48 that you get a glimpse at through the ER experience?
01:07:55 Yeah, I think you do see all those things.
01:07:57 I think on one end of the spectrum,
01:08:00 it is this very unique place
01:08:02 where you get all these unique insights.
01:08:03 On the other end, it can become a ho hum workplace
01:08:07 just like any other, which is sort of surprising.
01:08:09 As I mentioned before, humans seem to be able to get used
01:08:11 to almost anything and doctors can get ho hum used to,
01:08:15 oh, dying of a heart attack, oh, actively in labor
01:08:18 and the baby’s half out.
01:08:19 Oh, just ho hum, I know what to do, going about my job
01:08:23 and go home and have dinner with my family
01:08:26 and not think too much about it.
01:08:27 That’s amazing.
01:08:28 I do try to maintain both my fascination.
01:08:33 I think writers in general tend to think more
01:08:35 about what they see, write more about what they see,
01:08:37 maybe draw connections with what they see to other things.
01:08:40 So I do think that writer’s perspective
01:08:42 does help me kind of maintain my fascination
01:08:45 and my kind of more of an insightful perspective
01:08:48 than just a ho hum, water cooler conversation.
01:08:53 But you do see a lot.
01:08:55 In a way, medical problems are sort of
01:08:58 the great equalizer, right?
01:09:00 Class, race, culture, background,
01:09:03 the failings of the human body, the way it fails
01:09:05 and what we can do to help in those situations
01:09:08 is almost universal.
01:09:10 I always like this quote from, Chekhov was a doctor
01:09:13 and a writer and he treated a lot of peasants
01:09:18 very low class and also treated a lot of aristocrats.
01:09:20 And he wrote that they all have the same ugly bodies
01:09:24 basically, which I think is really right on.
01:09:27 And it’s sort of, you can see people
01:09:29 underneath a superficial layer of clothing,
01:09:32 maybe it’s the most expensive clothing
01:09:34 bought from the fanciest places,
01:09:35 but underneath their body is still failing in the same way
01:09:38 and they still have the same anxieties, the same worry
01:09:40 about mortality, the same concerns about why their poop
01:09:43 turned green today, all these things
01:09:46 that they bring to the table.
01:09:47 So in a way, it is this great equalizer
01:09:49 where people are kind of all the same in some ways.
01:09:53 Yeah, I feel like people sometimes, class, money,
01:09:58 fame, power, makes you for a time forget
01:10:02 that you’re just a meat vehicle.
01:10:06 And just as good and just as bad
01:10:09 as the other meat vehicles all around you.
01:10:14 In that sense, there’s this question sometimes raised,
01:10:18 are some people better than others?
01:10:20 And I usually answer no to that question because of that.
01:10:24 Yeah, some people might be better at math,
01:10:26 some people might be better at music.
01:10:29 But in the end, we’re just meat bags.
01:10:33 Beautiful as we are.
01:10:35 There’s a poem that just, a small tangent I want to take,
01:10:39 I just saw it, Just Acting, that you have written.
01:10:47 I have to, would you classify it as a poem?
01:10:49 Yeah.
01:10:50 At first, if I may read it, at first you enter the clinic,
01:10:54 shoulders weighed down by white coat pockets,
01:10:57 book stuffed, timid, you act out a role,
01:11:01 your white coat, a costume, your questions, a script,
01:11:05 your demeanor, a rehearsed act.
01:11:08 No one is going to buy this.
01:11:10 But then, as you play the role again and again,
01:11:13 repeating the lines and the motions,
01:11:16 the script slowly dissolves
01:11:17 and the interaction becomes thoughtless.
01:11:20 And the rehearsed act slowly fades into a profession.
01:11:24 You suddenly find yourself unable to tell
01:11:26 if you’re still acting or if you’re doing it for real.
01:11:31 And now you’re a doctor.
01:11:33 Jonathan Reisman, MD, Harvard,
01:11:36 Massachusetts General Hospital of Medicine
01:11:38 and Pediatrics Department.
01:11:39 Beautiful, so that is what it is to be a doctor.
01:11:44 You’re just acting.
01:11:45 Fake it till you make it.
01:11:46 Exactly, fake it till you make it.
01:11:48 And I think, I imagine every medical student
01:11:50 has this feeling when they first go into a room.
01:11:53 Like I talked about asking this nice old lady
01:11:56 about the color of her poop for the first time
01:11:58 and you’re just like, what am I doing here?
01:12:00 Like, does she believe I’m a doctor?
01:12:02 You know, this just feels absurd.
01:12:04 But then it’s, again, ho hum, becomes normal.
01:12:09 Now there’s not a sperm chapter in your book.
01:12:14 You mentioned offline that this is a second and a third book
01:12:17 that you’re working on all about sperm.
01:12:19 No, I’m just kidding.
01:12:21 But, or maybe I’m not.
01:12:24 Humor tends to make way for reality.
01:12:26 So the tweet was that a human, an average human male
01:12:32 produces 500 billion sperm, I believe,
01:12:36 which is about four to five times more
01:12:39 than the number of people who have ever lived.
01:12:42 And each of those sperm is genetically unique
01:12:45 so you can think of them, you can kind of imagine
01:12:48 the possible humans they could have created.
01:12:51 And they’re all different.
01:12:53 They have similarities, of course,
01:12:54 but they have peculiarities that make them different.
01:12:57 And you can think of all the different trajectories,
01:12:59 all the Einsteins, the Feynmans, the Hitlers,
01:13:03 and all the people who would have died during childbirth,
01:13:08 would have died early in their years
01:13:09 given the different diseases.
01:13:11 It’s fascinating to think about.
01:13:13 An average human, yeah, we’re all winners
01:13:17 of a very competitive race.
01:13:19 So the people who make it, we’re winners, hashtag winning.
01:13:23 Is there something that you find fascinating,
01:13:30 interesting, beautiful, ugly, surprising about sperm?
01:13:38 I think sperm is, yes, it is a very interesting bodily fluid.
01:13:43 Maybe I’ll write about it in a second or third book,
01:13:45 we’ll see, but I guess sperm is interesting
01:13:49 because it’s kind of the only projectile bodily fluid
01:13:53 from the body.
01:13:56 Vomit can be projectile.
01:13:57 Usually that’s a diseased state.
01:13:59 That’s not the expected kind of normal healthy state.
01:14:01 Oh, sneezing, would you classify that or no?
01:14:03 True, I guess it’s, yeah, there’s some particles in the air.
01:14:06 I guess it’s not a fluid, I mean, not a liquid, but true.
01:14:11 I mean, cough, in addition to sneeze, right?
01:14:13 Sneeze is how our nose gets rid of something
01:14:16 that shouldn’t be there.
01:14:17 Cough is how our lungs get rid of something
01:14:18 that shouldn’t be there.
01:14:19 Vomiting is sometimes how our stomachs
01:14:20 get rid of something that shouldn’t be there.
01:14:22 All projectiles sometimes in their own way.
01:14:25 Sperm is sort of interesting.
01:14:26 It’s created with the food for its journey.
01:14:28 Sperm mostly feed off of fructose, a kind of sugar,
01:14:32 for the few days that they live inside
01:14:34 the female genital tract.
01:14:35 But it’s sort of, I like comparing our genitals
01:14:38 to the genitals of the plant world, which is flowers,
01:14:40 and in the same way that a touch me not, for instance,
01:14:44 the kind of flower where when you brush up against it,
01:14:46 it sort of launches seeds into the distance
01:14:48 to try to survive in a way kind of the sperm
01:14:53 is doing something similar,
01:14:54 launched into the female genital tract,
01:14:56 and then all trying to find this,
01:14:58 competing against each other to find this egg.
01:15:01 It’s really amazing.
01:15:02 And when you learn about it from the biological perspective,
01:15:05 the most amazing thing is how many things can go wrong,
01:15:09 just in the sperm not surviving long enough
01:15:11 for it making it to the egg,
01:15:13 and then some genetic abnormality causing a miscarriage.
01:15:17 It’s sort of astounding that it works as often as it does,
01:15:21 and I think the lesson there is just that
01:15:23 people have a lot of sex, and so statistics just favor
01:15:26 it’s gonna work out a good number of times.
01:15:29 Yeah, and there might be intelligence in the design
01:15:31 of just the sheer number of sperm.
01:15:33 Maybe that’s yet another way
01:15:35 to inject variety into the system.
01:15:38 And redundancy, I guess.
01:15:40 We have two kidneys, we have two hands.
01:15:42 If we lose one, we can still go on.
01:15:44 We have however many millions of sperm
01:15:47 get sort of launched in every ejaculation
01:15:50 is if a bunch fail or don’t make it inside.
01:15:54 There’s papers on this, by the way,
01:15:56 that I read for some reason.
01:15:57 Not read, but skimmed for some reason,
01:16:00 which is talking about which sperm usually wins.
01:16:04 Like what are the characteristics of sperms
01:16:06 that are winning, and it’s not the fastest.
01:16:09 So apparently there’s some kind of slaughter
01:16:13 that happens early on, people will correct me,
01:16:15 but it’s not the fastest.
01:16:17 There is an aspect of it’s the luckiest.
01:16:19 It really is, like the body tries
01:16:21 to make it a random selection.
01:16:23 It tries to make it fair in making it as random as possible.
01:16:27 Interesting, and also interesting
01:16:29 that they’re fueled by fructose.
01:16:30 I didn’t really think about that.
01:16:32 So they’re a carb loaded athlete.
01:16:37 Right, with food for the journey.
01:16:38 Food for the journey, because I’m somebody
01:16:40 that actually does a lot of running on,
01:16:43 I guess you would call me a fat adapted athlete.
01:16:46 So I do sort of meat heavy diet.
01:16:51 And so you could do a lot of endurance kind of stuff
01:16:53 when you don’t need any carbs, any glucose,
01:16:56 any of that kind of stuff.
01:16:58 And you’re very low.
01:16:59 It’s interesting to think that sperm are like,
01:17:01 nope, they’re total bros.
01:17:04 Let’s go to the gym, sprint, performance,
01:17:08 short term performance is everything.
01:17:11 All right, well, that sperm, returning to the liver,
01:17:16 the place that deals with all our poor decisions.
01:17:20 No.
01:17:21 Many of them.
01:17:22 Many of our poor decisions.
01:17:24 Is there, you said that the liver does quite a few things.
01:17:30 What to you is fascinating, beautiful about the liver?
01:17:33 I’d say it’s primary function seems to be
01:17:35 as the sort of gatekeeper for what we eat and absorb.
01:17:40 You know, the entire gastrointestinal tract
01:17:42 from the esophagus to the rectum,
01:17:45 the blood flows from it, not back to the heart,
01:17:48 but to the liver where it’s first examined,
01:17:51 kind of things are evaluated, packaged,
01:17:55 you know, processed, detoxified, perhaps.
01:17:59 It’s kind of this great overseer
01:18:01 of what we digest and absorb.
01:18:03 And so it kind of keeps track of what’s coming in,
01:18:07 you know, the outside world that comes in
01:18:09 and will become part of us.
01:18:11 You know, that’s why partly the liver suffers
01:18:14 sometimes the injury from certain toxins like alcohol.
01:18:19 But beyond that, the liver is also the place,
01:18:21 as I said, it metabolizes things too.
01:18:23 So it metabolizes alcohol
01:18:25 and why it can be injured by alcohol.
01:18:27 It metabolizes drugs like Tylenol,
01:18:29 which is why Tylenol can be very toxic to the liver
01:18:33 when taken as an overdose.
01:18:36 So the liver, you know, even beyond that,
01:18:38 the liver produces a lot of different, you know,
01:18:42 things that float in the bloodstream.
01:18:43 It packages cholesterol and fats
01:18:46 and sends them to where they’re needed.
01:18:48 It deals with protein in the blood.
01:18:50 It deals with clotting factors in the blood,
01:18:51 helping the blood clot, you know,
01:18:54 processes things like bilirubin and other things
01:18:57 that really, as I mentioned,
01:18:58 is like 15 organs wrapped into one.
01:19:00 Maybe that’s why it’s sort of the biggest internal organ.
01:19:02 The skin’s bigger, but it’s not an internal organ.
01:19:06 Right, the biggest organ in the human body is the skin.
01:19:10 Right, but the liver’s the biggest internal organ
01:19:13 and it really is a powerhouse and does a lot,
01:19:15 which is why when people suffer from liver failure,
01:19:18 kind of everything goes wrong in a way.
01:19:21 And in terms of replacing organs,
01:19:24 what are organs that are easily replaceable,
01:19:28 which are not?
01:19:29 Like on the list of things that are hard to replace
01:19:31 and not, what would you put in number one?
01:19:34 What would you put like at the bottom?
01:19:37 Well, I’d say the kidneys are, you know, nothing’s easy,
01:19:39 but kidneys are easiest in a way.
01:19:41 Partly, I mean, maybe a big factor there
01:19:44 is that other people have two of them
01:19:45 and can give one to you.
01:19:46 So you don’t have to wait for people to die,
01:19:47 which is the case with hearts and livers.
01:19:50 Sometimes you can take a part of a liver
01:19:52 from someone who’s alive
01:19:53 and the liver does have this kind of mythological ability
01:19:57 to regenerate itself.
01:19:59 In the myth of Prometheus, he’s chained to a rock
01:20:03 and the bird eats his liver every day
01:20:04 and it grows back every day.
01:20:06 And that’s actually biologically accurate.
01:20:10 Not that you can completely get rid of it
01:20:11 and it’ll appear again,
01:20:12 but when pieces of it are removed or injured,
01:20:15 it does regenerate itself pretty amazingly.
01:20:19 So I’d say the kidneys,
01:20:20 the fact that there are more around,
01:20:21 also it’s, you know, the kidney is a smaller organ.
01:20:24 It’s often just, you don’t have to put a transplanted kidney
01:20:27 where the kidney should be in the back of the abdomen.
01:20:29 You can just kind of stuff it into the pelvis there
01:20:31 because it’s a smaller organ.
01:20:32 The liver would be hard because it’s huge.
01:20:36 And I guess we just have the most experience
01:20:38 with kidney transplants because they are the most common.
01:20:41 And the heart and the brain are probably quite difficult.
01:20:46 Brain, as far as I know, hasn’t been successfully done.
01:20:49 The heart is done.
01:20:52 And definitely I’ve evaluated a lot of patients
01:20:55 with a heart transplant.
01:20:56 It does work pretty well.
01:20:58 The mechanical heart substitutes
01:21:00 are also advancing quite rapidly these days.
01:21:03 For a failing heart,
01:21:04 there are certain kinds of devices
01:21:06 they can surgically implant.
01:21:08 Like when a failing heart isn’t able to push hard enough,
01:21:10 you know, that’s the heart’s job is pushing blood
01:21:13 with sufficient pressure to create blood pressure.
01:21:15 When it fails, there are actually these devices
01:21:17 you can strap onto the heart to help it pump harder.
01:21:21 Those are rapidly advancing.
01:21:23 Many of those were not available even 10 years ago
01:21:25 when I got out of med school and now they’re commonly used.
01:21:29 So maybe heart transplant won’t be as necessary
01:21:31 in the future if those mechanical things do advance.
01:21:34 And as I said, the heart is basically a mechanical pump.
01:21:37 So perhaps it would be the easiest organ
01:21:39 to replace with some mechanical device.
01:21:41 Now for something completely different,
01:21:43 returning to testicles for a time.
01:21:45 You posted a Instagram post of testicles as food.
01:21:51 Perhaps eating them doesn’t help libido
01:21:54 because ingested testosterone is totally metabolized
01:21:58 in the liver, returning to our liver,
01:22:01 leaving none to reach the bloodstream.
01:22:03 That is why testosterone only comes as injection
01:22:06 or topical foam, not as pills.
01:22:10 On the other hand, estrogen and progesterone
01:22:14 can be absorbed orally, hence the pill.
01:22:17 But testosterone is mostly responsible
01:22:19 for libido in women too.
01:22:21 I was not expecting for this biology lesson
01:22:23 when I was looking at an Instagram picture of,
01:22:28 are we looking at testicles?
01:22:30 Yeah.
01:22:30 Are these like, which species?
01:22:34 I believe all those are from cows.
01:22:36 From cows, cow testicles.
01:22:37 Cows are technically female, so bulls.
01:22:39 Yeah, well, speaking of which, just we’ll jump around a bit,
01:22:43 but you’ve also traveled the world quite a bit.
01:22:47 What is the craziest food you’ve eaten across the world?
01:22:56 What have you learned about the extremes
01:22:58 of the culinary arts by traveling the world?
01:23:03 I would say, I guess I’ve always been extra fascinated
01:23:07 with the diets of natives of the far north.
01:23:11 I spent some time there in Russia and in Alaska
01:23:15 and always loved their diet.
01:23:18 So when I worked in Alaska in emergency room
01:23:21 and did some other travels in Arctic Alaska,
01:23:24 and they eat a lot of fat.
01:23:27 Traditionally before contact,
01:23:29 more than half of all calories in the Inupiat Eskimo diet
01:23:33 came from blubber, marine mammal fat,
01:23:36 or also fat from fish, fat from ducks
01:23:38 and other birds that go up there to mate in the summer.
01:23:41 So things like raw whale blubber
01:23:43 was especially interesting for me and very exciting.
01:23:48 You know, I had some beluga whale chowder, things like that.
01:23:52 There’s just all these very unusual dishes.
01:23:55 You know, there’s a dish called Mikiyak,
01:23:58 which is whale meat fermented in whale blood,
01:24:03 which is quite delicious actually.
01:24:05 So is it cooked, is it eaten raw?
01:24:08 How do they like their fat?
01:24:09 Like in the same way up north in Russia, as you mentioned.
01:24:14 So they often eat it raw.
01:24:16 So the raw whale blubber is called Muktuk
01:24:20 and it’s often just sliced thin
01:24:22 and it’s sort of cold, but not frozen often when they eat it
01:24:25 and they slice it thin.
01:24:26 And a lot of people assume it would be very chewy,
01:24:30 but it’s not that chewy.
01:24:31 It’s quite pleasant actually
01:24:32 and has this kind of sea smell to it as you’re eating it.
01:24:36 I quite like it.
01:24:37 And what’s the culinary culture like?
01:24:41 Meaning, is it just source of energy or is it art?
01:24:45 Well, there’s, you know, traditionally,
01:24:47 there’s not a lot of cooking in the Arctic.
01:24:51 A lot of things are eaten raw,
01:24:53 partly because there’s not a lot of fuel for making fires.
01:24:56 So they will, you know,
01:24:58 some of the big rivers in Russia, for instance,
01:25:01 that flow north, they will bring trees,
01:25:03 you know, dead trees and logs up to the north
01:25:05 and they can get some wood that way.
01:25:07 And same thing in some of the rivers
01:25:09 kind of flowing northward from the Brooks Range of Alaska.
01:25:12 You do get some trees,
01:25:14 but just not enough to really produce a culinary art
01:25:18 that requires cooking with heat.
01:25:20 You know, they do have traditionally blubber lamps
01:25:24 where the blubbers of seals and whales are used
01:25:26 to create a little flame.
01:25:28 Often that’s for light and for a little bit of heat
01:25:32 and less for cooking.
01:25:34 But eating things raw is definitely a huge part
01:25:37 of the culture there.
01:25:38 And while I was, I went on a whale hunting trip
01:25:40 out on the spring ice in the Arctic Ocean by Barrow, Alaska.
01:25:44 And two of the guys, the Inupiat guys who had invited me
01:25:48 were kind of talking about how eating things raw
01:25:51 is sort of the most essential characteristic
01:25:53 of Inupiat culture.
01:25:54 And the one guy who’s half white, half Inupiat,
01:25:56 said people often doubt his ethnicity
01:25:59 because he looks like a white guy.
01:26:00 So he’ll, you know, bite the head off of a raw bird
01:26:04 to show them that he is truly Inupiat, is what he said.
01:26:07 That’s how you prove you’re legit.
01:26:09 We’re looking at an Instagram pic.
01:26:11 As a doctor, I was used to knowing fat
01:26:14 as the most maligned of all body parts
01:26:17 and the culprit in an obesity epidemic.
01:26:19 But in Arctic Alaska, fat has always meant
01:26:23 health and survival.
01:26:24 In fact, the entire story of life in the Arctic,
01:26:27 especially human life, is basically a tale of fat.
01:26:30 And in Barrow, what’s A.K.?
01:26:33 Alaska.
01:26:34 Alaska, okay.
01:26:36 A lawn covered with a whale blubber
01:26:39 is still equivalent of a plush green lawn
01:26:42 in temperature suburbia, swelling in its owner with pride.
01:26:46 And that’s what we’re looking at,
01:26:48 is a lawn full of whale blubber.
01:26:53 A beautiful, and this, so this is,
01:26:55 I mean, there’s a lot of calories there.
01:26:56 Oh, yeah.
01:26:57 And this can feed a lot of people.
01:26:58 A lot of energy, a lot of warmth.
01:27:01 Absolutely, and it’s delicious.
01:27:03 This was like, I was a kid in a candy store, basically.
01:27:06 I rounded a corner in Barrow.
01:27:08 So when people do get a whale
01:27:10 during the spring whaling season,
01:27:12 they raise a flag or the whaling captain
01:27:14 raises a flag over his house
01:27:15 and everyone in town is welcome to come try some.
01:27:18 And so before I went inside to try some,
01:27:21 I was kinda playing around with blubber
01:27:23 and I saw the, this is a bowhead whale.
01:27:26 I saw its heart, which was huge,
01:27:29 like the size of a yoga ball.
01:27:31 And that was, for me, just like amazing.
01:27:33 I spent probably the next 45 minutes
01:27:35 just looking at all aspects of it.
01:27:37 And the stump of aorta that was attached to it
01:27:39 was the size of my thigh.
01:27:41 That was really fascinating.
01:27:43 It’s similar Alaska and Northern Russia,
01:27:46 like Siberia and out there.
01:27:48 So where were you?
01:27:50 I think you have some pics from that time.
01:27:53 Where were you in Russia?
01:27:55 So I spent a lot of time in kind of Western Russia as well,
01:27:58 but I did take two trips to Kamchatka,
01:28:02 including Northern Kamchatka.
01:28:04 I didn’t go far enough,
01:28:06 I didn’t go to Chukotka, for instance,
01:28:08 until more recently when I was a ship doctor
01:28:11 on a wildlife cruise that sailed from Anadyr, Russia,
01:28:15 up to, through the Bering Strait into Wrangell Island.
01:28:19 And we stopped in some villages in Chukotka
01:28:21 and I got a chance to try some whale and stuff like that.
01:28:25 Northern Kamchatka, where it’s more the Koryak
01:28:27 are the indigenous people.
01:28:29 They do a lot of seal hunting,
01:28:30 so I had a lot of seal blubber,
01:28:31 but I don’t believe they do any whale hunting quite there.
01:28:35 But the Chukchi in a way are sort of, you know,
01:28:38 similar to the Inupiat in their diet and their life ways.
01:28:42 Of course, everyone’s diet, all these people’s diet
01:28:44 has changed dramatically in the last 100 years,
01:28:47 as it has for actually everyone
01:28:48 living in kind of modern societies.
01:28:50 But for them, perhaps more than anyone else
01:28:52 since their diet was the most extreme,
01:28:54 I think of any human culture on earth.
01:28:57 Just to stay on the wild travel you did,
01:29:01 and I should say, I’m using the word travel,
01:29:03 but it really, you were a doctor there.
01:29:10 Well, first of all, can you just comment on the decision
01:29:13 to go to such places and to help people,
01:29:17 to be a doctor there?
01:29:18 What was the motivation?
01:29:19 What was the thinking behind it?
01:29:20 Well, I think I got the travel bug
01:29:22 before I ever went to medical school
01:29:25 and even wanted to be a doctor.
01:29:26 So right after college, I kind of wasn’t very into college,
01:29:31 didn’t enjoy things, kind of wanted to get out there
01:29:33 and see the world, get out of New York City
01:29:36 where I was a student at NYU.
01:29:39 The first thing I did after finishing college
01:29:42 was I was invited to be an intern at a research center
01:29:45 in St. Petersburg, Russia.
01:29:47 I spent six months there on my first trip
01:29:49 and went back four more times to Russia,
01:29:52 traveled all over, including to Kamchatka twice
01:29:55 and other parts of the country.
01:29:57 I’d never heard of cities like Petrozavodsk
01:30:00 and Syktyvkar and Pskov.
01:30:02 I didn’t even know a word could start with P, S, K,
01:30:05 like the city of Pskov, but it can.
01:30:08 And I was sort of fascinated.
01:30:10 I was actually studying
01:30:12 the international environmental movement
01:30:14 and how it came to Russia
01:30:16 after the fall of the Soviet Union
01:30:18 and how organizations like Greenpeace
01:30:20 and World Wildlife Fund and the World Bank
01:30:23 are trying to kind of push the timber industry,
01:30:27 which is huge in Russia, toward a more sustainable path.
01:30:29 And so I was sort of evaluating how is it working?
01:30:32 If not, why not?
01:30:34 And that seems like such a little niche,
01:30:36 such a small detail about Russian society,
01:30:38 but in a way, researching that in depth
01:30:41 was almost this window into the entire country
01:30:44 and the history in a place I knew nothing about.
01:30:46 And I learned the language, traveled all over the country,
01:30:50 got to know the food, the history, the literature.
01:30:53 It was just an immersive and amazing
01:30:55 and life changing experience
01:30:56 that made me want to see every spot on the globe, basically,
01:31:01 and learn about every culture.
01:31:03 So I took that desire with me to medical school.
01:31:06 I decided I would go to medical school.
01:31:08 And from the very beginning,
01:31:10 I was intent on traveling around the world.
01:31:13 So a lot of my career has been fashioned
01:31:16 so that I’m practicing medicine in a place
01:31:18 with an interesting geographic context,
01:31:20 an interesting place with an interesting cultural context.
01:31:24 And that just makes it more interesting, I find.
01:31:27 Not only are medical services often more needed
01:31:29 in these remote and rural parts of the country and world,
01:31:32 so I feel like I’m taking my knowledge
01:31:35 and education experience to places where it’s needed,
01:31:38 but also for me,
01:31:39 it’s just such an enlightening experience,
01:31:41 the way culture, history, geography, climate
01:31:44 affects medical disease,
01:31:46 but just getting to know the people,
01:31:47 getting to know their culture,
01:31:49 being a very useful traveler
01:31:51 by providing medical services in that place.
01:31:54 And that’s taken me to Arctic Alaska,
01:31:57 to Pine Ridge Reservation, South Dakota.
01:31:59 I currently work in a few different parts
01:32:01 of Pennsylvania, Appalachia,
01:32:02 which for me is a unique geography and culture
01:32:06 that I didn’t grow up with, wasn’t familiar with.
01:32:08 So in some ways, it’s exotic for me as well.
01:32:12 I worked in other places too, like Kolkata, India, Nepal.
01:32:16 Just I think my love of travel has shaped my medical career
01:32:20 and being a doctor does give you these opportunities
01:32:23 to go to places and travel in a unique way
01:32:27 through the medical profession.
01:32:30 You know, there’s a documentary,
01:32:31 Happy People Here in the Taiga or something like that.
01:32:35 I think Warner Herzog voices it.
01:32:39 It tells a story of a simple life of survival in the taiga
01:32:43 and I think they’re trapping for food
01:32:47 and there’s an alcoholism problem too as well.
01:32:51 There’s like a very basic life of survival,
01:32:57 of loneliness, of desperation,
01:32:59 but also there’s a, I think the underlying claim
01:33:04 of the documentary is that that simple life
01:33:09 that simple life actually has a kind
01:33:12 of simple happiness to it, hence the name Happy People.
01:33:20 Can you speak to the life that people live in those places
01:33:24 when it may be simpler than you would
01:33:28 in a sort of big city life?
01:33:32 It’s definitely very different for sure.
01:33:36 You know, I guess I found like in some
01:33:38 of the remote villages of Kamchatka,
01:33:41 I was actually surprised how similar they were
01:33:44 in that I saw the same family strife,
01:33:48 the same fights, the same kind of pairing of relationships
01:33:55 and bickering and politics.
01:33:58 In a way, I’m from the New Jersey suburbs
01:34:01 and being in this remote village of Northern Kamchatka,
01:34:05 I remember writing an email to my friend
01:34:07 about how just it seemed so similar,
01:34:08 even though on the surface it was this exotic other world,
01:34:12 the incredible material know how they must have
01:34:15 to get their food from the land.
01:34:17 You know, that the number of animal species,
01:34:19 plant species, the behaviors of the animals,
01:34:22 seasons, how to live that way.
01:34:25 In a way, it’s more complicated in a way
01:34:27 that I find fascinating how people live on the land
01:34:29 and the knowledge and experience it takes
01:34:31 to do it well and survive.
01:34:33 You know, obviously other aspects of modern life
01:34:35 in a city are much more complicated
01:34:38 than they would be there, but I guess it’s,
01:34:41 that was something that struck me too,
01:34:42 that it’s simpler in some ways,
01:34:43 but more complicated in other ways.
01:34:45 So some of the complexity that happens in life
01:34:48 is originated from humans, not from the technology
01:34:52 or all that kind of stuff around us.
01:34:55 You can take the human out of modernity,
01:34:57 but they’re still human.
01:34:58 They’re still human, and they fill the empty space
01:35:01 with their own human complexities.
01:35:03 Are there people that just stand out,
01:35:07 memorable people, memorable experiences from those places?
01:35:13 Some people that maybe made you smile, made you cry,
01:35:19 changed who you are as a man, changed who you are
01:35:21 as a doctor, anything jumps to mind?
01:35:24 I think, you know, when I was, it was interesting,
01:35:26 when I was in Russia, I found that most of the people
01:35:29 I hung out with were old women.
01:35:31 I’m not sure why.
01:35:32 I mean, actually I didn’t meet a lot of old men in Russia,
01:35:36 which might speak to kind of life expectancy there
01:35:39 for men in particular.
01:35:41 But I found women, older Russian women,
01:35:44 including, you know, Russian from St. Petersburg
01:35:46 or some of the elderly women in Kamchatka,
01:35:49 who were, you know, some were Koriak,
01:35:51 some were half Koriak, half Russian, some were Chukchi.
01:35:55 I just found them to be so enlightening
01:35:58 the way they talked about history, about people,
01:36:02 so insightful about humanity, you know,
01:36:03 all they’ve lived through in the last 50 years
01:36:05 in some of these parts of Russia,
01:36:07 like the upheaval, societal upheaval,
01:36:10 the destruction, the building up.
01:36:12 It’s just something I could not even imagine.
01:36:15 And I think their insights were just very,
01:36:18 I’m not thinking of anything in particular,
01:36:19 but I just remember I could listen
01:36:21 to some of these elderly women talk about their lives
01:36:24 for hours and hours.
01:36:25 I remember there was this older,
01:36:26 elderly blind Koriak woman who you would have thought
01:36:31 was the, you know, most country bumpkin of country bumpkin,
01:36:34 and yet she couldn’t stop talking about
01:36:35 how much she loved reading Dostoevsky and Tolstoy,
01:36:38 which might also speak to the Soviet education system.
01:36:41 And it was just sort of surprising and fascinating,
01:36:43 and just those stories and perspectives on life
01:36:46 really stayed with me.
01:36:48 Yeah, with babushki.
01:36:53 There’s a wisdom, there’s a kindness.
01:36:57 I mean, I suppose that’s true for older people in general,
01:37:06 but there’s something about, it’s not just Russia,
01:37:09 it’s Eastern Europe, it’s like this kind of look of wisdom,
01:37:17 and not just like sort of middle class wisdom
01:37:22 or something like that.
01:37:23 It’s like I have seen some shit wisdom, I’ve seen it all.
01:37:30 And on the other side, I’m left here with a pragmatism
01:37:35 and a compassion, and also an ability to cook really well.
01:37:39 That’s for sure, absolutely.
01:37:41 There’s just this balance of just deep intelligence
01:37:44 and deep kindness, and yeah, I mean I part much of who I am
01:37:50 is because of the relationship I had with my grandmother
01:37:53 who was a Russian, Ukrainian born Russian grandmother.
01:38:01 Did you learn the Russian language?
01:38:03 I did, it’s quite rusty at this point,
01:38:05 but I did, one of these wonderful elderly Russians
01:38:10 in St. Petersburg sort of adopted me.
01:38:12 I think that was another thing that a lot of these
01:38:15 elderly women on every side of the country
01:38:18 kind of adopted me or saw me as this real curiosity.
01:38:21 This was around 2002, 2003, it just wasn’t common
01:38:26 for this sort of strange American to suddenly show up
01:38:29 in the middle of Kamchatka or even St. Petersburg,
01:38:32 and just absolutely ravenously curious
01:38:34 about everything they had to say.
01:38:36 So I often got adopted and one of them taught me Russian
01:38:40 and how to ride a horse, so the same babushka
01:38:44 taught me both of those things.
01:38:46 And like you said also, I should mention
01:38:48 that there’s something about the Soviet education system
01:38:51 where yeah, everybody reads Tolstoy, Dostoevsky,
01:38:54 it’s exceptionally well read.
01:38:56 No matter where life has taken you,
01:38:58 no matter where you come from,
01:39:00 the literature, the mathematics, the sciences,
01:39:02 they’re all like extremely well educated
01:39:06 and that creates a fascinating populace.
01:39:12 Like then you take that education,
01:39:15 that excellent early education,
01:39:18 and you throw a bunch of hardship at those people
01:39:22 and then they kind of cook in that hardship
01:39:26 and come out really fascinating people on the other end.
01:39:30 It makes me surprised sort of that, for instance,
01:39:32 like Russian medical science is not,
01:39:35 doesn’t, you don’t see a lot of sort of studies,
01:39:38 medical studies, advancing of medical science
01:39:41 come out of Russia.
01:39:42 It’s just sort of, I’m surprised sort of,
01:39:44 I wish that it would.
01:39:45 I visited Akademgorodok outside Novosibirsk,
01:39:49 which is an entire city the Soviets created
01:39:51 just for the study of science
01:39:52 and it’s like there’s the geology building
01:39:54 and there’s the biology building
01:39:55 and there’s the chemistry building
01:39:57 and I just feel like Russia has this potential
01:40:00 to be a science powerhouse or even in the medical sciences
01:40:03 but I guess you just, I don’t see it.
01:40:05 I’m not sure why.
01:40:07 I mean, you can certainly guess as to why
01:40:10 and I see the same thing in the other,
01:40:13 in the sciences I hold the dearest sort of,
01:40:15 in computer science, in engineering fields.
01:40:20 I kind of long held this desire, by long,
01:40:25 I mean, last couple of years
01:40:27 because a bunch of people reached out to me
01:40:29 from Yandex and Moscow State to give lectures there
01:40:33 to sort of connect.
01:40:34 You know, why so little science is coming out of there?
01:40:37 Why so little that we hear about?
01:40:41 And it feels like we should be able
01:40:42 to bridge the scientific community.
01:40:44 Like science, let’s even say,
01:40:49 even in turmoil of geopolitics, even in global conflict,
01:40:53 I feel like science should be bigger than that.
01:40:56 But why do we not hear from the scientists
01:41:00 is because of the limitations on human freedoms,
01:41:03 on scientific freedoms.
01:41:05 I feel like in China, in Russia,
01:41:09 in any regime of its sort, you should give freedom
01:41:14 to scientists to flourish and to interact with others
01:41:19 and you can only grow from that.
01:41:20 You shouldn’t suppress that.
01:41:23 The sort of Cold War ideas, we should put those aside.
01:41:27 As somebody who spent time in Russia,
01:41:31 as somebody who learned Russian,
01:41:35 do you have some thoughts that you want to say
01:41:38 about the war in Ukraine currently?
01:41:41 It’s tragic, of course.
01:41:44 Seemingly pointless to watch the destruction
01:41:47 of a country in real time.
01:41:51 I guess it’s, you know, when you read Russian history
01:41:53 and Ukrainian history, I guess it just,
01:41:55 it’s sort of, you know, destruction is a big part of it.
01:41:59 The populace being beaten down is a big part of it,
01:42:02 you know, from the Mongolian hordes
01:42:05 through the Tsar and the Soviets and Putin.
01:42:09 I guess, you know, it’s just,
01:42:11 in science in particular, medical science,
01:42:13 it feels like this sort of unrealized potential.
01:42:15 You know, the culture is so beautiful,
01:42:18 the people are so smart and well educated.
01:42:20 I think the word unrealized potential
01:42:23 is kind of how I feel.
01:42:24 That’s why I wanted to celebrate that part of the world
01:42:27 is there’s so many beautiful people,
01:42:29 so many brilliant people.
01:42:31 And I just happen to know the language
01:42:33 so I’m able to appreciate the beauty of those people.
01:42:36 I’m sure the same is true in China.
01:42:38 I’m sure, that’s one of the things that makes me sad
01:42:40 is there’s all these cultures that I don’t know about.
01:42:44 I can’t fully appreciate their brilliance.
01:42:46 Even Japan and places like that
01:42:48 that are sort of, there’s channels of communication
01:42:52 wide open and there’s a lot of interaction.
01:42:54 It’s still, not knowing the language,
01:42:56 I feel like I miss some of the culture.
01:42:58 Or Portuguese and, you know, looking at South America
01:43:01 and all that kind of stuff.
01:43:03 But anyway, in Russia there certainly is
01:43:06 that unrealized potential.
01:43:08 In Ukraine, so many brilliant scientists,
01:43:12 engineers came from Ukraine, from Russia.
01:43:14 And I hope they get to flourish soon.
01:43:18 And I hope we put this,
01:43:23 I hope we stop this war, because all war is hell.
01:43:29 Is there something to comment about the biology
01:43:31 of war, is there echoes of the emergency room experience?
01:43:41 Have you dealt with patients
01:43:46 that have been touched by war time?
01:43:49 Definitely, war and medicine has a very intricate
01:43:53 and complex relationship.
01:43:54 I don’t know if it was Walt Whitman who said it,
01:43:57 though he was a nurse during the Civil War,
01:43:59 that war is the best medical school.
01:44:01 But some people have said that.
01:44:03 And even advancements in medicine come from war.
01:44:08 The wars in Iraq and Afghanistan have, in some ways,
01:44:12 really revolutionized certain aspects
01:44:14 of the way we treat trauma patients
01:44:15 in the civilian world as well.
01:44:17 The importance of tourniquets,
01:44:20 the importance of transfusing whole blood
01:44:22 instead of red blood cells isolated from serum
01:44:25 and platelets, et cetera.
01:44:27 The importance of pain control in the battlefield,
01:44:29 that’s changed dramatically.
01:44:30 Everything from ketamine injections
01:44:32 to fentanyl lollipops in the battlefield.
01:44:35 So war has really improved medicine in many ways.
01:44:39 In another way, the Department of Defense
01:44:42 spends a lot of money on medical research
01:44:44 and really pushes the envelope.
01:44:46 DARPA is one aspect of the military budget
01:44:50 that really funds these moonshot experiments
01:44:52 that are really fascinating and really push the frontiers
01:44:56 more than seemingly most kind of universities
01:45:00 doing doctors and researchers doing their research.
01:45:04 So in a way, the space program,
01:45:06 which sort of was military initially
01:45:08 then became civilian under NASA,
01:45:10 also has led to a lot of advances and understandings
01:45:13 of health on Earth and in space.
01:45:16 So the military or war in general is a huge way
01:45:20 that medicine advances,
01:45:23 not to mention the epidemics that come.
01:45:25 My grandmother was from what’s today Moldova,
01:45:28 what was then Romania.
01:45:29 She got typhus during World War II.
01:45:33 So there’s typhus outbreaks, there’s cholera outbreaks,
01:45:35 you know, all these, even infectious disease things
01:45:38 can advance in war, which you wouldn’t expect.
01:45:40 You expect sort of trauma to be the sort of main problem,
01:45:43 but actually infection is a huge problem
01:45:45 throughout history and war.
01:45:46 So we can learn a lot.
01:45:48 It’s this kind of horrific natural experiment
01:45:51 in medical care.
01:45:53 Yeah, and I’ve recently been reading about
01:45:56 some of the horrific medical experiments
01:45:59 performed by Nazi scientists, Nazi Germany.
01:46:03 I’ll talk about it another time perhaps,
01:46:05 but nothing reveals the honesty of human biology like war.
01:46:13 Just to stay on your wild journeys for a little bit longer,
01:46:17 you have a tweet about Shackleton saying,
01:46:19 here’s a photo of Shackleton’s medical kit
01:46:22 from his storied expedition to Antarctica in the 1910s.
01:46:26 Some perigoric for pain, some laxative.
01:46:30 Only the essentials.
01:46:33 Would you put laxative under the essentials?
01:46:36 Anyway, sorry to interrupt.
01:46:39 When I worked as a ship doctor in Antarctica in 2018,
01:46:44 I had a huge cabinet full of meds and even EKG machine.
01:46:48 So if you can comment sort of on that contrast.
01:46:54 First of all, your own journey, how harsh was it?
01:46:56 How difficult was it?
01:46:58 And given that context, can you think about
01:47:02 how hard Shackleton’s journey was?
01:47:06 I think the difference is unimaginably stark.
01:47:09 One thing I do wanna point out is that
01:47:11 the use of laxatives early in the 20th century
01:47:14 and before that, they were used for a surprising
01:47:17 number of ailments where they probably did not help at all.
01:47:21 But I think that was a holdover from sort of
01:47:23 the old theory of medicine, the humoral theory
01:47:26 where you have to balance the fluids in the body.
01:47:28 And so causing people to vomit,
01:47:30 causing them to have diarrhea or purposely taking blood
01:47:34 out of them in bloodletting was a big part.
01:47:36 And I think that crazy use of laxatives
01:47:38 was maybe a holdover from that time.
01:47:41 But that being said, they were probably not eating
01:47:44 very high fiber food on that expedition.
01:47:47 So perhaps laxatives could have been helpful.
01:47:49 There’s a lot of seal, penguin and seal meat being eaten,
01:47:54 which is not super high in fiber.
01:47:56 So I don’t wanna discount the importance
01:47:58 of laxatives in that setting.
01:48:00 But that wouldn’t be the essential thing.
01:48:02 If you’re thinking of a tiny kit
01:48:04 that has only the essentials, I mean pain, yes.
01:48:09 Laxatives, I don’t know, maybe not.
01:48:11 I think the medical kit possibilities
01:48:13 were much narrower back then.
01:48:16 This was before antibiotics,
01:48:18 before I think germ theory might’ve been,
01:48:22 it was known, but there wasn’t much to do about it.
01:48:25 So the availability of medicines,
01:48:27 I mean, that’s something that exploded
01:48:29 over the course of the 20th century.
01:48:30 So what I can put in a backpack today
01:48:33 filled with modern medications, whether injectable
01:48:35 or to be taken orally is just many orders of magnitude
01:48:39 greater than what they had back then.
01:48:42 So when I went, my expedition was nothing like Shackleton’s.
01:48:46 I was on a huge cruise ship with 160 Japanese passengers
01:48:51 who came with their own translators.
01:48:53 And as I said, I had cabinets, not just one cabinet,
01:48:58 many cabinets full of medications,
01:49:00 both injectable, some patches, some pills.
01:49:04 I was very impressed actually with what was available there.
01:49:08 And I didn’t have to use a lot of it, thankfully,
01:49:11 though I did use some of it for people.
01:49:14 And I slept and I got free room and board on the ship.
01:49:19 So every Southern summer cruise ships
01:49:22 go take people to Antarctica,
01:49:24 the Southern Atlantic islands like the Falklands
01:49:26 and other parts of the South Pacific.
01:49:29 And then in the Northern summer,
01:49:30 the same kind of cruise ship explosion happens
01:49:34 going to Greenland and Iceland and Svalbard
01:49:36 and Franz Josef Land and other parts of the North Alaska.
01:49:40 So, and every ship needs a doctor.
01:49:42 So it’s a great opportunity.
01:49:44 They want specifically ER doctors to deal with emergencies,
01:49:48 but you’re really working in the middle of nowhere.
01:49:51 And all you have is the medications there on the ship
01:49:55 and supplies and your knowledge and experience.
01:49:57 And so it’s a very different experience
01:49:59 than working in a high tech modern hospital
01:50:02 with every bit of technology
01:50:03 and every sub specialist consultant available.
01:50:06 But I sort of liked that challenge.
01:50:08 I mean, I like going to the ends of the earth.
01:50:09 It’s beautiful, it’s exciting, it’s fascinating.
01:50:12 Practicing medicine in those settings is extra challenging
01:50:15 and really makes you hone some of your skills,
01:50:18 which is part of the reason that I sought them out.
01:50:22 Do you see echoes of some of that same effort?
01:50:25 I’ve gotten a chance to interact with astronauts
01:50:27 and those kinds of folks working on space missions.
01:50:30 Do you see some of those same echoes of challenging efforts
01:50:34 going out into space and maybe landing on Mars
01:50:37 and maybe beginning to build a small colony on Mars?
01:50:42 Yeah, I think the healthcare that is needed
01:50:44 will be a big part of that.
01:50:46 Obviously, we’re probably gonna send
01:50:47 overall quite healthy people,
01:50:49 but there’s a lot of medical decisions to make
01:50:51 about what should be brought, what should be expected.
01:50:54 To some extent, I’ve had a lot of doctors say,
01:50:57 oh my goodness, I can’t believe you work
01:50:58 in the middle of nowhere.
01:50:59 What do you do if someone gets a brain bleed,
01:51:02 like falls, hits their head, needs a neurosurgeon?
01:51:04 I mean, the obvious answer is they die.
01:51:06 You know, when you’re in the middle of Antarctica,
01:51:09 things kill you that wouldn’t
01:51:11 if you’re inside a university hospital
01:51:13 that’s fully equipped to help with every problem that arises.
01:51:16 Mars takes that to a crazy extreme, obviously.
01:51:20 I know that even going to Antarctica,
01:51:22 different countries have had different strategies.
01:51:24 I believe it was Australia used to kind of just,
01:51:28 in anticipation, remove people’s gallbladders
01:51:31 just so that it wouldn’t get inflamed
01:51:33 because that is a very common medical emergency.
01:51:36 So they would just remove it beforehand,
01:51:37 even though it was not diseased at all,
01:51:39 just so that while they’re stuck in Antarctica
01:51:41 over the winter, for instance, that wouldn’t be a problem.
01:51:44 You know, there’s many other issues that can arise.
01:51:47 But so those are some decisions to make.
01:51:49 Maybe the people who go into Mars
01:51:51 should have their appendix removed,
01:51:52 their gallbladder removed.
01:51:53 Maybe they should have a cardiac cath
01:51:55 to see if they have coronary artery disease
01:51:56 just to know their chances of getting a heart attack there.
01:51:59 Though it’s not always predictive.
01:52:00 You know, it’s hard to predict
01:52:01 who’s gonna get a heart attack,
01:52:02 but maybe with all the data around today,
01:52:05 we’ll get better at predicting.
01:52:06 But that will be a huge part.
01:52:07 You know, we can’t have people,
01:52:09 the few pioneers in a Mars colony
01:52:11 dying of heart attacks and things like that.
01:52:13 Don’t anticipate stuff.
01:52:13 Would you go?
01:52:15 You’ve gone to some harsh conditions to be a doctor.
01:52:18 Would you go to Mars to be a doctor?
01:52:21 It would definitely be amazing, I think,
01:52:24 because I have a wife and two small children,
01:52:26 probably not in the cards for me at this point, but.
01:52:30 You humans with your human attachments.
01:52:33 Sex and death.
01:52:35 If you just put more priority on the death than the sex,
01:52:39 I think we would be better off.
01:52:42 No.
01:52:44 I would love to go to Mars.
01:52:45 And actually, you know,
01:52:45 I practice high altitude medicine in Nepal.
01:52:48 Space medicine is sort of an extension of that.
01:52:50 You know, the air is just much thinner, like nonexistent.
01:52:53 You know, as you go higher in the mountains,
01:52:54 the things that happen to human physiology
01:52:56 are very bizarre and strange
01:52:59 and still not well explained by science.
01:53:01 And in space, it’s just like a crazy extension
01:53:04 of high altitude.
01:53:07 If I could just return to the, we didn’t really,
01:53:10 I think we mentioned a little bit about the food you had.
01:53:13 Just if we can high level say,
01:53:15 what is the greatest meal you’ve ever had?
01:53:18 So your last meal, let’s go.
01:53:21 If one more meal, I get to murder you after this.
01:53:26 This is your last day.
01:53:27 We get to spend it together.
01:53:28 Where in the world would you go?
01:53:29 What would you eat?
01:53:30 I would say the most delicious thing is bone marrow.
01:53:36 And I would love a full meal of bone marrow
01:53:38 for my last, last dish.
01:53:39 I did on my birthday in 2002,
01:53:43 ate a kilogram and a half of crab meat in Kamchatka.
01:53:46 And that was also amazingly delicious.
01:53:50 The king crab they have there is incredible.
01:53:52 But I would go with bone marrow,
01:53:54 which is I think just one of the most delicious foods.
01:53:57 And it’s sort of this weird body part.
01:53:59 You know, it’s basically all your stem cells,
01:54:01 not all of them, but the stem cells
01:54:03 that produce all your blood cells.
01:54:04 So they are spitting out billions of white blood cells,
01:54:07 red blood cells and platelets every day.
01:54:09 And there’s a bunch of fat in there as well.
01:54:12 Just one of the places the body stores fat.
01:54:14 And so you basically add heat and that’s all you need.
01:54:17 It’s like the perfect food.
01:54:18 You add heat.
01:54:19 The fat for frying the stem cells is already there.
01:54:22 There’s naturally a bone vessel to contain it all.
01:54:25 Probably add some flavor too.
01:54:27 It’s like the perfect food.
01:54:29 Does it matter which animal?
01:54:33 I prefer a larger animal just so there’s more of it.
01:54:35 I actually like, well that’s true.
01:54:37 I actually really like sort of bone marrow
01:54:39 from like chicken bones.
01:54:40 Right, just sucking it out of the bone.
01:54:42 Yes, I’m known for leaving absolutely nothing edible
01:54:46 on the plate except bone itself.
01:54:48 There’s one other human I know that loves bone marrow
01:54:54 as much as you do and that’s Joe Rogan.
01:54:57 So go, it’s unnatural how much that man loves bone marrow.
01:55:01 I understand why.
01:55:02 It’s amazing.
01:55:03 I love the steak part.
01:55:04 The bone marrow, you know what, let me argue with you
01:55:07 because I don’t know, it could be an acquired taste
01:55:12 but there’s just too much, it’s like too much
01:55:17 with too little work for it.
01:55:20 Like it’s as if you gave me lobster meat
01:55:23 without the lobster having to clean the lobster.
01:55:27 I just feel like I’m spoiling myself.
01:55:30 So it’s very fatty, it’s, I don’t know,
01:55:33 maybe I wanna work for something that tastes like that.
01:55:36 Well if you start from the whole animal,
01:55:37 you do have to work to get at it, right?
01:55:39 A lot of animals have the teeth and the jaw muscles
01:55:43 to chomp through bone, we do not.
01:55:45 So when you buy it from the store, it’s already sawed up
01:55:49 but I’ve definitely gotten marrow out of deer bones
01:55:52 with a hatchet, just chop off the fat end
01:55:55 and start spooning it out.
01:55:56 Or maybe I’ll revisit it, that’s fascinating.
01:55:59 And where, where would you eat it?
01:56:01 Where and which place of the world?
01:56:04 Is there something about who cooks it, who you eat it with?
01:56:10 You’re not allowed to pick your family.
01:56:12 Right.
01:56:13 Uh.
01:56:14 Uh.
01:56:14 Uh.
01:56:15 Uh.
01:56:17 So like which place in the world, rural or in the city,
01:56:21 those kinds of things, you’ve been
01:56:22 to so many fascinating places.
01:56:25 I would say I’m, Antarctica I would say
01:56:28 is one of the most picturesque places I’ve ever been.
01:56:31 I really did not, I didn’t know how mountainous it was
01:56:34 and I guess I knew there’d be ice
01:56:37 but just I didn’t know how much ice it was.
01:56:39 You know, it’s ice and mountains just overwhelming.
01:56:42 I just, you know, as kind of overwhelming bone marrow
01:56:45 might seem to you, sort of that feast for your eyes.
01:56:48 And just ice in general is amazing,
01:56:51 like the icebergs floating around Antarctica
01:56:54 is just astounding, like the different shapes,
01:56:56 the sizes are incredible.
01:56:59 There’s actually a, I believe it’s a US Navy website
01:57:02 that tracks the largest icebergs
01:57:03 and you can read about each of them and how big they are
01:57:06 and just the formations you see, similar up near Greenland,
01:57:10 though I have not been to Greenland.
01:57:12 Just ice in general is just amazing.
01:57:14 So I could just look at its different forms
01:57:16 while eating bone marrow forever, until you kill me,
01:57:18 that is.
01:57:19 Yeah, and afterwards we go.
01:57:21 There’s back to the death, the death and sex.
01:57:25 What is it about the ice?
01:57:26 Is it sort of the enormity of nature
01:57:29 that just reminds you that it’s going to be there
01:57:33 before you and after?
01:57:35 And then you get to partake in the eating
01:57:37 of the thing you need for maintaining of your biological,
01:57:42 temporary biological organism?
01:57:44 Yeah, I think it’s a few things.
01:57:47 One is just the shapes that you see,
01:57:49 the wave action, just eating away at these pieces of ice.
01:57:53 You get these arches and just these shapes.
01:57:55 I mean, it’s just like.
01:57:56 Geometry.
01:57:57 The geometry alone is amazing.
01:57:59 I studied math as an undergrad
01:58:01 and I’ve always appreciated geometry
01:58:04 and just the shapes alone are just look like brilliant works
01:58:07 of modernist art and just obviously no two
01:58:10 are ever the same.
01:58:12 Not to mention a lot of them are this unearthly blue color
01:58:16 that is just really startling and fascinating.
01:58:18 The same color of glaciers in various parts of the world,
01:58:22 that blue color is just really amazing.
01:58:26 And I also just love how it’s sort of this constant shedding
01:58:29 from our Antarctic continent, from Greenland.
01:58:32 It’s this constant process of snow falling inland
01:58:34 and pushing the glaciers further out to sea
01:58:37 and them breaking loose.
01:58:38 I mean, obviously it seems to be happening faster these days,
01:58:41 but it’s sort of this constant shedding
01:58:43 and sort of, I always like thinking about
01:58:45 how the body has something similar.
01:58:46 We’re constantly shedding and renewing
01:58:48 and rebuilding everything.
01:58:51 And so ice is sort of this constant similar process.
01:58:56 Yeah, I did not know you were a math undergrad.
01:59:00 So that, I mean, you just keep getting more fascinating.
01:59:05 Can you maybe take a small step into that direction?
01:59:08 What do you find beautiful about mathematics?
01:59:11 Why did you journey into that part of the world for a time?
01:59:15 I liked math.
01:59:16 I especially liked, so college math,
01:59:18 I did some calculus in high school.
01:59:20 When I got to college math,
01:59:22 I was amazed that there were no more numbers.
01:59:25 The digits disappeared.
01:59:26 It was just variables, concepts.
01:59:30 There was almost no more numbers at all.
01:59:32 It was like this totally abstract kind of way of thinking.
01:59:37 But that sort of reflects the natural world
01:59:39 and teaches you about the natural world,
01:59:40 though it’s sort of this perfect platonic ideal,
01:59:44 perhaps, of the natural world
01:59:45 that can still sort of help explain
01:59:47 what happens in the natural world.
01:59:49 But just these concepts are so abstract from life
01:59:53 and from the natural world.
01:59:56 I was actually getting interested in the natural world
01:59:58 at the same time when I was at NYU studying math.
02:00:02 I took a tour of Central Park that was pointing,
02:00:05 the guy, Steve Brill, was pointing out
02:00:07 these wild edible plants.
02:00:09 And I was learning to identify the first plants
02:00:11 and knowing what’s edible, what’s not.
02:00:13 That was totally fascinating.
02:00:15 And sort of this kind of thing
02:00:16 that I felt like was connecting me to nature.
02:00:18 And it was balanced with this utterly abstract science,
02:00:23 or utterly abstract lessons I was getting in math class
02:00:26 where I was thinking through series.
02:00:28 As we approach infinity, what happens to these equations?
02:00:31 And concepts of like rings and abstract algebra,
02:00:34 I don’t know, it was just this dichotomy
02:00:37 that I enjoyed both aspects of.
02:00:40 Yeah, the concepts.
02:00:41 But so different, this kind of logical,
02:00:48 rigorous view of the world and the world of biology.
02:00:52 Why the big, how did that feel to take the leap
02:00:55 into the biological, the mushy mess of the human body
02:01:00 from the mathematical, which is all very clean?
02:01:04 Right, it does feel like a big step.
02:01:07 I think there’s more connection than you think.
02:01:09 We talked about symmetry of the body earlier.
02:01:12 That is a real thing.
02:01:13 Fluid dynamics of how our various bodily fluids flow
02:01:18 and what makes them not flow as well
02:01:20 and what makes them flow better.
02:01:21 All these different aspects of science go into the body.
02:01:26 Everything from hard bone to softer kind of flesh
02:01:31 to liquids of various consistencies.
02:01:36 A lot of science and math does teach you
02:01:38 about kind of how the body works, how it can work better,
02:01:41 what happens in sort of disease states.
02:01:45 Yeah, I suppose there’s a connection.
02:01:49 There’s also kind of a sort of computational biology
02:01:54 of this computational equivalence of each of the disciplines
02:01:58 which are becoming more and more fascinating
02:02:00 with all the work that DeepMind is doing
02:02:02 and the work of genetics, all that kind of stuff,
02:02:04 simulating different parts of the body
02:02:06 to try to gain an intuition understanding of it.
02:02:09 That to me is super fascinating,
02:02:12 but sometimes it does feel like an oversimplification
02:02:15 of the way the body really does it
02:02:16 because the body is an incredibly weird complex system
02:02:21 and it finds a way.
02:02:25 The adaptability, the resilience,
02:02:27 the redundancy that’s built in, it’s weird.
02:02:31 It’s incredibly powerful and so unlike
02:02:34 the kind of computer based systems that we build,
02:02:38 at least we engineer in the software engineering world,
02:02:41 which kind of starts to make you think
02:02:43 how can we engineer computer systems in a different way
02:02:47 that make them more resilient in the real world?
02:02:50 That’s sort of the robotics question.
02:02:53 What do you think about that?
02:02:55 What does it take to build a humanoid robot
02:02:59 or robots that are as resilient as the human body?
02:03:02 How difficult do you think is that problem?
02:03:04 Having studied the human body,
02:03:06 how hard is the engineering problem of building systems
02:03:10 like that guy over there, the legged guy
02:03:13 that is as resilient as the human body
02:03:15 to the harsh conditions of the real world?
02:03:18 I think it’s very hard
02:03:20 and we definitely haven’t gotten there yet.
02:03:22 I think we could probably learn lessons
02:03:23 from people who are trying to grow artificial organs
02:03:26 in the lab to eventually transplant into people,
02:03:29 which would solve a huge problem
02:03:31 of needing to get those organs from others
02:03:33 and the rejection of putting a foreign material
02:03:35 inside your body.
02:03:37 Your immune system tends not to like that.
02:03:39 That has advanced a lot recently.
02:03:42 I think some advances actually have been
02:03:46 where we pay a lot of attention to stem cells,
02:03:48 stem cells, stem cells.
02:03:49 We can grow whatever we want out of stem cells,
02:03:51 but now there’s sort of a recognition
02:03:54 that what we call the extracellular matrix,
02:03:57 which is sort of the foundation of the body,
02:04:00 the thing that holds all the cells into their proper shape
02:04:02 and keeps them where they should be,
02:04:05 that is actually crucial.
02:04:07 And there’s probably a lot of signaling that goes on.
02:04:09 Like you stick a stem cell
02:04:11 on the right extracellular matrix,
02:04:12 it will turn into the kind of cell that you want
02:04:14 and take the right shape and position
02:04:16 and start functioning.
02:04:17 I think that’s been a huge, huge advance
02:04:21 knowing that it’s not just these celebrity stem cells
02:04:24 that are the answer.
02:04:25 It’s this kind of part in the background,
02:04:27 this sort of just like laying the foundation,
02:04:29 the system that you put these cells onto.
02:04:32 And we’re not there yet,
02:04:33 but there’s definitely a lot happening,
02:04:35 a lot of research happening.
02:04:36 And I think there’ll be some advances probably soon.
02:04:39 So now on the topic of interaction
02:04:42 of computational systems with biology.
02:04:47 So if you look at a company like Neuralink
02:04:49 or the whole effort of brain computer interfaces,
02:04:53 now there’s a neurosurgery component there.
02:04:56 We have to connect electrical systems
02:05:02 with biological systems.
02:05:04 So just even the implanting is difficult.
02:05:09 Then the communication is difficult.
02:05:11 But what would you say from what you know about the brain,
02:05:13 what you know about the human body
02:05:15 and all the beautiful mess that’s there,
02:05:18 how difficult is the effort of Neuralink?
02:05:20 Do you think it’s feasible?
02:05:22 I think it’s definitely feasible.
02:05:24 I think we need to probably know more than we do
02:05:27 and know how to connect it in all these ways.
02:05:31 I think some advances, for instance,
02:05:34 much less sexy, but really already impacting medical care
02:05:38 is something called deep brain stimulation,
02:05:40 which is done for Parkinson’s disease and others
02:05:42 where neurosurgeons implant this device
02:05:45 that’s electrically stimulates the part of the brain
02:05:48 that is not functioning in Parkinson’s disease.
02:05:51 And it’s quite dramatic how effective it works.
02:05:53 And I remember as a med student,
02:05:55 watching a neurologist literally like turn the electricity
02:05:58 up on this handheld thing,
02:06:00 and you could see the person’s Parkinson tremor go away
02:06:03 and you could see them start to walk
02:06:04 in a more steady fashion.
02:06:06 And I know there’s studies, there’s actually studies
02:06:09 or there may be studies in the future
02:06:11 studying the same deep brain stimulation
02:06:14 for everything from eating disorders to severe,
02:06:18 like severe OCD, like paralyzing OCD,
02:06:21 not just like I wanna wash my hands three times,
02:06:23 but and so I think the potential is there,
02:06:29 but I guess connecting the brain in a microscopic way
02:06:33 in sort of a multifaceted way,
02:06:35 there needs to be sort of a million connections
02:06:37 or some very high number of connections
02:06:39 for them to work fluidly.
02:06:40 As far as I know, I’m not an expert in the area.
02:06:43 First of all, I believe and I trust
02:06:45 in the adaptability of the biological system
02:06:47 to whatever crazy stuff you try to shove in there.
02:06:50 So it’s going to potentially reject things,
02:06:54 but it’s also going to, if it doesn’t reject things, adapt.
02:06:57 And if we can create computational systems that also adapt,
02:07:01 AI systems that adapt and can kinda,
02:07:05 both of them reach towards each other
02:07:07 and figure stuff out.
02:07:08 But actually our current AI systems are not very adaptable
02:07:13 to the what, like in the wild way
02:07:15 that biology is adaptable, like adaptable to anything.
02:07:19 And if we can build AI systems like that,
02:07:21 I feel like there’s some interesting things you could do,
02:07:24 but of course there’s ethics
02:07:25 and there’s real human lives at stake.
02:07:29 And there you can’t quite experiment.
02:07:32 You have to have things that work
02:07:35 and maybe simulation can help, but reality is,
02:07:40 it’s a dangerous playground to play on.
02:07:44 It is messy.
02:07:45 You tweeted that quote,
02:07:46 “‘If you look back from far enough into the future,
02:07:49 “’every doctor today will look like a total quack.’”
02:07:56 First of all, that’s humbling to think about.
02:08:00 Like we don’t know what we’re doing in the great,
02:08:03 like there’s been so much progress
02:08:05 that we kinda have this confidence
02:08:07 that we figured it all out.
02:08:09 If you look at history and you read how people thought,
02:08:13 I mean, there’s so many moments in history
02:08:14 where people really thought that they figured it all out.
02:08:18 It’s almost like there’s nothing else left to do
02:08:21 at every stage in history.
02:08:23 And then you realize no,
02:08:25 progress often happens like exponentially.
02:08:30 And every moment you continue to think
02:08:32 you figured it all out.
02:08:33 But if you’re being honest, if you’re being humble,
02:08:37 then you realize we’re just shrouded in mystery.
02:08:39 So what do we make of this?
02:08:41 Like how should we feel that?
02:08:42 How should you feel as a doctor?
02:08:44 How should we feel as scientific explorers
02:08:49 of the human body?
02:08:50 The fact that we’re probably going to be wrong
02:08:52 about everything we currently know.
02:08:54 Right, there’s a saying actually,
02:08:56 by the time you finish med school,
02:08:58 half of what you learned is wrong,
02:09:00 which is quite illustrative.
02:09:02 And becoming more true as time goes on,
02:09:05 so much medical research going on,
02:09:07 so much learning going on, it’s really wonderful in a way.
02:09:10 But in some ways we still learn these concepts
02:09:13 from the past.
02:09:14 And I know when you take a test as a medical student,
02:09:17 sometimes you know they want you to give the old answer,
02:09:22 but you know there’s a new answer
02:09:23 because of recent science,
02:09:24 but you know to give the old answer,
02:09:26 that’s now incorrect to get the question right on the test.
02:09:28 That happens actually quite a bit
02:09:30 because things change so quickly.
02:09:33 Yet, you know, when I look back at doctors
02:09:35 from centuries past, I mean, it’s absurd
02:09:38 what they were doing to their patients.
02:09:39 I mean, for probably for most of human history,
02:09:41 they were doing more harm than good.
02:09:43 You know, they’re draining people of their blood.
02:09:46 That was, you know, bloodletting was a huge part
02:09:48 of medical care.
02:09:51 You know, George Washington died of a paratonsular abscess,
02:09:55 an abscess right next to the tonsil,
02:09:57 which has the great name of Quincy,
02:09:59 and they bled him to death.
02:10:00 You know, I mean, kind of adding insult to injury.
02:10:02 Doctors are a menace and do a lot of harm.
02:10:05 I mean, hopefully not intentionally.
02:10:07 You know, even medical errors are still a huge problem,
02:10:10 cause of death and morbidity.
02:10:13 So we do a lot of things that are not great,
02:10:16 but you know, our knowledge, yeah,
02:10:18 it’s very imperfect at this point.
02:10:19 I do have some confidence.
02:10:21 You know, I guess perfect scientific studies
02:10:24 that try to get at the reality of the universe are essential
02:10:29 because when I think of why a certain medication works
02:10:33 for a certain condition,
02:10:34 it might make perfect sense in my head,
02:10:36 knowing the biology, the biochemistry, the anatomy,
02:10:38 it makes perfect sense, it must work.
02:10:40 I gave it to the patient, they got better,
02:10:42 and that’s happened 20 times in the last year,
02:10:44 but it’s, you know, I’m wrong.
02:10:46 Like when you actually do a study,
02:10:48 it actually doesn’t help, maybe it hurts.
02:10:51 And that’s really, I think the way we explain medications
02:10:55 working in our minds is often wrong
02:10:57 when you end up finally doing the study.
02:11:01 And some of the most interesting experiments
02:11:03 involve what we call sham surgery.
02:11:06 So for instance, people who injure their knee,
02:11:08 you know, arthroscopy where an orthopedic surgeon
02:11:10 goes in there with a scope, gets bits of bone out,
02:11:13 shaves down the cartilage, you know, cleans things up,
02:11:17 and it helps some people,
02:11:18 but they actually did some studies where one group of people
02:11:21 got the true arthroscopy and others just got sham surgery
02:11:24 where they put them to sleep,
02:11:26 made little cuts in the skin so they woke up with scars.
02:11:29 And then it turned out that it’s not clear
02:11:31 arthroscopy is actually helping.
02:11:33 And the same, there was a recent huge study
02:11:37 of putting a stent in someone’s coronary arteries
02:11:40 if they have stable chest pain,
02:11:41 not like I’m having a heart attack,
02:11:43 you need a stent like right then,
02:11:44 but, you know, kind of chronic coronary artery disease
02:11:48 where every time I run up the stairs, I get chest pain,
02:11:50 and then when I rest, it goes away.
02:11:52 Like obviously you put a stent,
02:11:54 you increase blood flow to the heart,
02:11:56 like how could that not work?
02:11:57 But then when they did the sham catheterization,
02:12:00 it actually looks like it might not actually help
02:12:02 better than the sham.
02:12:04 So I think those placebo controlled studies are essential.
02:12:07 I mean, it is shocking,
02:12:09 and this has been driven home during the last two years,
02:12:12 how hard it is to figure out
02:12:13 what the hell’s going on in the universe,
02:12:15 especially with our bodies.
02:12:16 Like it is really hard to get at the truth
02:12:18 and what you think makes sense, like often turns out,
02:12:21 I mean, the history of modern medicine
02:12:23 is littered with examples where it made perfect sense
02:12:26 and it seemed to help some patients,
02:12:27 and it turns out it’s not doing anything or it’s harmful.
02:12:31 Yeah, there’s all kinds of narratives swimming around.
02:12:33 We convince ourselves as a human civilization
02:12:36 that something is true.
02:12:37 There’s a propaganda machines, there’s just self delusion.
02:12:41 There’s a centralized communities,
02:12:45 like there’s a scientific community
02:12:47 that believes a certain thing.
02:12:48 There’s the conspiracy theories
02:12:49 that believe a certain thing.
02:12:51 Sometimes the scientific community, right?
02:12:52 Sometimes the conspiracy theorists are right
02:12:56 throughout human history, I mean.
02:12:57 And we now think the scientific community,
02:13:00 well, now the science has really figured it out.
02:13:02 We’re way smarter than we were in the past.
02:13:04 And then there’s these like interesting studies
02:13:08 that I’ve seen, I think Robin Hansen mentioned it to me,
02:13:12 that if you look at the entirety of medication,
02:13:16 like the effect of medication on human health,
02:13:19 if you do those kinds of broad studies,
02:13:21 does it actually help?
02:13:24 Like does quality of life,
02:13:26 lifespan, certain measures of the wellbeing,
02:13:30 does if you, and you look at human society as a whole,
02:13:34 does taking medication or not actually help?
02:13:37 And those studies find there’s no positive
02:13:39 or negative effect with medication.
02:13:42 And that’s a very kind of interesting perspective.
02:13:46 That mean you could probably argue a lot of ways,
02:13:51 but the point is, because you can bring up
02:13:56 literally a billion cases where medication
02:13:58 has significant positive impact on a particular patient,
02:14:01 but you have to kind of zoom out
02:14:03 and honestly look at the positive effects of medicine,
02:14:08 of lifestyle choices, diet choices, of exercise or not.
02:14:12 Maybe we’ll find eventually
02:14:13 that exercise is actually bad for you.
02:14:15 Maybe like there’s all kinds of things
02:14:20 that we’re going to, I feel like we’re going to figure out.
02:14:24 One of the things I think we’re going to figure out,
02:14:26 everything I’ve learned about my body,
02:14:30 is that aside from it being adaptable,
02:14:34 there’s a lot of very unique parameters
02:14:37 that are opaque to me that I’m measuring
02:14:39 through this feedback mechanism
02:14:41 by trying stuff and learning about it.
02:14:43 And one of the things we might learn
02:14:46 is that medicine cannot be done without collecting
02:14:50 a huge amount of data about each individual human.
02:14:53 So it’s absurd to be, like if I show up and see a doctor,
02:14:59 it’s absurd for that doctor
02:15:00 to have just a couple of minutes with me.
02:15:03 Like just looking at basic symptoms,
02:15:07 looking at such crappy data.
02:15:12 Like first of all, no long term data,
02:15:17 no longitudinal data, no historical data,
02:15:20 no detailed analysis of all the possible things.
02:15:25 Not just the related to your symptoms,
02:15:27 but related to other things that you’re not complaining about.
02:15:30 Just giving you a full picture of the data
02:15:33 and then using AI to help the human doctor
02:15:37 highlight the things that you should perhaps
02:15:39 pay extra attention to.
02:15:41 I think we’ll look back at this time as ridiculous
02:15:44 that doctors were expected to help anybody whatsoever
02:15:47 without having the data,
02:15:49 without having a huge amount of data about the human body.
02:15:52 Like you have to do so much with so little data.
02:15:55 It’s very 19th century.
02:15:57 It’s very 19th century.
02:15:58 So it relies on the brilliance of doctors
02:16:00 and of course the intuition,
02:16:02 the instinct you build up over time.
02:16:05 And that’s quite powerful.
02:16:06 The human brain is pretty damn good
02:16:09 for using experience to teach you
02:16:11 how to make a good decision.
02:16:12 But still it’s, you might as well be bloodletting.
02:16:16 Like it’s humbling to think about that.
02:16:21 It’s humbling.
02:16:22 It is humbling and it’s important.
02:16:24 I think doctors sometimes lose that humble perspective
02:16:28 on what they do.
02:16:30 And I think it’s very important
02:16:31 because as I said, medical history is just,
02:16:34 medical dogma has been tossed into the trash bin
02:16:36 so many times.
02:16:37 Something doctors were sure of was the case is not.
02:16:40 And it’s important to be cognizant of that.
02:16:46 You tweeted about somebody that had a big impact
02:16:52 just by reading about him on my life as well.
02:16:56 Still think about him.
02:16:58 Rest in peace, Dr. Paul Farmer.
02:17:00 A big inspiration to me.
02:17:01 His medical career was a testament
02:17:04 to what one person can do to improve the world.
02:17:07 So who was Paul Farmer?
02:17:09 And what made him a great doctor and a great man
02:17:12 and somebody who was an inspiration to you?
02:17:15 So Paul Farmer was a kind of pioneer of global health.
02:17:19 He started Partners in Health,
02:17:23 which is kind of an international health organization
02:17:25 that operates originally in Haiti,
02:17:28 also Rwanda and elsewhere.
02:17:30 And I think he was just so a zealot
02:17:34 for getting healthcare to some of the poorest people
02:17:37 in the world.
02:17:38 And I remember reading some of his books
02:17:41 and a book about him by Tracy Kidder
02:17:43 that’s really great, Mountains Beyond Mountains,
02:17:45 about how even when he was a medical student,
02:17:47 he was flying back and forth to Haiti in between exams
02:17:50 and just with this really intense focus and interest
02:17:55 in getting healthcare to where it’s not.
02:17:58 And I think traveling around the world,
02:18:00 especially to poor places like India, Calcutta, Nepal,
02:18:05 you really see how unevenly the benefits
02:18:07 of modern medicine are spread
02:18:09 over the surface of the earth.
02:18:10 Not only if you’re,
02:18:11 cause if you’re in Antarctica and have a heart attack,
02:18:13 you’re in serious trouble,
02:18:14 but just medications that cost pennies a day
02:18:19 can help people.
02:18:21 A lot of children in India under five die of diarrhea
02:18:25 and all they need is oral rehydration solutions
02:18:27 to stay hydrated.
02:18:30 Most of them can’t afford IV fluids, for instance,
02:18:32 to get admitted to the hospital.
02:18:33 And really dehydration just kills hundreds of thousands
02:18:37 of kids throughout the world.
02:18:38 Not to mention bacterial pneumonia also is a major cause
02:18:42 of death in children under five.
02:18:44 And many of them, not all, would be saved by amoxicillin,
02:18:48 which is just pennies.
02:18:50 And I, for me, I took a, had a path
02:18:54 and I wanted to have a career in global health.
02:18:56 And I started traveling abroad to India and elsewhere
02:18:59 when I was a medical student and continued doing that.
02:19:01 Paul Farmer was sort of one of the first
02:19:03 to kind of open everyone’s eyes, I think,
02:19:05 about the good you can do with just money
02:19:09 that we would, you know, change that we would throw away,
02:19:12 just, you know, put in a person, forget it,
02:19:14 or wherever we accumulate change these days.
02:19:16 So that’s very eye opening.
02:19:18 And while medical science advances and that’s good,
02:19:21 you know, we shouldn’t forget
02:19:23 that 100 year old treatments could save lives
02:19:25 in parts of the world where they’re just not available.
02:19:27 People should definitely read Mountains Beyond Mountains.
02:19:30 Just, for me at least, sort of a person from outside
02:19:35 all of it, it was the first person to make me realize
02:19:39 how difficult and the amount of humanity
02:19:43 that’s involved in being a doctor.
02:19:46 So it’s not some kind of cold economics based argument
02:19:50 about where to send treatments and so on.
02:19:52 That is there too, like you said,
02:19:55 basic treatments can help hundreds of thousands,
02:19:59 millions of people in many parts of the world.
02:20:02 But it’s also when you have a patient in front of you,
02:20:08 there’s some aspect of you that’s willing to give
02:20:11 a lot of your time, a lot of your money,
02:20:13 a lot of your effort to saving them,
02:20:16 even though it doesn’t make any sense.
02:20:20 It’s irrational in some sense, but it’s also human.
02:20:23 And that’s the struggle of every doctor.
02:20:25 Like when you have to choose how to allocate your time,
02:20:27 how to allocate your mental energy.
02:20:30 It’s a tough choice that a doctor has to make
02:20:34 and it’s a human choice.
02:20:35 It’s not some kind of cold game theoretic choice.
02:20:39 It’s also a human choice and it can be irrational
02:20:42 in some sense.
02:20:44 People are asking you for help.
02:20:45 That’s basically what every patient interaction is.
02:20:48 Someone’s asking you for help.
02:20:49 So your inclination is to help them.
02:20:52 And even if it means going above and beyond,
02:20:54 I mean, a lot of factors affect how compassionate
02:20:57 a doctor might be on any given day or point in their career,
02:21:02 their own stress and burnout, et cetera.
02:21:05 But it’s someone asking you for help
02:21:06 and so you do what you can to help them.
02:21:11 You’ve done quite a lot of things in your life.
02:21:15 It’s been an interesting journey.
02:21:18 Of course, there’s a lot of story yet to be written.
02:21:21 But what advice would you give to young people today?
02:21:24 In high school, maybe undergrad, college,
02:21:28 starting out on that journey.
02:21:30 Maybe trying to pick majors, trying to pick jobs,
02:21:34 careers, dreams and goals they can pursue.
02:21:38 What advice would you give them to have a career
02:21:40 they can be proud of or to even have a life
02:21:43 they can be proud of?
02:21:45 Well, I think having passion,
02:21:48 which isn’t always a voluntary thing.
02:21:50 You just have it or you don’t perhaps.
02:21:52 But becoming passionate about something
02:21:54 and following it wherever it takes you,
02:21:57 I think is really important.
02:21:59 You know, when I finished college
02:22:01 and sort of went to Russia for the first time,
02:22:03 that was in some ways the beginning of my whole career
02:22:06 and passions in my life.
02:22:09 And I didn’t know what I was going for,
02:22:11 what was gonna happen,
02:22:12 what kind of career it would turn into,
02:22:14 what kind of job would it help me get when I got back.
02:22:16 I wasn’t thinking about any of that.
02:22:17 I mean, I’m very fortunate I got that opportunity.
02:22:20 I’m very fortunate to be able to go and see those places
02:22:24 and have my mind opened.
02:22:25 And I think that really just the fuel from that passion
02:22:29 that was created during that time
02:22:30 is still 20 years later going strong.
02:22:33 I’m partial to healthcare.
02:22:35 I love being a doctor.
02:22:36 I think it’s the perfect combination
02:22:39 of kind of intellectual problem solving,
02:22:41 being a detective while also working with your hands.
02:22:44 You know, when you do procedures,
02:22:46 especially in the ER, it’s sort of the perfect combination.
02:22:49 I’m not a surgeon, but I do use my hands quite a bit
02:22:54 for a variety of reasons.
02:22:55 And so I always loved working with my hands.
02:22:57 I loved crafts, especially prehistoric crafts
02:23:01 before medical school.
02:23:03 And I just love kind of problem solving,
02:23:06 getting clues, figuring out what’s going on,
02:23:08 following your nose, using your instincts, your knowledge,
02:23:12 and also just keen observation of the patient.
02:23:15 After seeing patient after patient, hundreds of patients,
02:23:17 maybe thousands over years, you do get this sort of
02:23:20 innate kind of sense, this gestalt
02:23:22 about what might be going on.
02:23:24 And, you know, it’s not always a numbers thing.
02:23:26 That’s the thing.
02:23:26 There’s always, gestalt is actually a big part of medicine.
02:23:30 You know, you often in ERs or in hospitals,
02:23:33 hear a nurse or a doctor say something like,
02:23:35 this patient just doesn’t look good.
02:23:37 And it’s sort of, you can’t point to a number, a value,
02:23:40 a level in their blood, you know, a test,
02:23:43 but something about them.
02:23:45 And a lot of that I think has to do
02:23:47 with the color of their skin, believe it or not,
02:23:49 which can change in certain disease states.
02:23:52 But I think that it’s just,
02:23:56 medicine combines this observation, the skills,
02:23:59 the knowledge, it’s art and science, it’s human,
02:24:02 and it’s robotic, you know, algorithmic at the same time.
02:24:06 And I think it just, yeah, combines kind of
02:24:10 all my passions all in one.
02:24:11 And I would, you know, if anyone’s going into healthcare,
02:24:14 I’d strongly encourage them to do so, but I’m very biased.
02:24:16 So with that early passion, whatever that little flame was
02:24:19 that brought you to Russia, were you able to vocalize it
02:24:24 or was it just something like a gut
02:24:27 that’s pulled you towards some exploration
02:24:30 of the unknown or something like this?
02:24:33 I think it was a combination of things.
02:24:34 One was just going to a different place
02:24:36 that was different from where I grew up, you know.
02:24:39 The suburbs, you know, when you’re in high school,
02:24:42 you hate them, later on they don’t seem so bad.
02:24:44 But, you know, I just wanted to get,
02:24:45 I mean, I’m very fortunate how I was raised
02:24:48 and never wanted for anything that wasn’t rich,
02:24:51 but just to get out and see a different place,
02:24:54 a different people with a different culture
02:24:56 and history and language and literature
02:24:58 and to see different climates and geographies
02:25:00 and ecosystems, I just wanted to see something different.
02:25:03 And that, I guess that’s what I’ve sought after ever since.
02:25:07 So just that was just so fascinating.
02:25:09 Like my trip to Kamchatka in 2003,
02:25:12 where I was there for four months
02:25:14 and I didn’t speak English for, I think,
02:25:16 two months out of it.
02:25:17 And just, I remember lying on the floor,
02:25:20 some wooden floor in a hunter’s cabin
02:25:22 in the middle of Northern Kamchatka,
02:25:23 just being like, what am I doing here?
02:25:26 This is, I’m just so grateful for like the experiences
02:25:28 I was having, what I was seeing and realizing and learning.
02:25:32 It was just, I was so grateful,
02:25:33 even though I was lying on this hard, uncomfortable floor,
02:25:35 it’s just like, this is so amazing.
02:25:37 And that, I don’t think I’ll ever have another travel
02:25:40 as meaningful and life changing
02:25:41 as that particular trip to Kamchatka was.
02:25:46 Though I’m still striving after it.
02:25:47 You never replicate that first high, but you always try.
02:25:51 So I just think that seeing something different
02:25:54 is kind of the game.
02:25:56 And there wasn’t really a plan.
02:25:57 Cause I got a chance to talk to the CEO of Qualcomm recently
02:26:02 and his advice is, always have a plan.
02:26:07 And it sounds like you’re saying don’t have a plan.
02:26:13 Don’t need to have a plan.
02:26:16 Just listen to your gut, your passion and follow that
02:26:19 and see where that takes you.
02:26:21 Cause it’s telling you something.
02:26:23 Yeah, I think, I guess the plan could be specific
02:26:26 or it could be as general as I just wanna go far away
02:26:29 and see something very different, that’s my plan.
02:26:32 And I did just one line.
02:26:33 Yeah, just followed my nose from one thing to the next,
02:26:36 just being interested, following my passion.
02:26:38 And again, very fortunate I could do that.
02:26:41 Are there places in the world you’re kind of thinking
02:26:45 about that your life might take you at some point
02:26:52 to be a doctor there for a time,
02:26:55 to explore for a time that you haven’t yet?
02:26:58 I have some colleagues who do kind of global health work
02:27:01 in various countries in Africa and Central and South America.
02:27:05 I would really love to go to some of those places,
02:27:09 not just for a short trip,
02:27:11 but hopefully for an extended period of time
02:27:14 with sort of the healthcare being the ticket in,
02:27:17 but then maybe even bringing my children or just,
02:27:20 I guess at this point, some of the travel I dream about
02:27:23 is sort of replicating what I did
02:27:25 and showing it to my kids in a way.
02:27:27 But there’s still a lot I haven’t seen
02:27:29 and would love to see as well.
02:27:30 But I think those opportunities sort of lend themselves well
02:27:35 as a doctor with kind of the ability to go there
02:27:37 and sort of help patients,
02:27:39 but also teach medical students and residents.
02:27:42 Teaching is actually a huge part of being a doctor
02:27:45 that’s underappreciated,
02:27:47 but that’s actually part of the fun of being a doctor
02:27:48 is that you’re also a teacher.
02:27:50 Of course, the word doctor means teacher,
02:27:52 but it’s come to mean something else.
02:27:55 But in some of my jobs,
02:27:57 I’m working alongside medical students and residents
02:28:00 and I’m giving them my knowledge, my wisdom,
02:28:03 sharing with them stories.
02:28:04 And so that’s a very satisfying part of the job.
02:28:08 If we could take a brief step
02:28:10 into a dark place together for a time,
02:28:15 is there, what is a dark place you’ve gone in your mind
02:28:21 in your life?
02:28:22 What would be the darkest place you ever gone
02:28:26 for a time, for a moment?
02:28:32 And how did you survive?
02:28:34 How did you overcome it?
02:28:36 That’s a very good question.
02:28:39 I would say I haven’t had as dark moments
02:28:45 as many of the people who I care for in the emergency room.
02:28:49 I’m fortunate in that way.
02:28:51 I’ve had a pretty enjoyable, satisfying life.
02:28:56 I think everybody has dark moments though, including me.
02:29:00 One of the most shocking things I feel like
02:29:03 becoming an adult, my two big realizations have been,
02:29:07 one, no one knows what they’re doing.
02:29:08 And two, suicide is incredibly common,
02:29:12 like in all humans and all societies.
02:29:14 That I just find shocking.
02:29:16 I mean, I’ve never seriously contemplated myself,
02:29:18 but I wouldn’t say it hasn’t crossed my mind
02:29:20 during some more stressful times of life.
02:29:24 I think it crosses everyone’s mind.
02:29:27 And sort of as a kid, I found that I never would have guessed
02:29:31 how common suicide is.
02:29:32 It’s an important question to sort of the Camus question,
02:29:37 like why live?
02:29:40 Why?
02:29:41 Why?
02:29:42 Because like life, especially when you’re struggling,
02:29:46 especially when life is shit,
02:29:48 like why am I doing any of this?
02:29:51 And then on top of that, chemistry of your brain,
02:29:55 it could be as simple as diet and nutrition
02:29:58 and aforementioned exercise and things like this
02:30:02 that affect the chemistry such that you’re more predisposed
02:30:05 to go to the places of asking the question why,
02:30:09 and maybe struggling to find a good answer.
02:30:14 Because it’s actually a question with no good answer,
02:30:17 except something in your chemistry says,
02:30:21 well, I kind of like it.
02:30:23 But there’s no good intellectual answer.
02:30:26 And especially if day to day, it’s pain.
02:30:29 You get to see these stories of Robin Williams,
02:30:34 these people that are on top of the world
02:30:36 from an external perspective,
02:30:38 but from an internal perspective, it’s struggle.
02:30:42 Every day is pain, feels hopeless,
02:30:46 and yeah, that’s a question we all have to struggle with
02:30:51 or learn how to ignore.
02:30:53 Maybe because if you ask the question too much,
02:30:55 you’re not going to find a good answer.
02:30:59 That’s a choice you make.
02:31:00 I personally think you should ask that question a lot.
02:31:05 But maybe because I have the luxury of the chemistry I have
02:31:08 where I’m not in danger of seriously contemplating suicide.
02:31:13 But why live is an important question to answer constantly
02:31:18 and struggle to answer that constantly.
02:31:21 But people, I’ve been extremely fortunate
02:31:25 to meet people over the past couple of years
02:31:29 that are really struggling.
02:31:31 And you have probably met people
02:31:39 who are really struggling, like orders of magnitude
02:31:42 more people who are really struggling.
02:31:45 Some of it is psychological, a lot of it is biological.
02:31:49 And man, life is a motherfucker.
02:31:53 It’s pretty tough.
02:31:54 Very true.
02:31:55 I do think also past trauma plays a big role there
02:31:59 like we talked about, war wounds and PTSD.
02:32:03 A lot of people grew up with just horrific childhoods.
02:32:06 They were abused in one way or another.
02:32:09 And I think a lot of people who have not,
02:32:12 I’m not saying a majority, but a lot of people,
02:32:14 for instance, who I see in the ER coming in
02:32:17 for threatening suicide or actually trying and failing
02:32:20 and being brought to the ER,
02:32:22 a lot of them just have really traumatic experiences,
02:32:26 saw their parent commit suicide, were abused.
02:32:30 These leave scars in the human brain and mind.
02:32:32 And a lot of their subsequent lives
02:32:35 of whether it’s substance abuse, alcoholism, et cetera,
02:32:38 is almost trying to escape from their own memories.
02:32:40 And it’s sort of such this overwhelming battle sometimes.
02:32:45 Like sometimes people get ruined, it seems,
02:32:48 and just can’t be fixed, you know what I mean?
02:32:51 Yes, you can improve diet and health and your life choices
02:32:54 and seek out your passion and exercise.
02:32:57 And those definitely will help.
02:32:59 But sometimes just like, you know,
02:33:00 you bear the scars of the past
02:33:02 and there’s no getting rid of them.
02:33:04 Yeah, I think it’s possible to live with them.
02:33:08 I think so too. To the struggle.
02:33:10 I would never say give up, you know.
02:33:12 Keep fighting.
02:33:13 It is a constant, it can be a constant battle
02:33:15 for some people.
02:33:16 I know it can be, and I’ve talked to many of those folks,
02:33:20 I know it can feel hopeless, but keep up the good fight.
02:33:24 Hopelessness. Keep up the good fight.
02:33:26 Hopelessness is kind of one of the big suicide risk factors
02:33:29 that you sort of ask about as a doctor, you know,
02:33:32 do you feel hopeless? And that sort of can be a harbinger.
02:33:37 I have quite a few dark moments.
02:33:39 So if you’re listening and you’re struggling,
02:33:44 we’re in this together, brother and sister,
02:33:47 keep up the good fight.
02:33:51 Life is a motherfucker, as you said.
02:33:52 It’s really harder.
02:33:55 I think as a kid, you know, in a joy free childhood,
02:33:57 you don’t realize, like, obviously there’s a ton
02:34:00 you don’t realize about life,
02:34:02 but then when you get to be an adult,
02:34:03 you realize just how complex and hard it is.
02:34:07 Is it this hard for adult animals?
02:34:08 I don’t know. I don’t think it is.
02:34:13 So I haven’t seen the honesty of biology before you.
02:34:18 Do you think about your own death?
02:34:22 Do you contemplate death?
02:34:25 Are you afraid of your own death?
02:34:26 How do you make sense of it?
02:34:29 I’ve definitely thought about it,
02:34:31 especially maybe while doing certain risky things,
02:34:35 ice climbing and others where every time I looked down,
02:34:37 I thought about my own death.
02:34:39 But I think, you know,
02:34:41 I think having kids changes the equation for sure,
02:34:46 should change the equation perhaps.
02:34:48 So I think a lot of,
02:34:50 now when I think about what will happen when I die,
02:34:53 you know, there’s a lot of worrying about
02:34:56 what will happen to the people I care for.
02:34:58 You know, you think about things like insurance policy,
02:35:00 life insurance and, you know, disability insurance,
02:35:04 that’s not related to death, but more just injuries.
02:35:07 And that’s part of the weight, I guess,
02:35:09 that you feel as an adult,
02:35:13 that I think grows rapidly when you have kids.
02:35:16 Though not only, you know,
02:35:17 there’s other people you can care for,
02:35:19 your own parents and loved ones.
02:35:20 Like a lot of people depend on individuals.
02:35:23 And so you think about what will happen
02:35:25 to the other people when you die.
02:35:27 But also, to push back, that weight
02:35:31 might be something you’ve convinced yourself to think about.
02:35:35 It’s an important weight to think about.
02:35:37 But you focus on that weight to escape the other weight,
02:35:43 which is, at one point,
02:35:48 this consciousness just comes to an end.
02:35:51 And it’s hard to make sense of that.
02:35:54 We kind of delude ourselves in thinking,
02:35:56 okay, it just, yeah, it ends.
02:35:58 That’s the natural way of things and so on.
02:35:59 That makes sense, so we’re good.
02:36:01 Okay, that’s the way of life.
02:36:03 But I don’t think it’s cognitively easy
02:36:07 to just realize how terrifying that is.
02:36:12 We love life so much that the end of it,
02:36:18 it just, it’s something that makes no sense.
02:36:24 And if you linger on that thought,
02:36:26 I think it’s a painful, I would say even terrifying thought.
02:36:31 Not scared of like, in a way that’s
02:36:34 almost like philosophically terrifying.
02:36:36 Like, it just reminds you, maybe humbles you
02:36:39 that you don’t know anything about anything.
02:36:44 But one of the things we do as humans really well
02:36:47 is we, especially with kids, you realize,
02:36:50 okay, we start caring for others in the community,
02:36:53 in the family, and so on, and that distracts us.
02:36:56 So then we can at least focus on other people’s problems
02:36:58 and not deal with our own.
02:37:02 When I was a medical student, I was particularly
02:37:05 fascinated with kind of what actually happens
02:37:07 as people die, like in the last minute, seconds of life.
02:37:10 It’s sort of surprising sometimes,
02:37:12 like what actually kills people.
02:37:13 You know, like you can get, let’s say, a bad head injury
02:37:17 and you know, what kills you.
02:37:18 Sometimes it’s just your consciousness decreases
02:37:22 and you become kind of comatose, you aspirate,
02:37:26 your oxygen plummets, and you get cardiac arrest.
02:37:28 You know, that kind of sequence of events.
02:37:31 Or, you know, a heroin overdose,
02:37:34 let’s say you stop breathing.
02:37:36 Similarly, your oxygen goes down,
02:37:37 then you get a cardiac arrest.
02:37:38 So I was really fascinated with what actually happens,
02:37:41 what makes people die.
02:37:43 And it was sort of a morbid fascination, obviously,
02:37:45 like most of med school is.
02:37:47 And I had many instances where I’ve had patients pass
02:37:52 and as a medical student, I was sort of learning
02:37:55 what’s actually happening, watching it happen
02:37:57 and not always being able to prevent it.
02:37:59 It was sort of a scientific exploration.
02:38:03 Then the patient’s family comes in and are just devastated.
02:38:06 And then it’s like, rips you out
02:38:08 of this scientific perspective
02:38:10 and you just realize how horrible death is,
02:38:12 but the person’s fine.
02:38:14 You know, it’s the family, I guess.
02:38:15 And that’s why it’s always, I guess that pointed out
02:38:18 just how what people leave behind
02:38:20 is often kind of the horribleness of death.
02:38:22 Like just becoming unconscious and staying that way
02:38:25 doesn’t seem, I guess to me personally, so bad.
02:38:28 Sort of like going to sleep, not waking up,
02:38:30 not counting the pain and stuff that precedes it.
02:38:33 So the actual pain, the actual suffering
02:38:35 is often felt by the people who love the person who died.
02:38:39 So both financial pain, psychological pain,
02:38:43 for years missing them, all those kinds of things.
02:38:46 Right, never forgetting the anniversary of their death.
02:38:50 You know, just having flashbacks or something reminding you.
02:38:54 That sort of brought home to me sort of what death means.
02:38:57 And it was more about what people leave behind
02:39:00 than what happens to them specifically.
02:39:01 See, I like those concerns
02:39:04 because I feel like I can do a lot about those.
02:39:07 Those make sense to me.
02:39:09 Then just be, if you’re a father, just be a good father.
02:39:12 If you’re sort of, you mentioned sort of insurance.
02:39:15 Yeah, there’s like financial stuff to take care of.
02:39:18 What I don’t know what to do with
02:39:19 is the philosophical existential crisis
02:39:26 of the fact that this fricking thing ends.
02:39:28 It doesn’t, I don’t know how to deal
02:39:32 with the mystery that’s beyond death.
02:39:35 Why are we here?
02:39:36 Why are we born at all?
02:39:38 What is consciousness?
02:39:39 And you just look at yourself.
02:39:41 What is this?
02:39:42 Why do I have the capacity to suffer?
02:39:45 Why, why, all these kinds of why questions
02:39:47 that don’t have answers.
02:39:49 Speaking of which, let me ask you a why question.
02:39:52 The biggest ridiculous one.
02:39:54 What do you think is the meaning of life?
02:39:58 Having, with this book, studied the incredible,
02:40:01 beautiful biology of life, the components,
02:40:06 the engineering components that make up this human body.
02:40:09 But when you look at the entirety of it,
02:40:13 what is why?
02:40:15 Why are we here?
02:40:16 Sometimes, probably more often than not,
02:40:17 feel like the question of why is a trick
02:40:20 of the human brain.
02:40:21 And outside of our thoughts, there is no why.
02:40:25 Why is not something that’s in the universe.
02:40:28 It’s just this trick happening inside our brain.
02:40:31 So why is a game that the human brain plays on itself?
02:40:36 And then the reality of life doesn’t have why’s.
02:40:40 I do wonder if asking why
02:40:42 is sort of an evolutionary adaptation.
02:40:44 Like why, you know, maybe hunting, gathering.
02:40:48 Why does this plant grow there and not there?
02:40:51 Why do I see the same deer tracks
02:40:53 and by the same tree every three days?
02:40:55 Why, you know, why is this, why is that?
02:40:59 Why does this plant make me vomit and that plant doesn’t?
02:41:03 I guess those why’s are very practical
02:41:06 and oriented towards survival.
02:41:08 But then obviously, you know, we not only use why,
02:41:11 you know, we use it to maybe hunt better,
02:41:13 gather better, survive better,
02:41:15 but then we sort of extrapolate it
02:41:16 into these unanswerable questions, you know,
02:41:21 about why, like why does life exist?
02:41:23 And it’s possible that they’re not unanswerable
02:41:26 in the long arc of science and history.
02:41:30 It’s we’re just striving for the really difficult questions.
02:41:33 Right now, we just don’t know much about anything
02:41:36 and so we’re striving.
02:41:37 But there’s a long, so most of human history,
02:41:41 you were asking why questions
02:41:43 for which we now have very precise answers,
02:41:47 including with biology and physics
02:41:48 and all those kinds of things.
02:41:50 And maybe the why’s, this cutting edge of science,
02:41:54 of the explorer of the curiosity of the human mind.
02:41:57 Like man’s search for meaning
02:42:00 is the sort of the ultimate driver of the why.
02:42:04 And it’s almost like it could be an evolutionary adaptation
02:42:07 of asking exceptionally hard why questions
02:42:11 that will never get answered.
02:42:15 Like, so you should always have,
02:42:17 like it’s like a queue, it’s a stack of questions,
02:42:20 why questions, and that thing should never come
02:42:23 to the bottom, should always be striving.
02:42:26 And that’s useful for humans to come up
02:42:28 with better and better ways of survival.
02:42:30 And maybe from in a bigger perspective
02:42:34 for the universe to figure out something about itself.
02:42:37 And it’s just humans, just a useful tool for that.
02:42:40 Or life on Earth is a useful tool for that.
02:42:42 Well, John, this, you’re,
02:42:47 for people who should know, you’re from Philadelphia.
02:42:50 I’m from Philadelphia, so it’s an honor
02:42:52 that you would travel all this way
02:42:54 from a place I love to the new place I love
02:42:57 and that you’ll write this really incredible book
02:43:00 that celebrates the human body in the most honest of ways.
02:43:04 And thank you for everything you do,
02:43:05 for being a great educator, for being a great doctor,
02:43:08 for being a great person, and for spending
02:43:10 your really valuable time with me today.
02:43:11 Thank you, John.
02:43:12 Thanks for having me, Lex.
02:43:14 Thanks for listening to this conversation
02:43:16 with Jonathan Reisman.
02:43:17 To support this podcast, please check out our sponsors
02:43:20 in the description.
02:43:21 And now, let me leave you with some words from Paul Farmer,
02:43:24 a doctor who has inspired both Jonathan and me
02:43:27 with the way he practiced medicine
02:43:29 and the way he lived his life.
02:43:32 The idea that some lives matter less
02:43:35 is the root of all that is wrong with the world.
02:43:38 Thank you for listening, and hope to see you next time.