Civilization Is About To Change Forever: Truth About Immortality, Rich Vs Poor, AI & Ending Disease

many people believe that humans are born to die and that even if we could extend human life we shouldn't I hate that idea and believe that thanks to AI we are on the brink of a biotech Revolution that will radically extend human life to help us explore this Frontier I bring you today's guest a scientist and entrepreneur who believes that at a minimum AI is going to dramatically alter Health span and that will have thrilling consequences as long as we don't mess it up that in mind I bring you Dr Mamud Khan given the fact that most men lead lives of quiet desperation why should anybody care about extending their life well let's uh let's think about it from a society point of view and an individual point of view okay from a society perspective if we can keep the majority of people functional and health and I'm going to distinguish between what we think about as healthy versus independently function fun active contributors to society and their family and their loved ones if we can do that Society should care the GDP impact is calculated by Andrew Scott a professor at London Business School and Oxford University in England and others whove verified this data have shown that the impact in the US in terms of GDP is around1 to4 trillion dollar of GDP impact just for a 12-month extension of healthy life not maximum life they just keeping us healthy so Society absolutely should care Medicare UK NHS any of these organizations cannot currently afford the health care costs of just providing Health Care to people as they age it's not possible today we haven't figured out the solution well the Sol the alternative is just keep people healthy they have not only less need for chronic care but they continue to contribute now at an individual level most people I talk to and there been lots of surveys done people want to remain independent active and health not defined by a 20-year-old if you ask somebody 20 what is healthy and you ask somebody who's 40 or 60 what they mean by healthy most 60-year-olds will say hey can I continue to be active can I have the mental capacity and physical capacity to be independent and can I contribute professionally or personally in a meaningful way that's one aspect of what is being quote a healthy lifestyle right most people care that's what they want people don't want to live longer if you ask them the question do you want to live as long as possible and in their mind that's 30 years spent in a nursing home nobody that I know wants that very important distinction no doubt now I look at the moment that we're in right now as an incredibly disruptive moment there certainly as somebody that lives in the US you can feel the tension rationing up you can feel the sense of divide and when you look at what things exacerbate that anything that is going to negatively impact the economy is just going to put you in a really precarious position when we look at what's going on in terms of government spending and the the pyramid that's about to flip upside down where we go from most people are young to most people are old and there are fewer young people that take care of them when I look at the problem currently of an aging population where health is not taken into consideration and it's just lifespan and now we're spending just gobs of money on supporting people from a health care perspective um are we doomed if we don't Rectify this situation and get those health care costs under control well I wouldn't use the word doomed however I would ask ourselves what are the options we have those are challeng alling if we do you know no action is a decision and if we don't take any action in business as usual we've seen what's happened the last 20 30 years exactly as you point there are economic challenges now there's labor shortages on top of that and developed countries where the birth rate has dramatically Fallen the life expectancy over the last 60 7 years has been extended by at least 30 years let's say 20 years of that is requiring significant resources from a healthare system given that burden societies are asking ourselves what can we do and you know it is itself divisive because if you're a young person in a payforward society and developed countries are a payforward society by the way so are developing country just it's not structured and so in a in a payforward society I'm a young person working today I'm supposed to be paying taxes so I can take care of the last Generation Well if there's a few of those as you point out in that pyramid that that's okay that's part of being but all of a sudden if you're in China and you're one grandchild with four grandparents how am I supposed to contribute to that economic model let alone personally having to take care of that's divisive right how am I supposed to do that so what are the Alternatives it's going to have to be Innovation Innovation across the Spectrum which means everything from policies of how we think about our taking care of society down to technological breakthroughs and I don't mean just biology the whole spectrum of technology to allow leverage of the fewer and fewer young people we have as well as the ability to use fewer people to generate more and more activity both financially but also Services right that's true leverage and industrialization over the last 100 years has allowed humans to create huge leverage in every aspect of Our Lives what we have to ask ourselves now is what is that next scurve of that leverage right how can technology help us what are the policies that will enable that what's the financial policies that will do that what are societal Norms how do we how do we enable all of this and there there's multiple aspects of this uh not just biology and which means something that you do for a living we need to start talking to people in the terms that they understand and one of the biggest gaps and I've been in science 40 years is scientists can't be on their own telling this story scientists are not good at telling the story and what we learned in covid is what was being said as an expert was not what was being heard in some cases it divided us so I would say part of the challenge that we have to overcome is we got to figure out how to get people on the same page to understand what the challenge is but importantly also based on clear evidence point out the opportunity and the opportunity is huge everybody benefits one other thing about divisive what we have to think about is the Hales and the Have Nots not just within a society but across the world every human being is aging but imagine a world where you have technological breakthrough which allows a population and individuals to remain healthy longer more productive more able to contribute to their society all but if the only civilians and society that can do that are rich countries then that economic divide between the rich and the poor countries will continue to widen if that happens we're going to have increase this challenge of Haves and Have Nots so it's very important that we ask ourselves another question on the assumption that we can have technological progress and I'm pretty confident that will happen how do we democratize it how do we make sure that the masses are impacted in a way that whether you are less well off within the United States or are financially more capable you have access to this the only way to do that is democratization of Technology we used to think that some ubiquitous dream but cell phones told us and showed us that very expensive technology can become ubiquitous it it re it requ IR ired not just technological breakthrough but Innovation and business models and it was Innovation and business models that democratized cell phone technology the poor Rickshaw driver in a Asian country has a cell phone we would not have imagined that possible even 20 years ago so you talk about the opportunity being massive what is the opportunity exactly just extending the healthy life expectancy so let let's take a look at we Define retirement age let's say 60 or 65 you know this was defined as I'm sure you know after around World War II by European countries and the number was picked because most people didn't live past 60 so it a great model right well I'm going to give I'm going to guarantee you a government pension if you last live past 60 well if 90% of the population didn't do that I didn't have to take on responsibility so guess what 70 years later our definition of retirement age in most countries is till 60 or 65 we're assuming that after that age you're no longer contributing in a meaningful way and you become a net recipient well the first thing that that raises is as soon as you turn 65 are you are you now no longer contributing I would say people are churches Charities if you look at informal contribution to the GDP in the United States in Europe and the UK and many Asian countries older people continue to serve next Generations in countries with more formal employment why should there be in particular when knowledge workers are actually in high demand because there's fewer of them so these are the sort of links that we have to think about and say what is it we're extending right we're extending Health throughout your life allowing you to contribute through all stages of your life then it comes down to choices I'm not saying everybody should be working till they're 80 because they don't have a choice but we can choose to contribute and everybody has a chance to contribute in different ways whether it's taking care of your grandparents sorry grandchildren taking providing support to your local church your local charity volunteering at the local hospital or continuing to work as an executive new careers you and I have had more than one career why should it be one career or two careers or three careers why can't it be four careers now is society set up for that are we as Employer set up for that I'm going to be provocative what's the mission of an educational institute if it only serves you in your life until you're 22 is that the only mission of an educational institute maybe we have to ask us University presidents that their role in a society is far more than taking teenagers and giving them college degrees give me an example what would you want them to do why couldn't an engineer who was trained in the 70s and 80s be now retrained as a data scientist and an AI because they won't want to be hearing so this is my my big concern and I'm going to I'm going to pull a dark cloud over us for a second I by Nature I am optimistic but reality is constantly trying to convince me that I should be way more pessimistic and you said societal norms and I think that may be the thing that we most have to think about and when when I think about okay people have been raised thinking that they're going to get to retire at 65 that they can then put their hand out they have an expectation that somebody's going to look after them that like you said works when you've got a ton of people under you and most people have died by then you're one of the lucky few that's alive it does not work when you're super topheavy and that is a position that we're running towards and I feel like everybody has a sort of generic sense of either AI is going to save us robots are going to save us uh magically we I mean coming from a US perspective we'll be able to print our way out of it and just give print money uh and be able to give money away and everything's going to be great and the reality is I think that people are going to have to fundamentally shift their perspective but historically especially when debt gets involved the only time that people shift their perspective is when there is literal Bloodshed and so I find that deeply distressing and so when I think about how do we how do we migrate people to the real opportunity where so I am very hopeful that not only can we extend healthspan but we can extend lifespan I don't want to I don't want to believe uh that we're stuck at 120 I know we don't have evidence yet so I won't I won't back you into the corner of of uh telling me that it is possible but all of that is such a radical transformation that even if we just isolate it to the pyramid is going to flip we are demographics they're set there's no way to suddenly have a lot more young people you can have a lot more infants but you can't have a lot more 20-year-olds it takes 20 years to get there so we the pyramid is going to flip and now the question is how do we flip that pyramid well and I think if we don't change Cal norms and expect people to live and work longer and contribute more meaningfully to basically their own caretaking their own healthare uh contributing to GDP all of that if if we don't figure out a way to psychologically get people on board with that we are going to have a real a a catastrophe that I have not mapped out yet to figure out exactly what that catastrophe looks like because you have very angry old people in fact now that I say this out loud the the problem you will run into is they will continue to wield political force and now you will get you were referring earlier to what's known as the jinny coefficient for people that have never heard that word before where you get a massive divide between rich and poor I'm going to guess though I've not heard of it that there's an equal psychological principle that is political power and if you have the old generation wielding all the political power you will get an uprising of young people who just won't tolerate it help me see a way out of this so most of what you said were in full alignment and agreement it's interesting because everything you just described is not to solve a technical problem or a scientific ific problem but actually a societal norm and therefore leading to if possible policy reform but you won't get policy reform until you get the political clout to want to do it to reemphasize what one of the things you said in terms of the challenges one of the things that I read and I'm sure you saw this during covid people were starting to actually write in Publications and I remember a letter published in London Times actually stating why don't we let all people die from covid instead of shutting up society that was in the London times so the fact that it got published is not their opinion right in a free press you but it tells you if somebody's willing to write a letter in a highly visible publication how many people were thinking that okay so though that's starting to be seen if that letter is some evidence for that people were questioning in more than one country quote we're being shut down just to keep all people alive right that was Co what is 80% of deaths occurred in all people and so we've already witnessed that now the question is what are the learnings and and I'm a little bit more optimistic simply because when we look at rapid technological change and embracing technology in the past Industrial Revolution every body was scared all these manual workers are not going to have any jobs guess what happened gdps grew new professions got created then we saw that when we started to see agriculture start to get industrialized agriculture was the primary employer and guess what United States Europe it's it's a minority employer now so we've seen this when uh we first started to see computers come word processing printing the internet yeah lots of jobs got displaced the newspaper industry is is a relatively minor media industry today go back to the days of you know the the Heyday of newspapers it's very different media has become what you do very powerful reaches far more people so we've seen this and once people start to experience the positives they start to embrace the question really is how much of it was forced and how much of it was it people saw the opportunity yeah if You' asked travel agents 20 some years ago what do you think of the internet you'd have got a different answer than the traveler so I always think how do I get the the consumer to actually understand the opportunity and embrace it and then bring them along that needs to be said then science provides a solution not the other way around if we lead with the scientific argument we're going to end up in a very scary place cuz it's misunder understood so I'm a little bit more optimistic because I've seen there were times I'm let me give you an example there was a time if you go back post World War II people used to hide a diagnosis of cancer there it was a taboo so if you got diagnosed with cancer you didn't tell anybody why because cancer was a lethal diagnosis if you got told cancer it's done it's over it took a pioneering woman who took on the cause of breast cancer and said I am going to create public awareness that cancer can be conquered and the world doesn't have to be this hiding taboo guess what the National Institute of Health was created as the National Cancer Institute it took a whole movement and over the next 40 years we found the mechanisms of cancer and in many cases today Cancer is treatable and curable so what what's the analogy that getting old is um not the terrible thing that we once thought it was that you can be thriving and a strong contributor as we get older most people's mindsets the consumer you ask tell me what it means to get old and the first thing they think about is the visible part of people that might think it's onset of dementia pain immobility rigid they won't use those words um but all the negatives that are associated with the decline in function of our bodies and Minds as we get older that's the image so if you ask people you know that is the inevitable outcome that's that's what they see and yet it is clearly evident that loss of function at the pace that we've seen is not ubiquitous and certainly not not to be assumed is going to happen to everybody in fact in the majority of cases it is likely something that can be slowed down if not halted now how do you bridge that current understanding with the technical reality what's possible and one of the reasons I avoid about saying we're going to live longer although I'm I'm not actually questioning whether we can live past 120 or not I'm a pragmatic person let's show that we can keep people healthy as long as possible first and if one of the benefits of that is that people live longer so be it but the primary goal right now in my mind as a personal opinion is keeping functionality and healthiness for as long as possible for as many people as possible I always add that this is not for the benefit of a few wealthy people this should be for everybody if we don't do that we're going to have a true societal challenge you can reboot your life your health even your career anything you want all you need is discipline I can teach you the tactics that I learned while growing a billion doll business that will allow you to see your goals through whether you want better health stronger relationships a more successful career any of that is possible with the mindset and business programs and impact Theory University join the thousands of students who have already accomplished amazing things tap now for a free trial and get started today yeah it's very nice way of saying that we will have revolt on our hands uh it it does become a dystopian nightmare very fast if people one class of people are able to buy their way to immortality and feeling good and all of that and the other cannot but it's going to start there um as you look at this landscape as you lead people through this landscape I think that that's going to be one of the big challenges that you face how do you think about that right now in terms of um one what breakthroughs are real what what's happening right now and then how are we going to make sure that that is cheap enough that everybody will have access to it so first of all let's look at the fact that there are real differences which seem to be not just simply purely driven by biology so if you look at the differences in what life expectancy is a start if you look at the United Kingdom if you live in Glasgow versus if you live in London the life expectancy is at least 10 years shorter in glasow now are you saying that's class-based it's certainly zip Cod code based right we know that socioeconomic situation which is correlated with your postal code or zip code is an important driver of that how much of that is choices versus lifestyle versus the environment you live in all those are complex now without getting into the biology of all of those interactions it's clear that our human life expectancy and maintenance of health is Dri driven by some factors that appear outside our own control it's a function of where you were born and grow up on the assumption that if you're in Glasgow versus London or some parts of Chicago versus another part of sugar wherever you look there are clear disparities those disparities are helping us understand what are the mechanisms driving that we can keep populations healthy by understanding those differences that's one Public Health population level evidence another we've seen is populations living in certain parts of the world the so-called blue zones clearly have longer life expectancies what is the difference there what is it about growing up in some part of Italy or some part of Greece or some part of the north western part of Pakistan and India parts of Japan all over the world there are these blue zones what is different about those populations and it's easy to say well it's their lifestyle choices but there's clearly learnings in that so that's the human evidence now we look at animals we have observational evidence that different species live longer but more importantly starting with very simple single cell organisms which was first shown decades ago all the way through now to primates monkeys we've shown that interventions including uh therapeutic potential drugs not approved drugs potential drugs in some cases drugs that could be repurposed can change the life expectancy of otherwise randomized matched animal groups so that's reason to believe that this is possible now is it safe what's the optimal way of doing this with humans those remain to be determined the last piece and I'll give you an example of this it raises the question if biologic iCal loss of function has happened can that decline be slowed or reversed well if you think about the evidence from things like epigenetic reprogramming without getting into too much of the technical jargon essentially our DNA sequence our genetic code is the same today at my age in my 60s than the day I was born my genetic code hasn't changed the ability of my cells to read that code and replace themselves clearly has changed so the question really is is is there something wrong with my genetic code or is there something that is I'm losing the capability of Translating that genetic code there's more of it there than the genetic code because my DNA is the same and it's all already been shown by people like yamanaka who got the Nobel Prize for it that you take adult cells and you can actually change them back to genetically flury potential youthful cells so the code was always there now there are animal models that it's been shown in already in rodents mice and now even in apes and monkeys that you can take a dis diseased tissue in a living animal reprogram it cells such as in the retina and restore function and the most powerful evidence was on the cover page of nature from David Sinclair's Lab at Harvard where he took animals that lost vision from glaucoma an age related eye disease and restored their Vision by epigenetically reprogramming their retinal cells that's powerful it tells you what we used to think was permanent loss of vision actually to a degree now how much of it was restored we can't measure in an animal but we can show that it was an animal who couldn't see light now can see that gives us a lot of optimism technically to figure out what's the next step to go from we went from worms yeast to mice to monkeys the next step is how do we take that to humans in a safe manner we're that close what are the breakthroughs that you're most excited about in longevity you know it's a common question I get that since we're an investment team as well as a science funding team if I knew the answer to that it'll be a trillion doll answer I think there are several both Pathways and lines of evidence that excite my team myself my peers in other organizations we're actually approaching this say where is the highest chance of success in keeping a portfolio but I've been in science for 40 years and one thing I learned is you have to maintain the portfolio I'm of a school of thought that I don't think it'll be a single breakthrough some people think you know we're going to find the pathway that results in age related Decline and we're going to be able to treat it I think it's going to be different Pathways to different levels of emphasis and importance in different humans and what we're going to figure out is what they are and what combinations of those are most active in you versus most active in me and if I can personalize it to that level then I'm likely to address this and I think the simplistic view of I'm going to find the elixir of Youth as one molecule that we're going to put in the water supply and suddenly everybody's is so naive to and it underestimates the complexity of biology and the ability of biology to adapt we've had a billion years of evolution of life it has created all sorts of intricacies we have to recognize that aging is common to just about every living species originating from that one common cell a billion years ago and if it's that Primal then it's probably got multiple bations over the bill billion years of life's Evolution we need to understand this is where Ai and the modern Technologies where computational capability and biology are coming together are going to unlock some of that it will be more nuanced and personalized than that maybe in your case your eyes are aging faster than your heart in my case my heart might be aging faster than my liver in another person we all know people whose body has age but their mind is sharp we know other people whose brain is aged but their body is Young and so we know just from observation aging is not a single uniform effect it's a common term for probably a lot of very diverse processes which manifest in people in very diverse ways yeah I hope that gives you some context it does I'm going to paint a picture of the future and I want you to tell me where I go wrong so uh when I think about extending human life whether we're I I'm talking primarily about the combo of Health span and lifespan so this is only exciting for me anyway if we make 120 just you can count on that and the way that you can more or less count on getting to 65 I want to be able to count on getting to 120 and feeling like a million bucks okay so if I were in your shoes and I had to start making some bets the thing I'm going to be going from first principles and the thing I would want to bet on is what are going to be the things that can identify the patterns so my base assumption that everything rides on top of is that the human body is one to your point it's individualistic so you have to be looking at the level of the individual but there are going to be large patterns that you can pull out of the data so while every human is going to be different I will learn a lot more from population level um data sets on humans than I will from um mice right so AI is going to be able to parse through all that and instead of us taking these rough swags that blue zones and what is it that they have in common it's really going to look at okay I'm going to take let's say humans fall into 42 categories I'm going to break the humans into 42 categories these are the chunks that they break into these are the people that age brain first these are the people that age heart first whatever these are vascular diseases petera breaks these down into the Four Horsemen of death he says heart disease cancer neuro degenerative disease and type two diabetes all right type two diabetes is all lifestyle choices that that is a self-made problem uh but the I disagree on that but we'll come back really yes I'm very eager to hear about that uh the other three or four depending on your take um are almost certainly just predispositions for a weakness to aging so okay I'm making bets number one is going to be AI it's finding the different patterns number two is going to be how are we going to go about grouping those um things whether it's the four horsemen or something else and then how do we actually go about resolving those issues so so much of this is going to be about vasculature is my gut instinct uh and so how do we actually go in and address those one is going to be lifestyle so just uh whether it's a wearable device or whatever that tells me to eat this go to bed here there what whatever and you remove from me the need to think about it and to know it just tells me what to do and I do it um but we're also either going to have to find a way to make people care less about doing the things that we'll call bad behavior so take O zic A zic as a weight loss drug just makes you less hungry and so you don't have the sort of human compulsion to go eat that thing so now you're not doing a bad behavior that's going to cause you a problem or I have to create something that stops the bad behavior from being bad if that makes sense so those would be the areas that I would look for pattern recognition investing in AI um probably AI again in terms of getting down to the individual level and sort of wearable Technologies about what you should do when at the individual level and then the last stop on the train whether it's going to be drugs or other medical interventions actually going in at the cellular level and making the changes so those would be the the three three buckets that I would be thinking about where I'm looking for the Innovations what's the flaw in that thinking so let me add a fourth so there's I wouldn't say there's a flaw in the three I think they're all valid come back to the choices two diabetes yes we'll come back to that for sure there's a fourth and that is in the broadest and we we can get a little bit more specific in a minute but in the broadest sense our only real way we measure age today is based on your birth certificate I look at the day you were born and I tell you this is how old you are it has almost no um way of understanding even when I've aged that these two people are of a different age and we can all know 60y olds that look perceptively 80 and we know 60y olds who look 50 or 40 right so there's a clear difference some of those may be choices they've made over over their lives and uh but people have aged differently but we don't know how to measure in from one person to another how do you measure age okay let alone how do you measure it at an organ level okay and yes there are technologies that talk about methylation of DNA and this and the other but to measure age in an effective way you need to be able to measure three things one I got to be able to measure what your age is today however if I can measure your biological age today that doesn't help me other than I'm going to tell you something you probably already know which I feel older than I am or I feel younger than I am so it's a diagnostic with little other utility perhaps helping you intervene more in Lifestyles more aggressively with one person or another I don't know the second thing me that measurement has to be able to do is to be able to to predict for me the gradient and the rate at which you're aging now that's a much more powerful measure because if I could measure your rate of Aging when you were 30 I might be able to tell you you're on a much steeper slope than somebody else and therefore you should pay attention to this I don't have that technology today and the third characteristic should be able to do is it should be able to reverse if I make the Intervention which means I can demonstrate to you that because of the intervention whether it's lifestyle or it's a treatment or a device this is predicting you're going to live 10 years years longer that fourth variable does not exist today technologically until that happens we are not going to be able to design the clinical trials the therapeutic protocols the clinical protocols by the clinicians in the field to actually be able to do something about it I'm going to give you diabetes analogy when I was in I'm an endocrinologist I spent my professional career treating diabetes and researching diabetes if if you think about if you go back to the 70s when I entered Medical School hemoglobin A1c was not available finger stick blood sugars were not available to be able to do your own blood sugar and even those did not become useful until it was shown by the diabetes control and complication trial that A1C correlated with outcome of complications now I had something to say to my patient saying this is your A1C if you bring it down by 1% your risk of I complications goes down by X the equivalent of that is an exist in agent so it is going to be very critical for investment and funding to answer that question hasn't happened the NIH has not seen it as its mandate the UK medical research Council has not made it Priority to actually invest in developing the science to be looking at the so-called biomarkers of Aging with the three characteristics that I just showed you somebody's got to do that now industry you won't do it because you can't patent these things I don't want them patented why because if you patent them you will restrict their general adoption and if you restrict the general adoption you won't get a standard Benchmark by which to compare things so I just want to make sure there is a fourth pillar the very few people are talking about and yet it's the key enabler to the others the other three you just said are not going to happen until you get this done so that's one so should we be investing there absolutely my organization i' we've clearly said listen you got to go after this and make sure it's open source why you want the best signs to be adopted by industry by the regulator recognized remember and I'm sure you know the statins didn't take off until we had LDL cholesterol it was the fact that we could measure LDL cholesterol as a predictor of vascular risk and something that correlated with reversibility of that risk that you started to see a whole family of drugs what going to happen in agent got to do that that's number one the second is while these exist we are free living humans exactly to the point now how do they interact between them is it truly a biological intervention versus a sensor and a device and at what point does a biologic become a device and when does a device become a drug we are actually at the point with nanotechnology and all these other new technologies where is questioning even our scientific definition of these separations let alone our regulatory definition what if it's a combination of a device and a drug that's delivered in a certain Tim way should that go for regulatory approval in a as a device or a drug I can tell you there are challenges even our regulatory environment because we don't know where they fit we're trying to reverse fit things where bi ology doesn't naturally go there so it's more nuanced is my point in that and this is where we're having to now start to say where can we unravel some of this complexity and I totally agree with you big data Ai and large population sets will help us do that but at the same time I'm a firm believer in bringing the policy makers and Regulators to the table this meeting we're at today is very much including that because we need their guidance and their they're coming along on this journey to help us understand so we deliver to policy makers what they're going to be expecting and help them shape us and vice versa so that's where things will change all right so when I think about um blood sugar a continuous glucose monitor uh is whenever somebody asks me you know what should I do to radically change my health my answer is always if you let me put a CGM on you and you let me dictate what you eat simply by the readings that I get on your CGM I will change your life in in ways that they couldn't possibly imagine fat loss being the easiest but your joints hurting your sleep patterns all of it is going to be dramatically impacted by that um do you is there anything in the literature because I know you're going to hate the sort of vague question is there anything in the literature that indicates what aging actually is or are we literally blind at this point to the nature of Aging I think there's a lot of literature that tells us what the aging process is at a cell level very very strong literature around that a lot of to a lesser degree but still powerful literature that helps us understand the aging process at tissues and organs in various different organs to different degrees which start you know probably the least understand might be the brain but in other organs we're starting to understand that muscular scle bone you know is there anything that the different systems have in common there's a few for example sence the so-called accumulation of what the lay literature sometimes called Zombie cells cells that are are not functional but haven't died and got eliminated cence is a fairly common phenomenon that we're seeing tiir elongation is is a common phenomena and observation there's a lot of question marks whether it's something you can intervene on you know is it elongation isn't it the shortening of the tel but elongation sorry is an intervention y got it right and so those are common which of those are mechanistically a cause and are reversible right sence probably are some of the most powerful literature what causes inessence is it the breakdown of the methylation of the DNA itself well so what we know is what senescent cells are not doing is functioning normally what we know is that they're releasing molecules in their vicinity so-called um you know paracrine effect local effect of these molecules changing the function of normal cells recruiting and attracting inflammatory cells into those tissues so we know they do all of these things why some cells become essent and why some individuals accumulate more ccent cells than others that has not been fully understood on the other hand we have knowledge that certain molecules treatments drugs can reduce the ccent load of tissues we also know that reduction is associated with improved functionality so our knowledge has progressed all the way to understanding that mechanism in this Pathways for ex an example it is ready and there are clinical trials going on in humans today where drugs that actually reduce the sence load or reduce the impact of that syence actually are underway today so that's an example what what's the um mechanism that they're targeting are they just trying to kill this inessence cell or they actually making the inessence cell perform better three lines of interrogation or trials one is Target and eliminate the sinin cell just reduce the siness set load one of the challenges there is how do you identify very precisely a ccent cell from normal cells and eliminate them another is to reduce and buffer the impact of that sinin cell right either by reducing its function Etc the third is change the um decline of the normal tissues as a response to that so there's different Pathways that are being approached of course we have to remind ourselves that that sence exists at certain stages in our development for important functions too recovering from healings from a wound require some of those incent Pathways so completely blocking them and eliminating them to zero May well be quite detrimental so what is the sweet spot so we we know coming back to your question there are powerful mechanisms that we can intervene we're learning with Precision how to do that will that happen I'm pretty one of the things I would say I'm confident eventually we're going to figure this out we're at that stage right now it's a matter of time resource and Investments who will figure that out exactly of course if we knew that that's the only company I'd be investing in that we don't know we think about the mtor pathway right it's a commonly quoted pathway everybody's heard or many people have heard of you know why don't we just give metform to everybody and this is you know going to slow down is probably one of the most widely used drugs as you know for diabetes uh clinical trials in patients with diabetes has shown that survival is better in metformin treated patients near bersel and others have shown in multiple Publications that this is a powerful impact it is proposed that metformin's benefit is working through the mtor pathway can we come at drugs that are more specific very encouraging data including in humans have we proven it yet and will everybody B benefit from it without risks and side effects those trials some of the trials are underway so we are at human trial stage in a number of these pathways are you taking met Foreman one of the things I've learned to do as a physician is never answer what I do what I take really because you're worried people will copy you or what exactly so I you know as I said to you I I'm an endocrinologist and one of the commonest questions I'd get is well if you were in my place would you take it and I always turn around and say if I was in your place I wouldn't be treating myself interesting on a podcast that's a terrible answer I will tell you that right now uh so here's my take on this let me know what you think um I've had a lot of people on the show that do take that that take a whole host of things that are getting a lot of praise and I have not taken any of them because I am so paranoid about isolating compounds and I have a very bad feeling that uh so often something that's marked as a Wonder cure now a year from now is oh actually sorry that was killing you and I'm super paranoid about that I the fantasy thing that I hold out hope for is AI and just the ability to recognize patterns in an unbelievable volume of data and right now feels like the missing piece to me is we we need a way better understanding of all the complex interactions so for instance maybe um if you are diabetic taking um metformin is incredibly advantageous and the the length of your life would have been shortened were it not for metformin but if you don't have diabetes taking metformin now actually shortens your life it's going to be comple or if you're getting enough sleep every night and you take metformin and are diabetic then it's advantageous but if you're not getting enough sleep blah blah blah that you end up with a lot of complex interactions and until we can look at the whole data set how much sunlight are you getting uh genetically how well do you produce vitamin D like there are going to be so many complex interactions that unless you're really looking at something that's truly n of one you're never going to be able to figure out what the right play is and so for me the thing that I'm trying to do is stay alive long enough for us to get to what is often referred to as escape velocity so that you're you for every year that you live we now add more than a year to your life expectancy and so theoretically you are Immortal I don't think we're ever going to actually achieve immortality but that's probably a different conversation um yeah so because I'm not a doctor I don't mind telling people uh what I do but that yeah I would really tell people to be wary of isolating compounds let me respond and react um to one of things that you said I think which is very powerful and it raises a dilemma we have in society and in in the field clearly if you have diabetes and unless you have a contraindication metformin in most opinions is the first line of drug we also know as clinicians that if you are at risk of diabetes and have imped glucose tolerance giving you metformin is likely to delay the progression to full-blown hypoglycemia based on a threshold for blood sugar now it's a Continuum so it's sort of a artificial biological threshold but we call that a threshold right there is no drug approved by a regulatory Agency for the prevention of diabetes even today there are diabetes drugs and we are diabetes drugs that we know reduce the progression but they not a proof of that there are lots of reasons for that but one is to take a drug like metformin do I advocate that everybody who doesn't have diabet should be taking metformin no some people can have significant reduction in vitamin B12 levels which has complications which can cause harm we know your ability to build muscle from resistance exercise I'm not talking about big bodybuilders but resistance which we know is a good thing is mitigated if you take metformi so you put on less muscle if you take Metformin so we need to understand not only why but what is the implication of that for the individuals who do take metform how do you overcome that right is it more excise a different lifestyle so there are always tradeoffs and to your point we need to understand well there's a way we can do that can do a randomized control trial of healthy individuals look at known age related end points and do a met foran trial why hasn't that been done well first of all and this is a personal opinion it's a drug that's very cheap 5 10 cents a pill if that no patent there's no branded version that is going to sell to make money from it and so industry for good reasons no shareholder is going to pay a Company CEO to go on put lots of investments into proving the metformin works on the other hand government agencies don't typically invest in doing large clinical trials for generic drugs it's not on their radar screen who's going to do it and so I think one of the questions we have to ask ourselves in this whole field of what I look at as repurposing drugs is when drugs are either near off patent or have gone have patent can they be repurposed based on much greater science understanding after they've been on the market to where else they could do that requires a couple of things one is the funding the second is you know drug companies compete on my drug is more effective than yours it's a good thing right that's the private sector competitiveness but it raises a question should we ask the industry to pull all their safety data and so that for the common good safety becomes essentially open source so that as drugs are on the market we start to understand their safety profile because the benefit of a drug is two sides of an equation efficacy and risk it's both we talk a lot about efficacy but we can actually accelerate our understanding of safety by a lot of this changing and sharing data even while the Drug's on the market and then after it's gone off the market really pulling that how do we bring that about you the AI on just a population level data set will get you so far actually studying large data sets of people who've been treated in structured trials will give you a whole other level of complimentary depth in understanding but you need to have access to more than one trial do you see where I'm going so those data sets and I'm not talking about the Publications where you do some meta analysis based on the data that's published but actually getting at the source data and really interrogating it will open up all sorts of things now that raises litigation questions risk all of those but they're all solvable the last piece of this data I don't think we're going to be able to really unlock the power of AI and large data sets until we start to understand how do we do that protecting privacy without blocking access to it and so that's going to take without blocking access to what the data being collected right now if I went into uh a government data set in most developed countries and I said I want to look at the population data set to really understand this I cannot just simply go in as an academic researcher I can look at claims data if the Medicare for example gives me access to it but that tells me reimbursement data claims data only tells me what was optimized for billing can I get into understanding actually what the clinical record showed not what was built and we there's lots of literature that shows that claims data I'm using as an example does not TR fully represent the clinical data set do you think people should have to um assume it was anonymized but should people have to reveal their data so uh I'm imagining a future where um we're we're wearing ing our it's not a CGM but you're wearing something that's monitoring your blood levels on let's say a 100 different variables and uh we're also tracking mortality so I can see this person has this Blood profile and they live this long they have these ailments they complain about this again anonymized but do you think people should ought they I won't even say legally do you think morally they ought to give up their data you've raised the powerful point right and I very insightful question which is to what extent do you balance the individual versus the common good right this principle allies not only to Medical but lots of things and there are lots of areas where we do give up our individual rights for the common good take a contagious infectious disease we did this in covid right if you were covid positive we gave up certain choices in some countries you actually had a passport and if it was POS positive you could not enter certain buildings that was we gave that up wearing a mask was giving up our individual choice for the common good so the it really comes back to to what extent are we going to ask people to do this and to what extent so do as a scientist do I think there's going to be a huge significant public health and population level benefit absolutely but I'm not a social scientist to understand what will it take M okay I am very wary simply because we living in an increasingly divided cautious to use a very mild term but the world is almost to the point of lost trust almost right lost TR I say we spilled over Y and if that's the case then asking people to go that far I don't know how it's going to happen in many countries people are going to have to be convinced of the word you said anonymized I think the challenge in my mind is people don't trust that it's Anonymous yeah and I think that they have reason to trust it it's interesting I was asking you a question to which I don't know my own answer so I'm G to think out loud uh I I am hyper American so I don't think people should be forced to do it but I do think that they're I think it would be very wise of governments to incentivize um giving your data in a way that is anonymized the government is going to have to earn trust with that because good Lord I really don't think they've uh done a great job of earning people's trust but that would be that would be where I would want to lean I would want to see people incentivized to give that information I would want to see that information protected as fiercely as something can be protected and look I'll I'll anticipate the comments in the feed saying I'm being naive that is almost certainly true um but nonetheless I this to me feels extremely consequential so I am a big believer that if we can live forever oh if we can live forever we should it's very interesting uh I'm going to make that statement for now and then we can we can challenge it but I I would love I really want to live forever I will say that that that I can say with confidence uh I really want to live forever I do not see any way to get there without Ai and un obscene amount of data given my proclivities for personal freedom I don't see a way to get there other than to incentivize people to give up that data um if I even though I know my data will be breached if I'm honest I would give it up if that meant I could be a beneficiary of that information well let me give you an example when you voluntarily give up that data if you want to buy a life insurance policy today for which you see a perceived benefit for your loved ones usually the reason we buy life insurance policy you give up your medical record you go to a doctor you get a physical exam and you disclose your life habits and all the rest of it that's expected and people do it most people who have who are buying a life insury expect that that's going to happen if it's provided by your employer you get a limited life insurance policy than you don't but everything else you buy we're used to seeing that and I look at that analogy and I say that's a choice people who buy policies make and they clearly have a value from that can we learn from that behavior that's one toone benefit but now you're talking about getting a population but let me give you an interesting dilemma in the Aging field remember we talked about how to measure your age and your biological age if I give you a buy a life insurance insurance policy I use a date of birth if I get a job I provide my date of birth and my age is taken into account in terms of my employability not from discrimination but retirement age and employers look at you know how many years can we expect this person to work all the rest of it let's say I could tell you that you are 10 years older than your birth certificate should you be required to disc close that to your life insurance policy should they take that into account is that part of the actual equation does your should your employer know what your biological age is it certainly affects your employability certainly affects the actal tables so we're going to be actually facing these questions in the not too distant future so what you raising is absolutely hypothetical true I'm just saying it's going to become a practical reality in specific applications that we haven't anticipated yet but just imagine the day I can tell you that you are a aging 20 years faster than your peer you should you disclose that to your family should that affect your choices that you're making for your children should it affect whether you should have children or not there's going to be questions that technology is about to unlock enabled by big dat and all the rest of it that we haven't even started thinking about yeah this is uh this is where it gets very interesting so um I will ask the audience to forgive me if I change my mind down the line because I'm definitely thinking about this for the first time but here's how I would approach that uh I would certainly want to know that information I absolutely would not want my employer if I wasn't my own employer I would not want them to know that uh because it becomes far too easy to Black Hole somebody in that nah I just don't like that data point and so now it becomes impossible for somebody to get a job for instance my dad as he was nearing retirement age dyed his hair because he was completely gray he dyed his hair when he went on a job hunt and I said yeah that's a smart idea because it subconsciously gives the cue of youthfulness and vitality and I think positioning yourself with the full recognition of how you will be perceived is very wise and so there is just a truth that I think we want as the individual we want as much control over people's perception of us as possible and especially if they hold some sort of consequential sway over you however when it comes to life insurance I'm asking you to take a bet on me and the more that we can get to an Actuarial certainty I think that's more fair so from a life insurance perspective I do think that that is worthy of them uh or worthy for them to require that and at my previous company we took out keyman insurance on me for people that don't know what that is uh it's the assumption that if something happened to you that would have a material impact on the company and so the company will sometimes take policies out on a small handful of people um and so I had keyman Insurance on me and I did not enjoy that process that I felt like a piece of meat but at the same time I was like hey I'm asking millions of dollars if I were to die and so I was like yeah okay I get it um to your point these are things that we are going to have to sus out and I think that people are going to need to start forming opinions about this stuff uh and people are going to have to going back to that idea of societal Norms we are going to have to start making decisions about what this stuff means and getting this propagated out there as quickly as possible so now let's really get gross for a second okay this might go back to what you were saying about uh you took exception to Peter AA ranking type two diabetes or maybe it was the way I positioned it so I'm not speaking for Peter AA I will speak for myself pet a friend colleague amazing human being I love that guy more than you know uh but the reality is two diabetes according to Tom Bilu is a lifestyle Choice people are choosing to have type 2 diabetes and if they let me control what they eat they won't have type two diabetes uh and so I do think that there are certain things that are within people's control and if you are doing a self-inflicted wound like smoking that I will say yeah you are going to get put in into a bad category of life insurance of a whole host of things your health insurance should be more expensive if you smoke but by my standards it should also be more expensive if you can't modulate your blood sugar appropriately what say you so I grew up and got trained in endocrinology and specifically actually diabetes and metabolic disease from the school of thought that advocated exactly what you said that's how I was trained that's how I practiced and that's how I taught I was an academic center actually all my practicing career so if I reflect back and if some of my students and former students are listening they'll say well that's Dr Khan that's exactly what you were advocating what's as what's caused me to question that do I have evidence to counter what you've just said indirect you mentioned The glp1 Agonist right gp1 Agonist on the surface Cuts your appetite and therefore you make better choices as a neurophysiologist biologist which I'm not a neurophysiologist but if you ask the neurophysiologists there Isis a much broader question it actually does more than that it changes the whole gut incretin communication the biology changes uh that's one line of evidence that suggests this is more than just cutting the appetite changing our metabolism and so it becomes this chicken and the question is the diabetes prone person making bad choices making them diabetic or is it that underlying biology that becomes this vicious cycle I think this last round of therapeutic interventions has really raised questions the minds of endocrinologists let me ask you a point of question because you might know something I don't but I doubt it if you let me control what somebody eats can we agree that if you give me a hundred diabetic patients and remember I control what they eat they're locked in a room they can't touch food that I don't give them that I can get 100% of them to no longer be a diabetic I can say look there's no no question when I used to teach this philosophy I used to say if you go to a refugee camp uhuh or you go to any Mass Gathering crisis after a war or whatever people are now hungry you'll over time find no patients with type two diabetes just about that tells you is if you force human behavior to an extreme environment lock them up in a room of course their biology will reset that doesn't mean to say that they're underlying biologies is normalize because the minute they're out of that environment they rebound okay that's one the second is I'm just going to add another variable which I find fascinating outside my area of expertise for fascinating is the whole understanding or greater understanding of our microbiome we know if you take cly animal experiments and this is maturing rapidly you can take an overweight animal transplant those bacteria into an underweight animal and the underweight animal metabolism has changed and vice versa in fact Force feeding experiments are even more exciting because you take a thin animal's microbiome put them in another animal and try to force feed it still won't gain weight and so is that choice because there you're Force feeding it which is sort of the hey I'm eating even though I don't need to and if you put these different pieces of evidence together it starts to raise a question where is the distinction between choice and biology of the underlying itself I don't think it's that black and white anymore and I've been really self-reflecting and asking myself were the all the assumptions and the Norms that I accepted actually now being challenged it's no different than the discussion we've had around aging what is inevitable versus what is the underlying biology and the environment now the microbiome I find even more fascinating and simply because it then raises questions around even the environment we live in okay we have as modern humans changed our environment in dramatic ways many have had powerful public health impact but was there a price what's the consequence and how do you m again what are we learning from that so I just I hope with nothing else to achieve from this to raise a Seedling of a doubt to maybe we don't have the answer that black and white you can reboot your life your health even your career anything you want all you need is discipline I can teach you the tactics that I learned while GR growing a billion- Dollar business that will allow you to see your goals through whether you want better health stronger relationships a more successful career any of that is possible with the mindset and business programs in Impact Theory University join the thousands of students who have already accomplished amazing things tap now for a free trial and get started today let me ask you a question do you believe in Free Will Free Will as an as a person living in the Free World saying I'm deciding what I want to do yes not 100% so I I will confess something which my audience will have heard multiple times I don't believe in Free Will I there's just so then we're agreeing well I'm maybe even more Hardcore Free Will is an illusion but I don't think there's any way to live your life other than as if you had Free Will and so every argument that I make so oh God this this really gets complicated very quickly but here's how I look at this Free Will is an illusion however humans still change so the question then becomes if we don't have free will but we are changeable now what and so I think of myself quietly I don't talk about this out loud very often because it just will drive people to distraction but I think of myself as an algorithm I cannot help but say the things that I'm saying right now because of all my genetics my microbiome all the things I've encountered all the N of one things about me but because of that I am compelled to put certain ideas out into the world now the reason I think that's incredibly powerful and the the the notion or not even the notion the sense of compulsion I have to put certain ideas out into the world are because I know that even though I don't have Free Will and the people listening to this don't have free will they will still be changed by these ideas so it becomes a question of what ideas do we put out into the world knowing that all of us lacking Free Will are going to be shaped by the ideas that we encounter because I think it only makes sense to act as if you had free will then it's like okay acting as if you had Free Will what are the ideas that are going to shape people in the direction that makes the most sense to shape them into now that requires you to have a North star there has to be something something that you're aiming at you are the right person to have this conversation with because I've heard you say a thousand times that a Leader's job is to give people Vision you have to know what it is that people should be aiming at so I believe people should be aiming to maximize human flourishing to minimize human suffering we can get into what human flourishing means but basically to thrive to not be in emotional or psychic pain to um uplift not only yourself but other people because if you're a sociopath and you get joy out of punishing others that's that does not qualify in my book you have to be elevating other people as well um so the reason that I harp on Choice even though I don't think we have free will the reason that I say that uh being a type 2 diabetic is a choice is because that idea is going to influence that person's behavior and if they believe oh it's just my underlying biology there's nothing I can do then they won't do the things they need to do to reverse that problem you spoke earlier about you have to be able to show that this thing is the problem this biomarker is the problem and that I've done an intervention and I can measure that it move me backwards in in the right way and without that we're never going to make progress so that's my whole thesis with whether it's weight loss whether it's diabetes I get it it's way harder for some people I come from a morbidly obese family when you put me next to my wife we can eat calorie for calorie the exact same thing I will put on fat you will literally hear me getting fatter as I'm chewing it's crazy and my wife will just get very hot so she'll sweat through her clothes her sheets in the middle of the night I won't but I will put on fat cool so we now both have a genetic predisposition for one way of dealing with excess calories I put it on as adapost tissue she uncouples heat great now I am very emotionally traumatized by the fact that my wife can eat basically what whatever she wants and she doesn't get fat and I do but if I just lament that and I don't make different choices then I will be resigned to be like the rest of my family and I will be morbidly obese but instead because I've encountered an idea that influences my behavior which is that I'm in control of this now I make different choices and I get a different life outcome so I I'm not sure people that fall into your Camp they tend to be very compassionate and everything in my research tells me that you are very compassionate but I don't know that it actually helps people to not say hey you're in control make a different decision get a different outcome so let me let me challenge part of it please you've using the framework of freedom of Will and choice in related but to in my mind distinct um situations one is you raised the question of the mechanism and ideology and causation of diabetes and there my response is it is not all choice there's clearly genetic predisposition you take two obese individuals the risk of diabetes is not the same even though both are overweight in fact if you look at identical twin studies the concordance of type 2 diabetes and identical twins is not 100% even though their BMI is the same they're genetically clones they're not 100% And You could argue they've grown up in the same environment their behavior is nothing so there's clearly biological difference we know that from twin studies so all of that suggests that the eological discussion causitive discussion is not a black and white choice or not you've raised now a very different question which is if you're going to help some somebody intervene who already is on the trajectory to diabetes or has become diabetic as a clinician do you tell them and say listen this is not a you know this is not your fault it's choices absolutely not that's not the two different situations and two different arguments there you absolutely would say if you do the following this will improve your situation and it's never as a clinician now treating patients with diabetes for many many years it was about you're going to see Improvement now some patients May dram dramatic change it was absolutely clear that they changed their life we've seen obese people completely normalize their BMI something triggered it got them going others did and then relapsed While others made no change continue to progress so it's a spectrum and so as a clinician absolutely you start with improving what you can and then you sort of say whatever doesn't work now what else do I have as an option and that's a a intervention itional approach which is different than understanding the underlying causitive mechanism scientifically I hope that's clear you have to put two different Minds on when you're a researcher versus a clinician not the same now the other thing that we have to ask ourselves is that as we go forward what is it that we need to unravel in order to help more and more or a higher percentage of these people you earlier mentioned about sensors there's going to be some people who just basically you give them a diet prescription and exercise and they change their life there's others who need a feedback loop and that feedback loop might be weighing themselves feedback loop might be the sensor there may be another feedback loop maybe there's a subconscious feedback loop not just a conscious one that continues a neurological signal I'm hypothetically that continues to change their behavior it's a self because when you make a conscious decision I just saw my blood sugar go 300 I'm not going to eat that cake that's a feedback loop what if the feedback loop is in that conscious so I'm just raising those are all things that are technologically more and more possible we're all hearing about neuros stimulation of our autonomic nervous system show you given how impressively and I'm I mean this you've read those are on the horizon too we're starting to see neurom modulation of the autonomic nervous system through non-invasive stimulation sound this and the other is that if that's a feedback loop is that a conscious is that a behavior change free will do you understand where I'm going so we can't close the door on that and all of a sudden you're going to do a lot of public good potentially if you can unravel that so I think we agree wholeheartedly so one I've said many times I want my Tombstone to read you're having a bi ological experience the reason I'm trying to get people to understand that is everything in your life everything everything everything is mitigated by your biology so whether that is my wife being able to eat more calories than I can without putting on fat because she turns it into heat energy whereas I turn it into adapost tissue or something completely different uh that's irrelevant to me you are you as an N of one have uh you are a certain way your brain works a certain way your body works a certain way your gut Works a certain way it's going to be slightly different than all of your other humans you need to make sure that you tailor something exactly to you but the reality is that if you act as if everything were a choice you're going to be in a much better position so I need to do something different to maintain my physique than my wife does however we both still have to do a thing to maintain our physique and once you let yourself off the hook and you say oh oh well I I'm just born to be fat right I again coming from a morbidly obese family the number of times I've heard that like oh they used to say this to me all the time when I was a kid you're going to get fat too when you get older you're going to get fat too you're going to get fat too you're going to get fat too and so in my early 20s when I started eating fat I was like well I guess this is that like this is the moment everybody warned me about and then I realized that you can't eat an entire tub of Licorice and not get fat and I just used yeah I had many misconceptions about uh sugar primarily did not understand how it could become body fat that did not make any sense to me um and so when I said okay hold on my life is an exact reflection of my choices if I want a different life I need to make different choices all of a sudden even though my biology is different even though I may need a different feedback loop than somebody else even though something may be harder for me than somebody else the reality is everything I do has a has this will be interesting to see how you respond to this it has a knowable outcome not that we know it yet because I don't think that we can parse the data yet this is why I'm obsessed with AI is it is the promise of being able to find the patterns in an overwhelming AV Avalanche of data and right now we all just get paralyzed because there is so much data and we treat it as if it is not knowable and what I'm saying is this is knowable human biology is know able that we live in a determined universe that if I had the processing power to understand the beginning state of the Universe I could move forward or backwards and I think it is only that we don't yet have the processing power to track all those complex interactions now I've have heard that refuted that once you get into I think it's known as the three body problem once you have that third variable there's just too much complexity but when I hear that I just say we just don't have the ability to track the amount of complexity yet so look um I have no doubt in my mind that as computational capability and the power of processing structuring processing data Etc continues to go up and I think it'll continue almost exponentially we're seeing that we've witnessed it is going to unlock connections and associations in data that we never imagined one word of caution uh go back to 20 some years ago when the Human Genome Project was completed and the human genome had been sequenced a lot of people celebrated said now we will be able to identify every cause of disease because we know the human genome two flaws in that one is we hadn't sequenced the whole genome because at that time the computational power capability was such that anything than smaller than about 100 base pairs or so going off memory now was considered noise so we actually only sequent part of the human genome we just didn't have the computer capability to really sequence everything too much noise move forward we eventually did more recently complete the Human Genome Project as we sequence everything the second is we learned we had assumed that one gene sequence equal one protein and then we realized that there were more proteins than Gene sequences so there was clearly a amplification of that variability after the genome had been transcribed the data code read into what the protein so there was even more variability of multiple several fold and then we realized that protein function was even further Amplified in variability because of the so-called epome and so every time data has unlocked our understanding of this variability which is what you're getting at we've realized it's actually given us a window into how a billion years of evolution has created diversity not just through DNA sequence or now the types of RNA but all of these other things are happening what do I mean by that we will unlock more of what is in the biological data set so it now becomes known but it will also very likely open up New Frontiers which has happened every time because we have more Precision in our tools to understand another level of variability which is important it's absolutely important but I'm not of the school of thought say now given if we just take our existing data sets suddenly have the computational power this will give us all the answers it will give a lot more answers and it will raise questions so that we can continue to answer them and add more and more Precision to our understanding it's not going to be that simple we've been through this already in two waves that I just gave you examples of they actually allowed us to get to the next level of depth likely that's what's going to happen now I may be wrong I hope I'm proven wrong but history tells us this is likely to the case now should we be doing this absolutely for the reasons that I just said my job as a leader you know you quoted some of the things I've said as that's setting the vision is to help my organization and hopefully parts of the field put aside for a minute that noise that complexity and try and bring Simplicity to what the first step in getting to that goal is so that we harness and focus resource cuz progress is made through different organizations somewhat coordinated way taking on pieces of the puzzle and then bringing those pieces together right we need to be very clear as Leaders what does the endgame look like what are we trying to do and what's the first step to that how do you do that how do you take an incredibly complicated topic and boil it down to the first step you know I always ask my team three fairly straightforward questions right we we all know what our vision is right we want to expand healthy lifespan for the benefit of all simple powerful statement we help craft it health span benefit of all okay so if we look at that as our sort of guiding Northstar then we can say we got to focus on health span not just health and disease but Health that's linked to lifespan and we got to be able to democratize this so that it has scale and impact so if you put that filter on you say all right of all the things we could be doing the first filter is is this really in the health span space and can it really be democratized either because of in technology or because of moral reasons right you've read you know the possibility of taking plasma from young people and transfusing to old people to rejuvenate I can't ever Invasion approving in my organization that type of practice simply because I don't know how to scale it ethically morally commercially you you take your pick so it's not scalable but if we could understand what the circulating factor in young plasma is that rejuvenates a combination of peptides whatever they are and now manufacture them that's scalable so it's it's really understanding the scalability and the path to scalability and then asking ourselves what is is our right to succeed I don't like to use the word which I use in when I was in corporate life where it was much more appropriate I don't like to use the the term right to win because right to win is a very competitive mindset which when you're in a corporation in a business is your job right you're winning market share you're growing your market share you're leading you know winning the industry whatever right when you're trying to lead a field convene the best Minds convene the different disciplines and lead and make this into a movement you shouldn't be talking about winning you should be talking about leading not the same thing sometimes our leaders talk about being winners I don't agree in fact I gave a speech in Washington where I said the challenge we now have as Leaders of a country is we're starting to talk about Winners versus losers when we really should be talking about our history has been about leading the world and elevating everybody think about we're both Americans how did we see democratization of us inventions agriculture transport Communications entertainment internet GPS cellular phone technology all got democratized and we grew the world grew it was leading wasn't just winning so as a leader how do I motivate my people I say let's talk about leading this field what is our right to lead and what is our right to succeed as a leader so the the leadership I hope is clear now the question is what does success look like and that's where the road map comes in what's the first step in that journey to that Vision if I just say that is the end point and that's it it is so daunting most people will not take it on probably the biggest role I have as a CEO and you have as a CEO it's finding the best brightest Minds those young people to come join you in sharing that Vision they can always get a job question really I have to always ask myself is why would they work in my organization on our challenges versus another why is there this their choice you don't want the people who need who just coming because they need the job you want the people who have 10 choices but they choose to follow you you and you've heard me say this leadership is not a choice by the leader leadership is a choice that their followers make so how do I make it their choice that's where I give them a stretch goal but something they can perceive is Within Reach and that's I think is the job of leaders clear on the vision and then point out here's the first step if you achieve this you will gather the momentum to go and by the way attract many others to come and that's the right to lead can you attract can you bring people together if you think about this meeting one of the things that we're seeing at as we're starting to launch this meeting is the typical the the meeting of a typical aging geroscience Gathering it's about 150 200 people in the core biology of aging and investing in the Aging space we've had 1,800 people register for this meeting that's a log scale more I can't take the credit for that that's my team's job and they don't get all the credit the demand must have been out there what was missing in that void was the leadership role of catalyzing everybody to come together that's where the leadership and the right to lead if we actually bring together thousand 2,000 people at the same venue talking about the same issue from its different perspectives you have got the right right to lead but others did it for you it's very interesting um I am of two minds of that so I will point out Dear listeners that we are speaking to the former member of the commission on competitiveness or something like that so the US Council for competitiveness there we go so I know in your past is a a real understanding and recognition of the power of competition going back to the idea you're having a biological experience hum are designed to be competitive we we are hardwired to other somebody else and to want to win to put it in a nice way against that person and I'm a big believer don't try to change Behavior try to leverage it try to figure out what people are already doing and how do you hijack that neuron so I know that people want to win I know that people are going to look at some people as in group and some people as outgroup and how do I leverage that so one of my tools as a leader is hey we want to win like we want to we want to be the best YouTube channel on the planet we want to make the best video games as judged by who plays the most views the most whatever like I want to win now I want to do it in a healthy way I don't want to look at my um the people that I'm competing against as anything other than a worthy opponent that's a big thing for me I want to go up against people that are worthy people that I want to see them on their best day but I want to win I want to beat them I want to go head-to-head and I want to outperform them now if I don't like I don't know if you remember Nancy carrian but I don't want to go hit somebody in their knee uh so that I can beat them that is not interesting to me I want them to thrive so funny I've never talked about this but I had somebody reach out to me back channel uh about one of the biggest podcasters in the space you haven't even heard this and uh they were just lamenting like oh this person's trash like why are they getting so many accolades they're this they're that and that's not interesting to me I'm like they're better than me right now right now I want to believe that I can outperform them on a long enough timeline but they are currently better than me which is why they're getting more results than me and that lights me up like I'm on fire for that and I wonder because look I love that evolution is in a very unique position in that you guys Exist by Royal order not even Royal Decree or whatever the slightly lower version Royal order you guys are going to do this this is like a a mandate from the King himself cool love that and so you guys don't have some of the pressures but the human animal like if if you told me you need to go solve XYZ problem what do you need to make it happen I'm like oh find a way to make the people that win at that rich and people will do it I'm not saying that that's good I'm just saying it is it is true and people want to claw their way to the top the the best the brightest the most aggressive they want to win and do you think that one you've had a ton of success in your life and so it's much easier for you at this point you've not only do you have financial success corporate success that looks awesome on paper you also have marriage success kids grandkids like you've really got the thing and you've managed to align yourself with people that don't need a financial return but do you think that that is a scalable model or am I positioned in a more scalable solution where I'm like yeah just find a way to help people get rich and and the human Tendencies will take over you have um I think you've made some very profound statements uh many of which I would not argue with but I want to give them a slightly nuanced context by the way the only good decision I've really ever made was married the right woman 41 years ago everything else you just stated about my career and personal life is 90% hers and the rest I sort of came along on the journey so let's just put that on the record um there's very good scientific evidence that our motivations clearly change through our life stages there's no question when we're teenagers in our 20s we're very self-focused that's natural why because as a species as a young person you're trying to find your place in the world you want a voice you want to be heard but there's also very clear evidence that if you want to look at social impact um giving forward all those things that happens much later in your life a because you have the capacity but also because your thinking starts to become much more nuanced the gray are is what was black and white you know when you're a young teenager early 20 things are much more black and white you know it's the classic saying you you know more uh about a topic when you've read the textbook then versus when you wrote it okay having been both a reader and a writer I really knew far less after I written the textbook chapter than when I was a reader you learn your limitations so I think that's we've got to take that first all I want to make sure people understand what you're actually saying uh because you're were talking about this earlier that as the island of your knowledge grows so grows the shore of your ignorance it's called the Dunning kuger effect which has been on full display by the way because I know less about this topic I am far more bold in my predictions and my assessment of what the future is going to be uh you know just enough to feel like you know everything and you don't know so much that you realize oh my gosh I know nothing about this topic uh yeah well so I've I felt it personally my son was a Graduate School of Business at Yale every class he'd come back and tell me all the things I was doing wrong as a CEO that was his latest management class okay thank you son got it next time I teach in your class I'll make sure we come that's normal okay so that's one thing put that in context the other is competition is good the desire to win ethically morally just like you pointed out it isn't at the negative consequence somebody else that's good but it's a tool we know from let's say competitive prizes even in the uh technical field right prizes like the SpaceX prize which was sort of the publicly well-known prize not only achieve technical success but launch three or four very valuable companies by the participants in the race to be the first it's not bad her whole IP patent process incentivizes competition to be the first because you reap the greatest benefit from that return our whole IP structure in the western developed world is based on that I'm not saying compet I is bad but I'm saying it's not the only tool it is a tool in the armamentarium to bring forward an have social and public and better Humanity think about which scientist in recent memory has had probably saved more lives than any scientist to come if you think about it in life sciences it's a Nobel laurate called Norman borlock never made any money he wasn't in a compy competition but he was the the plant biologist that invented dwarf wheat that dwarf wheat funded by the US public health investment he was coming out of the Department of Agriculture and through government tax non-patented research developed DWF wheat most of the benefit for which was in South Asia because they went from one wheat crop a year to two as a result minimum of a billion people were saved from starvation think of that and so A Billion Lives saved saved not diseases treated I can't think of very many drugs that have ever done that if any and so was that by competition no the competitiveness there was to win and succeed to unlock a natural capability CU it was n natural breeding he wasn't doing GM or he actually created that breed so I give you that example to say massive good can happen at scale through collaboration now you use the word leverage I love that word but I give leverage another context in addition to what you're saying leverage in my mind allows you to do things primarily in two maybe three things first it results leverage it results primarily from collaboration when you collaborate you get leverage when you collaborate that leverage allows you to have scale that you as an individual couldn't and that scale allows you to get impact at a level that otherwise not possible so Leverage is one of those ways and so competition is one lever but on its own is rarely enough take the Space X price somebody got through did everybody suddenly start going to space no now you attracted Capital entrepreneurs material scientists people unlocked other things and now you're starting to see commercialization new countries are entering the competition for space but it took somebody to prove it in a competition on its own it wouldn't go any further think of any competition think of I gave you the example of cellular phones competition brought SE the private sector to give you cellular phone technology they didn't invented the invention came from the the US National Lab system that actually created the underlying technology same with GPS geolocation is happening because of that so it's that public private partnership when we think about the as a private sector we forget all of that which was actually in the non quote General competitive space the covid vaccine everybody says you know the private sector in 12 months gave us a vaccine no it was 10 years minimum of investment by the US tax taxpayer primarily in academic centers and the government labs to give you the underlying technology that could be rapidly applied that was the competitive part but you forget the other 90% which is not competitive without that there was no competition so I just give you that it's important as leaders that when we think about competitiveness we put it in the framework of what it will take not just one piece well said okay we've been talking a lot about extending people's lives why what what is a life well-lived what should people be doing with all this extra time you're going to give them I think that those is that's going to be coming back to people being able to do based on the choices they want to make the loss of functionality and the decline in health results mostly in a person's inability to do the things that they choose to do they make compromises they may want to do things that they no longer can simply because of a decline in their health a pilot who's flying gets grounded because their vision is does not have the same Acuity that they had when they 30 they lose their medical in a time when we probably need three times as many pilots in the US could say the same for air traffic control I'm just giving an example of an industry that's massively short right now in training that's why so many flights are canceled because they don't have crew why because we ground the pilots at certain age they don't pass their physical anymore they're done loss of ey visual Acuity is not a choice that's an aging process being able to maintain that allows them to choose to continue to flying or retire most Pilots that I know I happen to be a pilot actually will tell you they don't want to ground themselves they enjoy it they want to continue to contribute took Decades of experience to learn they're grounded so I can give you lots of examples a surgeon who no longer has the manual dexterity but has amazing intellectual experience 40 years of experience knowing not only how to operate but when to operate but what's the take away that contribution is a life well lived it's a choice contribution in the examples I've given you is professional another might be contribution because I want to be around to to teach my grandchildren things about their Heritage my values as their grandfather the society they live in is contribution being able to support not just financially enabling my children to do things because I'm around to be able to do things with my grandchildren is a contribution I remember my son coming to me uh and saying dad actually it was my son-in-law sorry Dad uh your grandson just went through a health and human biology class in school and they have to talk about human health and reproduction I think he needs to have a talk with you I said when was I the designated oh no I think you do it best and off we went for a walk I would think that's a very important contribution probably took it in my family situation in a better context taking it from their grandpa than their parent I play a a role in their life it's a cherished role so that's contribution I've given you two ends of the spectrum both are important if if I didn't have children I could be mentoring other young people I do Mentor young people who are no longer employees of mine but I'm still their Mentor being able to do that is very fulfilling for for me it's nothing to do with monetary return and they're not doing it because they work for me have you read man search for meaning no whoa uh I think you will love it the most it is one of the most influential books on me that I've ever read written by Victor Frankle survive the Holocaust and he um he talked about how basically you have to find meaning and purpose and it's sort of the Nichi and line of he who has a strong enough why can survive almost anyhow it's that same idea I think it's very much tied to contribution when I think a lot about fulfillment which for me is the ultimate point I don't think that life intrinsically has meaning I think we all give it meaning but I think to your point we've had a billion years of evolution you are hardwired to um to pursue what I call fulfillment as far as I can tell fulfillment has a recipe and that recipe is you have to work very hard to gain a set of skills that allow that you care about that allow you to serve not only yourself but other people and as much as I want to get away from that need to serve other people I really do think that that is intrinsic the one thing I think I would really struggle with is if I were alone on a deserted island or I was the last human I like to think that I would still be able to um emotionally Thrive but I don't know that's the one thing where if I didn't have another person to be able to do something for it'd be tough I think a lot about my life and why because I'm a very solitary person a very solitary person but I'm nested within the context of a very happy marriage and so and a business for that matter so while I don't pursue a lot of like friendships and go hang out with the boys and I just don't do any of that um um my cockiness around my ability to be alone is still nested inside of a deep sense of the word that comes to mind is obligation but in a positive way where I there are all these people that I need to help and do things for and show up for and be strong for uh and I think without that it would get dark very fast so you've just stated that like most vast majority of people you're human here's why I say that to my knowledge and there may be an exception that I haven't come across many animals teach the Next Generation all of them teach where the Next Generation emulates what the past the parent does it's mimicking and eventually by repetitive mimicking they pick up how to do something and that's how knowledge is passed and so if the M adult chimpanzee cracks a nut in a certain way the baby keeps doing it one way or another and eventually figures out that there's a certain way that it's done and it's figured out humans are the only ones that I know of that actively teach and through that active teaching they instruct that instruction is hard wide into us as a human species it's very unique about being human it is not simply we don't learn passively we learn through instructions that's a human attribute and what you're doing today is contributing to that active teaching of a very large following so I would challenge your term of you are you know quote a very individual whatever way you want to put it because not only is the marriage but you actually have an extended sphere of active influence through your current role through the businesses you've built and even the nutrition business Food business you built was in part to change and actively actively change and impart certain enable behaviors on your customers or consumers that What Makes Us human that is very much the part of where almost all of us are wired so there are some attributes and sometimes we forget we're actually the only active teachers in nature let me ask if we could live forever should we I don't know whether we should or not it's I honestly don't know um however it's the same as saying should we treat any biological process in my mind I come back to being a physician I want to alleviate suffering I want to prevent suffering aging causes probably more suffering than any condition I know even more so than hunger just look at the numbers and so if we can alleviate that and allow positive contribution to society I'm modest enough ambitious enough to push that envelope but modest enough to say I don't know beyond that what else might be possible I'm a strong believer in that's more of a moral question and so science should not scientist shouldn't derive the definition of Morality In fact one of the first things I did uh when we launched Evolution remember we we had two employees is I asked our number three employee of the team to put together an advisory expert advisory panel of bioethicist first thing I did it is I was fortunate with a long-standing friend uh who's professor at NYU Professor Arthur Kaplan to agree to chairing that he's one of the for most thinkers in the world in this space not a biologist but he's a bioethicist and I we approached him and said would you put together and he approached we both approached Professor Julian at Oxford who's the founding share of bioethics to join that then we approached somebody from Asia the Middle East and put together Global bioethics to start to ask the question what where is bioethics on the areas of we're working in shouldn't be my job as a CEO to do that and it shouldn't be a scientist's job to Define that I think this is where it's important to get the people who are thinking about this these questions including that should we should be guided by us I'm very very firm with the team we should be looking at where we want to go what the possibilities are we should always be guided by where that line is and remember as you know I know from your discussions ethics is itself an evolving science if I may use the term science you can use the word discipline it evolves it evolves with Society it evolves with knowledge and evolves because the questions being posed 20 years ago I said 50 years ago cancer was incurable and so there was never an ethical question of should you cure cancer we had no choice now it raises a different question and by the way cancer is very relevant to aging I just wanted to throw that in science has made amazing progress in curing Childhood Cancer most P children who got leukemia died today more than half majority will get cured we have the drugs we have the treatment lymphomas young men getting lymphoma young women getting lymphoma many cases are curable that's a win however we now 30 years of treatment of success have realized that most survivors of cancer have accelerated aging their bi body ages faster than their peers who didn't get treated for cancer so was it the underlying Cancer's existence changing their biology were there underlying biology different was the consequence of the treatment we need to answer those questions now which really will start to open a new frontier not only in what causes aging but when to intervene let's say we figured this out and we could prevent the future accelerate aging of a young person teenager young adult who's now being treated for cancer should we be intervening with quote I'm using the general term anti-aging therapy right after they've recovered from their cancer to prevent that don't know yet but we'd better start looking now because we're going to have a lot of successes that now are living with that there are some genetic diseases that we know cause can aging Down syndrome is an example accelerate aging they these children die as young adults their life expectancy is low what is it about the genetic change of downs that changes the aging process it's a single chromosomal difference right so there are now going to be ethical questions when do you intervene who should you intervene on so I don't want to be the only one answering the question it's a long answer your question I I've thought about this extensively and again I'm at a point in my life and say bring in the experts to help guide your thinking yes I've got it as the CEO I'm accountable for the decision at the end of the day but it should not be in a totally top down here let me tell you what the answer is I don't have the answer has the bioethics team that you put together giv you any warnings they have raised questions right I've I've given you an example of plasma transfusion right Young Blood Young Blood now let me let me actually ask you about the young blood I'm glad you brought that back up so uh I I I love the idea that somebody can monetize their body and if somebody wanted to sell their blood um why does that bother you or a bioethicist tell you why it bothers me it comes back to your question of Free Will and choice okay science over the years has evolved we lived through a period where um through persecution genocide we were experimenting on humans that is atrocious go back to World War II we we then lived through a period where we were experimenting on African-Americans without their consent right we were at some point incentivizing paying volunteers to do allow us to do research if they're prisoners they got extra privileges that's a form of payment is that free will is that choice or is that coercion all of those were coercion okay now if you are a poor person living in an inner city and you get a financial incentive to sell your plasma as a young man and picking man because to donate to somebody it is quite possible and the the have evidence suggests that the person selling their plasma is not of the so same socioeconomic class as the person buying if that happens is that coercion is that free will that sounds like free will to me why if I can sell my time why not my blood selling your time I think most BSIS would argue and I certainly am of that camp is an employment where there's a general here's a transparent value proposition for my time when I'm selling a part where do you draw the line I've sold my plasma can you sell an organ no because it's not replenishable right that would be where I draw the line okay so I don't know how much plasma I can take before I've done myself harm okay uh I mean let's let's take a look at this the prevalence of iron deficiency thin blood in lower social economic classes much higher than higher social economic classes are those the populations you want to be buying blood from even if it's fre that's a different question I'm just for me the ethics of the situation come down not to scal ability which was prior to asking that question the push back I'd always heard you give is I it's not scalable some things just aren't going to be scalable but at the same time I wouldn't want to I wouldn't want to deny somebody the ability to monetize their time energy body whatever in the way that they want if it is non-destructive because I get if it's like if it were like oh man I can't make ends meat and I want to sell my kidney I can see how that one can go gnarly pretty fast um and I would say I'm not a Libertarian so I'm not about like hey no regulation like obviously if we were going to do this you would want it to be something that's regulated to make sure if there is a limit to what people can give before it starts being detrimental that you draw those lines but this is this is a very interesting moment that we're going to live through uh anytime you're living through a hyper transition it's going to get weird really fast and so as we figure out what works what doesn't it's going to be weird uh there was a time where iPhones were basically only for the wealthy but then you get very good at producing them and the cost begins to decline though they're still pretty expens expensive but sell phones get cheaper and cheaper so if you look at this if there isn't a way to monetize it in the beginning like if we have to go from nothing to democratized with no intermediate step I think it's going to be extremely difficult the place where bioethics starts to scare me in terms of should we all live forever going back to that question is I think it was Max plank that said science does not Advance one Insight at a time it advances one funeral at a time you're having a biological experience the mind works in a certain way it is terrifying to me how hard it is for human beings to change if I'm right and we are all roughly the equivalent of 120 sided dice rolled and whatever your uh 120 sides roll up like that's just who you are and what you're going to be like and obviously the permutations are in the building billions or trillions and so the big question for me becomes all right if I look at people that can't change like they're crazy because my 120 sided dice came up that I'm just hyper malleable which feels very true and I think my brain should be studied for science because I forget very easily in a way that I find distressing that my wife wishes she had uh but nonetheless may be the key to why I'm so malleable I I just don't get my identity doesn't get caught up in weird things largely because I just don't hold on to them anyway I don't know if it's a blessing or a curse yet it's just how my dice have rolled and so to me experientially it does feel like humans can change a lot but when I step back and look at people I worry that Max plank is right that the only way to refresh a population to keep things moving and to keep progressing is for people to die off here's how I think Evolution has shaped us and this really worries me we are the ultimate adaptation machine but the way that we are created is such that you're hyper malleable at the beginning of your life and you become less so as you age and you more or less sort of Post 25 are very rigid not that you can't change but you probably won't and so functionally it becomes effectively the same thing and so because of that even though we are this extremely adaptable creature we do migrate out of the age of imprinting we become effectively a static being and so you need to refresh the population just by killing them off and so even though like I really want to see if we can get to living forever I'm also not sure that it's wise as I as I mentioned to you and I think we're agreeing I don't know if it's wise or not but fortunately right now we don't have to answer that question to continue to do what we're doing right so it's the what's the first few steps we got to make progress agree whether I agree on the notion that you know you have to kill off in order to make progress I don't agree with it as an absolute statement to because you have a more profound belief in our ability to change but societies continue to evolve right does that me because people die I'm not sure their ideas don't die they evolve do we live because we're physical beings or we live because we leave ideas which continue to evolve themselves but it's an evolution of those ideas not a revolution there's some things that challenge our norm and eventually we look at these laws of physics are being challenged nothing wrong with that but it's an evolution I don't think it's a revolution of a complete replacement there's updated versions of our ideology uh but are we biologically any different today than we were as cavemen there's no evidence for that yes there's been some calling of the her but modern humans biologically are are modern humans but what has evolved has been our thinking our morals our values those have been multi-generationally been evolved that's what makes us I said uniquely human so I don't think it's a just a replacement and you and I distinguish between our physical presence on this world versus the ideas we leave behind right and our our physical presence yes we'll have a fin night time as far as we can tell will it be permanent I don't know okay however let's ask ourselves that as as we you know this comes into the sort of our philosophy how do how do we live on even biologically we are still as humans going to be living five generations from now because our DNA will be our genetic code right down to that fundamental level your genetic code is still a derivative of your ancestors your germ cells are the oldest living cells from multiple Generations right so we know that is happening it's not depends on what you define as the unit you're coming down to that level you're coming down to the full society and culture level where do you want to draw the line of us living forever I don't think it's that simple uh and this is where we get into sort of the the scientific debate of you know life and the definitions but me as a biological organism being alive on this Earth contributing we have been striving to that contribution ever since medicine came about nothing new about it the day we figured out we could treat somebody with a fever and stop them from dying from a fever by giving them bark of a tree we were preserving life we were preserving functionality just using more precision and more and more powerful tools it's just an evolution of that you know a lot of people say to me well you know in our grandparents generation we never heard of cancer yeah because the life expectancy was 50 nobody lived long enough to get a cancer most cancers are age related now that we're living long enough we're getting those so now we've uncovered challenges type two diabetes was almost unheard of but at the same time adults didn't live long enough to be come have diabetes weight gain was part of that too while age is certainly a factor in type 2 diabetes I come back to my very strong conviction that this is you can track it to the increased amount of sugar that people eat and probably the ideology but as I said you define diabetes as hypoglycemia yes what do you define it as so how did we come up with the definition of diabetes at the you know we we Define a cut off about 118 milligrams per Des right it's an arbitary definition does it mean mean depending on who you look at is 120 118 is 116 not diabetes 11 not diabetes the pre-diabetes St so you're now you're putting the pre right so you're picking your cut offs what we do know is if you look at the onset of diabetes is clearly age related it's not 100% weight related it's a different in our body mass lean body masses a whole variety of things two individuals I'm Asian you're of Caucasian descent mhm my risk of getting type two diabetes or the same BMI is at least twice yours as we get into the higher bmis why is it my genetic risk from obesity is far higher than yours well so I'm making the same choices yeah okay so let's dive into it and the great news is that you will know so much more about this you you can correct me where I go and by the way this is why the who has challenged the definition based on BMI of healthy body weight in Asians versus Caucasians you're talking about the classification of obesity and ideal body weight well so ideal body weight is a very confounding issue I'm talking specifically about the reason I think uh diabetes is something to pay attention to is I think sugar will again lay not again but l terms it will burn you alive from the inside out you are going to glycate your tissues it's going to get gummy things are your ha1c levels are effectively how much sugar is binding to your proteins that the sugar binding to the proteins is a problem and your cellular Machinery will not work well because there is just a raw biological reality of what happens when there is an increased amount of sugar in the system glucose and your bloodstream you're you are now in the same way that a senescent cell makes it what we know is that it's not working properly what I know when somebody has the presence of too much uh glucose in their system is something breaks down now whether that's a response to the level of insulin in your bloodstream whether it's actually the sugar molecules binding up in your blood I I won't even speculate on that I will just say it is self-evident that there is a causal relationship between the amount of glucose that you in like I can break anyone no matter how resistant you are or no matter how good you are at handling an excess amount of sugar I can break anybody if you let me Give Them Enough sugar so given that that is a very predictable way to break the cellular Machinery I'm just saying you're going to want to pay attention to that and you can do this to a little kid it might be harder to do to a little kid but if you let me feed that kid like we feed a goose to get Pate like it it's it it's just too predictable of an effect yeah so that one to me is and look I I I have a feeling look you if if I were mapping your personality I really have a strong Instinct that you are hyper compassionate and that if you put humans on a spectrum I think any social creature has to have people that are hyper compassionate and has to have people that are hyper on the personal responsibility I'm probably somewhere in the middle um but my thing is getting people to understand that you're not a bad person if you're a type two diabetic even if it all was your choice and we both acknowledge that it's going to be harder for some people than others I think we also both acknowledge a free will is Just an Illusion anyway but again going back to you're changeable and so the ideas matter you're not a bad person if you're a type 2 diabetic I want to be very clear about that I don't pass any moral judgments I'm a big believer that you cannot hate that which you love I come from a morbidly obese Family full of type two diabetics I don't think they're bad people I don't think they're less than a non-diabetic I don't think it makes me better that I'm not a diabetic but when my norstar is to alleviate human suffering you want to talk about suffering make somebody a diabetic make them have to amputate their toes then their foot then their leg like that that is a nightmare scenario also just being inflamed all the time is nightmarish and this is a it is a solvable problem and it's all controlled through diet and I hope that people hear a message of Hope in that certainly not condemnation certainly not you're a bad person just hey there is a different choice you can make that will give you a different outcome and that outcome is a better as judged by suffering life I think as we talked earlier I'm not disagreeing all the benefits of lifestyle choices absolutely agree we we came back to this question based on the fact that we gain weight as we age what is irrefutable evidence that for the same body weight different populations have different risks of getting diabetes it's very clear you look at body mass index you look at you know total body which whichever variable adjust it for height because Asians on average have a lower height um you know in certain populations the predisposition to diabetes clearly is different if we look at populations with genetic predisposition disposition for diabetes some populations have prevalences of over 50% it raises the question what is it about those populations that either they're all making bad choices and in some cases the risk is 60 70% of their adults or is it a combination of things and I think as a scientist one of the things that we must always do is question our assumptions to say these exceptions to the rule May well be questioning the rule that's where I'm going now as you look at history and I'm sure you've done that since you've read a lot about sugar the last 50 years we had two camps we had the London UK camp which was a strong proponent of sugar is the bad culprit we had two camps in the US Minnesota and Boston there were strong proponents of fat fat is the culprit the fat camp won the consequence of that was actually quite profound we had a whole two to three decades of fat is bad we had low fat Foods we had you know low cholesterol this we had low that low and it that fat was replaced in all of our Supermarket foods with high starch high fructose corn syrup everybody wanted a low fat food because fat was bad okay that came because of the argument being now we can get into how food policy was changed and subsidies and what the drivers were I have spent enough time in thinking about food policy in part of my life uh to really dug into understand it wasn't by surprise that the US became the industry driver of high fructose corn syrup wasn't by accident clear policy changes okay then in the more recent past we've seen a rebalancing the sugar Camp arguments have come forward which is all the things you're espousing no question I've given careful thought in actually performing studies on how our body responds all the way to quantifying using radio tracers and radioactive labels to Inhumans to quantify what fraction of protein gets converted to Sugar versus the different sugars stuff I've published given that Collective we do get a much better picture of what you're articulating is that however it that itself all of that on its own doesn't leave leave you with the Assumption of this all or nonone it's one or the other and all I'm saying is there's variability amongst us and that variability results in different responses based on our underlying biology being different we are not there is not such thing in this context metabolically a prototypical single human being that's one of the challenges in creating a digital you know Avatar human to do experiments on it's likely going to be a digital twin not a digital human that's why and it's not just in drug development but understanding our biology if you go back to a paper I published back in the '90s when I was you know young scientist really got interest and saying hey if we eat a lot of protein what happens to it why doesn't our blood sugar go up when we eat protein well maybe it doesn't get converted to Sugar until we Quantified it I published that paper 60 % of the protein if I feed you within 8 hours of consuming it becomes sugar 60% appears in your blood as sugar and yet your blood sugar doesn't change and yes your insulin goes up why why is that different and then you start to understand it's not just the insulin and the sugar the glucagon is different the other hormones are different and so it's the net of that so that was the start of my career I mean I I was supposed to be a classical physician and ended up trying to ask when I got to be a graduate student of the Department of Agriculture most of my peers said why are you going from the medical school to the agriculture school I really wanted to understand this so I spent a fair amount of time thinking about this speaking of things you've spent a fair amount of time thinking about your company's going to need time to get the breakthroughs create the Innovations what lifestyle do you want to see people live so that they're still around to take advantage of the breakthroughs that are coming I think you know um somebody asked me the the same question in a different context which I think is a very important question which is why aren't we investing more in public health right the challenge with public health which I think is is a powerful tool is that there's a lot we know on what needs to be done which would have an impact on individuals and populations but the Gap is the Translating that knowledge into action so we need to invest a lot more in translation of that knowledge and the the you know almost clib example I give is you know if knowledge was the barrier then doctors had never smoke but we know many Physicians I personally know that still smoke not because it's they don't know of course they know I know cardiologists that smoke it's crazy they know but they still smoke so what is it and understanding that gap between knowledge and behavior needs a lot of research and interventions and so in the absence of that so one thing is advocating for that absolutely another thing is figuring out and asking people to do what we already know you and I in some ways I would use the word are fortunate we have bmis I'm just estimating and I know my BMI below 2 3 your below 23 we're in the minority and certainly in my age I inan my 60s I'm in the minority with that BMI and I'm being healthy in in that BMI what why am I different I asked myself that question why am I different what will it take to other for others to do because if others were doing all those things then yes I would answer your question I just don't know how to get others to do that I know what they need to do you live it every day I just don't know how to do it at a scale how do we figure that and I think we have way underinvestigated in the translational Public Health Science and we need to support schools of Public Health just as we're supporting biology uh we need to ask ourselves a question I don't know the exact number but it' be interesting to find out what percentage of US research funding goes to schools of Public Health versus other part academic an interesting question I my guess is a very significant minority yet they've probably had the biggest impact on population health and within that the sum of individuals and probably any part of the medical school but knowing what you know assume you're speaking to people that are willing to do what it takes they are out there um what would you advise them to do I'm guessing not we're not smoking I've never smoked not doing High so what should they be doing I think easy to state but I'll State calories limited to keep your BMI down so that's the quantity side I personally believe I eat everything I eat everything chocolate cake love it dessert love it fried food love it however infrequently abortion control and if you make up if you're going to indulge in one meal make it up for the other I don't have a problem with Indulgence the question is the frequency okay and if you keep that in mind quantity enough gap between meal you have a large meal then skip a meal and that's what I do I have one main meal a day I'm not intermittent fasting that's the fad maybe I was intermitting fasting for years but skip a meal regular activity I have a standing desk in my office yeah I can sit down you know it's the luxury of being the CEO like you hey guys but I have a standing desk I stand I like to hold many of my one-on-one discussions with my executive directs standing up they get used to it they kind of come and talk to mm about an issue we're both going to stand up at my desk it's this high so they have no choice they're going to sit and be underneath it they be standing so they stand after every meeting I go take a walk of the office little things like that good sleep pattern I go to bed early I don't eat late I usually have my dinner around 600 or 7 o' yes I have a busy travel schedule I'm typically on a flight every other week and they're not short flights I'm going to the UK to the US to the Middle East sometimes Asia right long flights I get off a plane I look at my sleep pattern I make sure I go for a walk out in the sunlight everything nothing profound but it's the some of the little things that make up my lifestyle spend a lot of time whenever I'm around with my grandchildren you know people ask me how how how come you so chilled out out you know you have a pretty busy Lifestyle the most calming thing I can do is have a conversation with my little grandchildren talk about it one of the funniest things I heard my grandson we were talking about space travel and I told him in 1969 we had a school class assignment which was to watch the landing on the moon so we could write something about it this was elementary school and I was telling my grandson about this few weeks later I heard him talking to his friend he says you know my grandpa was alive when they landed on the moon this was like the most remarkable I thought now I feel old right but telling them that story is part of that you know we immediately jump to things like what can we eat to stay healthy part of all of our our friendships our circles our family that balance is part of us it's what keeps us healthy I think it's a strong effect on our blood pressure on our stress levels uh we have the tools by the way to measure stress biochemically we can measure in your blood we can measure in your vascular system lots of tools it raises a question to me as a clinician I've got actually a team figur working on this you were talking about feedback I said if you didn't think have to worry about reimbursement insurance or Medicare or UK NHS whatever if you didn't have to worry about it and you didn't have to worry about the cost of it what are the best diagnostic tools we could bring to the table today that are available but not utilized because either they're not rebbur or they're too expensive and they're scientifically proven but the cost of getting them through a regulatory Pro I'm not talking about danger I'm talking about just diagnostic tools what would they be and if they were applied to assess function relative to aging how would you put not one device but the aggregate of it what would that panel look like I don't know the answer to that but I've got a team actually working on that not because we want to create IP around it but I want to bring the best Minds from around the world so we got opthalmologists who's studying vascul in the eye cardiologist studing vasculature muscular skeletal experts biochemists exercise physiologists using all the tools that they do in their profession but now to the clinic domain put it under one roof under one clinician say what that what does that protocol look like if you could do that and it's not going to take one specialty because there is actually not a residency you can do in that specialty you know Pioneers like petera sort of a self-taught but imagine now bringing all these disciplines into a formal training at that depth that hasn't happened what would that look like you know what that would be fascinating if I could do that measurement on you today I suspect you'd be in curious and if it could show well my eye vasculature is at this stage my peripheral vascular is this stage my muscle biologist my stress level in my endothelium is this layer you might want to know that might change so coming back to your question about what could people do there's things they could do but there's things we need to start thinking about doing to the profession so that those who choose now we talked about democratizing you're going to say well that's going to be really expensive and yeah you and I might be able to afford to do that but what about the masses well do you remember uh well I'm old enough you w't may not be old enough you remember I remember when antilock brakes came to the market you literally had to have a really expensive car because the first anti-lock brakes came on Formula 1 cars and they were so expensive it was never considered a technology to be democratized to now the cheapest Asian car you can buy has anti-lock brakes just about okay that was democratization of a very expensive technology for the reason you were saying earlier where you were going you need to have that test case of its potential in a limited market and then another part of Industry figures out out scale it this do the same on diagnostics now one of the question I'm curious what is that anti-ock in the Formula 1 car equivalent and there's lots of examples in Formula 1 that came inertial seat belts this and the other airbags that could be democratized but we need the investment to figure out what the that prototype looks like we haven't up until we started these initiatives it was really the domain of some very ultra wealthy client clinics we want to bridge that figureing it out not to just create commercial scale of it and then figure out how to democratize it but that we need to put to Consumers and I think there's a chunk of consumers I don't like calling them patients patients implies they're coming to you for a disease therapy they're consumers just like we consume anything else they're going to come forward and say I want to know if that now became part of your routine point of care assessment on an annual basis I think the cost would come down you could change Behavior I would want to know my stress level is at a much higher level than the average and I can change it I know that feeling this has been amazing where can people follow you online uh we update I say we because I have help supporting me to I've never got up to speed how to do but I love post posting things on my LinkedIn page we have a LinkedIn page for evolution itself uh through that and uh podcast like you know leaders like yourself uh you're right at The Cutting Edge of this and then there's others who sort of and I'm not trying to um flatter you but you know you yourself influence and then Inspire others to do other versions of this and you're going to see more and more of that and if you think about the announcements that we're making uh in the next 48 hours and certainly in the next 24 hours I think it'll get a lot of attention from people I love it I'm excited everybody speaking of things you should be excited about if you haven't already be sure to subscribe and until next time my friends be legendary take care peace if you enjoyed this episode be sure to check out this other conversation with Peter diamandis you're living through an inflection point in human evolution between Tech like AI Quantum Computing and biotech the next decade will bring about more dramatic change than the last 100 or even 200 years combined

Channel: Tom Bilyeu

Views: 230,932

Keywords: Tom Bilyeu, Impact Theory, ImpactTheory, TomBilyeu, Inside Quest, InsideQuest, Tom Bilyou, Theory Impact, motivation, inspiration, talk show, interview, motivational speech, Mehmood Khan, Hevolution, tombilyeu, Conversations with Tom, Health Theory, mindset, podcasts, how to be successful, entrepreneur, biotech, artificial intelligence, ai, technology, ai healthcare, healthcare, longevity, healthspan

Id: LcUetzyumdw

Length: 151min 34sec (9094 seconds)

Published: Tue Jan 23 2024