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Language: en
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 mmud 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
active contributors to society and their
family and their loved ones if we can do
that Society should care the GDP impact
as 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 12month extension of
healthy life not maximum life but but
just keeping us healthy so Society
absolutely should care Medicare UK NHS
any of these organizations cannot
currently afford the health care cost 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 lots of
surveys done people want to remain
independent active and health not
defined by a 20-year-old if you have
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 to take care of
them when I look at the problem
currently of an aging population where
Health SP is not taken into
consideration and it's just lifespan and
now we're spending just gobs of money on
supporting people from a healthc 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 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 70 years has been extended by at
least 30 years let's say 20 years of
that is requiring sign 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's it'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 Haves 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 great 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
really it requires
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
still 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 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 and 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 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
health span 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-y olds 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 cital norms and expect
people to live and work longer and
contribute more meaningfully to
basically their own caretaking their own
health care uh contributing to GDP all
of that if if we don't figure out a way
to psych locally 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 J coefficient for people
that have never heard that word before
where you get a massive divide between
rich and poor right
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 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
stying 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 Co 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 th 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
old people alive right that was covid
what is 80% of deaths occurred in old
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 everybody 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 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 because it's
misunderstood 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 postor
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 rigidness 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 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 of 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 12 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 dooll business
that will allow you to see your goals
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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'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
differen is 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 glasgal 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 D 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 CH 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 Northwestern
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 the
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 drug 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
biological 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
itself 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 and 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 ice to
monkeys 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 my 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 time
meal then it's probably got multiple
bifurcations over the 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 so uh when I
think about extending human life whether
we're I I'm talking primarily about the
combo of Health span and life span 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 Prin 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 Peter AA
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 by the way
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 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 OIC
OIC is 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
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 Ty
diabetes we'll come back 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 bed 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 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
meure 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 but
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 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 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 eye
complication 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 won't do it because you 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 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 have we' 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 that
risk that you started to see a whole
family of drugs what's 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 timed 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 biology doesn't naturally we 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 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 dict 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 sty you know probably the
least understand might be the brain but
in other organs we're starting to
understand that muscular scattle
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
is sometimes called Zombie cells cells
that are are not functional but haven't
died and got eliminated sin Essence is a
fairly common phenomenon that we're
seeing tiir elongation is is a common
phenomenon 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 telor but elongation sorry is an
intervention y got right and
so those are common which of those are
mechanistically a cause and are
reversible right syence probably is some
of the most powerful literature what
causes sence 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 ccent and
and why some individuals accumulate more
senescent 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 pathway is for ex
an example it is ready and there are
clinical trials going on in humans today
where drugs that actually reduce the
syence load or reduce the impact of that
sence 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 are they actually making this
inessence cell perform better three
lines of interrogation or trials one is
Target and eliminate the siness 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 and 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 sin
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 metformin 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 clinical trials in patients
with diabetes has shown that survival is
better in metform and 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 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 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 then the 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 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 that
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 complex 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 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 the
field clearly if you have diabetes and
unless you have a
contraindication metformin in most
doctor opinions is the first line of
drug we also know as clinicians that if
you are at risk of diabetes and have
impaired 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're
not appr pro for 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 diabetes
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 bodybuilding but resistance
which we know is a good thing is
mitigated if you take Metformin 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 Metformin
how do you overcome that right is it
more exercise a different lifestyle so
there are always trade-offs 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 endpoints and
do a metformin 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 and 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 after
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 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 a Drug's on the market
and then after it's gone off the market
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 a
some meta analysis is 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
our it's 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
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 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 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 trust I say
we spilled over yep 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 GNA
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 anonymous 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 EX
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 an
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 policy I
expect that that's going to happen if
it's provided by your employer you get a
limited life insurance policy then 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 your biological
age if I give you 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
disclose that to your life insurance
policy
M should they take that into
account is that part of the actal
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're raising is absolutely
hypothetical true I'm just is 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 enable AED
by big dad 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 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 key 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 I will speak
for myself pet a friend colleague resp
being I love that guy more than you know
uh but the reality is type two diabetes
according to Tom Bilu is a lifestyle
Choice people are choosing to have type
two 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 agonists on the surface cut
your appetite and therefore you make
better choices as a neurophysiologist
biologist which I'm not a
neurophysiologist but if you ask the
neurophysiologists they raised a much
broader question they actually does more
than that it changes the whole gut
incron 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 in the question is the diabetes
prone person making bad choices making
them
diabetic or is it an underlying biology
that becomes this fishous cycle I think
this last round of therapeutic
interventions has really raised
questions in the minds of
endocrinologists 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
question
when I used to teach this philosophy I
used to say if you go to a refugee camp
uh or you go to
any Mass Gathering crisis after a war or
wherever 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 their
underlying biologies 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
fascinating is the whole
understanding a greater understanding of
our
microbiome we know if you take suddenly
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 mitigate and 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 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
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Theory University join the thousands of
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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 will 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 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 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
that you're aiming at you were the 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
moved 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 his
adapost tissue she uncouples heat great
now I am very emotionally traumatized by
the fact that my wife can eat basically
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 two 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 in 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
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 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 made 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
continued 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 Interventional
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
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 but
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 neuromodulation 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
biological 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
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 getting 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 use 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
knowable that we live 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
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
genino two flaws in that one is we
hadn't sequenced the whole genome see
because at that time the computational
power capability was such that anything
than smaller than about 100 base pairs
or so I'm going off memory now was
considered
noise so we actually only sequen 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 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 set suddenly
have the compu ational 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 as 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 because
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 asked my team
three fairly straightforward questions
right we all know what our vision is
right with one to expand healthy
lifespan for the benefit of
all simple powerful statement we help
craft
it health span benefit of all so if we
look at that as our sort of guiding
North Star 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 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 imagine
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 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 it 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 is finding the
best brightest
Minds those young people to come join
you and 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 the
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
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 his different perspectives you have
got the right to lead but others do 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 counil 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
humans 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 is 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 it's 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 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 F
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
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
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 I want to make sure people
understand what you're actually saying
uh because you 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
Krueger 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
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 space prize which
was sort of the publicly well-known
prize not only achieved technical
success but launched 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 competition is bad but
I'm saying it's not the only tool it is
a tool in the armamentarium to bring
forward an AB 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
borock never made any money he wasn't in
a 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 to Wolf 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 a minimum of a
billion people were SA save from
starvation think of that and so A
Billion Lives saved saved not disease is
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
because 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 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 prise 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 the
private sector to give you cellular
phone technology they didn't invent it
the invention came from the 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 taxpayer primarily
in 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 well 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're 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 contr
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
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 takeaway that contribution is a life
we lived it's a choice contribution in
the examples I've given you as
professional another might be
contribution because I want to be around
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 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 survived the Holocaust
and he um he talked about how basically
you have to find meaning and purpose and
it's sort of the Nan line of he who has
a strong enough why can survive almost
anyhow it's that same idea I think is
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 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 cuz 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 my cocky 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 the 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 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 scientists
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
is one of the for most thinkers in the
world in this space not a biologist but
he's a
bioethicist and we approached him and
said would you put together and he
approached we both approached Professor
Julian at Oxford who's the founding
chair 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
that we're working in shouldn't be my
job as a CEO to do that and it shouldn't
be a scientist 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 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 in
many cases are curable that's a
win however we now 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 their underlying
biology different or 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 so 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 said 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 given 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 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
then liveed through a period where we we
were experimenting on African-Americans
without their
consent right we were at some point
incentivising 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 I'm
picking man because both to donate to
somebody it is quite
possible and the the 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 bists would argue
and I certainly I'm 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 class is 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
scalability 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 cell 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 100 20 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 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
12-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
maybe 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 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 do because you have a more
profound belief in our ability to
change but societies continue to evolve
right people die I'm not sure their
ideas don't die they evolve do we live
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 at 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 or you
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 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 live
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
become have diabetes weight gain was
part of that
too while age is certainly a factor in
type two diabetes I come back to my very
strong conviction that this is you can
track it to the increase amount of sugar
that people eat and probably theology
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 Mig per
deciliter right it's an arbitary
definition doesn't May being depending
on who you look at is 120 118 is 116 not
diabetes so 110 diabetes the
pre-diabetes stamp 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 it's clearly age
related it's not 100% weight related
it's a difference in our body mass lean
body masses a whole iety of things two
individuals I'm Asian you're of
Caucasian descent mhm my risk of getting
type 2 diabetes are 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 can correct
me where I go and by the way this is why
The Who challenge 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 Layman
not again but layman's terms it will
burn you alive from the inside out you
are going to GL ate 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
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 2 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 that 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 two 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
typee 2 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 as 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
lowfat 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
lowfat 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 uh 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 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 and I you
know young scientist really got interest
in 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 with 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 gr grate 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 trans
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 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 23
you're below 23 we're in the the
minority and certainly in my age I'm in
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 gu 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 risk 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 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 meals 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 intermittent 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 mym about an
issue we're both going to stand up at my
desk it's this high so they 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
7:00 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
sum 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 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 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
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 reimbursed or
they're too
expensive and they're scientifically
proven but the cost of getting them
through a regulatory 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 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
studying vascul in the eye cardiologist
tring 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
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 Peter AA 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 and if
it could show well my eye vasculature is
at this stage my peripheral vasculature
is this stage my muscle biologies 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 won't may not be old enough
you remember I remember when antiock
brakes came to the market you literally
had to have a really expensive car
because the first anti-lock brakes came
on Formula One 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
antiock 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 how
to scale it they 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 One 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 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