1 00:00:05,040 --> 00:00:07,720 Speaker 1: Today we're going to talk about the fascinating world of 2 00:00:07,920 --> 00:00:13,720 Speaker 1: prescription drugs and their intersection with culture and society. And 3 00:00:13,800 --> 00:00:16,240 Speaker 1: for that we're going to be joined by science journalist 4 00:00:16,480 --> 00:00:21,880 Speaker 1: Thomas Getz. Medications are some of the most consequential advancements 5 00:00:21,960 --> 00:00:26,720 Speaker 1: of modern life, but their stories are often quite nuanced 6 00:00:26,800 --> 00:00:30,840 Speaker 1: and complicated. What if some of our most common diseases 7 00:00:31,040 --> 00:00:35,519 Speaker 1: are design flaws of modern life? In other words, we 8 00:00:35,600 --> 00:00:39,920 Speaker 1: always need to be asking when we're treating biological illnesses 9 00:00:39,960 --> 00:00:43,760 Speaker 1: and when we're medicating our way around the world that 10 00:00:43,800 --> 00:00:47,440 Speaker 1: we've built. Also, does it matter if we are fixing 11 00:00:47,479 --> 00:00:51,880 Speaker 1: a root cause versus just circumventing it. If a pill 12 00:00:52,040 --> 00:00:57,200 Speaker 1: can quiet hunger or pain or anxiety, is that cheating? 13 00:00:57,720 --> 00:01:02,200 Speaker 1: Do cures ever create the next crisis? So today we're 14 00:01:02,200 --> 00:01:06,720 Speaker 1: going to talk about the larger stories of social ills 15 00:01:07,000 --> 00:01:14,120 Speaker 1: and public health. Welcome to enter cosmos with me David Eagleman. 16 00:01:14,240 --> 00:01:17,160 Speaker 1: I'm a neuroscientist and author at Stanford and in these 17 00:01:17,200 --> 00:01:21,480 Speaker 1: episodes we sail deeply into our three pound universe to 18 00:01:21,560 --> 00:01:42,280 Speaker 1: better understand the world around us. Generally, when we think 19 00:01:42,319 --> 00:01:46,399 Speaker 1: about medicine, we picture a simple story, which is a 20 00:01:46,520 --> 00:01:51,560 Speaker 1: disease appears science identifies the cause and a drug fixes 21 00:01:51,600 --> 00:01:57,040 Speaker 1: the problem. But biology is sufficiently complicated that it rarely 22 00:01:57,440 --> 00:02:02,240 Speaker 1: cooperates with stories that are that your body is trying 23 00:02:02,280 --> 00:02:06,920 Speaker 1: to regulate hunger and mood and pain and sleep and anxiety. 24 00:02:07,320 --> 00:02:11,440 Speaker 1: It balances internal signals against the outside world. But the 25 00:02:11,480 --> 00:02:15,960 Speaker 1: fact is that world has changed faster than our biology 26 00:02:16,160 --> 00:02:20,519 Speaker 1: ever could, and we now live in environments saturated with 27 00:02:20,919 --> 00:02:27,280 Speaker 1: calories and stimulation and stress and chemical shortcuts, and much 28 00:02:27,320 --> 00:02:30,320 Speaker 1: of the world that we've built is designed explicitly to 29 00:02:31,000 --> 00:02:35,079 Speaker 1: capture our attention and to override satiety and to make 30 00:02:35,160 --> 00:02:39,160 Speaker 1: us feel better fast. So it's no surprise that many 31 00:02:39,240 --> 00:02:45,640 Speaker 1: of the most common conditions of modern life, obesity, anxiety, insomnia, 32 00:02:46,160 --> 00:02:52,239 Speaker 1: chronic pain, heart disease, are what scientists sometimes call mismatched diseases. 33 00:02:52,480 --> 00:02:56,440 Speaker 1: In other words, we are ancient biological systems operating in 34 00:02:56,480 --> 00:03:00,120 Speaker 1: a world that we weren't really designed for, and when 35 00:03:00,160 --> 00:03:05,720 Speaker 1: those systems strain, we reach for medications. Now, prescription drugs 36 00:03:05,800 --> 00:03:10,400 Speaker 1: are fascinating from a biology perspective because they are in 37 00:03:10,480 --> 00:03:15,799 Speaker 1: a sense controlled perturbations. You stick some molecules into the bloodstream, 38 00:03:16,320 --> 00:03:20,200 Speaker 1: and those cross barriers and binder receptors and nudge the 39 00:03:20,280 --> 00:03:24,280 Speaker 1: activity in some circuits, and then we watch what happens. 40 00:03:24,760 --> 00:03:29,040 Speaker 1: Sometimes the effects are kind of miraculous, other times they're subtle, 41 00:03:29,440 --> 00:03:33,480 Speaker 1: And sometimes only decades later do we realize that a 42 00:03:33,600 --> 00:03:37,280 Speaker 1: drug meant to solve one problem created some new problem. 43 00:03:37,800 --> 00:03:42,200 Speaker 1: So we end up with medications for anxiety that camp 44 00:03:42,360 --> 00:03:46,800 Speaker 1: down fear, but they create dependence. We get painkillers that 45 00:03:47,320 --> 00:03:52,120 Speaker 1: blunt suffering, but they cause addiction. We have sleep aids 46 00:03:52,200 --> 00:03:56,680 Speaker 1: that knock us out but damage our normal sleep architecture. 47 00:03:57,040 --> 00:04:01,200 Speaker 1: Even the most elegant drugs can rip through the system 48 00:04:01,280 --> 00:04:03,880 Speaker 1: in ways that we never anticipated. Now. Part of the 49 00:04:04,000 --> 00:04:08,240 Speaker 1: challenge is scale. A lot of side effects don't reveal 50 00:04:08,320 --> 00:04:12,320 Speaker 1: themselves until thousands or millions of doses have been taken, 51 00:04:12,640 --> 00:04:15,280 Speaker 1: and part of it is just an issue of humility. 52 00:04:15,520 --> 00:04:21,479 Speaker 1: Our biology is staggeringly complex even today, prescribing a drug 53 00:04:21,520 --> 00:04:25,800 Speaker 1: as something like sending out a sonar ping and hoping 54 00:04:25,839 --> 00:04:30,040 Speaker 1: the echo tells us something useful about what's happening beneath 55 00:04:30,160 --> 00:04:34,960 Speaker 1: the surface. So this raises deeper questions. Are drugs treating 56 00:04:35,040 --> 00:04:40,599 Speaker 1: diseases or sometimes treating symptoms of the world we've built. 57 00:04:40,839 --> 00:04:45,320 Speaker 1: If a pill can quiet hunger signals or reduce cravings 58 00:04:45,400 --> 00:04:48,800 Speaker 1: or lift mood or dull pain. Does that mean the 59 00:04:48,880 --> 00:04:54,760 Speaker 1: problem is solved or merely postponed? And what about responsibility? 60 00:04:54,800 --> 00:04:59,320 Speaker 1: When nearly half the population struggles with obesity, or when 61 00:04:59,600 --> 00:05:04,560 Speaker 1: anxinxiety and depression are among the leading causes of disability worldwide, 62 00:05:05,080 --> 00:05:09,360 Speaker 1: is it meaningful to frame these as individual moral failures? 63 00:05:09,920 --> 00:05:15,240 Speaker 1: Or are we forced to confront the interaction between biology 64 00:05:15,560 --> 00:05:20,880 Speaker 1: and behavior and environment and forced to rethink what choice 65 00:05:21,400 --> 00:05:25,240 Speaker 1: really means. So these questions sit right at the intersection 66 00:05:25,520 --> 00:05:29,360 Speaker 1: of medicine and society. So to dig in on these topics, 67 00:05:29,400 --> 00:05:32,159 Speaker 1: there's no one better to sit down with than science 68 00:05:32,279 --> 00:05:34,880 Speaker 1: journalist Thomas Getz, who has just come out with a 69 00:05:34,960 --> 00:05:39,520 Speaker 1: new podcast series called Drug Story. Every episode of Drug 70 00:05:39,560 --> 00:05:44,920 Speaker 1: Story takes a single prescription drug like ozembic or xanax, 71 00:05:45,000 --> 00:05:48,800 Speaker 1: or ambient or opioids, and uses that drug as a 72 00:05:48,960 --> 00:05:52,320 Speaker 1: lens to tell a much larger story, a story about 73 00:05:52,360 --> 00:05:56,160 Speaker 1: disease and biology, but also about markets and incentives and 74 00:05:56,279 --> 00:06:01,200 Speaker 1: unintended consequences. Thomas gets is an award win journalist. He's 75 00:06:01,279 --> 00:06:04,480 Speaker 1: the former executive editor at Wired and the author of 76 00:06:04,800 --> 00:06:09,240 Speaker 1: The Decision Tree and The Remedy. He spent years reporting 77 00:06:09,279 --> 00:06:11,839 Speaker 1: on medicine and science, and he has a special eye 78 00:06:11,880 --> 00:06:17,600 Speaker 1: for connecting molecular mechanisms to human behavior and individual patients 79 00:06:17,640 --> 00:06:27,200 Speaker 1: to systemic forces. So here's my conversation with Thomas Getz. So, Thomas, 80 00:06:27,240 --> 00:06:30,919 Speaker 1: you've just come out with a podcast series called drug Story. 81 00:06:31,000 --> 00:06:31,960 Speaker 2: Tell us about that. 82 00:06:32,240 --> 00:06:35,840 Speaker 3: I spent the last ten twelve years on an unexpected 83 00:06:35,880 --> 00:06:40,719 Speaker 3: journey deep into pharmacy. So my background is in journalism 84 00:06:40,800 --> 00:06:42,720 Speaker 3: and I have a background in public health. But I 85 00:06:42,800 --> 00:06:46,600 Speaker 3: kept on thinking about the way we use drugs in 86 00:06:46,600 --> 00:06:51,599 Speaker 3: our society to really treat problems which are manifestations of 87 00:06:51,680 --> 00:06:55,040 Speaker 3: much larger problems. So when you think about the major 88 00:06:55,320 --> 00:07:01,360 Speaker 3: kind of maladies of the modern life, like the heart disease, ibetes, obesity, 89 00:07:01,560 --> 00:07:04,640 Speaker 3: even things like depression or anxiety, a lot of these 90 00:07:04,680 --> 00:07:07,760 Speaker 3: things are manifest because of the world we've built. But 91 00:07:07,760 --> 00:07:10,240 Speaker 3: then the thing that we have, one of the things 92 00:07:10,240 --> 00:07:13,160 Speaker 3: that we have to treat them are drugs. And so 93 00:07:13,200 --> 00:07:16,600 Speaker 3: we have medications and we have prescriptions, and it works 94 00:07:17,080 --> 00:07:21,280 Speaker 3: pretty well for some people, but it doesn't actually solve 95 00:07:21,360 --> 00:07:24,000 Speaker 3: the root problems of what's going on. And so I thought, 96 00:07:24,160 --> 00:07:26,680 Speaker 3: I thought the idea of the podcast is to use 97 00:07:27,240 --> 00:07:31,920 Speaker 3: individual drugs to tell these larger stories about disease and 98 00:07:31,960 --> 00:07:36,120 Speaker 3: society and economics and business, but really to focus on 99 00:07:36,160 --> 00:07:39,040 Speaker 3: the drug as a as a kind of proxy or 100 00:07:39,120 --> 00:07:41,480 Speaker 3: mcguffin to tell this larger story. 101 00:07:41,720 --> 00:07:43,560 Speaker 2: So let's take an example of some of the drugs. 102 00:07:43,760 --> 00:07:47,080 Speaker 1: You looked at the EpiPen for allergies, you look to 103 00:07:47,760 --> 00:07:53,200 Speaker 1: ambient for insomnia, xanax for anxiety, at opiates for pain. 104 00:07:54,960 --> 00:07:56,760 Speaker 1: What kind of through lines do you see when you 105 00:07:56,840 --> 00:07:58,800 Speaker 1: when you examine these different stories. 106 00:07:58,800 --> 00:08:02,560 Speaker 3: Right, Well, with that group you just did, all of 107 00:08:02,600 --> 00:08:07,040 Speaker 3: those drugs, oddly have had pretty massive unintended consequences. 108 00:08:07,520 --> 00:08:09,480 Speaker 2: So like EpiPen. 109 00:08:09,840 --> 00:08:13,360 Speaker 3: You know, EpiPen treats anaphylaxis, which is an allergic reaction, 110 00:08:13,440 --> 00:08:16,600 Speaker 3: a severe allergic reaction. But the reason that that kind 111 00:08:16,640 --> 00:08:20,160 Speaker 3: of we had this upsurge in food allergies over the 112 00:08:20,240 --> 00:08:25,320 Speaker 3: last twenty thirty years was actually because the official guidance 113 00:08:25,720 --> 00:08:30,720 Speaker 3: on food and possible allergic foods was exactly backwards. For 114 00:08:30,760 --> 00:08:34,520 Speaker 3: twenty years, the American Academy of Pediatrics was recommending that 115 00:08:34,679 --> 00:08:38,640 Speaker 3: parents avoid exposing their kids to peanuts and milk and 116 00:08:38,760 --> 00:08:41,760 Speaker 3: eggs early in life. Well, then that was under the 117 00:08:41,760 --> 00:08:44,080 Speaker 3: precautionary principle, the idea that they should you know, people 118 00:08:44,120 --> 00:08:47,079 Speaker 3: should do no harm and if something seems risky, then 119 00:08:47,120 --> 00:08:50,240 Speaker 3: avoid it until the kids are a little older. 120 00:08:50,400 --> 00:08:52,360 Speaker 2: Cow's milk, I assume, yeah, yeah, yeah, cow's milk. 121 00:08:52,440 --> 00:08:55,160 Speaker 3: Yes. Well, turns out that was exactly wrong. So it 122 00:08:55,200 --> 00:08:58,679 Speaker 3: turns out that early exposure is really useful and actually 123 00:08:59,240 --> 00:09:02,120 Speaker 3: helps actate their body in the immune system to these 124 00:09:02,160 --> 00:09:05,480 Speaker 3: possible allergens. And in fact, in countries where kids are 125 00:09:05,520 --> 00:09:08,160 Speaker 3: exposed to things like peanuts from a very early age, 126 00:09:08,320 --> 00:09:11,400 Speaker 3: there are basically no peanut allergies. So that was just 127 00:09:11,440 --> 00:09:16,119 Speaker 3: this massive unintended consequences of well well minded, well intended 128 00:09:17,240 --> 00:09:20,720 Speaker 3: guidance that that was just backwards. And so along comes 129 00:09:20,720 --> 00:09:23,240 Speaker 3: the EpiPen and and it was perfectly timed to take 130 00:09:23,240 --> 00:09:27,120 Speaker 3: advantage of this upsurge in food allergies. And along the 131 00:09:27,120 --> 00:09:29,640 Speaker 3: way they raised the prices click click click, and made 132 00:09:29,679 --> 00:09:31,960 Speaker 3: a lot of money and then had congressional hearings and 133 00:09:32,520 --> 00:09:34,800 Speaker 3: it was it was there was a lot of outrage 134 00:09:34,800 --> 00:09:37,240 Speaker 3: about the cost of drugs, which was really the EpiPen 135 00:09:37,400 --> 00:09:39,880 Speaker 3: was case a. But when you look at these other 136 00:09:39,960 --> 00:09:44,720 Speaker 3: drugs like xanax and ambient for instance, these were drugs 137 00:09:44,840 --> 00:09:47,360 Speaker 3: that at the time when they first came out, they 138 00:09:47,360 --> 00:09:50,880 Speaker 3: thought they were perfect pills. They thought they were magic, 139 00:09:51,000 --> 00:09:54,439 Speaker 3: almost magic pills, and because they worked, because they worked 140 00:09:54,520 --> 00:09:58,440 Speaker 3: really well, like ambient works pretty well to put people 141 00:09:58,520 --> 00:10:02,439 Speaker 3: to sleep, and and xanax worked really well to eliminate 142 00:10:02,559 --> 00:10:04,200 Speaker 3: somebody's anxiety really quickly. 143 00:10:04,400 --> 00:10:05,319 Speaker 2: But it turns out that. 144 00:10:05,320 --> 00:10:08,679 Speaker 3: These these same medications, because they work so well, they 145 00:10:08,720 --> 00:10:13,280 Speaker 3: create different human behaviors, and so people take them too much. 146 00:10:13,360 --> 00:10:15,400 Speaker 3: They tend to abuse them, they tend to get tolerant 147 00:10:15,440 --> 00:10:19,679 Speaker 3: to them, and it's really hard to stop using them oftentimes. 148 00:10:20,040 --> 00:10:22,040 Speaker 2: So those are great examples of kind. 149 00:10:21,880 --> 00:10:27,920 Speaker 3: Of the the unintended results of using these medications in 150 00:10:29,000 --> 00:10:34,800 Speaker 3: great amounts millions of people without enough kind of attention 151 00:10:34,920 --> 00:10:37,000 Speaker 3: paid to what are the possible consequences. 152 00:10:37,280 --> 00:10:39,680 Speaker 1: Yeah, our society is like a giant and amical system, 153 00:10:39,679 --> 00:10:41,160 Speaker 1: and so when you push down over here, you get 154 00:10:41,160 --> 00:10:43,920 Speaker 1: something else happening over here, and so on. Would we 155 00:10:44,400 --> 00:10:47,720 Speaker 1: have been better off without these drugs, though presumably not, 156 00:10:48,000 --> 00:10:53,440 Speaker 1: because if somebody has insomnia, or somebody has high anxiety 157 00:10:53,640 --> 00:10:56,240 Speaker 1: or an allergic reaction, we still want to be able 158 00:10:56,240 --> 00:10:56,800 Speaker 1: to help them. 159 00:10:56,840 --> 00:10:57,600 Speaker 2: What's your take on that. 160 00:10:57,760 --> 00:11:02,600 Speaker 3: Yeah, Yeah, totally. So, yes, these are useful medications. The 161 00:11:02,679 --> 00:11:07,920 Speaker 3: trick is how to use them. So again, thinking about 162 00:11:07,960 --> 00:11:11,680 Speaker 3: xanax or ambient, they're really at this point intended to 163 00:11:11,679 --> 00:11:14,760 Speaker 3: be used for very short periods of time when something 164 00:11:14,840 --> 00:11:18,280 Speaker 3: is acutely wrong. Right, so somebody is having a lot 165 00:11:18,320 --> 00:11:22,679 Speaker 3: of trouble sleeping, then maybe an ambient is appropriate to 166 00:11:22,800 --> 00:11:26,600 Speaker 3: use for a very short duration and then to remove 167 00:11:26,640 --> 00:11:30,480 Speaker 3: it and come up with much more durable, sustainable solutions 168 00:11:30,520 --> 00:11:33,560 Speaker 3: like not using your screen in bed and things like that, 169 00:11:34,040 --> 00:11:38,440 Speaker 3: more behavioral solutions. The trouble is that patients get prescribe 170 00:11:38,480 --> 00:11:42,760 Speaker 3: these drugs and they work, and so the patient reasonably 171 00:11:42,840 --> 00:11:45,280 Speaker 3: it says, why can't I keep on taking these drugs? 172 00:11:45,679 --> 00:11:50,079 Speaker 3: Where they're not necessarily cognizant of the dependencies or the 173 00:11:50,160 --> 00:11:53,760 Speaker 3: talents that their body are acclimating to the drugs. So 174 00:11:54,240 --> 00:11:58,160 Speaker 3: we have to think about these drugs not as the solution, 175 00:11:58,400 --> 00:12:02,320 Speaker 3: but as part of a much order kind of program 176 00:12:02,679 --> 00:12:06,360 Speaker 3: or treatment program. And one of the problems that we 177 00:12:06,400 --> 00:12:10,440 Speaker 3: have in medicine is that a lot of doctors are 178 00:12:10,480 --> 00:12:14,600 Speaker 3: just not trained or don't have the time to manage 179 00:12:14,920 --> 00:12:18,400 Speaker 3: individual therapies closely enough. And it's just a matter of 180 00:12:18,679 --> 00:12:21,640 Speaker 3: time and man hours and billing, and it's the complexity 181 00:12:21,679 --> 00:12:25,080 Speaker 3: of our healthcare system. But what happens in reality is 182 00:12:25,080 --> 00:12:27,360 Speaker 3: people get prescribed to drug, they leave the doctor's office, 183 00:12:27,480 --> 00:12:29,920 Speaker 3: it works, and they just keep refilling it. And so 184 00:12:30,000 --> 00:12:33,400 Speaker 3: for those drugs, those drugs that have potential abuse or 185 00:12:33,520 --> 00:12:36,280 Speaker 3: dependency issues, those are really the ones that we need 186 00:12:36,280 --> 00:12:38,839 Speaker 3: to work out or watch out for. And obviously opiates 187 00:12:38,880 --> 00:12:42,400 Speaker 3: are a prime example of this. You know, they really 188 00:12:42,520 --> 00:12:47,600 Speaker 3: should have only been prescribed for acute pain temporary short durations, 189 00:12:47,800 --> 00:12:51,160 Speaker 3: but they were widely prescribed for even moderate chronic pain, 190 00:12:51,520 --> 00:12:54,360 Speaker 3: and people took them for months, years, and we had 191 00:12:54,480 --> 00:12:56,040 Speaker 3: an epidemic of addiction. 192 00:12:56,360 --> 00:12:59,040 Speaker 1: And speaking of pain medications like opiates, where are we 193 00:12:59,080 --> 00:13:02,800 Speaker 1: now with that now, How that opiates are considered persona 194 00:13:02,880 --> 00:13:05,520 Speaker 1: non grata, what's the future of pain control? 195 00:13:05,880 --> 00:13:08,480 Speaker 3: One of the things about opiates that was that was 196 00:13:08,600 --> 00:13:11,839 Speaker 3: again kind of an undertended consequence, was that they were 197 00:13:11,880 --> 00:13:17,880 Speaker 3: really widely prescribed. When pain experts started to recognize that 198 00:13:18,280 --> 00:13:22,520 Speaker 3: and argue that pain should be acknowledged, should be a 199 00:13:23,520 --> 00:13:27,439 Speaker 3: was worthy of treatment, because pain was really not considered 200 00:13:27,440 --> 00:13:30,360 Speaker 3: and doctors were not treating patients for their pain, so 201 00:13:30,679 --> 00:13:33,320 Speaker 3: they there was a program around the late nineties early 202 00:13:33,360 --> 00:13:36,960 Speaker 3: two thousands called pain as the fifth vital sign, where 203 00:13:37,040 --> 00:13:41,160 Speaker 3: they instructed doctors. They were recommended doctors ask people just 204 00:13:41,200 --> 00:13:45,120 Speaker 3: like they took their blood pressure or their their breathing rate. 205 00:13:45,559 --> 00:13:47,840 Speaker 3: They said, okay, a fifth vital sign would be ask 206 00:13:47,920 --> 00:13:50,800 Speaker 3: your patients whether they're experiencing pain. So it was a 207 00:13:50,880 --> 00:13:53,320 Speaker 3: zero to ten scale. Zero is no pain, ten is 208 00:13:53,480 --> 00:13:57,959 Speaker 3: excruciating unbearable pain, and doctors started asking their patients about 209 00:13:57,960 --> 00:14:00,800 Speaker 3: their pain level. That was one dull in terms of 210 00:14:00,800 --> 00:14:03,679 Speaker 3: flushing out a problem that people a lot of people have. 211 00:14:03,760 --> 00:14:06,760 Speaker 3: Twenty twenty five percent of Americans deal with chronic pain, 212 00:14:07,000 --> 00:14:10,600 Speaker 3: so it's a massive issue. The problem, the unattended consequence 213 00:14:11,040 --> 00:14:13,960 Speaker 3: was that once that was on the table, it became 214 00:14:14,000 --> 00:14:17,640 Speaker 3: something that the physician was then obliged to treat. And 215 00:14:17,920 --> 00:14:20,920 Speaker 3: different people had very different ways of rating their pain. 216 00:14:21,320 --> 00:14:23,680 Speaker 3: So for me, what would be a two, could for 217 00:14:23,720 --> 00:14:26,320 Speaker 3: you be a ten. The doctor was really in no 218 00:14:26,440 --> 00:14:30,240 Speaker 3: way of understanding what the relative concern was. But the 219 00:14:30,960 --> 00:14:34,960 Speaker 3: treatment at hand at the time was opioids, and specifically 220 00:14:35,000 --> 00:14:37,880 Speaker 3: oxy content, which had just been approved as a supposedly 221 00:14:38,040 --> 00:14:41,560 Speaker 3: safe version of an opioid. So it seemed like a 222 00:14:41,560 --> 00:14:46,800 Speaker 3: great opportunity to use a so called safe drug to 223 00:14:46,920 --> 00:14:51,480 Speaker 3: treat a newly cognizant condition. Well, it didn't work out 224 00:14:51,480 --> 00:14:54,280 Speaker 3: that way. It turns out oxy content was highly addictive. 225 00:14:54,320 --> 00:14:59,400 Speaker 3: People would abuse it rampantly. So opioids solved the problem, 226 00:14:59,440 --> 00:15:02,080 Speaker 3: but they, as we've been saying, they created other problems. 227 00:15:02,360 --> 00:15:06,120 Speaker 3: So now or pain therapy are they're trying to find 228 00:15:06,160 --> 00:15:09,760 Speaker 3: new ways of dealing with again that very real problem 229 00:15:09,800 --> 00:15:12,000 Speaker 3: for twenty twenty five percent of Americans. So there are 230 00:15:12,240 --> 00:15:14,920 Speaker 3: new drugs, There are non opioid drugs. There's a new 231 00:15:14,960 --> 00:15:19,560 Speaker 3: one called gernaviks, which was just approved last year twenty 232 00:15:19,600 --> 00:15:24,800 Speaker 3: twenty five, by Vertex Pharmaceuticals. It's a non opioid peripheral 233 00:15:25,520 --> 00:15:28,720 Speaker 3: nerve agent, so it doesn't work on the brain, doesn't 234 00:15:28,720 --> 00:15:32,400 Speaker 3: work on the opioid receptors. They're very insistent and glad 235 00:15:32,520 --> 00:15:36,040 Speaker 3: that it works on the peripheral nerve systems. The trick though, 236 00:15:36,120 --> 00:15:39,000 Speaker 3: is that has only been approved for acute pain, not 237 00:15:39,440 --> 00:15:43,400 Speaker 3: chronic pain. So people can use it for two weeks 238 00:15:43,480 --> 00:15:47,560 Speaker 3: four weeks, but insurance will only cover it, will only 239 00:15:47,600 --> 00:15:50,160 Speaker 3: pay for the drug for that amount of treatment. Now, 240 00:15:50,160 --> 00:15:53,240 Speaker 3: I spoke for my podcast, I spoke to some patients 241 00:15:53,320 --> 00:15:55,960 Speaker 3: who actually have found it very useful for their chronic pain, 242 00:15:56,360 --> 00:15:58,600 Speaker 3: but their pain out of pocket, and that's one of 243 00:15:58,600 --> 00:16:00,840 Speaker 3: the problems. And it's about a thousand dollars a month 244 00:16:00,880 --> 00:16:02,560 Speaker 3: to pay out a pocket, which which is a lot 245 00:16:02,600 --> 00:16:06,200 Speaker 3: of money. So the drug company is trying to get 246 00:16:06,200 --> 00:16:09,840 Speaker 3: evidence that it works for chronic pain on a population level. 247 00:16:09,840 --> 00:16:12,280 Speaker 3: They're trying to bring that to the FDA. That's a 248 00:16:12,320 --> 00:16:16,840 Speaker 3: whole process that is ongoing. But we're still trying to 249 00:16:16,880 --> 00:16:21,040 Speaker 3: find solutions to pain. One of the things that actually works. 250 00:16:21,040 --> 00:16:23,280 Speaker 3: And again you know more about this than I, but 251 00:16:23,400 --> 00:16:26,440 Speaker 3: cognitive behavioral therapy for a lot of these issues turns 252 00:16:26,440 --> 00:16:30,880 Speaker 3: out to be a very effective long term solution. But 253 00:16:31,440 --> 00:16:34,920 Speaker 3: the issues there are access to therapists, access treatment, so 254 00:16:35,320 --> 00:16:39,120 Speaker 3: there are consequences or concerns onto a self. 255 00:16:39,480 --> 00:16:41,520 Speaker 1: I mean, the good news is with apps and AI 256 00:16:41,680 --> 00:16:44,720 Speaker 1: and so on, things like cognitive behavioral therapy can be 257 00:16:44,920 --> 00:16:49,320 Speaker 1: addressed at scale now in new ways totally. Yet people 258 00:16:49,400 --> 00:16:52,960 Speaker 1: still like in a sense taking pills. What's the attraction 259 00:16:53,200 --> 00:16:56,200 Speaker 1: to saying, hey, here's a solution, I swallow this, I'm 260 00:16:56,200 --> 00:16:57,000 Speaker 1: going to be fixed. 261 00:16:57,480 --> 00:17:00,240 Speaker 3: Well, it seems like an easy fix, and one of 262 00:17:00,240 --> 00:17:02,760 Speaker 3: the things I learned was it's only really in the 263 00:17:02,840 --> 00:17:06,160 Speaker 3: last fifty seventy five years that we've had this kind 264 00:17:06,240 --> 00:17:10,120 Speaker 3: of medicine cabinet of drugs like behind in most pharmacies 265 00:17:10,160 --> 00:17:12,520 Speaker 3: there are about two or three thousand drugs behind the counter. 266 00:17:12,600 --> 00:17:14,959 Speaker 3: A lot of those drugs have been only developed in 267 00:17:15,160 --> 00:17:16,000 Speaker 3: recent decades. 268 00:17:16,600 --> 00:17:18,720 Speaker 2: The big boom in the pharma. 269 00:17:18,480 --> 00:17:21,679 Speaker 3: Industry was in the fifties, sixties, seventies, eighties, where we 270 00:17:21,720 --> 00:17:25,840 Speaker 3: had these whole classes of drugs emerge. So they provided 271 00:17:26,880 --> 00:17:30,600 Speaker 3: real answers or apparently provided real answers to all these 272 00:17:30,640 --> 00:17:37,320 Speaker 3: problems heart disease, diabetes, you know, the ps, psychiatric concerns. 273 00:17:37,680 --> 00:17:40,680 Speaker 2: So that's awesome, but on the other. 274 00:17:40,520 --> 00:17:44,840 Speaker 3: Hand, we've only had a few years to understand what 275 00:17:45,000 --> 00:17:48,879 Speaker 3: works best. And one of the things that has always 276 00:17:48,880 --> 00:17:52,680 Speaker 3: surprised me is that the odds of any drug working 277 00:17:53,000 --> 00:17:57,560 Speaker 3: for any individual are roughly a coin flip. It's roughly 278 00:17:57,560 --> 00:17:59,840 Speaker 3: about fifty percent chance. So you go to something like 279 00:18:00,040 --> 00:18:03,879 Speaker 3: an antidepressant and there's kind of a thirty percent chance 280 00:18:03,960 --> 00:18:06,080 Speaker 3: than any given antidepressant is going to work for any 281 00:18:06,200 --> 00:18:06,840 Speaker 3: given patient. 282 00:18:07,200 --> 00:18:10,280 Speaker 2: So what that means is trial and error. 283 00:18:10,640 --> 00:18:14,280 Speaker 3: So patients are kind of start a drug, they take 284 00:18:14,320 --> 00:18:16,320 Speaker 3: it for a few weeks, they see if it works. 285 00:18:16,320 --> 00:18:18,160 Speaker 3: If it doesn't, they go to a different drug. If 286 00:18:18,160 --> 00:18:20,320 Speaker 3: that doesn't work, they go to a different drug. Well, 287 00:18:20,320 --> 00:18:23,240 Speaker 3: on average, it can take a person seeking treatment for depression. 288 00:18:23,280 --> 00:18:25,680 Speaker 3: It can take them six months or more to find 289 00:18:25,680 --> 00:18:27,760 Speaker 3: something that works. We talk about that as a process, 290 00:18:27,960 --> 00:18:31,320 Speaker 3: but it's not exactly a process for the patient's experience, right, 291 00:18:31,359 --> 00:18:35,520 Speaker 3: it's a it's a kind of a trudging through darkness. 292 00:18:35,119 --> 00:18:38,639 Speaker 3: It's a real struggle to get to something that works. 293 00:18:38,920 --> 00:18:43,280 Speaker 3: And that's true not just for psychiatric conditions or chronic pain. 294 00:18:43,680 --> 00:18:45,800 Speaker 3: It's also true for something like heart disease because you 295 00:18:45,840 --> 00:18:50,240 Speaker 3: have other variables like side effects like diarrhea is probably 296 00:18:50,240 --> 00:18:54,280 Speaker 3: the most common side effect to drugs. When you're taking chemicals, 297 00:18:54,280 --> 00:18:56,720 Speaker 3: putting them into the body, your body reacts in some 298 00:18:56,760 --> 00:18:59,520 Speaker 3: ways that are intended, some ways that are not intended. 299 00:18:59,680 --> 00:19:02,960 Speaker 3: Sometimes you can tolerate those unintended consequences, sometimes you can't. 300 00:19:03,400 --> 00:19:06,400 Speaker 3: So that all adds up into the recipe of does 301 00:19:06,480 --> 00:19:09,159 Speaker 3: it work. It's not just a clinical sense, it's like 302 00:19:09,280 --> 00:19:13,480 Speaker 3: does it work for you as a patient, And for 303 00:19:14,119 --> 00:19:17,880 Speaker 3: most conditions, that is a process, and it's a messy one. 304 00:19:17,920 --> 00:19:20,800 Speaker 3: And it's a muddy one, and it has a lot 305 00:19:20,840 --> 00:19:39,520 Speaker 3: of frustration and anxiety and frustration to it. 306 00:19:39,520 --> 00:19:42,280 Speaker 1: It seems to me the central issue is that biology 307 00:19:42,359 --> 00:19:45,760 Speaker 1: is insanely complicated, right. I mean, we often talk about 308 00:19:45,760 --> 00:19:47,960 Speaker 1: the brain is the most complex thing we've discovered in 309 00:19:48,000 --> 00:19:50,920 Speaker 1: the known universe. And so what we're trying to do 310 00:19:51,040 --> 00:19:53,600 Speaker 1: is say, look, here's a here's a molecule of a 311 00:19:53,640 --> 00:19:56,320 Speaker 1: particular shape, and if you take a bunch of those in, 312 00:19:56,680 --> 00:19:59,520 Speaker 1: they'll bind some receptor. And what we're going to hope 313 00:19:59,600 --> 00:20:04,080 Speaker 1: is that that that fixes this whole system, whether that's depression, anxiety, insomnia, 314 00:20:04,119 --> 00:20:07,520 Speaker 1: whatever it is. And it seems almost impossible that that 315 00:20:07,560 --> 00:20:10,399 Speaker 1: will ever work. But sometimes not just things in the 316 00:20:10,480 --> 00:20:13,400 Speaker 1: right direction, or let's say, for fifty percent of patients, 317 00:20:13,400 --> 00:20:17,320 Speaker 1: as you mentioned. So, what is your take on how 318 00:20:17,400 --> 00:20:20,919 Speaker 1: you see the drug industry nowadays? Having been doing this 319 00:20:21,000 --> 00:20:23,359 Speaker 1: drug story for a while now, how. 320 00:20:23,200 --> 00:20:23,720 Speaker 2: Are you seeing this? 321 00:20:23,800 --> 00:20:27,359 Speaker 1: Do you see drugs as miracles of biology that they 322 00:20:27,400 --> 00:20:30,960 Speaker 1: work sometimes or problems for society? 323 00:20:31,240 --> 00:20:35,800 Speaker 3: You're exactly right, these are complicated systems. You've got biology 324 00:20:35,840 --> 00:20:39,600 Speaker 3: and the brain, like the brain is even in these 325 00:20:39,640 --> 00:20:43,359 Speaker 3: biological illnesses, the brain is still at play. Like just 326 00:20:43,400 --> 00:20:47,320 Speaker 3: with allergies, there's this constant fear and concern about that 327 00:20:47,359 --> 00:20:50,120 Speaker 3: people have before they take an EpiPen shot. People who 328 00:20:50,160 --> 00:20:53,399 Speaker 3: have an EpiPen in their purse, they describe to me 329 00:20:53,440 --> 00:20:57,399 Speaker 3: this whole thing about like is a reaction EpiPen worthy 330 00:20:57,760 --> 00:21:01,280 Speaker 3: because they just aren't sure if they should waste that 331 00:21:01,320 --> 00:21:03,920 Speaker 3: shot or take that shot which costs three hundred dollars 332 00:21:04,040 --> 00:21:06,879 Speaker 3: or so. So there are all these psychological concerns that 333 00:21:06,920 --> 00:21:09,359 Speaker 3: get wrapped up into the biological So that's the first thing. 334 00:21:09,600 --> 00:21:13,080 Speaker 3: Now back to your question, like what about the drug industry. 335 00:21:13,359 --> 00:21:17,760 Speaker 3: I think drugs are an amazing accomplishment of our society 336 00:21:17,800 --> 00:21:21,000 Speaker 3: and of medicine and of clinical medicine and of public health. 337 00:21:21,119 --> 00:21:25,520 Speaker 3: Right like, they save and treat thousands of people, millions 338 00:21:25,560 --> 00:21:28,639 Speaker 3: of people every day in this country around the world. 339 00:21:28,720 --> 00:21:33,600 Speaker 3: They save lives, full stop. Drugs are a benefit to society. 340 00:21:33,880 --> 00:21:37,520 Speaker 3: The trouble comes when we expect drugs as you as 341 00:21:37,600 --> 00:21:39,680 Speaker 3: we just were talking about, like you take the pill 342 00:21:39,880 --> 00:21:43,440 Speaker 3: and it's going to fix the problem. That that isn't 343 00:21:43,440 --> 00:21:46,440 Speaker 3: the way it works. On the one hand, biology isn't 344 00:21:46,440 --> 00:21:50,520 Speaker 3: that simple, and two it isn't fixing the larger problems 345 00:21:50,520 --> 00:21:55,680 Speaker 3: of these these deeper social conditions that oftentimes are creating 346 00:21:56,160 --> 00:22:01,600 Speaker 3: the disease or the illness. So there's this great evolutionary 347 00:22:01,600 --> 00:22:05,320 Speaker 3: biologist in at Harvard called Daniel Lieberman, you might know them. 348 00:22:06,520 --> 00:22:10,120 Speaker 3: So he talks about these as mismatched diseases that we've 349 00:22:10,200 --> 00:22:12,960 Speaker 3: put our body like we've designed a world that is 350 00:22:13,080 --> 00:22:17,320 Speaker 3: very comfortable and accommodating, but it's not necessarily the world 351 00:22:17,359 --> 00:22:20,879 Speaker 3: that our bodies evolve to inhabit. And so we a 352 00:22:20,880 --> 00:22:24,480 Speaker 3: lot of these diseases, like heart disease or obesity, are 353 00:22:24,480 --> 00:22:27,960 Speaker 3: the results of the context in which we live. And 354 00:22:28,000 --> 00:22:31,480 Speaker 3: so the diseases we're getting, like like heart disease or obesity, 355 00:22:31,520 --> 00:22:35,800 Speaker 3: are not the inevitable result of human life. They are 356 00:22:35,840 --> 00:22:39,520 Speaker 3: the exact consequence of the world we've built, the food 357 00:22:39,560 --> 00:22:41,160 Speaker 3: systems we've created. 358 00:22:41,359 --> 00:22:44,040 Speaker 1: So this is a good segue into GLP one. Yeah, yeah, 359 00:22:44,080 --> 00:22:45,320 Speaker 1: so let's talk about that, right. 360 00:22:45,359 --> 00:22:48,080 Speaker 3: So glp ones are so I should say when I 361 00:22:48,160 --> 00:22:52,680 Speaker 3: started the episode on GLP one, so ozempic. 362 00:22:52,960 --> 00:22:54,520 Speaker 1: I was, by the way, for anyone who doesn't know, 363 00:22:54,600 --> 00:22:56,680 Speaker 1: GLP one's glucagon like peptide one. 364 00:22:56,920 --> 00:22:58,440 Speaker 2: And these are the drugs that people are taking for 365 00:22:58,480 --> 00:22:59,040 Speaker 2: weight loss. 366 00:22:59,320 --> 00:23:02,280 Speaker 3: Yes, and they they basically you'll describe it better than 367 00:23:02,280 --> 00:23:04,440 Speaker 3: I will, but I'll describe it in simple terms. They 368 00:23:04,520 --> 00:23:08,160 Speaker 3: basically interfere with the signal between your gut and your brain, 369 00:23:08,480 --> 00:23:10,640 Speaker 3: and so they turn off your cravings. 370 00:23:11,200 --> 00:23:12,000 Speaker 2: That's exactly right. 371 00:23:12,040 --> 00:23:14,240 Speaker 1: These are normal hormones that you have in your gut 372 00:23:14,320 --> 00:23:16,760 Speaker 1: that tell the brain, Okay, now you're full, go on, 373 00:23:16,880 --> 00:23:20,560 Speaker 1: do the next thing. And the GLP one drugs are 374 00:23:21,040 --> 00:23:24,400 Speaker 1: what are called agonists to these receptors. They mimic the 375 00:23:24,520 --> 00:23:27,080 Speaker 1: action of these hormones so that they tell the brain, hey, 376 00:23:27,160 --> 00:23:28,040 Speaker 1: no problem, you're full. 377 00:23:28,400 --> 00:23:30,360 Speaker 3: A lot like you're a neuroscientists, you explain it better 378 00:23:30,359 --> 00:23:32,280 Speaker 3: than I would. So the GLB ones what they do 379 00:23:32,560 --> 00:23:35,760 Speaker 3: is they they because they interfere with that signal, they 380 00:23:35,800 --> 00:23:39,040 Speaker 3: turn off what is called food noise in the brain. 381 00:23:39,119 --> 00:23:43,080 Speaker 3: So they stop people from craving these foods that you know, 382 00:23:43,640 --> 00:23:45,160 Speaker 3: eat more and more and more. 383 00:23:45,560 --> 00:23:47,560 Speaker 2: And they have other benefits as well. 384 00:23:47,600 --> 00:23:50,440 Speaker 1: But so what people feel like is just not hungry. 385 00:23:50,440 --> 00:23:52,040 Speaker 1: I'm just not thinking about. 386 00:23:51,760 --> 00:23:55,760 Speaker 3: Food, right, And so sometimes they so people who oftentimes 387 00:23:56,280 --> 00:24:00,320 Speaker 3: had spent decades trying to just not eat one or 388 00:24:00,840 --> 00:24:04,119 Speaker 3: find it easy to not eat one more or not 389 00:24:04,240 --> 00:24:08,439 Speaker 3: at all, and so it's been extremely helpful for individuals 390 00:24:08,480 --> 00:24:12,680 Speaker 3: for whom who have been struggling for years, for decades 391 00:24:12,880 --> 00:24:17,399 Speaker 3: with being overweight, being obese, and the consequent health consequences 392 00:24:17,440 --> 00:24:22,240 Speaker 3: of that like diabetes, joint pain, you know. 393 00:24:22,200 --> 00:24:24,960 Speaker 1: Obstructive sleep, app now, all the things that come with obesity, 394 00:24:25,040 --> 00:24:25,600 Speaker 1: that's right. 395 00:24:25,600 --> 00:24:27,760 Speaker 3: Just being able to move, just being able to live 396 00:24:27,800 --> 00:24:29,919 Speaker 3: a active life. 397 00:24:30,040 --> 00:24:33,080 Speaker 2: And how many millions of people are on these GLP 398 00:24:33,160 --> 00:24:33,760 Speaker 2: one drugs now? 399 00:24:33,760 --> 00:24:36,720 Speaker 3: Well, so there are there are about forty percent of 400 00:24:36,760 --> 00:24:40,280 Speaker 3: Americans ro obese, so that's that's more than one hundred 401 00:24:40,280 --> 00:24:45,600 Speaker 3: million people. And so far about ten percent of Americans 402 00:24:45,640 --> 00:24:50,040 Speaker 3: have taken a GLP one so that's that's thirty million people. 403 00:24:50,080 --> 00:24:52,560 Speaker 1: And when you say have taken, once you start, you 404 00:24:52,600 --> 00:24:56,360 Speaker 1: really have to continue, right, so you are taking people for. 405 00:24:56,320 --> 00:24:58,840 Speaker 3: Most people, but there is there is a it is 406 00:24:58,960 --> 00:25:01,560 Speaker 3: possible or for some I should say this, some people 407 00:25:01,600 --> 00:25:05,440 Speaker 3: do have success in tight trading, in backing off where 408 00:25:05,440 --> 00:25:07,400 Speaker 3: they reach their target weight and they're able to then 409 00:25:07,520 --> 00:25:12,840 Speaker 3: kind of maintain behavioral fixes that that don't make them 410 00:25:12,840 --> 00:25:14,880 Speaker 3: depend on the drugs. But yeah, for most people, they're 411 00:25:14,920 --> 00:25:17,280 Speaker 3: going to be taking the GLP one for the rest 412 00:25:17,320 --> 00:25:20,359 Speaker 3: of their life now, that there's nothing bad about that. 413 00:25:20,400 --> 00:25:21,439 Speaker 2: There's no shame in that. 414 00:25:21,960 --> 00:25:24,320 Speaker 3: If you are prescribed as statin, you will take your 415 00:25:24,320 --> 00:25:26,080 Speaker 3: statin for the rest of your life. If you have 416 00:25:26,119 --> 00:25:28,119 Speaker 3: a high bloodressure medication, you're you'll be taking that for 417 00:25:28,119 --> 00:25:28,680 Speaker 3: the rest of your life. 418 00:25:28,680 --> 00:25:30,520 Speaker 2: Blood thinners rest of your life. Yeah, exactly. 419 00:25:30,600 --> 00:25:32,560 Speaker 3: So it's not that that is that is one of 420 00:25:32,560 --> 00:25:34,760 Speaker 3: the things that we wait one of the ways we 421 00:25:34,920 --> 00:25:38,280 Speaker 3: use medicine. But the thing about golp ones is it's 422 00:25:38,440 --> 00:25:41,480 Speaker 3: very much an individual treatment, right it is. It is 423 00:25:41,800 --> 00:25:45,280 Speaker 3: one person changing the way they eat and it solves 424 00:25:45,280 --> 00:25:49,159 Speaker 3: the problem for them. When you're talking about a population 425 00:25:49,320 --> 00:25:53,240 Speaker 3: wide problem like obesity, again forty percent of Americans being obese, 426 00:25:53,320 --> 00:25:57,400 Speaker 3: soon to be fifty percent, you're looking at really huge 427 00:25:57,440 --> 00:26:02,200 Speaker 3: social issues that when you are prescribing things like glp ones, 428 00:26:02,240 --> 00:26:06,560 Speaker 3: which at present are very expensive drugs, it just becomes 429 00:26:07,040 --> 00:26:09,800 Speaker 3: a really difficult proposition to think about, Okay, well, how 430 00:26:09,840 --> 00:26:13,400 Speaker 3: are we as a society going to afford that, and 431 00:26:13,600 --> 00:26:17,119 Speaker 3: are there other changes that we could be making that 432 00:26:17,160 --> 00:26:19,680 Speaker 3: would be given the amount of money that we would 433 00:26:19,680 --> 00:26:23,160 Speaker 3: be spending, which is something like one point five trillion dollars. 434 00:26:23,240 --> 00:26:26,639 Speaker 3: If you put everyone everyone in America who's obese on 435 00:26:26,720 --> 00:26:29,560 Speaker 3: a GLP one at full price, it would be one 436 00:26:29,600 --> 00:26:30,600 Speaker 3: and a half trillion dollars. 437 00:26:30,920 --> 00:26:32,359 Speaker 2: So that's a lot of money. 438 00:26:32,520 --> 00:26:33,720 Speaker 3: We could do a lot of things with one and 439 00:26:33,720 --> 00:26:36,640 Speaker 3: a half trillion dollars, including change some of the food 440 00:26:36,680 --> 00:26:38,880 Speaker 3: systems that we have. So you just have to think 441 00:26:38,880 --> 00:26:42,560 Speaker 3: about the kind of trade offs and costs. 442 00:26:42,680 --> 00:26:45,000 Speaker 1: So specifically, what you're thinking about is you feel like 443 00:26:45,560 --> 00:26:51,760 Speaker 1: food manufacturers have done things to optimize food for consumption, 444 00:26:51,960 --> 00:26:56,280 Speaker 1: to make them salty and sugary and fatty and small 445 00:26:56,359 --> 00:26:59,119 Speaker 1: and tasty and so on, So you can keep going 446 00:26:59,160 --> 00:26:59,520 Speaker 1: with it. 447 00:26:59,800 --> 00:27:02,280 Speaker 2: This is what you're addressing. Yeah, well there's I mean, 448 00:27:02,640 --> 00:27:03,720 Speaker 2: they have been doing that. 449 00:27:03,680 --> 00:27:05,920 Speaker 1: Right and so and so the point you're addressing here 450 00:27:06,080 --> 00:27:09,879 Speaker 1: is that not only could we be addressing this with 451 00:27:09,960 --> 00:27:12,240 Speaker 1: drugs with JLP ones, but also doing something about the 452 00:27:12,240 --> 00:27:14,359 Speaker 1: food industry. I do have a question, though, what would 453 00:27:14,359 --> 00:27:18,560 Speaker 1: you How would you actually legislate that, because what they're 454 00:27:18,600 --> 00:27:21,719 Speaker 1: doing is making food so that people will buy that 455 00:27:21,760 --> 00:27:24,720 Speaker 1: food and enjoy that food, and you can't exactly legislate 456 00:27:24,760 --> 00:27:28,440 Speaker 1: to say, hey, don't make it as tasty as you have. 457 00:27:28,800 --> 00:27:31,960 Speaker 3: Right, So I'm not saying that you have to legislate it. 458 00:27:32,000 --> 00:27:35,800 Speaker 3: I'm not saying that it requires government intervention. It could, 459 00:27:35,960 --> 00:27:38,840 Speaker 3: but it doesn't require that. I think one of the 460 00:27:38,880 --> 00:27:41,879 Speaker 3: things that's interesting that we're seeing is that when people 461 00:27:41,920 --> 00:27:45,600 Speaker 3: take these GLP ones and the food noise turns off, 462 00:27:45,880 --> 00:27:51,200 Speaker 3: they independently change what they decide to eat. They eat 463 00:27:51,240 --> 00:27:56,159 Speaker 3: more vegetables, right, They don't eat the stuff that is 464 00:27:56,200 --> 00:27:59,159 Speaker 3: full of sugar, fat and salt that is on the 465 00:27:59,200 --> 00:28:02,679 Speaker 3: shelvesult processed foods, and so what you end up seeing 466 00:28:03,080 --> 00:28:08,000 Speaker 3: is that the food companies themselves are trying to anticipate 467 00:28:08,240 --> 00:28:12,040 Speaker 3: new products and develop new products that are in fact 468 00:28:12,240 --> 00:28:15,720 Speaker 3: more healthy, more appealing to the millions of people who 469 00:28:15,760 --> 00:28:19,160 Speaker 3: are taking glp ones. So that is a market based solution, right, 470 00:28:19,760 --> 00:28:23,840 Speaker 3: People's people are changing their behavior and the industry is 471 00:28:24,160 --> 00:28:27,960 Speaker 3: trying to change in turn. That would be wonderful if 472 00:28:28,119 --> 00:28:35,040 Speaker 3: food companies develop healthier, less quote unquote less addictive foods 473 00:28:35,600 --> 00:28:39,239 Speaker 3: that that people would want to buy and and that 474 00:28:39,280 --> 00:28:43,960 Speaker 3: don't don't end up, you know, manifesting in in excess 475 00:28:44,000 --> 00:28:45,280 Speaker 3: body fat and obesity. 476 00:28:45,800 --> 00:28:47,880 Speaker 2: So so some of that is. 477 00:28:47,640 --> 00:28:51,560 Speaker 3: Market based, but there is possibly a role for you know, 478 00:28:51,760 --> 00:28:55,920 Speaker 3: the FDA, the f and FDA stands for food. Food 479 00:28:56,120 --> 00:28:59,400 Speaker 3: labeling is something that they governed. They can control kind 480 00:28:59,440 --> 00:29:03,360 Speaker 3: of claims of being healthy, they can control claims of 481 00:29:03,680 --> 00:29:05,800 Speaker 3: good for you, things like that. So there are ways 482 00:29:05,800 --> 00:29:09,640 Speaker 3: that that regulatory arms can be brought to bear. 483 00:29:09,760 --> 00:29:11,480 Speaker 1: Yeah, and it makes sense because when people are on 484 00:29:11,560 --> 00:29:15,080 Speaker 1: GLP ones and they start eating more healthy foods, more 485 00:29:15,120 --> 00:29:19,520 Speaker 1: salubrious foods, it's because they know that they should be 486 00:29:19,600 --> 00:29:22,160 Speaker 1: doing it, and they no longer have the pull of 487 00:29:22,240 --> 00:29:25,760 Speaker 1: this tempting sugar, salt fat thing over there, so they're 488 00:29:25,800 --> 00:29:27,880 Speaker 1: able to just think through the problem and make the 489 00:29:27,960 --> 00:29:31,280 Speaker 1: right choice. And so making sure the labeling is correct 490 00:29:31,400 --> 00:29:36,239 Speaker 1: so that something doesn't erroneously say falsely say hey this 491 00:29:36,320 --> 00:29:39,480 Speaker 1: is healthy for you allows people to make good decisions 492 00:29:39,600 --> 00:29:40,760 Speaker 1: use the rationality there. 493 00:29:40,800 --> 00:29:43,360 Speaker 3: But I have a question for you, and I'm actually curious, 494 00:29:44,240 --> 00:29:49,040 Speaker 3: what do you make of the idea that foods are 495 00:29:49,080 --> 00:29:52,600 Speaker 3: addictive or might be addictive, that some foods could be addictive. 496 00:29:52,640 --> 00:29:55,040 Speaker 2: Do you think that's true that other I do think 497 00:29:55,040 --> 00:29:55,600 Speaker 2: it's true. 498 00:29:56,240 --> 00:30:00,840 Speaker 1: What's interesting is people sometimes use the word designed there 499 00:30:00,920 --> 00:30:04,000 Speaker 1: as in the companies designed the food. But there's also 500 00:30:04,000 --> 00:30:06,160 Speaker 1: a sense in which it's just evolved. It's a natural 501 00:30:06,200 --> 00:30:09,680 Speaker 1: evolution that you know, people gravitate towards things with more 502 00:30:09,760 --> 00:30:11,400 Speaker 1: salt and fat and sugar and so on, and they 503 00:30:11,560 --> 00:30:17,000 Speaker 1: like these things. So we've always had, you know, junkie 504 00:30:17,080 --> 00:30:19,240 Speaker 1: food like this, and we just have more and more 505 00:30:19,320 --> 00:30:21,280 Speaker 1: of it. So this leads to this interesting question that 506 00:30:21,320 --> 00:30:24,600 Speaker 1: you post in your podcast, which is does it seem 507 00:30:24,680 --> 00:30:28,400 Speaker 1: like it's cheating to take GLP ones? So, first of all, 508 00:30:28,400 --> 00:30:32,320 Speaker 1: what have you seen in your interviews in your research 509 00:30:32,760 --> 00:30:37,680 Speaker 1: do people feel like, hey, this is cheating to take 510 00:30:37,720 --> 00:30:40,280 Speaker 1: this drug and lose weight that way as opposed to 511 00:30:40,880 --> 00:30:42,840 Speaker 1: doing the hard work of going to the gym and 512 00:30:43,440 --> 00:30:44,880 Speaker 1: resisting and using willpower. 513 00:30:45,080 --> 00:30:47,560 Speaker 3: So that is the debate that is that has been 514 00:30:47,600 --> 00:30:50,440 Speaker 3: the debate in part around GLP ones. That has also 515 00:30:50,480 --> 00:30:53,960 Speaker 3: been the debate around obesity itself for decades, that this 516 00:30:54,120 --> 00:30:58,200 Speaker 3: was something that individuals should just you know, take control 517 00:30:58,200 --> 00:31:02,160 Speaker 3: of their own free will, live better, exercise more, lose 518 00:31:02,200 --> 00:31:05,440 Speaker 3: the weight. It's not that easy, and it hasn't worked 519 00:31:05,480 --> 00:31:09,280 Speaker 3: that way because that argument has been made for decades 520 00:31:09,600 --> 00:31:12,880 Speaker 3: and the obesity rate has been climbing every year, so 521 00:31:12,920 --> 00:31:16,680 Speaker 3: there's larger systems at play. Part of the problem I 522 00:31:16,720 --> 00:31:20,640 Speaker 3: think with that debate is that one the foods actually 523 00:31:20,680 --> 00:31:24,600 Speaker 3: are manipulating our brains in ways that are maybe outside 524 00:31:24,640 --> 00:31:27,240 Speaker 3: of our personal control, that they are addictive in some sense, 525 00:31:27,280 --> 00:31:30,960 Speaker 3: some of these foods. The other concern is that this 526 00:31:31,800 --> 00:31:37,880 Speaker 3: debate around cheating is one where we are blaming people. 527 00:31:37,960 --> 00:31:41,640 Speaker 3: There's still this kind of this notion of blame and 528 00:31:41,720 --> 00:31:46,959 Speaker 3: responsibility for obesity in particular, which we don't necessarily have. 529 00:31:47,040 --> 00:31:50,040 Speaker 3: There's a lot of stigma to obesity that we don't 530 00:31:50,080 --> 00:31:54,080 Speaker 3: have with other diseases, even something like high cholesterol. It's 531 00:31:54,080 --> 00:31:58,640 Speaker 3: just often behavioral based. It doesn't appear you don't look 532 00:31:58,680 --> 00:32:00,800 Speaker 3: when you have high cholesterol. It doesn't really look like 533 00:32:00,840 --> 00:32:03,240 Speaker 3: you do. So there's not as it's not as easy 534 00:32:03,240 --> 00:32:07,680 Speaker 3: to attribute stigma. But it's also a particularly American problem 535 00:32:07,880 --> 00:32:13,640 Speaker 3: or American argument about individual responsibility. Other countries, other cultures 536 00:32:14,040 --> 00:32:19,800 Speaker 3: do not have as strong a history of individualism and 537 00:32:20,040 --> 00:32:25,040 Speaker 3: individual responsibility, where there's two edges to the sword that 538 00:32:25,080 --> 00:32:29,400 Speaker 3: you are both have the freedom to pursue your own interests, 539 00:32:29,640 --> 00:32:32,760 Speaker 3: but also you have to be in control and suffer 540 00:32:32,840 --> 00:32:37,360 Speaker 3: the consequences of your decisions and choices. That is a 541 00:32:37,520 --> 00:32:42,600 Speaker 3: very American way of looking at individual choices, and again 542 00:32:43,160 --> 00:32:47,080 Speaker 3: Europe other societies do not have as strong a strain 543 00:32:47,240 --> 00:32:51,400 Speaker 3: of individualism. They have much more of a commonality or 544 00:32:52,200 --> 00:32:57,360 Speaker 3: communal notion of health and responsibility, and so they don't 545 00:32:57,400 --> 00:33:00,479 Speaker 3: kind of have this culture of blame, which is problem 546 00:33:01,040 --> 00:33:09,600 Speaker 3: again uniquely American one. 547 00:33:17,640 --> 00:33:20,000 Speaker 1: So this is interesting because it all comes down to 548 00:33:20,040 --> 00:33:23,560 Speaker 1: this question of whether obesity is a choice. Right, you're 549 00:33:23,600 --> 00:33:25,760 Speaker 1: saying with the double edged sword, you know, you have 550 00:33:26,800 --> 00:33:29,640 Speaker 1: all those freedom to do things, but also you're responsible 551 00:33:29,640 --> 00:33:31,880 Speaker 1: for your choices. But this is really the heart of 552 00:33:31,880 --> 00:33:36,440 Speaker 1: the issue is biologically there's a huge amount of variation 553 00:33:36,560 --> 00:33:39,640 Speaker 1: on any axis that you measure, and some of these 554 00:33:39,680 --> 00:33:42,840 Speaker 1: axes have to do with, for example, how much food 555 00:33:42,920 --> 00:33:47,560 Speaker 1: noise one has, how saated one can be when one eats, 556 00:33:47,600 --> 00:33:50,800 Speaker 1: and so on. There are genetic differences, there are you know, 557 00:33:50,960 --> 00:33:53,280 Speaker 1: childhood differences and so on. All these things add up 558 00:33:53,280 --> 00:33:57,280 Speaker 1: to people being quite different from one another. So the 559 00:33:57,360 --> 00:34:00,320 Speaker 1: question here is about choice, because this doesn't take weigh 560 00:34:00,360 --> 00:34:03,440 Speaker 1: somebody's choice, but it does bound it. And this is 561 00:34:03,480 --> 00:34:06,560 Speaker 1: I think the important part to recognize with all this 562 00:34:06,760 --> 00:34:09,920 Speaker 1: is that we all make choices and we're all bound. 563 00:34:10,040 --> 00:34:13,480 Speaker 1: We're fenced in by our biology, and sometimes we're fenced 564 00:34:13,520 --> 00:34:16,279 Speaker 1: in differently so the answer is both, we're you know, 565 00:34:16,360 --> 00:34:21,880 Speaker 1: we're making decisions, but we don't come to the table equally. 566 00:34:22,160 --> 00:34:24,160 Speaker 2: But I totally agree with that. 567 00:34:24,480 --> 00:34:27,960 Speaker 3: I would also say we're fenced in by our society 568 00:34:28,040 --> 00:34:31,680 Speaker 3: and culture and by industry. So in the nineteen eighties, 569 00:34:33,120 --> 00:34:35,960 Speaker 3: Nabisco and Craft, that two of the largest food companies 570 00:34:36,080 --> 00:34:40,239 Speaker 3: in the world, were bought by big tobacco companies, and 571 00:34:40,360 --> 00:34:44,280 Speaker 3: big tobacco brought all the science and engineering and marketing 572 00:34:44,400 --> 00:34:47,560 Speaker 3: that they had learned in cigarettes to food, and so 573 00:34:47,600 --> 00:34:52,320 Speaker 3: they started to create snack foods that were even better, 574 00:34:52,640 --> 00:34:56,799 Speaker 3: even more irresistible. Now you might say, like that's just 575 00:34:57,040 --> 00:35:02,240 Speaker 3: good business, that was just smart, you know, of their markets, 576 00:35:02,960 --> 00:35:04,920 Speaker 3: but there was a recent study that actually showed that 577 00:35:05,640 --> 00:35:10,919 Speaker 3: the food products that were sold by those companies when 578 00:35:10,920 --> 00:35:14,200 Speaker 3: they were owned by big tobacco were actually eighty percent 579 00:35:14,520 --> 00:35:19,480 Speaker 3: higher in salt, sugar, and fat than products that were 580 00:35:19,480 --> 00:35:24,440 Speaker 3: owned by non tobacco companies. So they were actually engineered 581 00:35:25,239 --> 00:35:31,160 Speaker 3: to be very high in those ingredients because people like them. 582 00:35:31,200 --> 00:35:34,000 Speaker 3: As you say, because that's what people are choosing. But 583 00:35:34,200 --> 00:35:37,840 Speaker 3: at what point does that notion of choice and choosing 584 00:35:37,920 --> 00:35:40,840 Speaker 3: certain products just because they taste better, just because we 585 00:35:41,280 --> 00:35:44,480 Speaker 3: crave them. At what point does that stop being an 586 00:35:44,520 --> 00:35:48,160 Speaker 3: individual decision and start being something that you know. There 587 00:35:48,200 --> 00:35:52,239 Speaker 3: are larger structures and forces at work. There's marketing in 588 00:35:52,280 --> 00:35:54,960 Speaker 3: terms of the grocery stores, and we're what's being put 589 00:35:54,960 --> 00:35:58,520 Speaker 3: at light level, that's paid for, that's placement. There's the 590 00:35:58,680 --> 00:36:02,799 Speaker 3: commercials that were being told these foods are irresistible and 591 00:36:02,840 --> 00:36:05,560 Speaker 3: that's a good thing. So those are all the contexts 592 00:36:05,600 --> 00:36:10,880 Speaker 3: that I think also surround these ideas of individual choice 593 00:36:10,600 --> 00:36:13,439 Speaker 3: that have a great deal of influence and have had 594 00:36:13,560 --> 00:36:17,920 Speaker 3: a great deal of invisible influence on our diets and 595 00:36:17,960 --> 00:36:20,000 Speaker 3: on our behavior in the past decades. 596 00:36:20,320 --> 00:36:22,120 Speaker 1: Absolutely right, And I think the way we can put 597 00:36:22,120 --> 00:36:25,040 Speaker 1: this together is to think about the fence lines around 598 00:36:25,080 --> 00:36:29,080 Speaker 1: your own behavior, given your biology, in the context of 599 00:36:29,239 --> 00:36:31,879 Speaker 1: the world that you're in. Some people will just have 600 00:36:31,920 --> 00:36:35,000 Speaker 1: the capacity to watch it Rito's commercial and resist and 601 00:36:35,000 --> 00:36:37,120 Speaker 1: not pick them up. And other people will watch it 602 00:36:37,120 --> 00:36:38,960 Speaker 1: and they have so much food noise from that, and 603 00:36:39,000 --> 00:36:42,360 Speaker 1: they have so much craving, and they're influenced by the 604 00:36:42,400 --> 00:36:44,759 Speaker 1: marketing and so on, and they go for it. The 605 00:36:44,840 --> 00:36:49,839 Speaker 1: question is, given your genetics and your experience, what is 606 00:36:49,920 --> 00:36:54,600 Speaker 1: your capacity to resist and make good choices in the 607 00:36:54,640 --> 00:36:55,400 Speaker 1: context that you're in. 608 00:36:55,560 --> 00:36:58,200 Speaker 3: Yeah, and it does have I mean there are socioeconomic 609 00:36:58,280 --> 00:37:03,719 Speaker 3: variables here too. Wealthier people have more opportunity and more agency. 610 00:37:04,640 --> 00:37:08,400 Speaker 3: One of your former colleagues, Albert Bendora, talks about self efficacy, 611 00:37:08,440 --> 00:37:12,960 Speaker 3: the ability to form our own make our own choices, 612 00:37:13,000 --> 00:37:15,960 Speaker 3: the confidence that we have to guide our own paths. 613 00:37:16,200 --> 00:37:19,560 Speaker 3: That is something that that wealthy people have much more 614 00:37:19,719 --> 00:37:21,760 Speaker 3: of than people who are not wealthy. 615 00:37:21,800 --> 00:37:22,759 Speaker 2: They they you know, more. 616 00:37:22,680 --> 00:37:25,080 Speaker 3: Stresses in life. So those are all those are all 617 00:37:25,120 --> 00:37:25,759 Speaker 3: issues as well. 618 00:37:26,200 --> 00:37:28,000 Speaker 2: Just before we go off GLP ones. 619 00:37:28,040 --> 00:37:31,680 Speaker 1: And my question is there are all these other consequences 620 00:37:31,719 --> 00:37:34,880 Speaker 1: that they're having that are extraordinary, like people are giving 621 00:37:34,960 --> 00:37:38,279 Speaker 1: up smoking and gambling and other sorts of things. 622 00:37:38,280 --> 00:37:39,200 Speaker 2: What's your take on this? 623 00:37:39,680 --> 00:37:42,279 Speaker 3: Well, it makes sense right again, you're the neuroscientist. I'm not, 624 00:37:43,080 --> 00:37:45,439 Speaker 3: but they seem to this. They seem to be things 625 00:37:45,480 --> 00:37:49,840 Speaker 3: that are also affected by these pathways. So substance abuse, drinking, 626 00:37:50,320 --> 00:37:55,279 Speaker 3: drinking alcohol to access. Uh, these are all behaviors that 627 00:37:55,680 --> 00:37:58,759 Speaker 3: where we're hitting our pleasure centers, we're hitting our dopamine 628 00:37:59,080 --> 00:38:02,560 Speaker 3: receptors whatever it is they work on our brain and 629 00:38:02,680 --> 00:38:06,439 Speaker 3: GOLP ones somehow turn it off, and it's I think 630 00:38:06,520 --> 00:38:09,320 Speaker 3: where they're just starting to do clinical trials in these areas. 631 00:38:09,600 --> 00:38:14,680 Speaker 3: It's extremely promising. It's extremely hopeful for human health much 632 00:38:14,680 --> 00:38:19,160 Speaker 3: more broadly. And remember, we're getting much stronger, better, more 633 00:38:19,200 --> 00:38:23,040 Speaker 3: effective GLP ones in the pipeline. We're going to start 634 00:38:23,080 --> 00:38:28,040 Speaker 3: having oral GLP one's pills. Right now it's injections. So 635 00:38:28,120 --> 00:38:31,040 Speaker 3: once we get to pills and that are going to 636 00:38:31,080 --> 00:38:36,000 Speaker 3: be more efficacious at fixing or addressing some of those behaviors, 637 00:38:36,000 --> 00:38:40,360 Speaker 3: some of those issues. I think the doors are wide 638 00:38:40,400 --> 00:38:42,640 Speaker 3: open to how these drugs are going to help us 639 00:38:42,960 --> 00:38:43,720 Speaker 3: in the years ahead. 640 00:38:44,040 --> 00:38:45,920 Speaker 1: Now, by the way, you made a very interesting calculation 641 00:38:46,000 --> 00:38:48,600 Speaker 1: in your podcast, which is that it would cost, as 642 00:38:48,640 --> 00:38:51,640 Speaker 1: you mentioned earlier, one point five trillion to get let's 643 00:38:51,680 --> 00:38:53,560 Speaker 1: just say we're talking about ABCD to get everyone with 644 00:38:53,600 --> 00:38:56,440 Speaker 1: ob city in America on these trucks. But what you 645 00:38:56,680 --> 00:38:59,880 Speaker 1: calculated is why this might actually make sense to spend 646 00:38:59,880 --> 00:39:00,480 Speaker 1: that money. 647 00:39:00,600 --> 00:39:03,440 Speaker 3: Yeah, well that's with the caveat that's full list price. 648 00:39:03,600 --> 00:39:06,040 Speaker 3: So you know they're talks about doing deals with the 649 00:39:06,080 --> 00:39:09,239 Speaker 3: drug companies to lower those prices. But roughly that had 650 00:39:09,320 --> 00:39:10,640 Speaker 3: one point five trillion dollars. 651 00:39:10,600 --> 00:39:12,200 Speaker 2: If it were that ye, why would it be worth it. 652 00:39:12,320 --> 00:39:15,080 Speaker 3: Yeah, So the reason it's worth it, I think is 653 00:39:15,120 --> 00:39:19,160 Speaker 3: because we spend hundreds of billions of dollars. We spend 654 00:39:19,200 --> 00:39:23,520 Speaker 3: five trillion dollars on healthcare in this country every year, right, 655 00:39:23,600 --> 00:39:26,319 Speaker 3: more than any other nation on Earth. And out of 656 00:39:26,360 --> 00:39:29,840 Speaker 3: that five trillion, we spend hundreds of billions of dollars 657 00:39:29,920 --> 00:39:33,719 Speaker 3: on obesity. We spend hundreds of hundreds of billions of 658 00:39:33,719 --> 00:39:37,560 Speaker 3: dollars on diabetes, hundreds of billions of dollars on heart disease. 659 00:39:37,960 --> 00:39:38,840 Speaker 2: So if we're. 660 00:39:39,040 --> 00:39:44,200 Speaker 3: Addressing obesity, which is upstream from all of these other conditions, well, 661 00:39:44,520 --> 00:39:48,080 Speaker 3: we would be chipping away at the amount we're expending 662 00:39:48,200 --> 00:39:52,200 Speaker 3: on those issues, right, So there it wouldn't be kind 663 00:39:52,239 --> 00:39:55,560 Speaker 3: of erasing them altogether, but we would spend far less 664 00:39:55,880 --> 00:40:00,279 Speaker 3: on diabetes if we had far fewer people go from 665 00:40:00,320 --> 00:40:05,200 Speaker 3: obesity into diabetes. That's one point, But the other issue 666 00:40:05,560 --> 00:40:08,520 Speaker 3: is really I think goes to kind of quality of 667 00:40:08,560 --> 00:40:12,000 Speaker 3: life and quality of health span, Like how do we 668 00:40:12,160 --> 00:40:16,520 Speaker 3: help people have the best possible life that they can, 669 00:40:16,640 --> 00:40:19,800 Speaker 3: the best possible health they can before they get sick. 670 00:40:20,120 --> 00:40:22,399 Speaker 3: And that's one of the things that's so promising about 671 00:40:22,440 --> 00:40:26,480 Speaker 3: these GLP ones is they're really good at prevention, and 672 00:40:26,760 --> 00:40:30,160 Speaker 3: so if we can if we can help people pay 673 00:40:30,200 --> 00:40:33,160 Speaker 3: that one point five trillion dollars to give people better 674 00:40:33,200 --> 00:40:36,480 Speaker 3: lives instead of waiting for them to get sick and 675 00:40:36,520 --> 00:40:39,200 Speaker 3: go in the hospital and you know, surgery and all 676 00:40:39,239 --> 00:40:41,440 Speaker 3: these other things that we spend that five trillion dollars on. 677 00:40:42,120 --> 00:40:45,360 Speaker 3: That's that's probably a good argument to spend that money. 678 00:40:50,040 --> 00:40:54,280 Speaker 1: That was my interview with Thomas Getz. Thomas's podcast Drug 679 00:40:54,360 --> 00:40:57,640 Speaker 1: Story dives into many topics that we didn't touch on here, 680 00:40:58,080 --> 00:41:02,560 Speaker 1: like lipiitour and heart does ease, or zoloft and depression, 681 00:41:02,800 --> 00:41:07,960 Speaker 1: or xanax and anxiety, or ambient and insomnia and so on. 682 00:41:08,200 --> 00:41:12,080 Speaker 1: So I just want to summarize by hitting three issues first. 683 00:41:12,160 --> 00:41:16,000 Speaker 1: From the point of view of biology, every drug is 684 00:41:16,040 --> 00:41:17,560 Speaker 1: a hypothesis. 685 00:41:18,000 --> 00:41:19,000 Speaker 2: It is a guess. 686 00:41:19,000 --> 00:41:23,600 Speaker 1: It's a carefully engineered intervention into a system that we 687 00:41:23,719 --> 00:41:29,040 Speaker 1: only partially understand. We identify a receptor or a pathway 688 00:41:29,120 --> 00:41:33,160 Speaker 1: or a circuit, and we nudget. Sometimes the result is great, 689 00:41:33,200 --> 00:41:38,200 Speaker 1: you get meaningful relief. Other times the effects are delayed, 690 00:41:38,400 --> 00:41:42,759 Speaker 1: or they're indirect, or they're only visible years later, when 691 00:41:42,760 --> 00:41:45,719 Speaker 1: millions of bodies have already been changed. The fact is 692 00:41:45,760 --> 00:41:49,400 Speaker 1: that even with all the massive progress in biology, we 693 00:41:49,480 --> 00:41:53,600 Speaker 1: still don't have predictable outcomes, and we're not going to 694 00:41:53,760 --> 00:41:56,360 Speaker 1: for as far as we can squint into the future, 695 00:41:56,400 --> 00:42:01,560 Speaker 1: We're always working to scratch out insight to a vast 696 00:42:01,960 --> 00:42:07,399 Speaker 1: dynamical system that is shaped by evolution and development and experience. 697 00:42:07,880 --> 00:42:11,640 Speaker 1: So when we intervene chemically, we always want to act 698 00:42:11,680 --> 00:42:15,560 Speaker 1: on a single system, but we essentially never can. Instead, 699 00:42:15,640 --> 00:42:19,399 Speaker 1: all we can do is perturb a system that's going 700 00:42:19,440 --> 00:42:23,839 Speaker 1: to adapt and compensate, and that often surprises us. For 701 00:42:23,880 --> 00:42:27,719 Speaker 1: the most part, medicine just can't tackle the complexity of 702 00:42:27,920 --> 00:42:32,040 Speaker 1: everything happening under the hood, at least not yet. Medicine 703 00:42:32,040 --> 00:42:36,520 Speaker 1: can't simulate the entirety of your biology, at least not yet, 704 00:42:36,760 --> 00:42:40,760 Speaker 1: and certainly can't simulate your biology decades into the future 705 00:42:41,160 --> 00:42:44,120 Speaker 1: to see what the long term effects of drugs are 706 00:42:44,320 --> 00:42:49,520 Speaker 1: or aren't. When you're dealing with exceedingly complex systems like 707 00:42:49,520 --> 00:42:53,120 Speaker 1: the human body, it's just impossible to have certainty. And 708 00:42:53,160 --> 00:42:55,880 Speaker 1: that's exactly why so many of the drugs on the 709 00:42:55,920 --> 00:43:01,680 Speaker 1: market come with complicated stories that stretch beyond the biology. 710 00:43:01,400 --> 00:43:03,080 Speaker 2: Into societal issues. 711 00:43:03,480 --> 00:43:05,320 Speaker 1: The second thing I want to point out is the 712 00:43:05,400 --> 00:43:09,720 Speaker 1: question that is always there about the distinction between normal 713 00:43:09,840 --> 00:43:16,120 Speaker 1: human experiences and medical conditions. If you have grief after 714 00:43:16,160 --> 00:43:20,360 Speaker 1: you lose a parent, or sadness after some hardship, or 715 00:43:20,440 --> 00:43:24,960 Speaker 1: anxiety in stressful moments, those shouldn't be thought of as diseases. 716 00:43:25,040 --> 00:43:30,160 Speaker 1: Those are just appropriate human responses to life. They become 717 00:43:30,440 --> 00:43:34,600 Speaker 1: medical diagnoses when they persist without a clear cause, when 718 00:43:34,600 --> 00:43:38,759 Speaker 1: they become chronic, when they start to impair your daily functioning, 719 00:43:38,880 --> 00:43:43,040 Speaker 1: like we see with clinical depression or anxiety disorders or 720 00:43:43,120 --> 00:43:46,520 Speaker 1: chronic pain. In those cases we can say, okay, the 721 00:43:46,600 --> 00:43:49,799 Speaker 1: issue is not just a specific event or injury, but 722 00:43:49,880 --> 00:43:54,480 Speaker 1: an ongoing physiological state, and treating it medically can both 723 00:43:54,560 --> 00:43:58,439 Speaker 1: be appropriate and life changing. And modern medicine has made 724 00:43:58,680 --> 00:44:03,319 Speaker 1: unbelievably great progress in addressing these conditions with drugs as 725 00:44:03,440 --> 00:44:09,040 Speaker 1: part of broader treatment approaches. But the boundary between normal 726 00:44:09,160 --> 00:44:16,160 Speaker 1: human suffering and diagnosable disease, that boundary is subjective sometimes 727 00:44:16,160 --> 00:44:19,800 Speaker 1: and it's always blurry, and that raises really difficult questions 728 00:44:19,800 --> 00:44:25,040 Speaker 1: about when treatment is warranted and how society decides which 729 00:44:25,080 --> 00:44:29,960 Speaker 1: conditions justify large scale medical intervention. And these are questions 730 00:44:29,960 --> 00:44:34,120 Speaker 1: for which there are no simple or definitive answers. Finally, 731 00:44:34,160 --> 00:44:37,239 Speaker 1: I want to highlight Thomas's view that many of the 732 00:44:37,280 --> 00:44:41,440 Speaker 1: conditions we now medicate, things like obesity and anxiety and 733 00:44:41,520 --> 00:44:46,400 Speaker 1: pain and insomnia, these are signals, their messages from nervous 734 00:44:46,400 --> 00:44:50,920 Speaker 1: systems doing their best to regulate themselves in a world 735 00:44:51,000 --> 00:44:55,359 Speaker 1: that often pushes them out of equilibrium. Drugs can help, 736 00:44:55,400 --> 00:44:59,560 Speaker 1: sometimes they help enormously, but they also reveal the limits 737 00:44:59,600 --> 00:45:04,879 Speaker 1: of a purely pharmacological solution. They remind us that biology 738 00:45:04,960 --> 00:45:11,040 Speaker 1: and culture are never cleanly separable, and that treating downstream 739 00:45:11,160 --> 00:45:15,839 Speaker 1: symptoms without addressing upstream causes is only going to take 740 00:45:15,920 --> 00:45:20,080 Speaker 1: us so far. So we're probably never going to find 741 00:45:20,200 --> 00:45:25,359 Speaker 1: the perfect molecules that finally fix everything. But perhaps we'll 742 00:45:25,400 --> 00:45:31,000 Speaker 1: get better at integration drugs alongside changes that we're able 743 00:45:31,040 --> 00:45:34,480 Speaker 1: to make in our environment and our behavior, in our 744 00:45:34,640 --> 00:45:40,080 Speaker 1: policy and our technology, we'll get better at pairing molecules 745 00:45:40,120 --> 00:45:45,840 Speaker 1: with psychology and neuroscience and social design. So to my mind, 746 00:45:46,120 --> 00:45:49,400 Speaker 1: one of the most important things about understanding prescription drugs 747 00:45:49,680 --> 00:45:53,399 Speaker 1: is resisting simple stories, and Thomas does a good job 748 00:45:53,400 --> 00:45:57,760 Speaker 1: with that. Prescription drugs have changed the world for the better, 749 00:45:58,400 --> 00:46:02,600 Speaker 1: and also their stories can be complicated. So what we 750 00:46:02,680 --> 00:46:05,719 Speaker 1: can do is keep researching. We can build bigger and 751 00:46:05,760 --> 00:46:09,520 Speaker 1: bigger simulations with the help of massive computational models. 752 00:46:09,960 --> 00:46:12,920 Speaker 2: We can leverage AI to understand those models. 753 00:46:12,960 --> 00:46:17,640 Speaker 1: We can measure carefully, we can watch for unintended consequences. 754 00:46:17,920 --> 00:46:19,400 Speaker 2: And that's what science does. 755 00:46:19,600 --> 00:46:23,880 Speaker 1: It just keeps getting better, such that in one hundred 756 00:46:23,920 --> 00:46:29,120 Speaker 1: years from now, when some future broadcaster makes Drug Story two, 757 00:46:29,760 --> 00:46:33,040 Speaker 1: the interplay between our drugs, our bodies, and the world 758 00:46:33,080 --> 00:46:40,840 Speaker 1: we've built will hopefully be much more straightforward. Go to 759 00:46:40,880 --> 00:46:44,080 Speaker 1: eagleman dot com slash podcast for more information and to 760 00:46:44,160 --> 00:46:47,799 Speaker 1: find further readings. Join the weekly discussions on my substack, 761 00:46:48,000 --> 00:46:51,000 Speaker 1: and check out and subscribe to Inner Cosmos on YouTube 762 00:46:51,120 --> 00:46:54,160 Speaker 1: for videos of each episode and to leave comments Until 763 00:46:54,200 --> 00:46:59,160 Speaker 1: next time. I'm David Eagleman, and this is Inner Cosmos.