WEBVTT - David B. Agus M.D. 0:00:02.920 --> 0:00:05.400 One of the most respected and best known oncologists in 0:00:05.400 --> 0:00:08.600 the world is doctor David Aegis. He leads the Ellison 0:00:08.760 --> 0:00:11.800 Medical Institute at the University of Southern California, where he's 0:00:11.800 --> 0:00:14.280 also a Professor of Medicine. I had a chance racing 0:00:14.360 --> 0:00:16.320 to sit down with him to talk about the high 0:00:16.400 --> 0:00:19.279 incidence of cancer now and how one treats cancer in 0:00:19.320 --> 0:00:22.439 modern life. Cancer has been around for thousands of years. 0:00:22.560 --> 0:00:25.600 How does one get cancer? Is it genetic? Is it 0:00:25.680 --> 0:00:27.800 a behavioral or environmental? 0:00:28.280 --> 0:00:28.560 Yes? 0:00:28.960 --> 0:00:32.279 Yes, and yes so there certainly are what we call 0:00:32.360 --> 0:00:37.120 genetic predispositions. There's a several dozen genes that if you 0:00:37.159 --> 0:00:39.720 inherit a faulty copy of it, your risk of cancer 0:00:39.760 --> 0:00:42.000 is dramatically higher than the average population. 0:00:42.760 --> 0:00:47.199 But cancer is a change in the genome. Sometimes behavior, sometimes. 0:00:46.720 --> 0:00:50.959 Things you smoke, things you do can cause or induce 0:00:51.159 --> 0:00:52.080 changes in DNA. 0:00:52.159 --> 0:00:53.880 So you don't get it from your parents. 0:00:53.960 --> 0:00:56.760 You can cause them through what you do. But there 0:00:56.800 --> 0:00:59.840 has to be a change in DNA to get cancer. 0:01:00.120 --> 0:01:00.280 Has it. 0:01:00.400 --> 0:01:02.000 Nixon said that we're going to have a war on 0:01:02.040 --> 0:01:05.080 cancer when he was president, and that was more than 0:01:05.120 --> 0:01:08.679 fifty years ago. Have we really made progress in combating 0:01:08.680 --> 0:01:10.199 cancer in the last fifty years. 0:01:10.360 --> 0:01:13.800 The answer is we've made tremendous progress, but it's not enough. 0:01:14.280 --> 0:01:17.680 So we now have immunetherapy right your own immune system 0:01:17.800 --> 0:01:21.440 can attack the cancer. We now have molecularly targeted therapy 0:01:21.440 --> 0:01:24.480 with every single patient in the country it's covered by Medicare, 0:01:24.560 --> 0:01:27.880 can have their cancer DNA sequenced and we can potentially 0:01:28.000 --> 0:01:31.200 use a pill to target a molecular alteration or an 0:01:31.200 --> 0:01:34.240 on switch in his cancer and turn it off. All 0:01:34.280 --> 0:01:37.000 of those by time, but we haven't cured the disease. 0:01:37.200 --> 0:01:39.960 Now. Some people say they get full body scans, and 0:01:40.200 --> 0:01:42.680 other people say that's not good for you because it's 0:01:42.760 --> 0:01:46.600 not cost effective and also you might get too much radiation. 0:01:47.880 --> 0:01:49.680 What do you think about full body scans as a 0:01:49.680 --> 0:01:51.200 way to take whether you have cancer or not. 0:01:51.560 --> 0:01:54.000 So there are MRIs now which don't have radiation to 0:01:54.040 --> 0:01:57.600 do full body scans, so certainly looking on a scan 0:01:57.800 --> 0:02:02.680 can be helpful. Many times one centimeter cancer is still 0:02:02.800 --> 0:02:06.200 many one hundred million cells. So it has yet to 0:02:06.280 --> 0:02:09.639 be proven that using anology like that with the exceptional 0:02:09.720 --> 0:02:12.920 lung cancer where it clearly works in smokers, So smokers 0:02:12.960 --> 0:02:14.400 every year should get a scan. 0:02:14.720 --> 0:02:17.840 You catch it early. You can cure the lung cancer, but. 0:02:17.840 --> 0:02:20.200 In other cancer really hasn't been shown to make a 0:02:20.240 --> 0:02:24.280 dramatic difference. Breast cancer it does, lung cancer it does, 0:02:24.320 --> 0:02:25.799 but many of the others it hasn't. 0:02:25.880 --> 0:02:26.280 Yet. 0:02:26.520 --> 0:02:29.840 We need better imaging technology, we need better blood tests, 0:02:30.200 --> 0:02:33.920 but most of our resources are spent on treating and 0:02:33.960 --> 0:02:36.640 figuring out new ways to understand the biology of cancer, 0:02:37.320 --> 0:02:41.160 very little on the diagnosis and the identifying early of cancer. 0:02:41.520 --> 0:02:43.440 Now, there are different types of cancer in terms of 0:02:43.480 --> 0:02:46.959 its potential fatality, and you measure cancer by how long 0:02:47.080 --> 0:02:50.160 one survives after five years? Is that more or less it? 0:02:50.280 --> 0:02:50.520 Yeah? 0:02:50.520 --> 0:02:54.200 I mean from diagnosis, cancer is categorized by having stage one, 0:02:54.360 --> 0:02:57.600 stage two, stage three, stage four. What does that really mean? 0:02:58.280 --> 0:03:00.239 They're all a little bit different depending on the type 0:03:00.280 --> 0:03:02.919 of the cancer. Stage four means it's all over the body. 0:03:02.960 --> 0:03:06.280 It's metastasized to different parts of the body. Stage one 0:03:06.440 --> 0:03:10.480 means it's confined. Stage two normally means it's spread but 0:03:10.600 --> 0:03:14.080 in a local area, and stage three means it's spread 0:03:14.160 --> 0:03:16.239 a little bit more than local, but it's still in 0:03:16.280 --> 0:03:18.720 half of the body. And again the stage four is 0:03:18.760 --> 0:03:22.520 all over. So as you go up in stages survival goes. 0:03:22.320 --> 0:03:24.120 Down and outcome goes down. 0:03:24.200 --> 0:03:26.560 Now I've been told that the cancer that is the 0:03:26.600 --> 0:03:30.359 most survivable is breast cancer if detected in stage one 0:03:30.520 --> 0:03:32.840 I think a ninety eight percent survival rate or something 0:03:32.880 --> 0:03:36.480 like that, and we detect this by having mammograms. Right, 0:03:36.880 --> 0:03:39.560 So what should men get? Should men get a PSA 0:03:39.680 --> 0:03:42.480 every year which helps with prostate cancer detection? 0:03:43.040 --> 0:03:43.400 Why not? 0:03:43.560 --> 0:03:46.680 I mean, so there's an argument that you know, well, 0:03:46.800 --> 0:03:49.119 if you find a PSA test and PSA is high, 0:03:49.160 --> 0:03:53.080 we're doing over number, too many biopses, too many prostate surgeries, 0:03:53.080 --> 0:03:53.800 and too many reiation. 0:03:53.920 --> 0:03:54.840 And that's true. 0:03:55.240 --> 0:03:58.680 So finding a cancer doesn't necessarily mean you need to 0:03:58.760 --> 0:04:00.840 treat it, which I know which is a weird statement. 0:04:01.320 --> 0:04:04.840 But there are many cancers, some indolent prostate cancer, indolent 0:04:04.880 --> 0:04:09.520 thyroid cancer, some indolent breast cancer, so that don't necessarily 0:04:09.560 --> 0:04:12.960 need aggressive treatments but can be followed. So we call 0:04:13.000 --> 0:04:16.840 that active surveillance. So we need to develop better guidelines, 0:04:16.880 --> 0:04:20.200 better ways of framing or talking about them. I say, cancer, 0:04:20.880 --> 0:04:24.000 you panic, I want treatment, But in many of them 0:04:24.160 --> 0:04:27.080 there's no benefit to doing treatment and lots of side effects. 0:04:27.279 --> 0:04:30.080 Now, some people say that the incidence of cancer, which 0:04:30.120 --> 0:04:31.960 is to say people getting it is higher than it 0:04:32.040 --> 0:04:33.960 was twenty or thirty or forty years ago. Is that 0:04:34.000 --> 0:04:36.480 because detection is better than it used to be. 0:04:36.520 --> 0:04:39.359 All right, So the dirty secret is we have no idea. 0:04:39.800 --> 0:04:42.560 We don't collect data well in the United States. What 0:04:42.680 --> 0:04:45.159 we do know is that there's not a dramatic rise 0:04:45.200 --> 0:04:47.160 in cancer in the United States. But what we are 0:04:47.200 --> 0:04:50.880 seeing is a troubling trend is younger people are getting 0:04:50.880 --> 0:04:51.680 more cancers. 0:04:51.720 --> 0:04:52.240 That's real. 0:04:52.640 --> 0:04:56.440 We have no idea why, but we are seeing younger people, 0:04:56.560 --> 0:05:00.119 more colon cancer, more breast cancer, and other cancers in 0:05:00.160 --> 0:05:03.640 younger individuals twenty thirty forty year olds that we never 0:05:03.760 --> 0:05:04.240 used to see. 0:05:04.279 --> 0:05:06.359 What do you think could possibly be the cause? I 0:05:06.360 --> 0:05:08.279 assume pollution or the environment. 0:05:08.279 --> 0:05:11.520 In some ways, we assume it's either something in the environment. 0:05:11.640 --> 0:05:16.720 We assume its diet, it's ultra process foods, it's microplastics, 0:05:16.760 --> 0:05:21.039 it changes in the microbiome. We really don't know until 0:05:21.080 --> 0:05:23.760 we start to collect data we can, and we don't 0:05:23.760 --> 0:05:27.080 really have a data collection system unfortunately in the United States. 0:05:27.160 --> 0:05:31.200 So when younger people get cancer, what is their prognosis 0:05:31.240 --> 0:05:33.360 these days? And what can they really do to deal 0:05:33.400 --> 0:05:34.000 with cancer. 0:05:34.520 --> 0:05:37.280 So it's interesting all of the regimens we have surgery, 0:05:37.320 --> 0:05:41.440 chemotherapy were designed around people who were older with cancer. 0:05:42.080 --> 0:05:45.000 I do think the biology of younger cancer is very different. 0:05:45.040 --> 0:05:46.040 So first of all, we need to. 0:05:45.960 --> 0:05:50.000 Develop regimens meant for younger people. That being said, we 0:05:50.080 --> 0:05:53.440 also have to start screening younger people for cancer. The 0:05:53.480 --> 0:05:56.839 age of colon cancer screening dropped from fifty to forty 0:05:56.880 --> 0:06:00.960 five recently, and it probably should drop even further. So 0:06:01.000 --> 0:06:04.520 if you have any family history of cancer, we probably 0:06:04.520 --> 0:06:06.080 should start screening earlier. 0:06:06.160 --> 0:06:13.800 So the best way somebody can prevent cancer is eat well, exercise, 0:06:15.120 --> 0:06:18.520 get an annual check up, and what else can you 0:06:18.560 --> 0:06:18.919 do well? 0:06:18.920 --> 0:06:20.600 I think there's a cadre of blood tests. You should 0:06:20.600 --> 0:06:21.839 get an irregular cadence. 0:06:22.240 --> 0:06:24.599 I think that you need to talk to your doctor 0:06:24.640 --> 0:06:28.719 about potential medicines that can lower risk. Things like aspirins, 0:06:28.760 --> 0:06:32.080 statins and other things can lower cancer risk in the 0:06:32.160 --> 0:06:35.360 right individuals. If you have a family history or others, 0:06:35.920 --> 0:06:38.400 and it's know your family history, figure out what Aunt 0:06:38.480 --> 0:06:41.560 Marge died from and really understand because many of those 0:06:41.560 --> 0:06:44.800 family histories carry down from person to person. Important to 0:06:44.800 --> 0:06:47.560 know in today's world. I can sequence your genome literally 0:06:47.600 --> 0:06:50.320 overnight and know if you would inherited the gene that 0:06:50.440 --> 0:06:53.120 gave you higher risk for those diseases, and then we 0:06:53.240 --> 0:06:56.080 get a target of prevention based on that gene that 0:06:56.160 --> 0:06:56.520 you have. 0:06:56.839 --> 0:07:01.080 Well, should everybody get their geneme tested or because is 0:07:01.120 --> 0:07:02.040 it expensive to do that? 0:07:02.120 --> 0:07:04.720 You can look at all the cancer risk genes for 0:07:04.839 --> 0:07:07.120 about one hundred dollars in today's world, and I think 0:07:07.160 --> 0:07:07.760 it's important. 0:07:07.800 --> 0:07:08.760 Knowledge is power. 0:07:09.279 --> 0:07:13.120 Okay, Remember the generation before us, if they had cancer 0:07:13.240 --> 0:07:15.400 was considered a sign of weakness, and many never talked 0:07:15.440 --> 0:07:18.840 about it. So getting a real accurate family history sometimes 0:07:18.960 --> 0:07:19.840 is really hard. 0:07:20.040 --> 0:07:22.280 I've been told that if a man lives long enough, 0:07:22.360 --> 0:07:25.280 he will get prostaate cancer. Now, if you're eighty or older, 0:07:25.320 --> 0:07:27.600 you're going to die of something else, probably, But is 0:07:27.600 --> 0:07:30.120 that true that every man, probably, if he lives long enough, 0:07:30.160 --> 0:07:31.240 will get prostaate cancer. 0:07:31.800 --> 0:07:35.680 So there's no question that the indulin prostate cancers are 0:07:35.800 --> 0:07:37.760 very common. If I walk through the streets of New 0:07:37.840 --> 0:07:41.560 York City and bib seed everybody over sixty, I'd find, 0:07:41.720 --> 0:07:44.600 you know, thirty five or so prostate cancers. 0:07:44.960 --> 0:07:47.000 But again, most of them won't cause a problem. 0:07:47.280 --> 0:07:49.720 What we know is we can grade the aggressivity of 0:07:49.800 --> 0:07:51.720 the cancer and know which are the ones that are 0:07:51.720 --> 0:07:54.240 going to cause a problem. We have a blood test 0:07:54.280 --> 0:07:57.840 called PSA that is very good based on the slope 0:07:57.880 --> 0:08:00.720 of the curve, the change in the number, it's starting 0:08:00.760 --> 0:08:03.840 to identify which are the more aggressive ones. Doing a 0:08:03.880 --> 0:08:08.120 biopsy is not a horrible procedure, and under the microscope 0:08:08.240 --> 0:08:10.360 we can say, hey, this is going to be bad 0:08:10.560 --> 0:08:12.960 or don't worry about this one. So we're getting a 0:08:13.000 --> 0:08:15.080 lot better about dealing with them now. 0:08:15.120 --> 0:08:19.800 At Johns Hopkins, where you trained, a famous procedure was 0:08:19.840 --> 0:08:22.800 developed for prostate cancer. They kind of minimize some of 0:08:22.800 --> 0:08:26.520 the adverse effects of a prostate surgery. Is that a 0:08:26.560 --> 0:08:29.560 good thing to do? If you're going to prostate surgery? 0:08:29.800 --> 0:08:31.760 Have this kind of procedure. It's done by a computer 0:08:32.160 --> 0:08:34.400 and it's a robot. I guess i'd should say that 0:08:34.400 --> 0:08:35.720 does the actual surgery. 0:08:35.760 --> 0:08:37.760 Patrick Walsh was a rock star. 0:08:38.000 --> 0:08:41.760 Patrick Walls was a young urologist at Hopkins who at 0:08:41.800 --> 0:08:43.920 the time people took out the whole prostant and the 0:08:43.920 --> 0:08:47.320 problem is the nerve looked like the prostate tissue. So 0:08:47.320 --> 0:08:50.480 they were taking out the nerve and they had continence problems. 0:08:50.480 --> 0:08:52.040 Impotency problem and all the men. 0:08:52.600 --> 0:08:57.880 So Patrick looked in kids who had basically died during childbirth, 0:08:58.040 --> 0:09:01.360 young kids and was able in those kids to know 0:09:01.400 --> 0:09:04.240 where the nerve was and develop what's called the nerve 0:09:04.280 --> 0:09:08.800 sparing prostatectomy and started to pioneer that approach. Now with 0:09:08.880 --> 0:09:11.720 a robot, we can go on through a small incision, 0:09:12.000 --> 0:09:14.160 blow up the abdomen so there's a high pressure so 0:09:14.160 --> 0:09:17.200 there's almost no bleeding. And instead of looking down a 0:09:17.200 --> 0:09:19.480 cave where the prostate is deep in the abdomen, you 0:09:19.520 --> 0:09:20.240 blow it up on a. 0:09:20.200 --> 0:09:22.920 Big sony screen, great visualization. 0:09:23.040 --> 0:09:26.479 You could take out that prostate and have better outcomes 0:09:26.480 --> 0:09:29.600 in terms of side effects, and the patient literally can 0:09:29.640 --> 0:09:30.680 go home the same day. 0:09:30.800 --> 0:09:33.040 So I know you do things other than on college 0:09:33.080 --> 0:09:36.160 sheep and tell us what does the Ellison Institute do. 0:09:36.800 --> 0:09:40.280 We are at Technology Application Institute, so we develop drugs. 0:09:40.360 --> 0:09:43.120 We now have a large AI group that can design 0:09:43.240 --> 0:09:49.400 molecules targeting areas of cancer. So we're designing a molecule 0:09:49.400 --> 0:09:53.120 that hits part of the prostate cancer signaling cascade to 0:09:53.160 --> 0:09:56.240 block it. That'll go into the clinic next year. We 0:09:56.320 --> 0:09:58.760 have a breast cancer molecule that we're made with AI. 0:09:58.960 --> 0:10:02.160 So with AI, we can actually use AI to what 0:10:02.240 --> 0:10:04.400 is the structure of the target and then what is 0:10:04.440 --> 0:10:06.920 the structure of the molecule, And what would have taken 0:10:07.040 --> 0:10:10.280 many years, we literally can do it in months is 0:10:10.400 --> 0:10:13.240 design a molecule to go into the clinic. So that's 0:10:13.280 --> 0:10:17.120 been a tremendous advance for us and enable us to 0:10:17.160 --> 0:10:19.560 have a whole pipeline of drugs to treat cancer. 0:10:19.840 --> 0:10:22.200 Now I am now seventy five years old, and when 0:10:22.240 --> 0:10:24.400 you get to be seventy five, you worry about your 0:10:24.400 --> 0:10:27.360 body collapsing and not working. You also worry about your 0:10:27.520 --> 0:10:31.280 mind not working so much so on Alzheimer's, what's the 0:10:31.320 --> 0:10:34.599 best way for me to prevent myself from getting Alzheimer's 0:10:34.720 --> 0:10:36.040 or some kind of dementia. 0:10:36.120 --> 0:10:38.520 So one of the largest studies ever done in Europe, 0:10:38.679 --> 0:10:41.560 what they showed is every year you delay retirement, you 0:10:41.640 --> 0:10:43.920 reduce the incidents of Alzheimer's by three percent. 0:10:44.480 --> 0:10:46.600 So it's the old adage you don't use it, you 0:10:46.720 --> 0:10:47.120 lose it. 0:10:47.600 --> 0:10:51.400 So keeping your brain engaged making yourself uncomfortable, which you 0:10:51.440 --> 0:10:54.320 are good at doing with your myriad of activities, is 0:10:54.440 --> 0:10:56.080 fantastic And I love that. 0:10:56.280 --> 0:10:59.120 Now you've had a lot of very famous patients, like 0:10:59.240 --> 0:11:03.200 Steve Jobs. Our famous patients are more difficult to deal 0:11:03.240 --> 0:11:05.439 with than the average person because they have big egos, 0:11:05.480 --> 0:11:07.560 or they're easier to deal with because they just say, 0:11:07.720 --> 0:11:09.280 take care of this problem and I'll trust you. 0:11:09.760 --> 0:11:12.000 They're all different. I mean, you know, there are people 0:11:12.120 --> 0:11:14.560 I take care of who are amazing. You know, Jack 0:11:14.640 --> 0:11:16.400 Kemp was a remarkable individual. 0:11:16.600 --> 0:11:19.520 And when I first started care of him, he goes, 0:11:19.559 --> 0:11:20.959 you need to do me a favor and I want 0:11:20.960 --> 0:11:21.880 you to come to my house. 0:11:22.559 --> 0:11:25.200 And I go, okay, thinking we're going to discuss his 0:11:25.280 --> 0:11:27.920 case and what's going on. And what he did was 0:11:27.960 --> 0:11:30.440 he had his whole family sitting in a long table 0:11:30.840 --> 0:11:33.600 and he had his church come and serve them dinner. 0:11:33.920 --> 0:11:36.440 He wanted me to see who he was and he said, listen, 0:11:36.679 --> 0:11:39.360 you make all the decisions. I trust you, but I 0:11:39.400 --> 0:11:42.040 want you to understand my value system. And it really 0:11:42.120 --> 0:11:45.160 was a beautiful way of approaching things. And it's a 0:11:45.160 --> 0:11:47.560 privilege to take care of anybody that they put their 0:11:47.600 --> 0:11:49.320 health their future into my hands. 0:11:49.679 --> 0:11:52.160 Let's talk about your own background. So where were you born? 0:11:52.720 --> 0:11:53.960 Baltimore, Maryland? 0:11:54.080 --> 0:11:57.040 Balmer as they call were okay, And was your father 0:11:57.120 --> 0:11:57.880 at Hopkins. 0:11:58.600 --> 0:12:01.840 My father went to Hopkins Undergraduate and University of Maryland 0:12:01.880 --> 0:12:02.520 Medical School. 0:12:02.679 --> 0:12:05.760 Where did you go to school in Baltimore or somewhere else? 0:12:06.320 --> 0:12:10.080 I went to school in Philadelphia. My father had moved 0:12:10.120 --> 0:12:13.400 as a professor. He was initially drafted from Baltimore. 0:12:12.960 --> 0:12:13.600 To the Air Force. 0:12:13.640 --> 0:12:16.120 We went to San Antonio, Texas, and I went to 0:12:16.200 --> 0:12:18.440 Saint Mary's Hall. I was the first one of the 0:12:18.480 --> 0:12:20.560 first two boys that went into a school that went 0:12:20.600 --> 0:12:23.880 from nursery all the way through college. And you know, 0:12:23.880 --> 0:12:25.840 I still remember first grade. I was one of two 0:12:25.920 --> 0:12:29.040 boys in the school. Then we went to Philadelphia, and 0:12:29.080 --> 0:12:32.560 then I went undergraduate to Princeton and med school at 0:12:32.640 --> 0:12:36.720 University of Pennsylvania, and then internship in residency at Johns Hopkins, 0:12:37.000 --> 0:12:39.720 fellowship at Sloan Kettering, and then to the NIH for 0:12:39.760 --> 0:12:40.400 a few years. 0:12:40.760 --> 0:12:42.840 And so did you know from the beginning you wanted 0:12:42.840 --> 0:12:45.719 to be an oncologist or a medical researcher? When did 0:12:45.720 --> 0:12:46.840 you realize what you wanted to do? 0:12:47.280 --> 0:12:49.480 Well? I was a geek as a kid. You know. 0:12:49.520 --> 0:12:51.960 It was about ten years after Sputnik and I did 0:12:51.960 --> 0:12:54.920 this little competition where you had to do this test, 0:12:55.440 --> 0:12:57.360 and we were one of four kids chosen and we 0:12:57.400 --> 0:13:00.640 went lab to lab across the country where we kind of, 0:13:00.760 --> 0:13:02.480 you know, got to tinker in the labs. And I 0:13:02.600 --> 0:13:05.280 loved being in the lab, and so as I got older, 0:13:05.320 --> 0:13:08.280 I kind of realized that I wanted to apply the 0:13:08.360 --> 0:13:09.320 lab to patients. 0:13:09.400 --> 0:13:11.679 I couldn't just be in the lab. Oncology. 0:13:11.760 --> 0:13:14.160 Cancer was an amazing place because something in the lab 0:13:14.200 --> 0:13:17.640 could be translated right away to patients. Patients were willing 0:13:17.640 --> 0:13:19.520 to take the risk. I was willing to take the risk. 0:13:20.080 --> 0:13:21.920 So that got me into cancer. 0:13:22.040 --> 0:13:25.200 So today, how many people work at the institute. 0:13:24.760 --> 0:13:27.720 Now about two hundred and fifty. 0:13:26.840 --> 0:13:29.920 And so you're teaching at the medical school and also 0:13:30.000 --> 0:13:35.439 running the institute, and you also do clinical work for patients. Yeah, 0:13:35.520 --> 0:13:37.600 so how do you take care of your own health? 0:13:37.960 --> 0:13:39.600 You know, you have to set priorities and you have 0:13:39.640 --> 0:13:42.240 to learn to say no. So I'd be at home 0:13:42.320 --> 0:13:43.560 every day of the week for dinner. 0:13:43.720 --> 0:13:45.920 I don't go out. I say no to a lot 0:13:45.960 --> 0:13:48.920 of things my business. It's easy to say no, Oh, 0:13:49.000 --> 0:13:50.800 I have a patient emergency, I can't go to this, 0:13:50.880 --> 0:13:52.960 I can't go to that. It makes it very easy 0:13:52.960 --> 0:13:56.640 to say no. I really try to make my schedule regular. 0:13:57.120 --> 0:13:59.600 You know, it turns out if you snack in between 0:13:59.600 --> 0:14:02.880 a meal the next day, your body expects that snack 0:14:02.920 --> 0:14:05.920 and insulin corts. All the stress hormones go up, You 0:14:06.040 --> 0:14:09.920 lose productivity, your metabolism goes down, you gain weight. It's 0:14:10.040 --> 0:14:13.040 really tough on the body. So I'm very regular with 0:14:13.160 --> 0:14:15.600 when I get up, when I eat, when I go 0:14:15.679 --> 0:14:18.800 to bed, and that makes an enormous impact on your 0:14:18.840 --> 0:14:19.600 overall health. 0:14:19.720 --> 0:14:22.560 Well, you have two children. Were you able to convince 0:14:22.600 --> 0:14:23.680 them to go to medical school? 0:14:23.840 --> 0:14:26.480 One of them went to medical school, the youngest I 0:14:26.520 --> 0:14:27.560 didn't convince him. 0:14:28.000 --> 0:14:30.920 You know, he wasn't going to go. He was, you know, 0:14:30.960 --> 0:14:33.040 went to MIT. Was a total. 0:14:32.720 --> 0:14:37.200 Techie, totally into programming, AI and data. And then COVID 0:14:37.240 --> 0:14:40.200 happened and he was privileged to work for a group 0:14:40.280 --> 0:14:42.560 analyzing data on COVID and trying to help with some 0:14:42.600 --> 0:14:45.280 of the COVID software for some of the clinical trials, 0:14:45.280 --> 0:14:47.920 and he kind of learned, you know, I want to 0:14:47.920 --> 0:14:49.040 do things to help people. 0:14:49.080 --> 0:14:50.400 I want to do things that matter. 0:14:50.600 --> 0:14:53.800 So what about some free medical advice? What about a statin? 0:14:53.840 --> 0:14:57.040 Shouldn't everybody take a statin? There for a certain age, they. 0:14:56.960 --> 0:15:01.440 Are remarkable drugs lowering LDL, which is a surrogate many 0:15:01.520 --> 0:15:04.720 camps for inflammation in the body. Lowering that LDL has 0:15:04.720 --> 0:15:07.480 a benefit in heart disease, and there is a risk 0:15:07.520 --> 0:15:11.080 reduction in cancer. And so I certainly am a believer 0:15:11.200 --> 0:15:13.800 if you have a family history of heart disease or cancer, 0:15:14.200 --> 0:15:17.000 that you want an LDL in the more acceptable range 0:15:17.040 --> 0:15:18.200 or the lower risk range. 0:15:18.200 --> 0:15:18.960 And it makes sense. 0:15:19.080 --> 0:15:21.440 What about red meat. I don't eat red meat, but 0:15:21.480 --> 0:15:22.800 I don't know why that's going to make me live 0:15:22.840 --> 0:15:24.520 longer or not. Is red meat healthy for you? 0:15:25.000 --> 0:15:27.880 Well, in a large study in Europe, they show that 0:15:27.920 --> 0:15:29.120 three servings a week. 0:15:28.960 --> 0:15:30.080 Had no health detriment. 0:15:30.560 --> 0:15:33.000 There is a health benefit in several studies with grass 0:15:33.000 --> 0:15:33.600 fed beef. 0:15:33.960 --> 0:15:36.840 So it's the key is moderation. Don't eat process meat. 0:15:36.960 --> 0:15:40.120 People who had processed meat every. 0:15:39.840 --> 0:15:42.880 Day for twenty years had about a twenty percent increase 0:15:42.920 --> 0:15:45.480 in colon cancer. So yeah, if you have a hot 0:15:45.480 --> 0:15:48.160 dog a day for twenty years, it can increase colon cancer. 0:15:48.200 --> 0:15:51.960 So I probably wouldn't do that, but a moderation it's fine. 0:15:52.240 --> 0:15:54.160 I don't drink alcohol either. Is that going to make 0:15:54.200 --> 0:15:54.840 me live longer? 0:15:55.040 --> 0:15:55.840 Not necessarily. 0:15:55.880 --> 0:15:59.400 Again, the warnings on alcohol, So there's an association small 0:15:59.440 --> 0:16:03.120 with alcohol and cancer, particularly women and breast cancer. There's 0:16:03.160 --> 0:16:06.840 also an association of things like toast and coffee with cancer. 0:16:07.240 --> 0:16:10.400 When you burn the coffee bean or toast, that brownness 0:16:10.440 --> 0:16:16.400 is a krylamide which has carcinogenic properties just like alcohol does. 0:16:16.680 --> 0:16:19.720 But it's a very, very minor contributor. Despite all the 0:16:19.800 --> 0:16:22.400 hullabaloo that was made over the last couple of months. 0:16:22.760 --> 0:16:25.600 So today, if I wanted to live another ten or 0:16:25.640 --> 0:16:28.800 fifteen or twenty years in a healthy way, your recommendations 0:16:28.840 --> 0:16:31.720 to me, if I can summarize it, is, maybe take 0:16:31.720 --> 0:16:35.920 a baby aspirin, maybe take a statin, exercise a little 0:16:35.920 --> 0:16:39.400 bit every day, don't eat too much red meat, don't 0:16:39.480 --> 0:16:43.600 drink too much alcohol, and pray a little. 0:16:43.360 --> 0:16:47.600 Bit, and consider heart imaging. Okay, figure out where we are, 0:16:47.720 --> 0:16:48.880 where we're starting from. 0:16:49.400 --> 0:16:51.320 Look at all you be up to date with all 0:16:51.320 --> 0:16:55.400 your vaccines, which is critical. Make sure that regular blood 0:16:55.440 --> 0:16:59.480 values are on good order, and then consider genetic testing 0:16:59.480 --> 0:17:01.200 if you have a family history of anything. 0:17:01.760 --> 0:17:04.720 One thing I've often wondered about, and maybe you, based 0:17:04.760 --> 0:17:07.159 on your experience, you can tell me what age do 0:17:07.280 --> 0:17:10.400 people really begin to think about dying. In other words, 0:17:10.440 --> 0:17:12.360 what age they really go to their lawyer and say, 0:17:12.359 --> 0:17:14.200 all right, I really want to worry about my will, 0:17:14.680 --> 0:17:16.119 or I really go to the doctor and say I 0:17:16.200 --> 0:17:19.840 want to live longer. Is that at age sixty, sixty five, seventy, 0:17:19.840 --> 0:17:21.280 Where do you see it? Based on your pages that 0:17:21.320 --> 0:17:23.400 are really beginning to think about death for the first time. 0:17:23.440 --> 0:17:24.120 So it's interesting. 0:17:24.119 --> 0:17:26.679 A study came out earlier last year or later at 0:17:26.680 --> 0:17:29.680 the end of last year that was looked at biologic 0:17:29.760 --> 0:17:32.480 age and said the biggest change in health happened. 0:17:32.200 --> 0:17:35.000 At age forty three in age sixty, so. 0:17:35.040 --> 0:17:38.880 That's when you know medical issues change the most forty 0:17:38.880 --> 0:17:42.160 three and sixty and both of those time points when 0:17:42.200 --> 0:17:45.400 things happen is when you start to kind of realize 0:17:45.440 --> 0:17:48.520 that you're not immortal. And so I see that very 0:17:48.560 --> 0:17:52.119 commonly in patients. You know, most of my patients. You know, 0:17:52.160 --> 0:17:54.320 the first thing I have is listen, you have a cancer. 0:17:54.359 --> 0:17:55.800 I'm gonna be able to control it. I don't think 0:17:55.840 --> 0:17:58.800 you'll die from it, but I would recommend getting your 0:17:58.840 --> 0:17:59.640 affairs in order. 0:17:59.760 --> 0:18:01.480 There's nothing wrong with being prepared. 0:18:01.960 --> 0:18:03.600 You know, hope for the best, but plan for the 0:18:03.680 --> 0:18:06.320 worst is a very reasonable thing. I've seen too many, 0:18:06.359 --> 0:18:09.120 and I'm sure you have too people who weren't prepared 0:18:09.200 --> 0:18:12.800 and horrible fights within family because they weren't prepared, and 0:18:12.840 --> 0:18:13.840 that's not a good thing. 0:18:14.080 --> 0:18:16.439 So I guess the most dangerous words in English language 0:18:16.480 --> 0:18:18.400 are maybe, get your affairs in order. 0:18:18.560 --> 0:18:20.480 No, I think it's a reasonable thing. I think it's 0:18:20.480 --> 0:18:21.200 an important thing. 0:18:22.520 --> 0:18:25.199 There's nothing wrong with it, And I'm not saying it 0:18:25.280 --> 0:18:26.240 is an alarmist thing. 0:18:26.280 --> 0:18:27.159