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Speaker 1: Welcome back to Behind the Bastards, a podcast that tells

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Speaker 1: you everything you don't know about the very worst people

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Speaker 1: in all of history. And this week, I'm one of

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Speaker 1: the laziest people in all of history because I'm getting

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Speaker 1: a week off of researching and writing a script. Thanks

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Speaker 1: to my good friend, Dr. Kaveh Hoda, who has come

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Speaker 1: in and wrote, written, wrote, wrote, wrote, wrote, wrote, Kabe,

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Speaker 1: welcome back to the show. Thank you so much. How

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Speaker 1: are you doing?

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Speaker 2: It is so nice to see you both. I miss

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Speaker 2: your faces when I don't get to see them.

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Speaker 1: That's right.

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Speaker 2: And now I get to see your faces, and that

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Speaker 2: makes me happy. And then I get to talk to you.

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Speaker 2: Now it's my turn. You've done so much. Yes. You've

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Speaker 2: done so much to bother people. It was terrible stories.

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Speaker 2: Really made him unhappy a lot.

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Speaker 1: Yeah.

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Speaker 2: It's my turn to give back to you.

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Speaker 1: Wait, wait.

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Speaker 3: I'm going to give you a present first. Have you

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Speaker 3: had fiber today, my friends? You should eat more fiber.

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Speaker 1: Yeah, Kavit does always say that.

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Speaker 2: Thank you. Fiber zaddy here.

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Speaker 3: You're welcome.

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Speaker 2: Fiber zaddy. That's what they call me online, Robert. Fiber zaddy.

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Speaker 1: Yeah.

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Speaker 2: And I looked it up, and it's a good thing, apparently,

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Speaker 2: to be a zaddy. So that's me.

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Speaker 1: No, that's good.

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Speaker 2: You know, Robert, let me ask you a question. when

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Speaker 2: you envision a doctor, someone trustworthy, someone you feel like

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Speaker 2: you should be listening to, someone with advice you would follow,

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Speaker 2: what do they look like in your mind? What do

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Speaker 2: you envision? Are they handsome? Are they fit? Are they charismatic?

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Speaker 2: And don't lie to me, Robert. I can tell when

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Speaker 2: you're lying.

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Speaker 1: Honestly, I picture my old pediatrician, Dr. Sherrod, who was

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Speaker 1: the doctor I had growing up as soon as we

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Speaker 1: moved to the Dallas area. He was a a really good,

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Speaker 1: I had a bunch of like weird health issues around

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Speaker 1: my allergies as a kid. And every other doctor we

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Speaker 1: went to was, or every other pediatrician we went to

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Speaker 1: had a lot of trouble figuring out what to do.

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Speaker 1: And Dr. Sherrod did not. He was a really good doctor,

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Speaker 1: like helped me with my allergy problems as a kid,

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Speaker 1: was just always, like my mom worshiped the guy. He

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Speaker 1: was great. That's probably why I have such a positive

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Speaker 1: opinion about doctors, because I grew up with a really,

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Speaker 1: really good one.

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Speaker 3: Must be nice.

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Speaker 1: Yeah, I think about him.

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Speaker 2: And Sophie, what about.

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Speaker 1: You?

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Speaker 3: You know the details of all my medical history, both

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Speaker 3: of you. A little sour on doctors these days, you know.

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Speaker 3: But I love you and I love my brother and

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Speaker 3: you're both doctors.

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Speaker 1: There you go.

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Speaker 2: I'm one of the good ones, Robert. I'm one of

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Speaker 2: the good ones. Well, you know, here's the thing. You

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Speaker 2: are both doing, I think, the reasonable thing, which is

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Speaker 2: you are using your own memories, your own relationships with

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Speaker 2: people you know and have met and you know to

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Speaker 2: be good doctors. But I would think, unfortunately, that's not

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Speaker 2: always the case in this country. Yeah. Yeah. Are thinking

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Speaker 2: of a doctor. First of all, they're probably thinking of

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Speaker 2: a male doctor, although most evidence we have would actually

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Speaker 2: suggest you're better off with a female doctor. They've actually

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Speaker 2: looked at that.

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Speaker 1: Just in general?

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Speaker 2: Well, for particular, the study showed it was, like, in

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Speaker 2: patient hospitalizations, but... It's certainly not worse. It's funny that

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Speaker 2: this had to be done, but at one point there

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Speaker 2: had to be a study that said having a female

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Speaker 2: doctor is not worse. Actually, it's probably better. We'll probably

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Speaker 2: get more of that. We'll probably get more of that

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Speaker 2: in the future, too.

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Speaker 1: It's a systemic issue. like most of my doctors in

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Speaker 1: an adult have been women and I usually, I just

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Speaker 1: feel like they pay, have paid more attention.

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Speaker 2: To me, I guess. Yeah. I think that's probably it.

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Speaker 2: You know, the study didn't really specify why, but I mean, I, I,

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Speaker 2: I suggest I am, I'm guessing that's probably it, but

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Speaker 2: I think the truth is for a lot of people there,

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Speaker 2: they're going to think of this doctor that's like tall

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Speaker 2: and handsome and stately and well put together. Someone they

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Speaker 2: could imagine wearing like a tailored suit on general hospital.

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Speaker 2: or like fitted scrubs on Grey's Anatomy. Of course, of course.

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Speaker 1: You got to tailor your scrubs that you're going to

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Speaker 1: throw out.

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Speaker 2: It is crazy to me, the tailored scrub thing. I

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Speaker 2: wear the biggest, baggiest, goofiest looking scrubs at work. I mean,

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Speaker 2: here's the thing. My favorite part about my job is

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Speaker 2: that I essentially get to wear pajamas to work. That's fantastic.

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Speaker 3: Us too.

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Speaker 1: Yeah, I mean, I am wearing pajamas right now.

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Speaker 2: That's a good point. I could have skipped a lot of...

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Speaker 2: medical training and just gone straight to podcasting. But hey,

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Speaker 2: live and learn. But I told my brother. So people

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Speaker 2: are thinking like these Dr. Oz's and the Dr. Drew's

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Speaker 2: and these kinds of guys. Tell you something right now.

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Speaker 2: I'm going to tell you right now. I'm going to

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Speaker 2: take a stance here. I think doctors should be schlubby

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Speaker 2: and silly looking. Basically, I should be like the max

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Speaker 2: handsomest doctor that you should envision. It shouldn't get better

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Speaker 2: looking than me.

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Speaker 1: Yeah.

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Speaker 2: Anything better looking than me, you're going to run into problems.

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Speaker 2: We've seen it time and time again. And I have

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Speaker 2: another question for you. Have you ever heard of a Dr.

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Speaker 2: Dennis Lowe or Dr. Faith Fitzgerald?

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Speaker 1: No, but Dr. Faith, I'm already getting like, uh-oh. I'm concerned.

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Speaker 1: That could be a problem. I mean, I know it's

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Speaker 1: a normal name for a lot of people, but just

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Speaker 1: the name Dr. Faith really concerns me.

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Speaker 2: Well, I'll tell you this. The reason you don't know

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Speaker 2: of them is because they were amazing doctors. And they

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Speaker 2: dedicated their lives to service and education. And I'm assuming

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Speaker 2: they never had a Q score greater than 20.

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Speaker 1: I'm sorry, Dr. Faith. I apologize for judging you.

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Speaker 2: And Dr. Dennis Lowe. Dr. Faith Fitzgerald passed, but Dr.

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Speaker 2: Dennis Lowe still kicking. And I was lucky enough to

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Speaker 2: be mentored by both of these terrific and caring doctors.

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Speaker 2: And that's why we're not talking about them today. But

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Speaker 2: we'll be talking about someone you have heard of, one

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Speaker 2: of the most famous most influential, and most widely followed

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Speaker 2: doctors in popular culture, Dr. Peter Attia.

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Speaker 1: Oh, boy. I know that name.

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Speaker 2: Have you heard? Yeah, I'm curious. What is the thing

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Speaker 2: you've heard? I guess I know what it is. Not much.

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Speaker 1: He just shows up. I mean, he's involved in the administration, right? Like,

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Speaker 1: he's been one of those guys who's been— Very peripherally.

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Speaker 2: Yeah. Very peripherally. He is someone that the wackier people

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Speaker 2: in the administration— sometimes cite to show that they're not

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Speaker 2: so wacky. He kind of does a little bit of

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Speaker 2: science washing. We'll get into that. But he's the doc who,

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Speaker 2: more than any other modern doctor, has worked to popularize

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Speaker 2: and legitimize the field of longevity medicine. Are you guys

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Speaker 2: familiar with that?

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Speaker 1: Yeah, like the Brian Johnson try to live forever. I mean,

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Speaker 1: like the quack end of it is Brian Johnson measuring

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Speaker 1: his sleep erections.

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Speaker 2: Obviously.

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Speaker 1: There's a good reason to care about longevity. You know,

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Speaker 1: like that's that's there's also definitely a non-quack side of it.

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Speaker 3: Oh, yeah.

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Speaker 2: We're going to get into that. We're going to get

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Speaker 2: into the good and the bad of it. So like

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Speaker 2: what I.

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Speaker 3: Know about him is he exchanged quite a lot of

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Speaker 3: emails with a not so friend of the pod, Jeffrey Epstein.

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Speaker 2: Yeah, I have a question about you are correct. And

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Speaker 2: we're going to get to that. Um, but my question

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Speaker 2: for you is Jeffrey Epstein, like, and you've probably made

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Speaker 2: this reference already, but is he like the Forrest Gump

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Speaker 2: of terrible people? Because the fact that he showed up

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Speaker 2: in the story, that wasn't even the reason I wanted

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Speaker 2: to talk about Peter Attia. And then when I was

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Speaker 2: learning more about him and I discovered that I was like,

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Speaker 2: is he involved with every questionable person?

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Speaker 1: Well, I mean, kind of, yeah, but like Forrest Gump,

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Speaker 1: it was just sort of like coincidental that he kept

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Speaker 1: winding up in all of these historical situations. Jeffrey Epstein

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Speaker 1: like knows and was involved with a lot of powerful

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Speaker 1: people because he was providing them with services, so to speak,

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Speaker 1: or he wanted the cloud associated with them because it,

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Speaker 1: because there were people who didn't do anything awful that

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Speaker 1: Epstein either funded or invited to a lot of things.

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Speaker 1: Because he liked to camouflage himself being surrounded by great scientists.

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Speaker 1: And after his arrest, the people who were legitimately just

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Speaker 1: caught up and didn't know anything and were legitimately just

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Speaker 1: caught up in shit, they stopped hanging out with him

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Speaker 1: once he was charged and convicted of child molestation. But yeah, anyway.

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Speaker 2: Well, he shows up here. And we're going to get

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Speaker 2: into that. Before we do, there's a lot of other

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Speaker 2: things I want to talk about. That actually wasn't even

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Speaker 2: the main reason I wanted to discuss him. We're going

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Speaker 2: to get into the good and bad of it. We're

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Speaker 2: going to have a little bit of a nuanced, I'm sorry,

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Speaker 2: an advanced discussion. We're going to do the risks and

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Speaker 2: benefits talk, just like you're supposed to with everything in medicine.

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Speaker 2: We're going to talk about the potential harms of over-testing

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Speaker 2: and over-medicating. We'll talk about whether it's important to have

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Speaker 2: the VO2 max of a Tour de France cyclist, how

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Speaker 2: important it is to track your blood sugars by the

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Speaker 2: minute if you're not diabetic, and if it's normal for

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Speaker 2: your doctor to be on an email thread with Jeffrey

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Speaker 2: Epstein discussing the nutritional benefits of cunnilingus.

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Speaker 1: Yeah, no, that doesn't, that seems questionable.

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Speaker 2: Yeah. I don't know if you want to use that

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Speaker 2: as a cold open, but, you know, welcome to Behind

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Speaker 2: the Bastards.

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Speaker 1: Yeah, Behind the Bastards, the only podcast that just said cunnilingus.

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Speaker 1: Probably not the only one. One of them, though.

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Speaker 2: Okay, so before we get into this episode, I have

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Speaker 2: to clarify a couple things. He's not going to be

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Speaker 2: the worst person you've discussed on the show. He's not

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Speaker 2: even the worst doctor you've discussed. He's not even the

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Speaker 2: worst doctor you've discussed with me on the show. He's

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Speaker 2: obviously not a bastard on the level of Stalin or

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Speaker 2: Saddam Hussein or Mark Zuckerberg. But in my mind, he

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Speaker 2: represents a new kind of danger in medicine, one that

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Speaker 2: doesn't come from direct harm to patients, but from credibility

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Speaker 2: and from charisma and from privilege, from someone whose influence

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Speaker 2: is outsized and ideas are actively reshaping and whose model

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Speaker 2: of care, in my mind, is deepening inequality in this country.

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Speaker 2: His whole approach is this sweeping reimagining of healthcare that

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Speaker 2: claims to prevent heart disease, neurodegeneration, and all this stuff.

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Speaker 2: And it sounds great, but it's not all supported by

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Speaker 2: randomized trials. It relies a lot on speculative pharmacology and

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Speaker 2: under-tested and aggressive biomarker manipulation and testing. We'll talk all

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Speaker 2: about that. I obviously take issue with some important aspects

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Speaker 2: of his practice, this whole model of manosphere wellness influencer

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Speaker 2: or Maha adjacent doctor is something I find very troubling.

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Speaker 2: History has shown us that if we don't nip these Dr.

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Speaker 2: Oz's in the bud early, they can become real problems

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Speaker 2: for everyone down the road.

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Speaker 1: They wind up in charge of everybody's healthcare.

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Speaker 2: Yeah. That's right. The people who are now in charge

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Speaker 2: are the people I... We're all internet trolls 10 years ago,

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Speaker 2: and it blows my mind. It's bleak. So about the Manosphere,

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Speaker 2: because I think it's kind of important that we discuss it. Actually,

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Speaker 2: I have to say, one of the first times I

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Speaker 2: was really exposed to it, it was a couple years back.

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Speaker 2: You probably don't remember because you see this stuff all

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Speaker 2: the time. But somebody tweeted that Robert Propp and I

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Speaker 2: were part of the quote-unquote leftist Manosphere, and I didn't

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Speaker 2: know what that meant. I still don't know what that means.

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Speaker 2: It's not great, I don't think. I don't think it

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Speaker 2: was a compliment.

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Speaker 1: I doubt it. What Manosphere are we a part of?

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Speaker 2: Okay.

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Speaker 3: As the girly pop on the podcast, fuck no.

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Speaker 1: Yeah. No.

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Speaker 2: Thank you.

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Speaker 1: I don't know what that's supposed to mean, but okay.

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Speaker 2: Okay. I think Dr. Atiyah might maybe take issue with

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Speaker 2: being labeled part of the Manosphere, but a large... part

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Speaker 2: of his strongest support comes from there, and his appeal

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Speaker 2: really comes from that same milieu that creates our Joe

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Speaker 2: Rogans or Andrew Hubermans.

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Speaker 1: Joe's Rogan, but sure.

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Speaker 2: Yeah, right, right.

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Speaker 1: It's like Attorney's General.

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Speaker 2: Like Johns Hopkins, yeah.

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Speaker 1: Right, exactly.

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Speaker 2: Atiyah's rise, whether he likes it or not, is inseparable

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Speaker 2: from this podcast industrial complex. They all exist in the

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Speaker 2: same ecosystem. Now, I'm not an expert in this. In fact,

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Speaker 2: most of what I know about the weirder parts of

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Speaker 2: the online world I've learned from you people here on

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Speaker 2: Cool Zone Media.

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Speaker 1: Yes, that is kind of our milieu.

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Speaker 2: And you don't know, there's been a number of times

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Speaker 2: that I've like texted Garrison to be like, hey, can

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Speaker 2: you explain what this means or this means? And I'm

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Speaker 2: like the old boomer like who needs help with their VCR.

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Speaker 2: But here's what I- No, no, that's good. That's good.

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Speaker 3: That's good that Garrison's being a resource. We love that.

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Speaker 3: It's like, hi, I know things.

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Speaker 2: It's like the modern equivalent of walking an old person

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Speaker 2: across the street.

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Speaker 1: Yeah.

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Speaker 2: And I appreciate that.

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Speaker 1: But it's the internet, yeah.

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Speaker 2: It's the internet. But I think if you think of

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Speaker 2: this online male self-improvement world as a Venn diagram, I

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Speaker 2: think you'd see four circles. And please correct me if

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Speaker 2: I'm wrong and weigh in on this. But one, you

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Speaker 2: have the manosphere, the red pillars, the... looks maxing people,

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Speaker 2: online forum dudes. In another, you have the bro science

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Speaker 2: fitness sphere, the testosterone growth hormone guys, bodybuilders.

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Speaker 3: Sure.

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Speaker 2: The third is the tech optimization sphere, biohackers. That's, again,

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Speaker 2: where Andrew Huberman comes in. Yeah. Silicon Valley longevity enthusiasts

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Speaker 2: like Brian Johnson. Yeah. Who we'll have to talk about

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Speaker 2: at some point in this. And also then there's also

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Speaker 2: the mainstream wellness sphere people. They're less offensive in general,

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Speaker 2: more standard fitness stuff like your Chris Hemsworth and Hugh

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Speaker 2: Jackman's proponents of the health standard.

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Speaker 1: Hugh Jackman, yeah.

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Speaker 2: Hugh Jackman.

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Speaker 3: Yeah.

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Speaker 2: And Peter lives somewhere in between all of these, but

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Speaker 2: probably more three and four. Not that far from the Manosphere, though.

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Speaker 2: And the Manosphere definitely borrows from him, particularly his language

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Speaker 2: on testosterone, metabolic health, VO2 max, protein. His audience definitely

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Speaker 2: shared with Rogan, too. And I will say this, actually,

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Speaker 2: here in San Francisco, so... Silicon Valley tech folk love him.

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Speaker 2: And I've met some very reasonable people who listen to

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Speaker 2: him and follow him closely. I've had people with no

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Speaker 2: history of diabetes ask me about getting continuous glucose monitors

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Speaker 2: because of what they've heard on his podcast. That was

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Speaker 2: really eye-opening for me. So what sets him apart from

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Speaker 2: these people is that he doesn't talk about gender politics

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Speaker 2: too much. He has or had... a lot of female followers,

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Speaker 2: especially after Guess Who exposed him, Oprah. And he also

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Speaker 2: had a 60 Minutes profile piece. And more than most

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Speaker 2: of the people in this world, he does actually seem

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Speaker 2: to look for evidence-based medicine. He cherry-picks it a bit

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Speaker 2: when he does. Yeah, sure. But he's... I think he's

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Speaker 2: actually a smart guy. I know a lot of doctors,

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Speaker 2: like Dr. Oz and Dr. Ben Carson, all these guys,

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Speaker 2: they're very successful, and I think people consider them smart.

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Speaker 2: But in truth, I don't actually find them that intelligent.

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Speaker 2: They're great at surgery, and they're very hardworking. But, you know,

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Speaker 2: they're surgeons. I'm sorry, surgeons.

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Speaker 1: Sorry.

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Speaker 2: We could talk about the difference between neutral medicine and

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Speaker 2: surgery at some point, if you guys like. But I

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Speaker 2: never found these two.

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Speaker 1: Weird Al wrote a song about that. People are aware.

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Speaker 2: Yeah. Did he really?

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Speaker 1: Yeah. Like a Surgeon.

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Speaker 2: Oh, yeah, that nailed it.

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Speaker 1: To the tune of Madonna's Like a Virgin, yeah.

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Speaker 2: Yeah, yeah, yeah. Well, as with most things, it was

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Speaker 2: explained early in the 80s by Weird Al Yankovic. Yeah.

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Speaker 2: But I never found them that smart. It's actually kind

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Speaker 2: of wild how far you can go in medicine with

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Speaker 2: some charm and some hard work, and I think those

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Speaker 2: two are examples of that. But I think Atiyah, he's

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Speaker 2: really smart. And I have to tell you, as I

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Speaker 2: prepared for this episode, there were multiple points where I

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Speaker 2: was like, I actually, I like a lot of what

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Speaker 2: he says. More than expected. I agree with some of

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Speaker 2: his recommendations. And there's even some stuff in his history

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Speaker 2: that I empathize with. But there is definitely this pipeline

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Speaker 2: of men who start with guys like Atiyah and Huberman

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Speaker 2: and end up with Peterson and Tate. He's like the

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Speaker 2: evidence-based gateway to the manosphere. And that's one of the

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Speaker 2: reasons why I think I want to discuss him here

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Speaker 2: with you folks.

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Speaker 1: Right.

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Speaker 2: Before we get into him, though, let's talk a little

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Speaker 2: bit about longevity medicine in general and what it actually is.

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Speaker 2: Its proponents would say that for the past century, medicine

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Speaker 2: has been reactive. You've probably seen people talking about this, quote-unquote,

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Speaker 2: sick care, right?

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Speaker 1: You get sick— Yeah, shocking that doctors focus most on, like,

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Speaker 1: saving people's lives when they're ill. I mean, like, obviously

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Speaker 1: preventative medicine is important, but it's not weird that that's

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Speaker 1: the way it, you know, goes.

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Speaker 2: Yeah, that's kind of what we have to do, because

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Speaker 2: if we don't, then what's going to happen? You have

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Speaker 2: no one else to take care of you. But there's

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Speaker 2: some truth to that. Like, it's always important to think

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Speaker 2: about preventive care. And in longevity medicine, it's meant to

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Speaker 2: be sort of a way to flip the dynamic, that

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Speaker 2: it's preventive, personalized medicine that aims at expanding not just

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Speaker 2: your lifespan, but what they call your healthspan, those years

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Speaker 2: that you're in good health. It's driven by something called

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Speaker 2: the geroscience hypothesis, which is basically aging itself is the

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Speaker 2: shared root of most chronic disease. Right. So instead of

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Speaker 2: playing whack-a-mole with one disease at a time, you could,

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Speaker 2: in theory, delay all of them. And like every system

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Speaker 2: that is totally on the up and up, you can

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Speaker 2: consider it like a pyramid. The base is the lifestyle components.

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Speaker 2: The middle is measurement, tons of testing, wearable, biologic age

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Speaker 2: clocks that claim they can tell you how old you are.

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Speaker 2: And at the top level of this pyramid of this

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Speaker 2: particular field of medicine is is the experimental frontier with

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Speaker 2: drugs and supplements aimed at aging pathways like metformin, rapamycin,

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Speaker 2: NAD +. You might have seen that one already. One

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Speaker 2: pattern about all these meds, including the ones that we'll

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Speaker 2: discuss later, there's some impressive effects that are in mice

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Speaker 2: or lab animals, but limited or really non-existent proven effects

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Speaker 2: in humans. the evidence of longevity medicine working in people

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Speaker 2: and humans is actually pretty thin. And we're not even

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Speaker 2: sure if we're measuring the right things with these biologic

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Speaker 2: clocks and that sort of thing. So, and of course,

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Speaker 2: there's a question of safety of taking some of these

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Speaker 2: medications long-term. We'll get to that. I think some parts

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Speaker 2: of this field are generally very interesting, and I'm hopeful

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Speaker 2: that some good science will grow out of it. But

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Speaker 2: the more I learn about longevity medicine in general, the

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Speaker 2: less I like it. The thought of these uber-wealthy technocrats

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Speaker 2: learning to expand their lifespans even more than they already have,

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Speaker 2: I find to be kind of terrifying. And as we're

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Speaker 2: going to get into in the second episode, longevity medicine

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Speaker 2: is particularly bad because it disproportionately affects the wealthy, if

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Speaker 2: it works at all, allowing them potentially to to extend

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Speaker 2: their influence, consolidate their power, and delay the generational progress

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Speaker 2: of science and cultural, political progress and all that stuff.

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Speaker 2: I don't know, maybe I'm being nihilistic, but my question

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Speaker 2: for you and you both, I'd love to hear what

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Speaker 2: you have to say, is would you even want to

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Speaker 2: live forever? I'm assuming the answer is no, but how long,

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Speaker 2: be honest, how long would you want, what's the longest

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Speaker 2: you would want to live for?

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Speaker 1: I don't know, like, I can't imagine It depends. I

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Speaker 1: think the big thing for me, and there's some reasonable

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Speaker 1: people in the longevity space who talk about this, is, like,

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Speaker 1: health span. Like, I would like to stay healthy and

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Speaker 1: mobile and independent forever. you know, the entirety of my

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Speaker 1: life that said, I don't know that I'd want to

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Speaker 1: live longer than like 90 years at kind of the outside,

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Speaker 1: you know, like, I don't think like the kind of

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Speaker 1: max human lifespan, more or less like 90 to 100

401
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Speaker 1: or so. I don't feel like that seems great. If

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Speaker 1: I could not like be miserable and decrepit and dealing

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Speaker 1: with like Parkinson's or Alzheimer's or whatever, you know, like

404
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Speaker 1: at the end of it, right? Like, that's kind of

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Speaker 1: the big thing for me. as opposed to like objective lifespan.

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Speaker 1: Cause I do think I'm already, there's already things that

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Speaker 1: I know are like good changes to society that I'm

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Speaker 1: never going to be okay with. Like at some point

409
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Speaker 1: we'll figure out, you know, some degree of self-driving or

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Speaker 1: we'll finally get our shit together and replace all the

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Speaker 1: cars and with good public transit and whatnot. I like driving.

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Speaker 1: I know that's bad. And I support society reforming and

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Speaker 1: getting out of its addiction to cars. That'll just never

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Speaker 1: be something I'm personally ever able to enjoy as much

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Speaker 1: as other people. So I don't want to go on

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Speaker 1: too long, to the point where, hopefully, if things go well,

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Speaker 1: the world will be a lot better in 70 years

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Speaker 1: or however, 50 years, 40 years uh but i don't

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Speaker 1: know that i'll be comfortable in it right you kind

420
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Speaker 1: of hope that the world evolves beyond you if you're

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Speaker 1: not a shitty person i think you know what i.

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Speaker 2: Love after everything you've seen and studied you're still kind

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Speaker 2: of an optimist on the inside i mean i.

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Speaker 1: Don't know if i think that's likely i i know.

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Speaker 2: You can't say that because you have to be cool

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Speaker 2: and like you know You have to be aloof in

427
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Speaker 2: whatever podcasts are, but you're kind of an optimist, and

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Speaker 2: I love it.

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Speaker 1: The darker thing would be to say, I don't want

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Speaker 1: to live through the complete collapse of the biosphere's ability

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Speaker 1: to support life, which certainly seems likelier than us getting

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Speaker 1: rid of cars and developing good public transit.

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Speaker 3: You could have said that first, but you didn't, because

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Speaker 3: you're an optimist.

435
00:22:02,300 --> 00:22:04,659
Speaker 1: I would be nice on the internet to people. I

436
00:22:04,680 --> 00:22:06,820
Speaker 1: don't want to depress people anymore. I do that too often.

437
00:22:07,260 --> 00:22:08,860
Speaker 2: Sophie, how long would you go for?

438
00:22:09,160 --> 00:22:12,200
Speaker 3: Well, if I could be healthy and Anderson could be healthy-

439
00:22:12,910 --> 00:22:16,350
Speaker 3: You know, probably the same answer as Robert. I don't

440
00:22:16,369 --> 00:22:18,770
Speaker 3: want to be, I don't want to be uncomfortable. I

441
00:22:18,770 --> 00:22:21,490
Speaker 3: don't want to be, like, miserably uncomfortable and a burden

442
00:22:21,530 --> 00:22:26,140
Speaker 3: to the people around me, one. And, like, you know,

443
00:22:26,260 --> 00:22:28,500
Speaker 3: if they could, like, health max my dog to live

444
00:22:28,540 --> 00:22:32,220
Speaker 3: longer and live great and be strong and live long.

445
00:22:32,280 --> 00:22:35,359
Speaker 3: I mean, that would be sick. I don't know if

446
00:22:35,380 --> 00:22:37,680
Speaker 3: we need to do that for people. But for dogs,

447
00:22:38,150 --> 00:22:39,490
Speaker 3: dogs don't live long enough as is.

448
00:22:40,590 --> 00:22:43,270
Speaker 2: I agree with both of you about the health span.

449
00:22:43,390 --> 00:22:45,410
Speaker 2: I think that is very important. I think we should

450
00:22:45,450 --> 00:22:48,450
Speaker 2: be focused more on living our best lives for as

451
00:22:48,510 --> 00:22:49,270
Speaker 2: long as we can.

452
00:22:49,530 --> 00:22:49,710
Speaker 3: Yeah.

453
00:22:49,760 --> 00:22:52,480
Speaker 2: Eventually, it will catch up to us all. But, I mean, yeah,

454
00:22:52,500 --> 00:22:54,100
Speaker 2: I think that's a realistic thing to do.

455
00:22:54,140 --> 00:22:56,040
Speaker 3: There's chia seeds in this shit.

456
00:22:56,500 --> 00:22:58,140
Speaker 2: For you. Look at you. For you.

457
00:22:58,160 --> 00:22:58,570
Speaker 1: Health nut.

458
00:22:59,740 --> 00:23:02,240
Speaker 2: You know, for me, a big part of this is

459
00:23:02,290 --> 00:23:05,830
Speaker 2: not just the longevity medicine aspect of it. It's that

460
00:23:05,950 --> 00:23:10,090
Speaker 2: I dislike concierge medicine in general. Yeah.

461
00:23:11,000 --> 00:23:11,689
Speaker 1: It feels bad.

462
00:23:13,100 --> 00:23:15,620
Speaker 2: It feels bad. Well, there's a reason. It shrinks access

463
00:23:15,740 --> 00:23:18,910
Speaker 2: for everyone that's not wealthy and turns healthcare into this

464
00:23:19,430 --> 00:23:24,830
Speaker 2: subscription-based privilege rather than a social responsibility to take care

465
00:23:24,850 --> 00:23:28,190
Speaker 2: of people. And a typical doctor who moves into a

466
00:23:28,230 --> 00:23:32,370
Speaker 2: concierge practice, and by the way, I understand very well

467
00:23:32,670 --> 00:23:34,450
Speaker 2: why you would want to do that. And there's like

468
00:23:34,530 --> 00:23:37,629
Speaker 2: a non-zero percent chance that I will eventually sell out

469
00:23:37,750 --> 00:23:40,510
Speaker 2: and have my own concierge practice. So I get it.

470
00:23:41,040 --> 00:23:44,260
Speaker 2: But a typical doctor who moves into a concierge practice

471
00:23:44,660 --> 00:23:47,590
Speaker 2: will reduce their panel from something like 2,000 to 3,000

472
00:23:47,590 --> 00:23:51,770
Speaker 2: patients closer to 300. And this is only accelerating the

473
00:23:51,810 --> 00:23:55,310
Speaker 2: collapse of our healthcare system. And it's also leading to

474
00:23:55,350 --> 00:23:57,990
Speaker 2: ethical drift in the medical profession. And concierge medicine is,

475
00:23:58,350 --> 00:24:02,510
Speaker 2: right now, really the only delivery system for longevity medicine

476
00:24:03,150 --> 00:24:05,830
Speaker 2: for these people. We'll get into that. But let's get

477
00:24:05,869 --> 00:24:12,359
Speaker 2: into the idea of it all. But first... Oh, but first.

478
00:24:12,460 --> 00:24:15,850
Speaker 1: You know what will make you live forever? The sponsors

479
00:24:15,890 --> 00:24:18,710
Speaker 1: of this podcast. I guarantee it. And if you don't

480
00:24:18,770 --> 00:24:21,590
Speaker 1: live forever, you can sue iHeartMedia. You know?

481
00:24:21,790 --> 00:24:23,190
Speaker 3: No, no, no, no, no.

482
00:24:23,190 --> 00:24:25,350
Speaker 1: Sophie, Sophie, it's perfect. They can't look. If they don't

483
00:24:25,369 --> 00:24:26,710
Speaker 1: live forever, how are they going to sue us? If

484
00:24:26,780 --> 00:24:29,540
Speaker 1: they die, what are they going to do? No, no, no, no, no, no.

485
00:24:29,740 --> 00:24:30,780
Speaker 1: It's the perfect scam.

486
00:24:30,800 --> 00:24:31,550
Speaker 3: No, no, no, no, no, no.

487
00:24:31,560 --> 00:24:34,020
Speaker 2: It's the perfect scam. We'll be way out of the

488
00:24:34,040 --> 00:24:36,010
Speaker 2: podcast game by the time they figure it out.

489
00:24:36,040 --> 00:24:37,780
Speaker 1: Yeah, we'll be in El Salvador by then.

490
00:24:38,630 --> 00:24:41,070
Speaker 3: Robert, don't tell them where we're going.

491
00:24:41,510 --> 00:24:43,400
Speaker 2: It's okay. Honduras is what we meant.

492
00:24:43,440 --> 00:24:45,840
Speaker 1: We're really going to North Korea, Sophie, but we're not

493
00:24:45,859 --> 00:24:46,680
Speaker 1: going to tell them that.

494
00:24:46,700 --> 00:24:48,950
Speaker 2: Robert, no.

495
00:24:56,210 --> 00:24:59,510
Speaker 1: And we're back. Sophie and I aren't moving to North

496
00:24:59,570 --> 00:25:03,330
Speaker 1: Korea to avoid extradition laws. We didn't spend years working

497
00:25:03,390 --> 00:25:07,630
Speaker 1: out a plan with Kim Jong-un or whichever Kim we've

498
00:25:07,650 --> 00:25:09,310
Speaker 1: got in there right now. I think it's Jong-un, right?

499
00:25:09,770 --> 00:25:10,229
Speaker 1: I forget.

500
00:25:10,369 --> 00:25:11,450
Speaker 2: Anyway, Kava, let's continue.

501
00:25:11,490 --> 00:25:14,150
Speaker 3: You should probably learn that before, you know.

502
00:25:15,109 --> 00:25:17,920
Speaker 2: Kim Jong-un. Yeah, his dad was Kim Jong-il. Look, whoever I've.

503
00:25:17,859 --> 00:25:20,500
Speaker 1: Been emailing is in charge of North Korea according to

504
00:25:20,520 --> 00:25:22,459
Speaker 1: the guy I've been emailing and sending money to.

505
00:25:22,480 --> 00:25:24,159
Speaker 2: You just call him Kim. It's fine.

506
00:25:24,600 --> 00:25:25,219
Speaker 1: Exactly.

507
00:25:25,240 --> 00:25:29,360
Speaker 2: I get it. Let's talk about Peter Attia. Let's start

508
00:25:29,380 --> 00:25:33,120
Speaker 2: with the early years. He's talked a lot about his childhood,

509
00:25:33,780 --> 00:25:37,980
Speaker 2: but it's usually in these controlled, self-narrated ways through podcast

510
00:25:38,020 --> 00:25:42,240
Speaker 2: monologues or interviews or his book, Outlive, The Science and

511
00:25:42,359 --> 00:25:45,359
Speaker 2: Art of Longevity. There's been a couple of very useful

512
00:25:45,420 --> 00:25:49,440
Speaker 2: pieces written about him, but not any real investigative biography.

513
00:25:49,480 --> 00:25:52,070
Speaker 2: So we have to reconstruct his early life with what's

514
00:25:52,130 --> 00:25:54,090
Speaker 2: been revealed in his podcast. I listen to a lot

515
00:25:54,109 --> 00:25:57,290
Speaker 2: of podcasts, both his and others that he's been on

516
00:25:57,630 --> 00:25:59,949
Speaker 2: and what I can gather from online sources. So he

517
00:25:59,990 --> 00:26:04,390
Speaker 2: was born in Toronto in 1973 to Egyptian parents who

518
00:26:04,410 --> 00:26:07,010
Speaker 2: had immigrated to Canada. I don't think a lot of

519
00:26:07,030 --> 00:26:08,830
Speaker 2: people know that he's Egyptian. I didn't actually until we

520
00:26:08,850 --> 00:26:11,429
Speaker 2: started this. And it's a little bit of a personal

521
00:26:11,470 --> 00:26:14,859
Speaker 2: bummer for me whenever you see a famous Middle Eastern

522
00:26:15,160 --> 00:26:19,100
Speaker 2: type doctor that's not rad. He described his parents as

523
00:26:19,140 --> 00:26:22,220
Speaker 2: highly educated, intellectual, not sure what they did for work.

524
00:26:22,540 --> 00:26:25,230
Speaker 2: From some interviews, I got the sense that It was

525
00:26:25,270 --> 00:26:28,310
Speaker 2: white-collar work, but in his book, Outlive, he actually refers

526
00:26:28,450 --> 00:26:30,949
Speaker 2: at one point to his father working in a limestone quarry.

527
00:26:31,470 --> 00:26:34,020
Speaker 2: So I'm not sure. I'm assuming there's not a lot

528
00:26:34,060 --> 00:26:36,640
Speaker 2: of white-collar jobs in a limestone quarry, but I could

529
00:26:36,660 --> 00:26:36,920
Speaker 2: be wrong.

530
00:26:36,980 --> 00:26:39,140
Speaker 1: No, I mean, I guess the limestone could turn your

531
00:26:39,180 --> 00:26:43,570
Speaker 1: collar white because it's limestone. So maybe, like, literally, yeah.

532
00:26:43,810 --> 00:26:46,850
Speaker 2: Yeah, that's right. That's what I was thinking. And I'm

533
00:26:46,890 --> 00:26:49,330
Speaker 2: sure this is not surprising to anyone, but his family

534
00:26:49,490 --> 00:26:54,980
Speaker 2: was very achievement-oriented. He described them as emotionally restrained and

535
00:26:55,040 --> 00:26:59,379
Speaker 2: demanding in subtle, culturally specific ways. And then that last

536
00:26:59,500 --> 00:27:03,469
Speaker 2: aspect is probably pretty similar to Dr. Oz and his backstory,

537
00:27:03,970 --> 00:27:06,130
Speaker 2: and it's something I actually know a little bit about myself.

538
00:27:06,190 --> 00:27:10,530
Speaker 2: I could probably dedicate four whole episodes to this particular topic,

539
00:27:10,609 --> 00:27:14,820
Speaker 2: but I'll just keep it short here, that being a

540
00:27:15,220 --> 00:27:19,060
Speaker 2: physician of Middle Eastern descent myself, My family and my

541
00:27:19,119 --> 00:27:23,850
Speaker 2: father in particular were also very clearly achievement-oriented, but it's

542
00:27:23,890 --> 00:27:26,190
Speaker 2: also a large part of how and why I became

543
00:27:26,230 --> 00:27:30,470
Speaker 2: a doctor and why I've had any success. That being said,

544
00:27:30,490 --> 00:27:32,909
Speaker 2: one major difference between me and him, as I was

545
00:27:33,210 --> 00:27:34,840
Speaker 2: reading about him and thinking about him, I don't think

546
00:27:34,960 --> 00:27:38,940
Speaker 2: anyone would ever mistake my family for being emotionally restrained.

547
00:27:39,600 --> 00:27:43,199
Speaker 2: Like a lot of Persian households, we felt things out loud,

548
00:27:44,420 --> 00:27:47,380
Speaker 2: you know, very loudly. And his family situation felt like

549
00:27:47,460 --> 00:27:51,660
Speaker 2: a more high-pressure immigrant household with love being expressed only

550
00:27:51,700 --> 00:27:54,399
Speaker 2: through achievements and not as much through affection. And I

551
00:27:54,440 --> 00:27:59,359
Speaker 2: think that is fertile soil from which an optimization-obsessed man

552
00:27:59,780 --> 00:28:03,040
Speaker 2: can grow. I'm assuming this is a recurring theme you've

553
00:28:03,100 --> 00:28:07,160
Speaker 2: seen in some of the people you've covered. You did Dr. Oz, right? Yeah, yeah.

554
00:28:07,180 --> 00:28:08,360
Speaker 1: We've talked about Dr.

555
00:28:08,500 --> 00:28:08,640
Speaker 3: Oz.

556
00:28:08,660 --> 00:28:12,720
Speaker 1: We've talked about most of the Oprah industrial complex bastards.

557
00:28:13,380 --> 00:28:13,700
Speaker 3: Yeah.

558
00:28:13,720 --> 00:28:17,040
Speaker 2: That's great. So he described himself as a very anxious

559
00:28:17,100 --> 00:28:19,920
Speaker 2: child who was obsessed with being perfect and was terrified

560
00:28:19,940 --> 00:28:23,220
Speaker 2: of disappointing people. I think a lot of doctors can

561
00:28:23,240 --> 00:28:26,730
Speaker 2: understand that and relate to that. Doctors are people pleasers.

562
00:28:27,170 --> 00:28:29,030
Speaker 2: And sometimes this is helpful, sometimes it's not.

563
00:28:29,109 --> 00:28:30,030
Speaker 1: Well, not always, but yeah.

564
00:28:30,430 --> 00:28:30,670
Speaker 2: Dr.

565
00:28:30,810 --> 00:28:31,410
Speaker 1: House, of course.

566
00:28:32,050 --> 00:28:33,490
Speaker 2: Yeah, right. He was not a people pleaser.

567
00:28:33,510 --> 00:28:34,410
Speaker 1: Being an exception, no.

568
00:28:34,990 --> 00:28:37,100
Speaker 2: The most, actually, interestingly enough, this is a small aside.

569
00:28:37,119 --> 00:28:40,220
Speaker 2: Remember I mentioned Dr. Faith Fitzgerald? She was this brilliant

570
00:28:40,560 --> 00:28:44,650
Speaker 2: internal medicine doctor at UC Davis. And the rumor is

571
00:28:44,670 --> 00:28:48,390
Speaker 2: that she was the basis for that character. Not because

572
00:28:48,410 --> 00:28:51,630
Speaker 2: she was crotchety or mean. She was actually super sweet

573
00:28:51,670 --> 00:28:55,450
Speaker 2: and nice. But just because she was one of these brilliant, like, diagnosticians.

574
00:28:55,470 --> 00:28:56,850
Speaker 1: She was so good at her job, yeah.

575
00:28:56,930 --> 00:29:01,760
Speaker 2: Yeah, right. So he excelled at school academically from a

576
00:29:01,800 --> 00:29:03,720
Speaker 2: young age. Top of his class. I have no doubt

577
00:29:03,740 --> 00:29:07,640
Speaker 2: about that. He also said that being smart was the

578
00:29:07,820 --> 00:29:11,520
Speaker 2: only thing I had. And quote... If I was not exceptional,

579
00:29:11,780 --> 00:29:14,540
Speaker 2: I was nothing, which I think is like the Middle

580
00:29:14,600 --> 00:29:18,040
Speaker 2: Eastern equivalent of Ricky Bobby's, if you're not first, you're last.

581
00:29:18,620 --> 00:29:22,420
Speaker 1: Yeah, yeah. Being normal is the greatest shame there is. Sure,

582
00:29:22,440 --> 00:29:23,260
Speaker 1: if that makes sense.

583
00:29:23,820 --> 00:29:28,400
Speaker 2: Yeah, a lot of pretty textbook gifted kid identity formation

584
00:29:28,660 --> 00:29:31,990
Speaker 2: stuff happening here. And there's also some overlaps with Andrew

585
00:29:32,030 --> 00:29:34,510
Speaker 2: Huberman and Dr. Oz in that they all have this

586
00:29:34,550 --> 00:29:38,770
Speaker 2: sort of early athleticism and these signs of obsession with

587
00:29:38,810 --> 00:29:41,720
Speaker 2: being physical and physical fitness. He reports that he was

588
00:29:41,840 --> 00:29:44,960
Speaker 2: always pushing himself physically and was drawn to endurance sports

589
00:29:45,000 --> 00:29:46,800
Speaker 2: that tested his limits. And this is a seed for

590
00:29:46,820 --> 00:29:50,040
Speaker 2: things that come up later for him. Ironman races, swimming

591
00:29:50,080 --> 00:29:52,959
Speaker 2: the Catalina Channel, the VO2 max focus he's big on.

592
00:29:53,520 --> 00:29:56,740
Speaker 2: He was also a boxer, which is, you know, actually

593
00:29:56,800 --> 00:29:59,940
Speaker 2: surprises and surprise people, but... It's one of my favorite

594
00:29:59,960 --> 00:30:02,380
Speaker 2: things to watch in terms of sports is boxing. My

595
00:30:02,420 --> 00:30:04,900
Speaker 2: dad was not only a doctor, but he was a

596
00:30:05,100 --> 00:30:06,460
Speaker 2: boxer when he was younger. So I kind of grew

597
00:30:06,500 --> 00:30:08,960
Speaker 2: up watching it. And although the doctor in me does

598
00:30:09,080 --> 00:30:13,200
Speaker 2: not love what boxing does to your brain, I do

599
00:30:13,500 --> 00:30:17,220
Speaker 2: enjoy watching the boxing. And that is a dirty little secret.

600
00:30:17,640 --> 00:30:20,719
Speaker 2: that I've never shared on air before. So there you go,

601
00:30:20,740 --> 00:30:23,570
Speaker 2: a little Behind the Bastards exclusive there. Who doesn't?

602
00:30:23,830 --> 00:30:26,550
Speaker 1: I mean, especially just from a medical standpoint, I love

603
00:30:26,630 --> 00:30:29,010
Speaker 1: watching CTE as it happens, you know?

604
00:30:29,570 --> 00:30:32,650
Speaker 2: I mean, just in real time, yeah. I mean, I

605
00:30:32,690 --> 00:30:34,590
Speaker 2: will watch it and just be like, God, I don't

606
00:30:34,610 --> 00:30:36,780
Speaker 2: feel good about this, but I'll watch it nonetheless.

607
00:30:36,800 --> 00:30:38,170
Speaker 1: I love it, I love it.

608
00:30:38,740 --> 00:30:41,360
Speaker 2: Something that is not a very bastard-like trait about him

609
00:30:41,700 --> 00:30:44,660
Speaker 2: is that he has been open about dealing with anxiety

610
00:30:44,680 --> 00:30:48,690
Speaker 2: issues perfectionism, and fear of failure, and even anger issues.

611
00:30:49,390 --> 00:30:51,800
Speaker 2: It's usually in the context of how he overcame it,

612
00:30:52,490 --> 00:30:54,410
Speaker 2: but that's just stuff we have to be talking about.

613
00:30:54,810 --> 00:30:56,710
Speaker 2: We have to be talking about moral injury in doctors.

614
00:30:56,730 --> 00:31:00,120
Speaker 2: We have to be talking about how doctors have psychological

615
00:31:00,140 --> 00:31:02,440
Speaker 2: and psychiatric issues, just like anyone else, and how to

616
00:31:02,480 --> 00:31:05,100
Speaker 2: get past that. So kudos for him for discussing it.

617
00:31:05,100 --> 00:31:07,580
Speaker 2: He's actually even talked on air about going to a

618
00:31:07,620 --> 00:31:11,770
Speaker 2: recovery center in Kentucky called Bridge to Recovery, not for alcohol,

619
00:31:11,810 --> 00:31:15,480
Speaker 2: but for what sounds like anger management. So Actually, I

620
00:31:15,500 --> 00:31:17,480
Speaker 2: feel like if he focused all his work on just

621
00:31:17,600 --> 00:31:20,020
Speaker 2: like that, how his background created issues for him and

622
00:31:20,400 --> 00:31:22,160
Speaker 2: how to address that, I think he'd be a pretty

623
00:31:22,200 --> 00:31:26,540
Speaker 2: cool dude. But, you know, regardless, it seems like he

624
00:31:26,600 --> 00:31:31,100
Speaker 2: didn't get unconditional love growing up. And whether that left

625
00:31:31,140 --> 00:31:34,080
Speaker 2: an emotional wound that shaped his relationships or need for

626
00:31:34,200 --> 00:31:37,980
Speaker 2: mastery or later why he fell prey to the gravitational

627
00:31:38,080 --> 00:31:41,280
Speaker 2: pull of powerful people like Jeffrey Epstein, I think is

628
00:31:41,320 --> 00:31:45,340
Speaker 2: something to discuss. And I'll be upfront, I am not

629
00:31:45,580 --> 00:31:48,580
Speaker 2: a psychologist, I am not a psychiatrist. I am a

630
00:31:48,840 --> 00:31:54,020
Speaker 2: simple gastroenterologist, which is essentially an ass dentist. But I

631
00:31:54,100 --> 00:31:58,300
Speaker 2: think it's important to touch on the psychological components of

632
00:31:58,340 --> 00:32:01,000
Speaker 2: his drive. And actually, I think from listening to him talk,

633
00:32:01,040 --> 00:32:02,740
Speaker 2: I think he would agree that that's an important thing

634
00:32:02,760 --> 00:32:07,330
Speaker 2: to discuss as well in his credit. Yeah. In his book,

635
00:32:07,370 --> 00:32:12,790
Speaker 2: he briefly mentions kind of obliquely experiencing trauma. But he

636
00:32:12,810 --> 00:32:15,870
Speaker 2: never really explains it. I didn't see what that meant,

637
00:32:16,030 --> 00:32:18,520
Speaker 2: what he was referring to. Did he just mean the

638
00:32:18,620 --> 00:32:20,740
Speaker 2: upbringing that we've already discussed, or was there something else?

639
00:32:20,780 --> 00:32:24,360
Speaker 2: I couldn't find that. But he does great. He gets

640
00:32:24,760 --> 00:32:29,459
Speaker 2: into Stanford Medical School after completing a Bachelor of Science

641
00:32:29,510 --> 00:32:33,630
Speaker 2: in Mechanical Engineering and Applied Mathematics at Queens University. Not

642
00:32:33,670 --> 00:32:37,970
Speaker 2: the typical humanities, biologic science-leaning approach a lot of medical

643
00:32:38,010 --> 00:32:40,600
Speaker 2: students do. Nothing wrong with that. I mean, I studied

644
00:32:40,640 --> 00:32:43,400
Speaker 2: biology and music in college, and it was always cool

645
00:32:43,440 --> 00:32:46,050
Speaker 2: to me when someone came from a different mindset, like

646
00:32:46,130 --> 00:32:50,330
Speaker 2: engineering or some systems-minded thinker. I think there should absolutely

647
00:32:50,750 --> 00:32:52,990
Speaker 2: be room for that. I think it's cool. He loves math.

648
00:32:53,210 --> 00:32:56,270
Speaker 2: It actually makes me wonder if being a doctor didn't

649
00:32:56,330 --> 00:32:59,500
Speaker 2: come with this sense of accomplishment or achievement that he

650
00:32:59,540 --> 00:33:01,580
Speaker 2: could show his family. I wonder what he would have done.

651
00:33:01,660 --> 00:33:03,880
Speaker 2: Probably could have been very useful to the world in

652
00:33:03,920 --> 00:33:06,520
Speaker 2: that sense as well. And I'll say this. I know

653
00:33:06,560 --> 00:33:10,140
Speaker 2: Stanford pretty well. I did rotations there. did research there

654
00:33:10,160 --> 00:33:12,620
Speaker 2: as well. And they do great research. A lot of

655
00:33:12,680 --> 00:33:17,090
Speaker 2: very important bench-to-bedside translational science happens there. And this is

656
00:33:17,110 --> 00:33:20,410
Speaker 2: going to be a hot take and one that I

657
00:33:20,450 --> 00:33:25,310
Speaker 2: will certainly regret. But since I do have some familiarity

658
00:33:25,390 --> 00:33:28,150
Speaker 2: with what I speak, I will say this. It's not

659
00:33:28,170 --> 00:33:30,960
Speaker 2: the best place to go for clinical training if you

660
00:33:30,980 --> 00:33:32,780
Speaker 2: really want to take care of patients.

661
00:33:33,460 --> 00:33:35,700
Speaker 1: Strong stance, Andy Stanford, coming out here.

662
00:33:36,700 --> 00:33:40,230
Speaker 2: I know. And I'm going to Absolutely going to regret

663
00:33:40,250 --> 00:33:41,870
Speaker 2: that and probably ask you to cut it. But no,

664
00:33:41,890 --> 00:33:44,020
Speaker 2: you know what? We're going to do it. We're going

665
00:33:44,060 --> 00:33:47,440
Speaker 2: with it. The best rotations you get when you're there

666
00:33:47,720 --> 00:33:49,820
Speaker 2: are when their students and their residents get to do

667
00:33:49,880 --> 00:33:53,400
Speaker 2: time at the Santa Clara Valley Medical Center, which is

668
00:33:53,420 --> 00:33:57,080
Speaker 2: this terrific county hospital that Stanford works with and that

669
00:33:57,240 --> 00:34:00,360
Speaker 2: I spent most of my training in. Fantastic place. And,

670
00:34:00,380 --> 00:34:02,280
Speaker 2: you know, I'll give an excuse. I mean, I don't

671
00:34:02,320 --> 00:34:03,640
Speaker 2: need an excuse to give them a shout out, but

672
00:34:03,720 --> 00:34:05,690
Speaker 2: I'll take any time I can. Santa Clara Valley Medical

673
00:34:05,710 --> 00:34:06,450
Speaker 2: Center is rad. Yeah.

674
00:34:06,810 --> 00:34:09,109
Speaker 1: If you get, go hurt yourself now and go there.

675
00:34:09,239 --> 00:34:09,760
Speaker 1: You know what?

676
00:34:09,780 --> 00:34:10,530
Speaker 2: Ideally, ideally.

677
00:34:10,640 --> 00:34:12,540
Speaker 1: And shoot a nail gun into your hand and head

678
00:34:12,600 --> 00:34:13,100
Speaker 1: right over.

679
00:34:13,120 --> 00:34:13,299
Speaker 2: Yeah.

680
00:34:13,320 --> 00:34:13,660
Speaker 1: You know?

681
00:34:13,780 --> 00:34:18,620
Speaker 2: Yeah. Yeah. No, great people, great doctors, really great mission

682
00:34:18,820 --> 00:34:21,680
Speaker 2: there for the doctors there. So, and I know people

683
00:34:21,700 --> 00:34:23,640
Speaker 2: that went to Stanford around this time, and it's clear

684
00:34:23,660 --> 00:34:26,370
Speaker 2: that even then he was standing out. People knew he

685
00:34:26,410 --> 00:34:29,029
Speaker 2: was going to be kind of something at an early age.

686
00:34:29,510 --> 00:34:32,250
Speaker 2: He was athletic. He already had this shaved head look

687
00:34:32,290 --> 00:34:37,279
Speaker 2: that we kind of see now. What was that? Okay.

688
00:34:37,620 --> 00:34:38,319
Speaker 1: Shaved head. Sure.

689
00:34:38,840 --> 00:34:39,020
Speaker 2: Right.

690
00:34:39,180 --> 00:34:39,480
Speaker 1: Yeah, yeah.

691
00:34:39,560 --> 00:34:43,180
Speaker 2: I mean, there's some guys that lean into that early. Easier.

692
00:34:43,260 --> 00:34:44,840
Speaker 1: He's got the Mr. Clean.

693
00:34:44,860 --> 00:34:47,799
Speaker 2: And it looks good on him.

694
00:34:48,280 --> 00:34:49,200
Speaker 1: It's a good look for some people.

695
00:34:49,219 --> 00:34:50,460
Speaker 3: He has the right head shape.

696
00:34:51,200 --> 00:34:52,320
Speaker 2: It won't work for me. I hate to say it.

697
00:34:52,320 --> 00:34:54,300
Speaker 2: I will tell you that right now. It's going to

698
00:34:54,320 --> 00:34:57,220
Speaker 2: be bad news. I'm going to Turkey when things get

699
00:34:57,260 --> 00:34:57,910
Speaker 2: real bad here.

700
00:34:57,930 --> 00:34:58,310
Speaker 1: I am.

701
00:34:58,960 --> 00:35:00,880
Speaker 2: I can't. It's not going to be good for me

702
00:35:00,960 --> 00:35:02,600
Speaker 2: if I don't. I'm going to need to do something

703
00:35:03,120 --> 00:35:06,580
Speaker 2: when I get bald, because my head's not this well-shaped

704
00:35:06,640 --> 00:35:11,990
Speaker 2: as his. So he graduates, and he matches at general

705
00:35:12,030 --> 00:35:15,450
Speaker 2: surgery residency at Johns Hopkins. It sounds like he was

706
00:35:15,469 --> 00:35:18,230
Speaker 2: going to go into a surgical oncology field after that.

707
00:35:19,230 --> 00:35:22,490
Speaker 2: But as we'll discuss, he didn't actually finish his surgical residency.

708
00:35:23,230 --> 00:35:25,460
Speaker 2: A general surgery residency, and stop me any time if

709
00:35:25,580 --> 00:35:27,820
Speaker 2: I'm going into the weeds here about this, but I

710
00:35:27,860 --> 00:35:30,569
Speaker 2: think it's kind of important to note, they're usually about

711
00:35:30,650 --> 00:35:32,690
Speaker 2: five years long. It can be longer based on if

712
00:35:32,710 --> 00:35:34,950
Speaker 2: you do research, and if you do a fellowship or

713
00:35:35,070 --> 00:35:37,550
Speaker 2: extra training on top of that, like surgical oncology, it

714
00:35:37,570 --> 00:35:40,310
Speaker 2: can be even longer. He did some time at the

715
00:35:40,450 --> 00:35:44,600
Speaker 2: NIH as well, which, you know, Johns Hopkins was great

716
00:35:44,620 --> 00:35:47,700
Speaker 2: for getting funded research, at least then. I mean, who

717
00:35:47,719 --> 00:35:49,980
Speaker 2: knows now with the country being the way it is,

718
00:35:50,040 --> 00:35:53,490
Speaker 2: but it's still a very prestigious place, Johns Hopkins, great

719
00:35:53,510 --> 00:35:57,770
Speaker 2: place to go. In year five, what ostensibly could have

720
00:35:57,810 --> 00:36:02,870
Speaker 2: been his last year, he quits residency. It's not clear

721
00:36:02,930 --> 00:36:04,910
Speaker 2: if he was counting the extra year of surgical oncology

722
00:36:04,950 --> 00:36:07,650
Speaker 2: and that, but he's towards the end of his training

723
00:36:07,810 --> 00:36:11,300
Speaker 2: and he quits. Now, I think this is something to discuss.

724
00:36:11,320 --> 00:36:14,400
Speaker 2: I have no evidence that he was forced out, but

725
00:36:14,420 --> 00:36:16,400
Speaker 2: I do have to say it's always a little unusual

726
00:36:17,100 --> 00:36:20,400
Speaker 2: for residency programs when someone leaves. In the rare cases

727
00:36:20,440 --> 00:36:23,479
Speaker 2: I've seen it, there's usually a reason. There's usually someone's

728
00:36:23,520 --> 00:36:27,600
Speaker 2: being forced to leave. In this case, I don't see that,

729
00:36:27,860 --> 00:36:32,049
Speaker 2: but it is always something good to note. Even people

730
00:36:32,090 --> 00:36:34,350
Speaker 2: who doubt whether or not they want to be practicing

731
00:36:34,410 --> 00:36:38,989
Speaker 2: physicians and they hate residency still finish it to at

732
00:36:39,030 --> 00:36:41,799
Speaker 2: least give them the option of being a doctor afterwards

733
00:36:41,860 --> 00:36:46,509
Speaker 2: if they want. I actually loved residency, but I would never,

734
00:36:46,610 --> 00:36:48,879
Speaker 2: ever do it again. It is by far the most

735
00:36:49,060 --> 00:36:53,500
Speaker 2: challenging time of a young doctor's life, particularly in the beginning.

736
00:36:53,600 --> 00:36:56,060
Speaker 2: I mean, you don't sleep. Him and I were both

737
00:36:56,140 --> 00:36:58,839
Speaker 2: around the same time, him before me, but we both

738
00:36:58,900 --> 00:37:02,580
Speaker 2: experienced what life was like before the 80-hour work restriction.

739
00:37:02,880 --> 00:37:05,600
Speaker 2: There is a restriction now, so you don't work more

740
00:37:05,620 --> 00:37:08,020
Speaker 2: than 80 hours, and that was considered soft.

741
00:37:08,200 --> 00:37:09,900
Speaker 1: Just a nice, mild 80 hours, yeah.

742
00:37:11,140 --> 00:37:13,549
Speaker 2: And we were... I was like the first class to

743
00:37:13,590 --> 00:37:18,069
Speaker 2: really experience how, to see how different that was. So

744
00:37:18,110 --> 00:37:21,989
Speaker 2: I was a lucky one. But anyways, so generally the

745
00:37:22,030 --> 00:37:26,100
Speaker 2: last year of residency isn't necessarily easy, but it tends

746
00:37:26,180 --> 00:37:30,780
Speaker 2: to be easier. You have more specialty rotations. You're usually

747
00:37:30,840 --> 00:37:33,660
Speaker 2: not on call as much. But it is interesting because

748
00:37:33,680 --> 00:37:36,380
Speaker 2: we've seen this now a couple times in people that

749
00:37:36,400 --> 00:37:40,190
Speaker 2: are related to the manosphere or related to the current administration.

750
00:37:40,250 --> 00:37:43,969
Speaker 2: For example, Casey Means, I don't know if you're familiar

751
00:37:44,050 --> 00:37:48,719
Speaker 2: with her. She was President Trump's, Donald Trump's earlier surgeon. Right.

752
00:37:48,760 --> 00:37:49,040
Speaker 1: Yes.

753
00:37:49,080 --> 00:37:50,040
Speaker 2: Sophie doesn't like it.

754
00:37:50,060 --> 00:37:50,940
Speaker 3: We talked about this.

755
00:37:51,260 --> 00:37:51,520
Speaker 1: Yeah.

756
00:37:51,700 --> 00:37:52,420
Speaker 2: Yes. Yes.

757
00:37:53,140 --> 00:37:57,779
Speaker 3: She was like very like wellness guru-y type content and

758
00:37:57,900 --> 00:38:02,570
Speaker 3: had very questionable opinions on scientifically proven things.

759
00:38:03,140 --> 00:38:06,880
Speaker 2: You're exactly right. She's really a co-architect of that Maha

760
00:38:06,960 --> 00:38:11,180
Speaker 2: messaging that's pushed and still being pushed. And she dropped

761
00:38:11,340 --> 00:38:15,399
Speaker 2: out of her OHSU head and neck surgery residency six

762
00:38:15,489 --> 00:38:21,270
Speaker 2: months before completing her five-year program. Now, as opposed to

763
00:38:21,290 --> 00:38:24,170
Speaker 2: with Peter, there are some different accounts. No one's ever...

764
00:38:24,210 --> 00:38:26,670
Speaker 2: I haven't heard anything from anyone, even people who knew him,

765
00:38:26,770 --> 00:38:29,969
Speaker 2: that there was a reason he left other than what

766
00:38:29,989 --> 00:38:33,020
Speaker 2: he says. But with her... Her account is, you know,

767
00:38:33,360 --> 00:38:37,160
Speaker 2: basically she got sick of the stick care and etc.

768
00:38:37,219 --> 00:38:39,870
Speaker 2: But her colleagues have a slightly different account of why

769
00:38:39,969 --> 00:38:44,100
Speaker 2: she left. But I have no reason to doubt him.

770
00:38:44,280 --> 00:38:46,440
Speaker 2: To be honest, people should be able to quit, leave

771
00:38:46,460 --> 00:38:49,640
Speaker 2: what's not right for them. Actually, more doctors probably should

772
00:38:49,960 --> 00:38:52,720
Speaker 2: do it. I know too many doctors that are unhappy

773
00:38:52,760 --> 00:38:55,859
Speaker 2: and stuck in that sunken cost fallacy where they feel

774
00:38:55,880 --> 00:38:58,200
Speaker 2: like they can't quit or leave. You could actually even

775
00:38:58,730 --> 00:39:03,370
Speaker 2: question why Abdul Saeed didn't even go to residency in

776
00:39:03,410 --> 00:39:05,589
Speaker 2: the first place. I think in his case, it makes sense.

777
00:39:05,630 --> 00:39:08,450
Speaker 2: He never bills himself as a clinical doctor. He doesn't

778
00:39:08,650 --> 00:39:11,580
Speaker 2: seem to have any interest in providing direct patient care.

779
00:39:11,600 --> 00:39:15,719
Speaker 2: He's more interested in the broader strokes of public health. Now,

780
00:39:16,640 --> 00:39:20,200
Speaker 2: for Peter, when he was asked about why he left

781
00:39:20,280 --> 00:39:25,150
Speaker 2: residency without finishing or becoming a board-certified MD, he reports

782
00:39:25,530 --> 00:39:27,330
Speaker 2: that he left on his own accord because he became

783
00:39:27,870 --> 00:39:32,440
Speaker 2: disillusioned with the medical system, what he called Medicine 2.0,

784
00:39:32,440 --> 00:39:35,560
Speaker 2: which the fact that he's already referring... Okay.

785
00:39:35,600 --> 00:39:35,839
Speaker 3: Yeah.

786
00:39:35,840 --> 00:39:40,060
Speaker 2: 2.0, huh? Yeah. Okay. You're getting a vibe already that

787
00:39:40,640 --> 00:39:41,680
Speaker 2: it's being referred to as.

788
00:39:41,820 --> 00:39:44,959
Speaker 1: Excited for Medicine 2. Medicine 1 did too much, like,

789
00:39:44,980 --> 00:39:49,450
Speaker 1: you know, vaccines, stopping the spread of horrible plagues... making

790
00:39:49,469 --> 00:39:51,130
Speaker 1: it so that you don't stub your toe and then

791
00:39:51,170 --> 00:39:53,730
Speaker 1: die of an infection. I'm excited to see what Medicine

792
00:39:53,730 --> 00:39:57,620
Speaker 1: 2.0 brings us. Yeah, and it just really has— 70-hour erections?

793
00:39:57,820 --> 00:39:58,680
Speaker 1: The sky's the limit.

794
00:39:59,200 --> 00:40:03,080
Speaker 2: Well, he calls what we're experiencing now Medicine 2.0. What

795
00:40:03,120 --> 00:40:06,140
Speaker 2: he wants to offer you is Medicine 3.0.

796
00:40:06,140 --> 00:40:09,219
Speaker 1: Was medicine 1.0 like arsenic and telling you to go

797
00:40:09,320 --> 00:40:10,600
Speaker 1: to the sea when you're sick?

798
00:40:11,860 --> 00:40:16,430
Speaker 2: I don't know. But he calls it medicine 2.0, and

799
00:40:16,450 --> 00:40:18,950
Speaker 2: it really just strikes me as odd because it has

800
00:40:18,969 --> 00:40:22,450
Speaker 2: this real sort of like Silicon Valley bro vibe to

801
00:40:22,510 --> 00:40:26,020
Speaker 2: it just off the bat, you know, doing that. And

802
00:40:26,080 --> 00:40:28,260
Speaker 2: he explains that he did this because he had essentially

803
00:40:28,280 --> 00:40:32,630
Speaker 2: a crisis of faith. Again, he sells this frustration as

804
00:40:32,830 --> 00:40:35,910
Speaker 2: the symptom, saying that it's built to react to disease

805
00:40:35,950 --> 00:40:38,090
Speaker 2: instead of preventing it. And whenever I hear that, it

806
00:40:38,150 --> 00:40:41,540
Speaker 2: has a real, like, pick-me energy. I'm a different kind

807
00:40:41,560 --> 00:40:44,320
Speaker 2: of doctor, you know? I'm not like the other doctors,

808
00:40:44,960 --> 00:40:46,780
Speaker 2: you know? I'm a cool doctor.

809
00:40:47,200 --> 00:40:49,279
Speaker 1: Yeah, yeah, yeah.

810
00:40:49,320 --> 00:40:51,950
Speaker 2: That's a bit of a red flag. Keep that in mind.

811
00:40:52,410 --> 00:40:55,910
Speaker 2: And when this topic comes up, he explains why he

812
00:40:55,950 --> 00:40:59,090
Speaker 2: left by telling a story about his last year in residency.

813
00:40:59,660 --> 00:41:02,660
Speaker 2: when he was treating a patient in the ICU with

814
00:41:02,700 --> 00:41:07,009
Speaker 2: an antibiotic called gentamicin. Now, gentamicin is a type of

815
00:41:07,050 --> 00:41:09,830
Speaker 2: antibiotic called an immunoglycoside. This is gonna be on the test.

816
00:41:10,870 --> 00:41:13,950
Speaker 2: And it's used for bad infections sometimes, and it gives

817
00:41:13,969 --> 00:41:18,410
Speaker 2: you really powerful activity against gram-negative bacteria. But here's the

818
00:41:18,469 --> 00:41:21,230
Speaker 2: issue with it. There is a narrow therapeutic window that

819
00:41:21,250 --> 00:41:22,920
Speaker 2: you kind of have to hit when you use it.

820
00:41:23,770 --> 00:41:30,120
Speaker 2: The effective dose is actually pretty close to the toxic dose. Ah, okay.

821
00:41:30,180 --> 00:41:31,540
Speaker 1: Yeah, I can see how that could be a problem.

822
00:41:31,640 --> 00:41:33,800
Speaker 2: You can see why this is a problem. And small

823
00:41:33,900 --> 00:41:37,900
Speaker 2: errors can cause real harm, permanent harm to either your

824
00:41:37,940 --> 00:41:41,319
Speaker 2: kidneys or giving you what's called ototoxicity. You can lose

825
00:41:41,360 --> 00:41:45,840
Speaker 2: your hearing from it. It's terrible. It's a board's question

826
00:41:45,860 --> 00:41:48,500
Speaker 2: when you're young. And it's one thing you always keep

827
00:41:48,520 --> 00:41:50,520
Speaker 2: in mind. You rarely see it. I don't think I've

828
00:41:50,540 --> 00:41:52,950
Speaker 2: ever seen it. But there's systems in place to help

829
00:41:52,989 --> 00:41:55,839
Speaker 2: prevent this from ever happening. It is something that has

830
00:41:55,860 --> 00:41:57,560
Speaker 2: to be monitored carefully because if you give too much,

831
00:41:57,980 --> 00:42:01,049
Speaker 2: you can cause permanent damage. But if you give too little, well,

832
00:42:01,070 --> 00:42:04,950
Speaker 2: then you're not stopping this bacteria that may be trying

833
00:42:05,210 --> 00:42:09,650
Speaker 2: actively to kill you. So it is an interesting antibiotic

834
00:42:09,670 --> 00:42:12,940
Speaker 2: in that sense. And it's tightly controlled with weight-based dosing

835
00:42:13,310 --> 00:42:15,469
Speaker 2: And checking kidney functions to make sure you're getting rid

836
00:42:15,489 --> 00:42:15,660
Speaker 2: of it.

837
00:42:15,810 --> 00:42:15,989
Speaker 1: Okay.

838
00:42:16,210 --> 00:42:19,529
Speaker 2: And checking peak and trough levels. So you check the

839
00:42:19,570 --> 00:42:21,529
Speaker 2: blood when it's at its highest point. You check the

840
00:42:21,570 --> 00:42:24,109
Speaker 2: blood when it's at its lowest point. So you're getting

841
00:42:24,140 --> 00:42:27,340
Speaker 2: a sense of where you need to give the dosing.

842
00:42:28,600 --> 00:42:31,399
Speaker 2: It's not the kind of drug that a resident should

843
00:42:31,440 --> 00:42:36,879
Speaker 2: be casually fucking around with. Right. There's generally protocols for

844
00:42:36,900 --> 00:42:37,180
Speaker 2: its use.

845
00:42:38,120 --> 00:42:42,770
Speaker 1: Really, it's a measure-twice-cut-once kind of drug. Exactly.

846
00:42:42,830 --> 00:42:46,760
Speaker 2: Or they die. And this is why pharmacists are so amazing.

847
00:42:47,100 --> 00:42:54,080
Speaker 2: Because the amount of deaths pharmacists have you know, prevented

848
00:42:54,480 --> 00:42:59,720
Speaker 2: by double checking doctor's orders, mine included, you know, cannot

849
00:42:59,800 --> 00:43:03,730
Speaker 2: be underplayed. It is, it is huge. And there, that's

850
00:43:03,790 --> 00:43:07,690
Speaker 2: why at most hospitals and Johns Hopkins, Johns, it's not,

851
00:43:08,190 --> 00:43:11,089
Speaker 2: by the way, it's Johns Hopkins. It's not John. It's

852
00:43:11,110 --> 00:43:14,609
Speaker 2: like Ruth, Ruth's Chris's steakhouse. It's a, I never understood that,

853
00:43:14,640 --> 00:43:19,520
Speaker 2: but at Johns Hopkins, it's attending approved and pharmacy driven.

854
00:43:19,540 --> 00:43:21,739
Speaker 2: It's like the pharmacists are really the ones that, that

855
00:43:21,760 --> 00:43:25,219
Speaker 2: you rely on for these sorts of things. So while

856
00:43:25,239 --> 00:43:27,320
Speaker 2: he's caring for this patient, receiving the antibiotics, he starts

857
00:43:27,390 --> 00:43:31,870
Speaker 2: considering there has to be a better way to optimize

858
00:43:32,489 --> 00:43:35,830
Speaker 2: the timing of this drug. He wanted to disrupt the

859
00:43:35,870 --> 00:43:37,810
Speaker 2: way it's delivered. He didn't say those words disrupt, I

860
00:43:37,830 --> 00:43:41,219
Speaker 2: don't think, but that is how I feel. I feel

861
00:43:41,239 --> 00:43:43,120
Speaker 2: like he said it in that Silicon Valley sense of

862
00:43:43,140 --> 00:43:48,750
Speaker 2: the word to disrupt. He's a disruptor. So he stays up.

863
00:43:49,520 --> 00:43:52,250
Speaker 2: He stays up late while he's on call. He presumably

864
00:43:52,330 --> 00:43:55,410
Speaker 2: studies up on the drug's half-life and other factors, and

865
00:43:55,450 --> 00:43:59,049
Speaker 2: he creates an Excel spreadsheet that would change the timing

866
00:43:59,110 --> 00:44:02,620
Speaker 2: to more accurately predict when the drug would hit trough levels,

867
00:44:02,719 --> 00:44:05,920
Speaker 2: and that's the best time to give it. It's not

868
00:44:05,960 --> 00:44:08,219
Speaker 2: entirely clear to me if this was a problem that

869
00:44:08,239 --> 00:44:12,060
Speaker 2: was in need of solving. I mean, the current method

870
00:44:12,100 --> 00:44:13,839
Speaker 2: may not be that efficient. There's a lot of moving

871
00:44:13,880 --> 00:44:17,080
Speaker 2: parts to it. It's hard to know. Whenever he brings

872
00:44:17,100 --> 00:44:20,310
Speaker 2: this up on podcast, it's usually with like some, you know,

873
00:44:20,330 --> 00:44:24,069
Speaker 2: dude bro who doesn't, like, have follow-up medical questions for him, but.

874
00:44:24,290 --> 00:44:25,209
Speaker 1: Yeah, yeah, yeah.

875
00:44:26,290 --> 00:44:28,230
Speaker 2: So it's hard to know. I mean, I would actually,

876
00:44:28,250 --> 00:44:29,710
Speaker 2: if I had a chance to talk to him, that's

877
00:44:30,210 --> 00:44:32,340
Speaker 2: actually probably the first thing we'd start with is talking

878
00:44:32,380 --> 00:44:37,320
Speaker 2: about this story. And he apparently ran it by an

879
00:44:37,380 --> 00:44:40,239
Speaker 2: infectious disease fellow, and they recommended against doing it, but

880
00:44:40,260 --> 00:44:44,330
Speaker 2: he does it anyways, right? He enacts this new dosing

881
00:44:44,370 --> 00:44:49,310
Speaker 2: protocol without his attending's approval, or without any communication with

882
00:44:49,330 --> 00:44:52,270
Speaker 2: the pharmacy. And when he tells his attending this the

883
00:44:52,330 --> 00:44:55,200
Speaker 2: next morning, when everyone's doing rounding, and they're all standing around,

884
00:44:55,239 --> 00:44:57,400
Speaker 2: you stand around a group, do you guys know what

885
00:44:57,420 --> 00:45:00,219
Speaker 2: rounding is? Do you know what attending is? Stop me

886
00:45:00,239 --> 00:45:01,500
Speaker 2: if I'm using medical jargon.

887
00:45:01,520 --> 00:45:03,719
Speaker 1: Yeah, like doing your rounds, you mean?

888
00:45:03,840 --> 00:45:04,420
Speaker 2: That's right.

889
00:45:04,719 --> 00:45:10,779
Speaker 1: Like in-house. Scrubs actually shows that a lot more. Yeah, yeah, yeah.

890
00:45:11,080 --> 00:45:14,230
Speaker 3: But for the audience... If you haven't seen House, you

891
00:45:14,270 --> 00:45:17,330
Speaker 3: haven't seen Grey's Anatomy, it's when a bunch of doctors

892
00:45:17,750 --> 00:45:20,529
Speaker 3: discuss a case and go around and discuss all the

893
00:45:20,570 --> 00:45:21,830
Speaker 3: cases they're assigned to.

894
00:45:22,110 --> 00:45:25,140
Speaker 1: You lead the doctors who are doing their residency around,

895
00:45:25,180 --> 00:45:29,200
Speaker 1: and a more experienced doctor is talking them through as

896
00:45:29,239 --> 00:45:32,200
Speaker 1: they look at different patients and stuff to learn.

897
00:45:33,219 --> 00:45:37,160
Speaker 2: That's exactly right. Every time, though, just to be clear, listener,

898
00:45:37,800 --> 00:45:39,890
Speaker 2: Robert knows what he's doing. Every time he says, yeah,

899
00:45:39,910 --> 00:45:41,750
Speaker 2: it's like house, he knows that a little part of

900
00:45:41,770 --> 00:45:43,570
Speaker 2: my soul dies, and that's why he does it.

901
00:45:43,950 --> 00:45:47,630
Speaker 1: No, I mean, my last direct experience with rounds was

902
00:45:47,650 --> 00:45:51,069
Speaker 1: when my dad was dying. His oncologist took a bunch

903
00:45:51,090 --> 00:45:53,750
Speaker 1: of students around, and they were doing their rounds, and

904
00:45:54,130 --> 00:45:57,509
Speaker 1: I overheard them talking about my dad's case, where he

905
00:45:57,550 --> 00:46:00,759
Speaker 1: was just like, yeah, this one really is a very

906
00:46:00,800 --> 00:46:03,759
Speaker 1: surprising case. We didn't expect it to go. It was

907
00:46:03,800 --> 00:46:09,109
Speaker 1: not a great thing to hear after his... because it didn't, like,

908
00:46:09,160 --> 00:46:11,020
Speaker 1: the case did not proceed the way he had expected.

909
00:46:11,040 --> 00:46:15,140
Speaker 1: It was not, like, expected to be a very serious situation.

910
00:46:15,200 --> 00:46:17,739
Speaker 1: He wound up dying. So I got to overhear him, like,

911
00:46:17,780 --> 00:46:19,880
Speaker 1: talking to students about that. But yeah, I know what

912
00:46:19,920 --> 00:46:20,319
Speaker 1: rounds are.

913
00:46:20,400 --> 00:46:23,319
Speaker 2: Yeah, you know, it is a, it's never fun to

914
00:46:23,340 --> 00:46:24,989
Speaker 2: be the interesting case.

915
00:46:25,120 --> 00:46:25,190
Speaker 3: No.

916
00:46:25,200 --> 00:46:26,050
Speaker 2: Or the family of the interesting.

917
00:46:26,070 --> 00:46:28,730
Speaker 1: No, you really don't want to be interesting. No. Yeah.

918
00:46:29,150 --> 00:46:31,310
Speaker 2: God, now I feel like an asshole for making fun

919
00:46:31,350 --> 00:46:31,750
Speaker 2: of you.

920
00:46:31,770 --> 00:46:35,010
Speaker 1: No, I mean, I didn't blame him. Like, he's an oncologist, right? Yeah.

921
00:46:35,710 --> 00:46:36,850
Speaker 1: That's the job. Okay.

922
00:46:36,890 --> 00:46:40,610
Speaker 2: Okay. So he enacts this new dosing protocol, and he's

923
00:46:40,660 --> 00:46:43,839
Speaker 2: telling the team about it. And the attending is the

924
00:46:44,320 --> 00:46:46,200
Speaker 2: head of the team, the person that's out of training.

925
00:46:46,239 --> 00:46:47,719
Speaker 2: They kind of run the team. They're at the top

926
00:46:47,739 --> 00:46:50,819
Speaker 2: of the ladder. They spend the least time there. You know,

927
00:46:50,880 --> 00:46:52,520
Speaker 2: the interns, residents, they're the ones that are there all

928
00:46:52,540 --> 00:46:54,680
Speaker 2: the time. And the attendant kind of comes in for

929
00:46:54,860 --> 00:46:58,400
Speaker 2: a period of time, but not as long. And he

930
00:46:58,440 --> 00:47:01,319
Speaker 2: thinks he's going to get lauded for being a very

931
00:47:01,360 --> 00:47:06,220
Speaker 2: special boy here. Instead, he gets chewed out. his attending

932
00:47:06,260 --> 00:47:09,980
Speaker 2: considers it a serious breach of safety and hierarchy. And

933
00:47:10,560 --> 00:47:14,580
Speaker 2: I have to tell you, things, I think, have overall

934
00:47:14,600 --> 00:47:17,580
Speaker 2: gotten better, but there are few things worse than having

935
00:47:17,660 --> 00:47:22,710
Speaker 2: attending totally dress you down in rounds around other people.

936
00:47:23,310 --> 00:47:27,310
Speaker 2: And in some places, particularly, I think, Johns Hopkins, that's

937
00:47:27,330 --> 00:47:28,750
Speaker 2: the kind of place where that sort of thing is

938
00:47:28,790 --> 00:47:30,730
Speaker 2: going to happen. Less so here on the West Coast,

939
00:47:30,790 --> 00:47:36,080
Speaker 2: where we are. People tend to be more chill, but... Man,

940
00:47:36,100 --> 00:47:39,560
Speaker 2: there are attendings that kind of get a little kick

941
00:47:40,100 --> 00:47:44,430
Speaker 2: out of seeing their intern, their medical student, their resident cry. Like,

942
00:47:44,890 --> 00:47:50,310
Speaker 2: it is terrible. So I actually, even though I agree

943
00:47:50,350 --> 00:47:54,529
Speaker 2: with the attending, I do feel for him in this case.

944
00:47:54,610 --> 00:47:57,049
Speaker 2: I don't know what happened to the patient. There's never

945
00:47:57,110 --> 00:47:59,230
Speaker 2: any discussion of that, if it hurt the patient or

946
00:47:59,250 --> 00:48:01,710
Speaker 2: if it didn't. I'm assuming it didn't. I'm hoping, but

947
00:48:01,770 --> 00:48:06,370
Speaker 2: I don't know. I assume the attending was worried that

948
00:48:06,770 --> 00:48:09,989
Speaker 2: changing the testing and dosing could have either invalidated the

949
00:48:10,030 --> 00:48:14,390
Speaker 2: levels or caused the next level to be uninterpretable, or

950
00:48:14,430 --> 00:48:16,750
Speaker 2: maybe even wind up delaying the patient's care even more.

951
00:48:16,850 --> 00:48:20,490
Speaker 2: So I'm not sure why the attending was so mad.

952
00:48:20,950 --> 00:48:22,860
Speaker 2: I never found anything from their perspective. But at the

953
00:48:22,880 --> 00:48:26,719
Speaker 2: end of the day, it's their, it's totally their responsibility.

954
00:48:26,739 --> 00:48:28,380
Speaker 2: It comes down to them. So if anything happens to

955
00:48:28,400 --> 00:48:33,239
Speaker 2: that patient, I can understand why they'd be so pissed. Right. Now,

956
00:48:34,150 --> 00:48:39,549
Speaker 2: That response pisses off Atiyah, who feels his brilliance is

957
00:48:39,590 --> 00:48:44,140
Speaker 2: being stifled. And he feels that this is an example

958
00:48:44,400 --> 00:48:49,680
Speaker 2: of medicine punishing out-of-the-box thinkers. But before I tell you

959
00:48:50,160 --> 00:48:52,390
Speaker 2: more about what happens next, I want to tell you

960
00:48:53,469 --> 00:48:58,070
Speaker 2: that coming up soon, you're going to hear some in-the-box thinkers.

961
00:48:58,390 --> 00:48:58,830
Speaker 2: That's right.

962
00:48:58,870 --> 00:49:01,890
Speaker 1: Maybe. That's right. Maybe. The box of money that you

963
00:49:01,930 --> 00:49:02,870
Speaker 1: need to give to them.

964
00:49:03,410 --> 00:49:06,009
Speaker 2: Or I was thinking Blue Apron, if they're still sponsors.

965
00:49:06,050 --> 00:49:06,549
Speaker 2: If not, screw them.

966
00:49:06,570 --> 00:49:08,430
Speaker 1: Blue Apron does send boxes. I think they may have

967
00:49:08,450 --> 00:49:11,010
Speaker 1: gone out of business because of all of the deaths,

968
00:49:11,070 --> 00:49:12,629
Speaker 1: but I'm not sure. You know?

969
00:49:13,370 --> 00:49:13,610
Speaker 2: No, no.

970
00:49:13,650 --> 00:49:15,310
Speaker 1: We don't joke about the island anymore. We just joke

971
00:49:15,350 --> 00:49:15,850
Speaker 1: about the deaths.

972
00:49:16,190 --> 00:49:17,450
Speaker 2: Ah, that's funnier anyway. Because they didn't kill a lot

973
00:49:17,469 --> 00:49:20,940
Speaker 2: of people. Yeah. All right. Well, let's... take a little break.

974
00:49:20,980 --> 00:49:23,680
Speaker 2: I'm taking over the podcast now, folks. I'm calling the

975
00:49:23,739 --> 00:49:26,180
Speaker 2: ad breaks. We'll be right back.

976
00:49:26,930 --> 00:49:37,489
Speaker 1: Yeah. And we're back. Kava, you really should explore at

977
00:49:37,570 --> 00:49:41,660
Speaker 1: some point accidentally creating a conspiracy theory about a company

978
00:49:41,700 --> 00:49:44,040
Speaker 1: that people really do believe and then you have to

979
00:49:44,219 --> 00:49:46,460
Speaker 1: backtrack it because you didn't realize that it was going

980
00:49:46,500 --> 00:49:48,940
Speaker 1: to actually be taken seriously it's always.

981
00:49:48,800 --> 00:49:51,489
Speaker 2: A good time that is um is that is that

982
00:49:51,530 --> 00:49:55,550
Speaker 2: real that happened people actually believe you're very clear obvious jokes.

983
00:49:55,489 --> 00:49:57,670
Speaker 1: For sure for sure that's why we stopped making the

984
00:49:57,710 --> 00:50:00,109
Speaker 1: blue acorn jokes yeah people someone was like is there

985
00:50:00,130 --> 00:50:04,219
Speaker 1: really an island Yeah. More than one person took it seriously.

986
00:50:04,940 --> 00:50:08,300
Speaker 2: I will say this after my first or second appearance

987
00:50:08,480 --> 00:50:12,359
Speaker 2: on this podcast many years ago, um, you, you did

988
00:50:12,440 --> 00:50:16,210
Speaker 2: do an ad break and you bleeped out the name

989
00:50:16,489 --> 00:50:20,330
Speaker 2: of the, the, the company. And I got a number

990
00:50:20,370 --> 00:50:23,230
Speaker 2: of messages from people begging for me to tell them

991
00:50:23,750 --> 00:50:27,750
Speaker 2: who it was, who it was. And I was like, no,

992
00:50:27,770 --> 00:50:31,930
Speaker 2: I signed an NDA. I can't say that. Um, But yeah,

993
00:50:32,160 --> 00:50:33,760
Speaker 2: I guess I'm not surprised that people took it seriously.

994
00:50:34,680 --> 00:50:38,480
Speaker 2: But speaking of taking things seriously, last we left off,

995
00:50:38,600 --> 00:50:43,490
Speaker 2: Peter Attia felt his brilliance was being stifled, and he

996
00:50:43,630 --> 00:50:46,630
Speaker 2: took that seriously, and he was very upset. I listened

997
00:50:46,650 --> 00:50:49,270
Speaker 2: to a couple of podcast interviews he did about this,

998
00:50:49,969 --> 00:50:53,860
Speaker 2: and this is something he said. It struck me as anti-intellectual.

999
00:50:54,520 --> 00:50:57,900
Speaker 2: Maybe my model wasn't perfect. We'll never know. But the

1000
00:50:57,940 --> 00:50:59,989
Speaker 2: fact that nobody even cared to see if there was

1001
00:51:00,030 --> 00:51:04,589
Speaker 2: a better way to do this drove me batshit crazy. Now,

1002
00:51:04,610 --> 00:51:07,190
Speaker 2: here's the thing. Let me say something here. Let me

1003
00:51:07,230 --> 00:51:09,350
Speaker 2: say something here. Let's take a little quick aside here.

1004
00:51:10,230 --> 00:51:13,350
Speaker 2: I think this is very emblematic of my broader thoughts

1005
00:51:13,550 --> 00:51:18,250
Speaker 2: on Peter Ortia. Maybe he had a good idea. And

1006
00:51:18,310 --> 00:51:21,860
Speaker 2: we should always be trying to push science forward and

1007
00:51:21,920 --> 00:51:26,279
Speaker 2: deliver things better, deliver better care. But you know when

1008
00:51:26,300 --> 00:51:28,950
Speaker 2: he says, we'll never know because nobody cared to see

1009
00:51:28,969 --> 00:51:30,450
Speaker 2: if there's a better way to do it. There is

1010
00:51:30,489 --> 00:51:32,110
Speaker 2: a better way to do it. You can make a

1011
00:51:32,150 --> 00:51:35,549
Speaker 2: study out of it. Why not do that? He's right.

1012
00:51:35,650 --> 00:51:38,500
Speaker 2: We'll never know if it works because he didn't study it.

1013
00:51:38,550 --> 00:51:41,370
Speaker 2: He had the idea and he didn't study it. This

1014
00:51:41,450 --> 00:51:44,129
Speaker 2: could have very easily been done at a place like

1015
00:51:44,190 --> 00:51:47,529
Speaker 2: Johns Hopkins. And you could do this and prove that

1016
00:51:47,550 --> 00:51:50,890
Speaker 2: it works. If it's not unethical, an IRB will review

1017
00:51:50,910 --> 00:51:52,110
Speaker 2: it as such and you can prove it.

1018
00:51:53,020 --> 00:51:53,200
Speaker 1: Yeah.

1019
00:51:54,219 --> 00:51:57,680
Speaker 3: I just want to add that I'm really enjoying the

1020
00:51:57,760 --> 00:52:00,719
Speaker 3: way that you pronounce Johns Hopkins every time. Yeah.

1021
00:52:02,230 --> 00:52:07,069
Speaker 2: Johns Hopkins. I really have to really stress the plurality

1022
00:52:07,110 --> 00:52:09,670
Speaker 2: of Johns. There's more than one John involved in the

1023
00:52:09,690 --> 00:52:15,280
Speaker 2: Hopkins of this situation, and I don't understand it. So

1024
00:52:15,390 --> 00:52:18,340
Speaker 2: this will probably bum out the doctors on my little

1025
00:52:18,540 --> 00:52:21,560
Speaker 2: group chat, you know, my little doctor group chat that

1026
00:52:21,580 --> 00:52:24,399
Speaker 2: I run some of this stuff by. But as I'm

1027
00:52:25,040 --> 00:52:28,200
Speaker 2: researching this guy for this episode, and I use the

1028
00:52:28,219 --> 00:52:31,549
Speaker 2: term research lightly, Actually, there's a lot of things I

1029
00:52:31,640 --> 00:52:35,940
Speaker 2: like about him. If he was more inherently a physician

1030
00:52:36,480 --> 00:52:41,820
Speaker 2: and less a business-y sort of like accountant engineer guy,

1031
00:52:41,840 --> 00:52:45,000
Speaker 2: I think he could have been a great doctor. And

1032
00:52:45,040 --> 00:52:47,960
Speaker 2: like Peter. Pete, I don't know if you're listening.

1033
00:52:47,980 --> 00:52:48,200
Speaker 1: Yeah.

1034
00:52:48,860 --> 00:52:53,279
Speaker 2: My Middle Eastern brother. I don't think it's too late

1035
00:52:53,340 --> 00:52:56,819
Speaker 2: for you to have an amazing redemption arc. I think

1036
00:52:57,340 --> 00:53:01,450
Speaker 2: it's still possible. Yeah. But that mentality has to change.

1037
00:53:01,510 --> 00:53:04,509
Speaker 2: I mean, be just a doctor. Do the doctor thing,

1038
00:53:05,570 --> 00:53:07,690
Speaker 2: says the medical podcaster.

1039
00:53:07,730 --> 00:53:10,609
Speaker 1: Says the doctor. Yeah, I mean, like, yeah. You don't

1040
00:53:10,670 --> 00:53:14,350
Speaker 1: have to, yeah. You don't have to make bedfellows with

1041
00:53:14,390 --> 00:53:18,440
Speaker 1: the worst people in the world to do medicine.

1042
00:53:18,780 --> 00:53:22,180
Speaker 2: We'll get to that in the next episode. So basically

1043
00:53:22,200 --> 00:53:24,500
Speaker 2: what he was doing here is an unauthorized experiment. And

1044
00:53:24,520 --> 00:53:28,250
Speaker 2: I know this sounds like a... sort of small potatoes

1045
00:53:28,310 --> 00:53:30,630
Speaker 2: issue to a lot of the Behind the Bastards listeners.

1046
00:53:31,969 --> 00:53:35,219
Speaker 2: It's not mass murder. And again, he's not as bad

1047
00:53:35,280 --> 00:53:38,160
Speaker 2: as RFK Jr., who I really, really, really don't like.

1048
00:53:38,180 --> 00:53:40,460
Speaker 2: You probably know that. I don't enjoy him very much.

1049
00:53:41,360 --> 00:53:46,140
Speaker 2: I don't like the man. But this laissez-faire approach to

1050
00:53:46,219 --> 00:53:48,739
Speaker 2: medicine and science is just not how science works. Science

1051
00:53:48,780 --> 00:53:52,140
Speaker 2: is supposed to be a little boring. Yep. Honestly, 10

1052
00:53:52,140 --> 00:53:55,779
Speaker 2: years ago, I probably wouldn't be bothered by this at all.

1053
00:53:56,930 --> 00:54:00,390
Speaker 2: But what has happened over that time is that a

1054
00:54:00,469 --> 00:54:02,370
Speaker 2: lot of the little stuff in medicine that we just

1055
00:54:02,410 --> 00:54:05,350
Speaker 2: let slide has added up. And it's led us to

1056
00:54:05,370 --> 00:54:08,410
Speaker 2: where we are now in this country. 20 years ago,

1057
00:54:08,830 --> 00:54:11,430
Speaker 2: if I heard about Gwyneth Paltrow putting a jade egg,

1058
00:54:11,920 --> 00:54:15,820
Speaker 2: you know, up her hoo-ha, or somebody using essential oils

1059
00:54:15,920 --> 00:54:19,460
Speaker 2: to cure their diabetes— It's the medical term. Sure. It's

1060
00:54:19,480 --> 00:54:21,759
Speaker 2: the medical term. We would laugh and move on. That

1061
00:54:21,780 --> 00:54:25,799
Speaker 2: would be it. But— All these things add up over time.

1062
00:54:25,910 --> 00:54:29,420
Speaker 2: The more nonsense we let go by without saying anything

1063
00:54:29,480 --> 00:54:32,520
Speaker 2: because it's easier to ignore it, the more coffee enemas

1064
00:54:32,760 --> 00:54:35,439
Speaker 2: we let slide now because we don't want to have

1065
00:54:35,480 --> 00:54:37,860
Speaker 2: to explain to you that you don't need to detox

1066
00:54:38,000 --> 00:54:40,120
Speaker 2: outside of your liver and kidneys and that it's bad

1067
00:54:40,500 --> 00:54:45,239
Speaker 2: for you. The more of this we let go, the

1068
00:54:45,420 --> 00:54:49,240
Speaker 2: easier it is to eventually have confusion around important public

1069
00:54:49,280 --> 00:54:53,259
Speaker 2: health care issues, like vaccines, for example. It creates this

1070
00:54:54,190 --> 00:54:57,390
Speaker 2: murkiness around science where people can be like, yeah, there's

1071
00:54:57,410 --> 00:55:01,540
Speaker 2: lots of different ways to interpret science. Like, it's religion. And, like,

1072
00:55:02,140 --> 00:55:03,359
Speaker 2: that's not how science works.

1073
00:55:03,380 --> 00:55:05,680
Speaker 1: Yeah, you're reading tea leaves as opposed to just trying

1074
00:55:05,700 --> 00:55:09,180
Speaker 1: to figure out, like, what works and doesn't empirically.

1075
00:55:09,500 --> 00:55:09,680
Speaker 3: Yeah.

1076
00:55:09,719 --> 00:55:12,259
Speaker 2: Because now we have, like, this thing where people are like, hey,

1077
00:55:12,560 --> 00:55:16,930
Speaker 2: you have your interpretation of science, I have mine. And sure,

1078
00:55:16,950 --> 00:55:18,810
Speaker 2: to some degree, that is true. People can have different

1079
00:55:18,830 --> 00:55:24,020
Speaker 2: interpretations of the study. But there are basic tenets of

1080
00:55:24,460 --> 00:55:27,360
Speaker 2: science that need to be met before you can do that. Anyways,

1081
00:55:29,100 --> 00:55:32,890
Speaker 2: in listening to Atiyah talk about this particular experience in

1082
00:55:32,930 --> 00:55:36,070
Speaker 2: his podcast, sometimes he acknowledges, yeah, it was kind of

1083
00:55:36,110 --> 00:55:37,690
Speaker 2: a bit reckless what I did. In his book, he

1084
00:55:37,710 --> 00:55:41,330
Speaker 2: kind of comes across as much more like contrite, and

1085
00:55:41,350 --> 00:55:43,830
Speaker 2: he seems to understand that maybe he was just trying

1086
00:55:43,850 --> 00:55:47,430
Speaker 2: to prove himself. But I actually feel like in the

1087
00:55:47,489 --> 00:55:50,839
Speaker 2: more truthful moments when he's talking about this on the

1088
00:55:50,880 --> 00:55:55,430
Speaker 2: Manosphere podcast, He interprets this as less of being a

1089
00:55:55,510 --> 00:56:02,319
Speaker 2: misguided intern to being more of a misunderstood iconoclast. Okay. Yeah.

1090
00:56:02,960 --> 00:56:06,580
Speaker 2: He uses the story to justify leaving surgery and setting

1091
00:56:06,600 --> 00:56:09,899
Speaker 2: him up as this maverick thinker ready to tell you

1092
00:56:10,000 --> 00:56:12,859
Speaker 2: the one trick your doctors don't want you to know.

1093
00:56:12,880 --> 00:56:17,660
Speaker 2: And there's a telling quote that I heard him talk

1094
00:56:17,680 --> 00:56:21,020
Speaker 2: about in an interview about why he really left. Okay.

1095
00:56:21,660 --> 00:56:26,620
Speaker 2: He didn't feel residency was a meritocracy. So on an

1096
00:56:26,719 --> 00:56:29,620
Speaker 2: interview with a guy named Jocko, are you familiar with Jocko?

1097
00:56:29,640 --> 00:56:32,540
Speaker 1: Oh, Jocko Willick. Yes, yes. The former SEAL team guy

1098
00:56:32,580 --> 00:56:36,879
Speaker 1: who was the officer in charge of the American snipers unit.

1099
00:56:36,900 --> 00:56:38,839
Speaker 1: We talked about them in our SEAL episodes because their

1100
00:56:38,880 --> 00:56:42,580
Speaker 1: unit killed a lot of civilians or was alleged by

1101
00:56:42,620 --> 00:56:44,890
Speaker 1: another Navy SEAL of having killed a lot of civilians.

1102
00:56:45,390 --> 00:56:47,239
Speaker 2: That checks out. That checks out. I have to tell you,

1103
00:56:47,489 --> 00:56:50,250
Speaker 2: in preparation for this episode, I exposed myself to some

1104
00:56:50,430 --> 00:56:51,730
Speaker 2: real Manus Fury stuff.

1105
00:56:51,830 --> 00:56:53,010
Speaker 1: Yeah, yeah, yeah.

1106
00:56:53,030 --> 00:56:56,750
Speaker 2: And that felt real Manus Fury up in there. Yes,

1107
00:56:56,770 --> 00:57:00,290
Speaker 2: I felt like discipline, self-improvement type stuff. Yeah. So he's

1108
00:57:00,310 --> 00:57:04,450
Speaker 2: having this discussion with Jacko. And in regards to residency,

1109
00:57:04,489 --> 00:57:08,190
Speaker 2: he said, quote, we all get paid the same. We

1110
00:57:08,230 --> 00:57:10,190
Speaker 2: all take the same number of years to get through.

1111
00:57:10,210 --> 00:57:14,960
Speaker 2: First of all, If I said that exact quote, I

1112
00:57:15,000 --> 00:57:17,410
Speaker 2: would mean it in the 100% different way he does.

1113
00:57:19,490 --> 00:57:21,910
Speaker 2: But he said, okay, we all get paid the same.

1114
00:57:22,340 --> 00:57:24,100
Speaker 2: We all take the same number of years to get through.

1115
00:57:24,140 --> 00:57:27,020
Speaker 2: It seems crazy to me. There's no other system where

1116
00:57:27,060 --> 00:57:29,380
Speaker 2: that would be the case. Like, I couldn't think of

1117
00:57:29,460 --> 00:57:33,160
Speaker 2: another system where they just had this complete, total lack

1118
00:57:33,590 --> 00:57:36,870
Speaker 2: of meritocracy. And I'm like, bro, what are you talking about?

1119
00:57:36,910 --> 00:57:40,370
Speaker 2: That is the point of residency. We all have to

1120
00:57:40,450 --> 00:57:42,830
Speaker 2: do the work. You all have to do it. We're

1121
00:57:43,110 --> 00:57:44,190
Speaker 2: all in this shit together.

1122
00:57:44,350 --> 00:57:47,260
Speaker 1: That's the whole thing, right? Is that, like, everybody has

1123
00:57:47,300 --> 00:57:51,180
Speaker 1: this same basic kind of, like, not the same, but, like, yeah,

1124
00:57:51,640 --> 00:57:54,400
Speaker 1: there's a standardized procedure for getting prepared to go be

1125
00:57:54,420 --> 00:57:55,720
Speaker 1: an independent doctor, right?

1126
00:57:55,960 --> 00:57:59,300
Speaker 2: And that's why, like, Even if you're on a flight

1127
00:57:59,430 --> 00:58:01,700
Speaker 2: and there's nobody around to help you, if there's a

1128
00:58:01,720 --> 00:58:05,640
Speaker 2: psychiatrist there, you're still better off with the psychiatrist helping

1129
00:58:05,660 --> 00:58:08,580
Speaker 2: you through an emergency than somebody who has no experience.

1130
00:58:08,940 --> 00:58:10,820
Speaker 2: Because they've been through a lot of this shit. You

1131
00:58:10,840 --> 00:58:14,140
Speaker 2: get a lot of training during this time. And it's

1132
00:58:14,180 --> 00:58:17,340
Speaker 2: not about the prestige or the paycheck. That can come later.

1133
00:58:17,960 --> 00:58:20,900
Speaker 2: And I'm trying to think of an analogy here. It's

1134
00:58:20,920 --> 00:58:23,980
Speaker 2: a bit hard to do, but it'd be like, say somebody...

1135
00:58:25,200 --> 00:58:28,240
Speaker 2: Somebody shows up to boot camp, and they're already able

1136
00:58:28,280 --> 00:58:32,120
Speaker 2: to do like 50 pull-ups. And they're expecting because of

1137
00:58:32,140 --> 00:58:35,760
Speaker 2: that they can like skip rifle training. Right, right.

1138
00:58:35,780 --> 00:58:37,169
Speaker 1: The pull-ups will be enough. Yeah.

1139
00:58:37,230 --> 00:58:39,590
Speaker 2: Yeah, because they're ahead of the curve. It's like, great,

1140
00:58:39,750 --> 00:58:41,970
Speaker 2: congratulations on the pull-up, but you still don't know how

1141
00:58:41,990 --> 00:58:43,330
Speaker 2: to be like a Marine, dude.

1142
00:58:43,790 --> 00:58:44,110
Speaker 1: Yeah.

1143
00:58:45,010 --> 00:58:47,970
Speaker 2: Being smart and hardworking doesn't mean you know how to

1144
00:58:48,030 --> 00:58:48,840
Speaker 2: practice medicine.

1145
00:58:49,470 --> 00:58:52,720
Speaker 1: No, no. Being able to answer all of the questions

1146
00:58:52,780 --> 00:58:54,700
Speaker 1: on a test doesn't mean that you know how to

1147
00:58:54,740 --> 00:58:56,970
Speaker 1: practice medicine because there's like a lot more. It's just

1148
00:58:56,990 --> 00:59:00,170
Speaker 1: like you could have someone who knows intellectually and can

1149
00:59:00,210 --> 00:59:03,370
Speaker 1: explain how to deal with like a gunshot wound or

1150
00:59:03,410 --> 00:59:06,030
Speaker 1: like a fucking horrible broken leg with the bones protruding

1151
00:59:06,050 --> 00:59:08,570
Speaker 1: from the skin. But then if they actually sit down

1152
00:59:08,610 --> 00:59:10,380
Speaker 1: in front of a person, they have like a panic

1153
00:59:10,400 --> 00:59:13,080
Speaker 1: attack because they can't handle blood that person may have

1154
00:59:13,100 --> 00:59:14,880
Speaker 1: all of the knowledge but they still can't be a

1155
00:59:14,920 --> 00:59:17,220
Speaker 1: doctor because you can't be scared of blood and be

1156
00:59:17,260 --> 00:59:18,280
Speaker 1: a doctor.

1157
00:59:18,110 --> 00:59:22,150
Speaker 2: That's it's exactly it's exactly right it takes actually i

1158
00:59:22,210 --> 00:59:27,120
Speaker 2: think years of being an actual attendee to get past,

1159
00:59:27,300 --> 00:59:29,450
Speaker 2: to get to where you need to be. You know,

1160
00:59:29,870 --> 00:59:32,209
Speaker 2: even after years, I think you still should have some

1161
00:59:32,310 --> 00:59:36,310
Speaker 2: imposter syndrome. Like, I don't think the imposter syndrome should

1162
00:59:36,350 --> 00:59:42,400
Speaker 2: go away anytime soon. I think that's just something that

1163
00:59:42,460 --> 00:59:45,640
Speaker 2: we always need to be humble about. But something, I mean,

1164
00:59:45,880 --> 00:59:47,520
Speaker 2: speaking of humble, there is a little bit of a

1165
00:59:47,560 --> 00:59:50,060
Speaker 2: prestige of a sort. If you really wanted to, if

1166
00:59:50,080 --> 00:59:53,050
Speaker 2: you're really good at You do get asked to be

1167
00:59:53,430 --> 00:59:56,800
Speaker 2: a chief resident, like I was. That is a little

1168
00:59:56,840 --> 00:59:58,540
Speaker 2: bit of prestige. Stop, you were chief resident?

1169
00:59:58,680 --> 00:59:59,580
Speaker 3: Humblebrag.

1170
00:59:59,600 --> 01:00:03,260
Speaker 2: Humblebrag. I was chief resident. That is correct.

1171
01:00:03,720 --> 01:00:06,780
Speaker 3: Oh, my God, honey. I did not know you were

1172
01:00:06,860 --> 01:00:07,260
Speaker 3: that good.

1173
01:00:07,300 --> 01:00:09,959
Speaker 1: I didn't realize we had a chief resident on the pod.

1174
01:00:09,980 --> 01:00:10,370
Speaker 3: No, no, no.

1175
01:00:10,400 --> 01:00:14,230
Speaker 2: If I'm being honest, they're like, hey, we need some

1176
01:00:14,250 --> 01:00:18,070
Speaker 2: schmuck to stick around one year. And not take a

1177
01:00:18,110 --> 01:00:22,180
Speaker 2: paying job and just do some teaching. So it's, you know,

1178
01:00:22,320 --> 01:00:24,340
Speaker 2: they were much smarter people. And you were like, I

1179
01:00:24,400 --> 01:00:26,600
Speaker 2: volunteer as tribute.

1180
01:00:26,680 --> 01:00:28,260
Speaker 1: Yeah.

1181
01:00:28,300 --> 01:00:29,860
Speaker 2: They had a sucker in me. I was a target.

1182
01:00:29,940 --> 01:00:32,419
Speaker 1: I've always thought of you as the Jennifer Lawrence of medicine. Yeah.

1183
01:00:32,820 --> 01:00:35,880
Speaker 2: That's always been what I've called myself. Cave from the block.

1184
01:00:35,920 --> 01:00:36,020
Speaker 1: Yeah.

1185
01:00:36,460 --> 01:00:37,000
Speaker 2: Absolutely.

1186
01:00:37,520 --> 01:00:37,600
Speaker 3: So.

1187
01:00:38,370 --> 01:00:39,190
Speaker 2: Anyways, after this.

1188
01:00:39,210 --> 01:00:40,760
Speaker 1: I think you're thinking of a different Jennifer, but okay.

1189
01:00:41,070 --> 01:00:42,860
Speaker 2: Yeah, I don't know. I didn't catch the reference, but

1190
01:00:42,880 --> 01:00:44,040
Speaker 2: I just wanted Jennifer Lopez.

1191
01:00:44,060 --> 01:00:46,560
Speaker 1: Let's talk about Jennifer Lawrence from Hunger Games.

1192
01:00:46,680 --> 01:00:47,919
Speaker 3: I explained the whole thing.

1193
01:00:47,960 --> 01:00:50,240
Speaker 1: Yes, yes, yes. That's all good. That's all good.

1194
01:00:50,440 --> 01:00:53,360
Speaker 2: Yeah, yeah. Yeah, I didn't understand the Jennifer Lopez of

1195
01:00:53,400 --> 01:00:55,140
Speaker 2: it at all, but I thought it was still good.

1196
01:00:55,580 --> 01:00:58,080
Speaker 2: So he makes this decision. He's going to leave residency.

1197
01:00:58,680 --> 01:01:01,660
Speaker 2: And after a chance encounter with a radiologist who worked

1198
01:01:01,760 --> 01:01:05,560
Speaker 2: previously at a consultant firm named McKinsey and Company in

1199
01:01:05,580 --> 01:01:07,980
Speaker 2: Palo Alto, that name might be familiar to some of you,

1200
01:01:08,690 --> 01:01:12,180
Speaker 2: He leaves medical training to try his hand at consulting.

1201
01:01:13,040 --> 01:01:16,270
Speaker 2: And I think I'll probably pick up there for the

1202
01:01:16,530 --> 01:01:19,890
Speaker 2: second part and the conclusion of this topic, I guess,

1203
01:01:20,290 --> 01:01:23,740
Speaker 2: when we get into... some more of the real bastardy

1204
01:01:23,780 --> 01:01:28,540
Speaker 2: parts of this. But let's maybe end there for now.

1205
01:01:28,560 --> 01:01:30,740
Speaker 2: Does that sound like a good plan? It's your podcast.

1206
01:01:30,800 --> 01:01:33,270
Speaker 2: I don't want to be running your podcast. You tell

1207
01:01:33,310 --> 01:01:34,110
Speaker 2: me what you want to do.

1208
01:01:34,250 --> 01:01:37,370
Speaker 1: I appreciate it. Thank you for, again, doing the episodes

1209
01:01:37,390 --> 01:01:39,290
Speaker 1: this week. That's going to be part one. We'll be

1210
01:01:39,350 --> 01:01:42,890
Speaker 1: back on Thursday for part two. Until then, Kavit, you

1211
01:01:42,910 --> 01:01:45,860
Speaker 1: want to tell the people where they can find former

1212
01:01:45,940 --> 01:01:47,600
Speaker 1: chief resident Dr. Kavahota?

1213
01:01:47,780 --> 01:01:50,180
Speaker 2: That is how I think I should be referred to.

1214
01:01:50,780 --> 01:01:53,480
Speaker 2: At all times. Okay. So thank you again very much

1215
01:01:53,520 --> 01:01:56,570
Speaker 2: for letting me come on and do this. It's fun.

1216
01:01:56,650 --> 01:02:00,870
Speaker 2: It's a lot of this conversation I think is really important.

1217
01:02:00,890 --> 01:02:02,330
Speaker 2: I'm really glad that we get to have it. There's

1218
01:02:02,370 --> 01:02:04,850
Speaker 2: a lot that's going to go into this conversation, particularly

1219
01:02:04,870 --> 01:02:08,050
Speaker 2: the second part that says a lot about our state

1220
01:02:08,070 --> 01:02:10,500
Speaker 2: of medicine, where we're heading, why I find it troubling.

1221
01:02:11,140 --> 01:02:13,820
Speaker 2: And I appreciate you guys having me. So thank you

1222
01:02:13,840 --> 01:02:16,710
Speaker 2: so much. Okay. So some of your listeners may already

1223
01:02:16,790 --> 01:02:19,630
Speaker 2: know that they can find me on my podcast, The

1224
01:02:19,650 --> 01:02:23,350
Speaker 2: House of Pod. It's a relatively fun, informal look at

1225
01:02:23,470 --> 01:02:26,170
Speaker 2: medicine and science. And we take a look at wellness

1226
01:02:26,210 --> 01:02:29,420
Speaker 2: and health grifters and talk about RFK Jr., all the

1227
01:02:29,460 --> 01:02:32,940
Speaker 2: terrible things he's doing to usher in this golden age

1228
01:02:33,040 --> 01:02:35,780
Speaker 2: of diarrhea that we are in. And you can find

1229
01:02:35,820 --> 01:02:39,540
Speaker 2: that anywhere you look for podcasts. And both of these

1230
01:02:39,800 --> 01:02:42,410
Speaker 2: fine people I'm talking to today have been on that

1231
01:02:42,450 --> 01:02:45,140
Speaker 2: podcast in the past, so you'll hear people you'll know

1232
01:02:45,200 --> 01:02:48,700
Speaker 2: and love. But starting later this month, there's also something

1233
01:02:48,720 --> 01:02:51,080
Speaker 2: very exciting for me that I'm very excited about and

1234
01:02:51,100 --> 01:02:53,360
Speaker 2: I want to tell you all about. It is my

1235
01:02:53,420 --> 01:02:57,020
Speaker 2: new podcast about Persian history. It's going to be a

1236
01:02:57,200 --> 01:03:03,300
Speaker 2: fun look at Persian contributions to the world of art, medicine, science, philosophy,

1237
01:03:03,320 --> 01:03:05,540
Speaker 2: taking a look at a lot of things that we've

1238
01:03:05,620 --> 01:03:07,400
Speaker 2: sort of been either written out of or at least

1239
01:03:07,480 --> 01:03:10,500
Speaker 2: minimized in, in terms of telling the history of it.

1240
01:03:11,340 --> 01:03:14,260
Speaker 2: It's going to be with my co-host, my friend Shaheen Daivari.

1241
01:03:14,320 --> 01:03:17,060
Speaker 2: If you guys watch Survivor Season 48, he was on that.

1242
01:03:17,880 --> 01:03:22,350
Speaker 2: I'm really enjoying preparing this and recording these episodes. I

1243
01:03:22,370 --> 01:03:24,170
Speaker 2: think it's going to be a ton of fun for

1244
01:03:24,210 --> 01:03:26,570
Speaker 2: you all as well, even if you're not Persian. It's

1245
01:03:26,590 --> 01:03:28,970
Speaker 2: just if you like anything about history and fun storytelling,

1246
01:03:28,990 --> 01:03:32,390
Speaker 2: we're going to be doing that. It is called Persian

1247
01:03:32,630 --> 01:03:35,510
Speaker 2: of Interest. So keep your eye out for that, please.

1248
01:03:35,530 --> 01:03:36,170
Speaker 2: I like that.

1249
01:03:36,370 --> 01:03:36,510
Speaker 1: Awesome.

1250
01:03:36,530 --> 01:03:38,450
Speaker 2: Thank you. Thank you. I feel pretty proud about that one.

1251
01:03:39,070 --> 01:03:42,060
Speaker 1: Check it out, everybody. Check out Persian of Interest and

1252
01:03:42,100 --> 01:03:44,760
Speaker 1: check out part two of this on Thursday.

1253
01:03:45,240 --> 01:03:45,780
Speaker 2: Bye, everybody.

1254
01:03:46,020 --> 01:03:52,460
Speaker 3: Bye. Behind the Bastards is a production of Cool Zone Media.

1255
01:03:52,660 --> 01:03:56,380
Speaker 3: For more from Cool Zone Media, visit our website, coolzonemedia.com.

1256
01:03:56,780 --> 01:03:59,400
Speaker 3: Or check us out on the iHeartRadio app, Apple Podcasts,

1257
01:03:59,580 --> 01:04:03,090
Speaker 3: or wherever you get your podcasts. Full video episodes of

1258
01:04:03,120 --> 01:04:05,860
Speaker 3: Behind the Bastards are now streaming on Netflix, dropping every

1259
01:04:05,930 --> 01:04:08,570
Speaker 3: Tuesday and Thursday. Hit Remind Me on Netflix so you

1260
01:04:08,610 --> 01:04:12,060
Speaker 3: don't miss an episode. For clips and our older episode catalog,

1261
01:04:12,120 --> 01:04:16,030
Speaker 3: continue to subscribe to our YouTube channel, youtube.com slash at

1262
01:04:16,090 --> 01:04:20,800
Speaker 3: Behind the Bastards. We love about 40% of you, statistically speaking.