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Explore your curiosity - Interesting people with fascinating stories.
Life consists of three things:
-The stories we tell others
-The stories others tell us
-The stories we tell ourselves.
Evan, welcome aboard to the show. So happy to have you here today. And might I say Doctor. Evan, welcome aboard to the show.
Speaker 2:Thank you so much Ari for having me and please, it's just Evan. I don't need to be Doctor. Evan, unless I have a TV show like Doctor. Phil or Doctor. Oz, then maybe I'll go with that.
Speaker 1:Would you be Doctor. Nadler? Don't know.
Speaker 2:Talk about that later. That's too formal. I want to be something a little bit more. So Bill Nye lives around the corner for me.
Speaker 1:Really? Science guy.
Speaker 2:The science guy. And that's such a cool, like, moniker that I would have to be something like Doctor. E, the medical OG, or something that's like something that has, like, some cachet to it.
Speaker 1:I love that. I love that. So, so let's, let's start from the beginning. Why become a doctor? What was the fire that was burning in your heart that you wanted to work yourself to the bone?
Speaker 2:To be a doctor. That's an interesting, I think, it's not actually something that I necessarily think about that much, but I guess, so I, this is not necessarily a story you want to hear about your doctor or your surgeon, because it does not show. I want to hear it more. Cause it doesn't show particularly great judgment. But when I was, I think five, I was jumping off the top of bunk beds with my best friend from childhood.
Speaker 2:And I missed the beanbag chair that we were supposed to be landing on, or I got kind of sort of on it. But then my elbow followed through and hit the floor and chattered basically. So I think, you know, so then I went to an orthopedic surgeon and I think that that's what got me interested. But it's really, you know, it's not it's something I've always like, even in high school. Like, it was never really a question what my career was going be.
Speaker 2:So it's kind of weird. Like, it's weird that
Speaker 1:The I pressure from the Terrence?
Speaker 2:Not really because my dad was a statistician who actually worked at Bell Labs and then AT and T. So back in the day he was, yeah, he was like, you know, you guys in AI now are the geniuses, but he was one of those sort of cutting edge geniuses back in Bell Labs a long time ago. And then my mother, who's also a badass in her own right, she was a lawyer. But I like to like her claim to fame. She has two claims to fame.
Speaker 2:One is she was at Columbia Law School before Ruth Bader Ginsburg was there. So you can, that tells you how old how long ago it was. And I believe she was like the sixth female lawyer in the state of New Jersey because it's some like newspaper in New Jersey did a story on her and they didn't say, you know, top five. They said, you know, like the way they described her is like one of the first or some some like vague and vague vague and even some of word Some vagueness that, like somewhere probably between six and ten. But anyway,
Speaker 1:she she gets the OG.
Speaker 2:She gets the OG. But so no, I mean, medicine was never like, I mean, it wasn't on their radars at all. So I don't know. I, you know, I know that my dad did not follow in his family's footsteps and gave up the department store business that my family, you know, from the old country came over here to, to, they ran a department store in Passaic, New Jersey. And he was the end of that store because he didn't take it over because he was the only male son.
Speaker 2:Well, that's a, that's a redundancy. He was the only son. And so none of the women back then were allowed to run the business. And when he said he didn't want it, that was the end. Anyway, so that's right.
Speaker 2:That's getting back to your question. I think just positive experiences. It's kind of like anything like role models, right? Like, you know, when you have a positive mentor or role model or whatever, it sort of, even if the field wasn't necessarily where you thought you might be going, sometimes it just takes that person, that one person who like gets you and inspires you. And, so
Speaker 1:To me, is, it's one of the weirdest things I've experienced how one person in one moment, which is random that you not necessarily spent all these hours with them, can change your life in just a fraction of a moment. I was suffering from terrible, terrible tension headaches. I was basically being sedated, The level of medication got to that level where I couldn't even do my job. So I was like, you know, I'm gonna try a different doctor. I came to this new doctor, he basically gave me this like string with like a small little weight at the end and said don't move your hand, just with your mind move the weight.
Speaker 1:And lo and behold, the weight starts moving and he explains the kind of micro muscles in the hand and I am in fact moving it, but there's very, subtle muscles that basically control everything in your body. And then he gave me a bunch of exercises to do, attention headaches disappeared. So that that single moment, it was less than half an hour. It changed my life. Right?
Speaker 1:A thing that I had just disappeared.
Speaker 2:That's super, super interesting. And I actually like when people talk to me about alternative medicine or. This wasn't, this was a bonafide doctor. It wasn't like voodoo. I know, no, But acupuncture, alternative things, Chinese medicine, whatever you call all the different things.
Speaker 2:There are, there's still a ton that we don't understand. Like, I'm impressed that your, your provider was able to figure that out for you because, you know, cause I don't think, don't think that that's necessarily something. I certainly didn't learn that in medical school. Let's put it that way. That's something he figured out on his own later in his life, which is, like I said, to me, it's interesting.
Speaker 2:Have a very, I like, I like outliers. I like, although that was a book that I didn't read. There are lots of good books that I didn't read like outliers. And actually I was thinking about Chaos Theory and that Chaos book was another good book I didn't read, but had on my shelf that I should have read. Like, think you learn a lot from the people that don't fit the mold.
Speaker 1:Yes, absolutely.
Speaker 2:And that's sort of where my childhood obesity thing has sort of taken me. I've learned a lot from the kids that don't actually meet the standard description of what you would think is going on.
Speaker 1:So let's dive into that. I have a initial question. What do you learn about eating right or dietary recommendations or anything about kind of food and health from that perspective in med school?
Speaker 2:Not enough.
Speaker 1:I know my wife's answer, absolutely nothing. Is that true in the-
Speaker 2:I said not enough. She went with absolutely nothing, but there's similar responses. So it's not entirely true. Like we do get some nutrition classes when you're, let's say you're doing an endocrinology rotation and you're learning about diabetes, you learn about diet. And actually, as a surgeon, there well, surgeons used to actually be the the the nutritionists in the hospitals.
Speaker 1:Really?
Speaker 2:Yeah. Because we would put in the gastro stomy tube. Oh, that's right.
Speaker 1:Before the surgery, you need to.
Speaker 2:Yeah. And that too. And and so we were the experts for a long time. And actually, I went to med school at University of Pennsylvania where something called total parenteral nutrition was actually invented by surgeons. That's actually nutrition that you can get through your vein, which can actually keep you alive.
Speaker 2:Like you don't have to eat anything. And this nutrition through the vein can keep you alive. So we don't learn a lot.
Speaker 1:Pediasure or something like that. Something like that. What's that called?
Speaker 2:Oh, PediSure. So PediSure is actually the thing. Well, PediSure is either, you can actually, I think, drink PediSure, but it's also put in, so for children and adults who can't eat, you put in a tube in their stomach to feed them, and then you can put PediSure for kids in there. And, adults have a different version. But, but anyway, that's getting back to your original question.
Speaker 2:We don't learn enough. And I've been on my platforms advocating for obesity education in medical schools. And I'm working with, Drexel to try to get some medical education involving obesity, in general, not just childhood obesity. And there's a group, there's a professional society, called the, the Obesity Society, lack of a not a very, not a very out of the box name, but, they're working they're doing a pilot study with a few medical schools to try to get a curriculum there because yes, we don't learn enough. I mean, you can go back to the sort of the origins.
Speaker 2:We don't learn anything about preventative medicine really in general. Like it's not The U S model is not a preventative model. It's a, it's not a proactive model. It's a reactive model. Like you get a disease, we treat you.
Speaker 2:You get a complication of the disease. We treat that. You get a complication of the medication we give you. We treat that, you know, so it's just We
Speaker 1:are trying to be diagnostic, but, not preventative.
Speaker 2:Exactly.
Speaker 1:Kind of early diagnostic. That's what I'm I have a fucking colonoscopy plan. So there you go.
Speaker 2:Yeah, exactly.
Speaker 1:Yeah. So let me ask you this. Okay. A city. It's the general public.
Speaker 1:There are some very solid opinions that I'm not sure if they're true or not, so we're gonna we're gonna do some myth busting here.
Speaker 2:So the oxymoron of solid opinion, those two words should never really go in the same sentence. Because if it's an opinion, it's still an opinion. The yeah. No. The I do a lot of posting on LinkedIn about whatever happens to pop into my brain that day.
Speaker 2:And I also have filmed some YouTube videos on similar topics. And one of them is how did the medical community lose the trust of the population? Like, why is it now that a social media influencer why is it now that the woman who's been a who's been
Speaker 1:That's a can of worms you're opening now. The
Speaker 2:woman who's been recommended as the surgeon general appointee never finished her medical training, but she wrote a book and has a bunch of followers and has a huge online community. And now she's been nominated basically to be the most, in theory, the most trusted voice in medicine, which is like bonkers, if you ask me. But that's where we are. And that's the reality of I mean, that's RFK Jr. Platform is making America healthy again as if the medical community has never given two bits about keeping America making America healthy.
Speaker 2:Like, if this is all new, like, you know, and it it's a lot of it is truly like, don't trust the docs. Don't trust the people who've been doing it. Trust me and my people because we know the real story, which is kind of scary actually, if you ask me.
Speaker 1:There's a dangerous rabbit hole here of, you know, well, what does science actually know? I don't know if I want to go down that rabbit hole.
Speaker 2:Well, that's what your, that's what your AI is going do for you. Right? It's going to go scour all the data and, congregate it, accumulate it.
Speaker 1:So what what data is it gonna scour? The influencer's opinions? Or PubMed? PubMed being one
Speaker 2:of the
Speaker 1:trusted medical journals.
Speaker 2:Well
Speaker 1:Which data is it gonna take or both? Or the one that has the most likes? I'll tell you, PubMeds doesn't have likes.
Speaker 2:Right. So that's a great that's a great question. And, actually, I learned something that I was watching a YouTube video with my son because he's way into
Speaker 1:that trusted source of information.
Speaker 2:Yes. It has to be gospel if it's on YouTube because I'm on YouTube and I'm speaking only the gospel. There you go. But the but this it was actually going over the origins of Yahoo search engine versus what page in Brin, I think the guy's name was, who
Speaker 1:At Google.
Speaker 2:At Google. And the different, like and this is I probably I'm probably getting this wrong. But the difference between what Yahoo used to do is it would just look for how many times the word was mentioned, like on a on a an Internet or whatever. And that's how it it that's how it gave you its preferred its number one search engine result. But then I guess somebody learned that you could put if you hid the word, let's say, in white text on a white background, the the algorithm didn't pick that up or didn't, like, didn't you didn't see it if you were looking at it.
Speaker 2:So you could game the system just by adding all this stuff. But then
Speaker 1:That was the very, very early days of what we call search engine optimization.
Speaker 2:Right.
Speaker 1:Yahoo actually just decided what the order was based on their own decisions. So there, and you actually had to sign your website up. So it was what we called indexed, while Google was what we call references. So basically you had to be like an authority and authority was built on how many people were pointing to you as an authority. Right.
Speaker 1:That changed the world.
Speaker 2:Right. And that's what I was gonna say about, that was the point I was gonna make. So I'm trying to explain AI to like an AI expert, which is probably, probably
Speaker 1:That's dangerous.
Speaker 2:Yeah. That's much dangerous. Probably not well. Maybe not the right smartest thing to do. Let's talk about medicine.
Speaker 1:It's been a long day.
Speaker 2:But the Let's let's But, you know, but I think that getting to your point is that I'm hoping that the, you know, the academic it won't it'll almost be like so it's there's something called impact factor in medical publications where it's like sort of the quality of the journal you're publishing and then how many people cite it when they're publishing similar studies. I'm hoping that that's what I'm hoping that's where we're going.
Speaker 1:So just to keep the audience who's not physicians or married to a physician like myself, when we call a site is basically when somebody in their research says, oh, I used that research. And the thinking is that if you get cited by a whole bunch of people, then maybe you're not full of shit. And then the other aspect is this is a common man's interpretation
Speaker 2:of this. I know, but I mean, publish lots of stuff and I'm still full of,
Speaker 1:Fair enough. Fair enough. But that's the likes of the, you know, of the medical research process. And then of course we have meta research which keep me honest here is the most trusted version of it where you have 100 researchers and you're like, oh, we look at all the research and we're like, there's a clear trend that, you know, a 100 researchers say that this is true. So it's, that's kind of how you're likely to be so at this stage.
Speaker 2:Meta analysis, which is I think what you're referring Yes. To is an interesting
Speaker 1:See, now I'm teaching a doctor about science, so now I'm the idiot.
Speaker 2:No. It's good. This is like this is what these conversations are supposed to be about. Like, I'm hoping that at the end of the day, you all have taught me something about medicine, and I'll have taught you something about AI or at least vice versa.
Speaker 1:Least vice versa.
Speaker 2:The Meta Meta analysis. And and I don't I don't wanna go back to RFK because this is not a political podcast. But during his confirmation hearings, senator from Louisiana, who was a doctor, basically said there are these meta analyses that show that vaccines are not causing autism. And RFK's response was, well, you need to go look at this one study by so and so. Right.
Speaker 2:And so, right. So in theory
Speaker 1:I thought you were going to say, that's not as bad as I thought what you were gonna say. What I thought you were gonna say, but my nephew took this like,
Speaker 2:this is one case. Right. But it's similar because he said, you know, so like what you're saying is that levels of evidence, meta analysis is supposed to be the highest and obviously one report. But what he could have said, which is where I was going with this, is that meta analyses are actually only as good as the data that are, or the index studies that are fed into them. If you have a bunch of crap yeah.
Speaker 2:Oh, yeah. Garbage in, garbage out. You have a bunch of crappy studies. You do meta analysis of crappy studies. You may tell people that you have a great finding, but it's actually Yeah.
Speaker 2:Just crap.
Speaker 1:Yeah. I mean, I I don't wanna go down the the the path of, you know, is science does science even work? Obviously, I'm firmly in the we got to the moon, so we have figured a few shit out, and the scientific method works. I'm firmly in that camp as I hope you are too. I'm just joking.
Speaker 1:Obviously you are. We're being very cynical today.
Speaker 2:Yes, exactly.
Speaker 1:I hope the audience
Speaker 2:will We're gonna have to retitle this Cynical Cynicism by Ari Bloch and Evan Nadler. The Cynicism Hour.
Speaker 1:Yes. This is now so, okay. So, so without going down the rabbit hole too much, there is an issue in the world where science as a definition is trying to get to the closest approximation of an absolute truth and it's on this everlasting journey of figuring it out and sometimes we get it wrong, sometimes we get it partially right and then ten years later we figure out there were some things that we didn't know because it took ten years to figure it out. That erodes public trust in certain ways especially when you look at this narrow picture of like oh they said it was fine and it wasn't and now you hate doctors or researchers or whatever. The fact that drugs are so expensive doesn't make us love the pharmaceutical industry.
Speaker 1:Like, there's so many things going on specifically in America, which creates these compounding effects. What the fuck? Like, how do we deal with this? What are we what are we doing wrong? Like, how what should we change to kind of bring people back to, yes, the earth is round.
Speaker 2:Yeah. I think that's
Speaker 1:the first
Speaker 2:time I've been on a podcast where the question I was asked was what the fuck. It's slightly more specific than that, but okay. We'll go with it.
Speaker 1:Let's go with it.
Speaker 2:The so, well, everything you said is accurate, right? Like there was a ulcer disease, for instance, in I was first, first training in the early nineties. It was just the era where we figured out it was related to a bacteria. Like no one had any clue that ulcer disease is related to a bacteria. We thought it was all these other things.
Speaker 2:Stress. Yeah. Stress, coffee, alcohol, all these other things. So there's definitely things evolve over time as the science gets better. And that's what we want.
Speaker 2:We want to, we want better technology and better science and better understanding to improve medicine and improve everything, improve life. But I also like to because I'm a wannabe mathematician, I like to remind people about the bell curve and that, you know, there's a certain people think that, you know, so like for instance, I'm I'm a obesity guy and they get, you know, Ozempic comes out or semaglutide comes out and it says you lose 15% of your body weight. Well, that's the average. And within one standard deviation of that average, either plus or minus, you don't know what the standard deviation is because you didn't get that in the press release. But even if you go in that one standard deviation, that's still only basically two thirds of people.
Speaker 2:Right? So there are all these people who, and they might be your neighbor, who lose a ton of weight on somatic retardant, think it's the best thing ever and just tell you, like, you should do it. And then you don't lose any weight. You're like, UTF, my neighbor taking the same exact drug did awesome and I didn't do that well. And is that like, did I I'm not cheating?
Speaker 2:I'm not, you know, slurping down smoothies all day. And then there are other people on the other end of the bell curve who no matter what they do, they don't respond. But like, I think people science isn't binary. And I think people want it to be like they just want an answer. They want they want the COVID vaccine is safe or it's not safe.
Speaker 2:It works or it doesn't work. And the truth is that it's mostly safe other than a few cases of complications, just like anything else in medicine. And it mostly works. It may not prevent infections, but it makes your infection less severe. People don't like nuance.
Speaker 2:People like black and white people like, yeah, I mean, I think people are just sort of
Speaker 1:Here's the problem. Right? A lot of this is social psychology, right? It's negativity bias. It's the, you know, recency bias, which is, oh, something happened recently.
Speaker 1:It's the sample of one bias where like, oh, my friend. So there's so much in the way humans think that is not scientific. There's nothing more counterintuitive to human beings than statistics, right? It just doesn't compute. Like if you want to put anybody to sleep on my show, we talk about standard deviations.
Speaker 1:Like that's the way to go. So so there's all this psychology that's fucking us up.
Speaker 2:Are you calling me a bad guess because I said standard deviations on your podcast?
Speaker 1:I love statistics, so I wouldn't I wouldn't call you that. But here's my other problem. And this is where I attack you as a doctor. I ask doctors like, oh doctor, doctor, like I have disease X, is there a like, tell me what is the chance that I'm gonna die or whatever. It's like, oh, I can't tell you there's no number.
Speaker 1:So I was taught a trick on how to figure it out. You say to the doctor, oh, doctor doctor, is it a ninety percent chance I'm gonna gonna die? No. No. No.
Speaker 1:No. No. Sixty? No. No.
Speaker 1:No. Forty? Well,
Speaker 2:I don't know.
Speaker 1:So it's 40% doctor. Why couldn't you fucking tell me 40%? So so why do doctors do that? Why do you have to play that trick? Know, because doctors know what the percentages are.
Speaker 1:It's a little bit more complicated than this. You've got false negative, false positives. You've got the version of that. Why don't we answer human beings or patients with the actual data?
Speaker 2:Yeah. Well, it's a
Speaker 1:trick question. It's a loaded question. It is.
Speaker 2:So I think, you know, so in my in my practice, when people ask me, what's the chance that I won't respond to the bariatric surgery that you're going offer my daughter or me as a person, whatever, I give them a number. I tell them, well, in adults, it's about twenty percent of people regain weight or don't lose enough weight after surgery. And in kids, it's probably less, but we don't I'm honest when I say we actually don't know because it hasn't been around long enough for us to study it long enough. But I've been told that, not answering your question exactly, but I'll get back to that in a second. But I've been told by people that one of the things that they like about my bedside manner or my way I interact with patients in general is I'm very to say things that I don't know, which I think most doctors are trained to be the authority and they don't want to give any impression that they might not know the answer.
Speaker 2:I think that's one of the reasons they don't give you numbers because they don't want be involved. Argument,
Speaker 1:You create more trust. I would trust a doctor. Look, there is no fucking way that my doctor knows everything. So if my doctor will never admit that there's something that he or she doesn't know, I don't trust them. So I would argue that your approach of admitting to this is not my area of expertise, my areas of expertise is X, not Y, that actually increases my trust in
Speaker 2:Even within my area of expertise, and think of myself as actually probably the world's expert in what I do, there's still a ton I don't know. And so I tell people that. But I think that goes back to your question about numbers. Like, won't give people a number that I can't actually back up. So when you said that doctors know the numbers, I don't think they know them as well as you might give them credit for because because the number, know, as you know, you could do 10 different studies of what what's the mortality rate of disease X, which is what you were talking about.
Speaker 2:And you'll get 10 answers that are within, you know,
Speaker 1:depending on
Speaker 2:And then you could do the boring statistics. And I'm not going to use the word again, but it's abbreviated SD.
Speaker 1:You have been reprimanded. It's okay.
Speaker 2:And then it's like, give people the best information you can. That's my modus operandi for everything I'm doing right now is just an actually it's always been the way I've practiced medicine is I just give people as much information as I can, as honestly as I can, whether they like it or not, because I'm from New Jersey and I can't I'm just totally transparent. It's really bad for relationships and for marriage and things like that. But it's it's not bad when you're a doctor or a surgeon. And I'd let people do with whatever with the information, what they want.
Speaker 2:Like, don't obviously I have my opinions about what might be better or best for any individual patient. But the reality is is that medicine in general, I think, is best practiced when the patient is leading and leading the way. And also the patient is like, you know, like in agreement with the doc or provider or whatever, that this is the path they want to take. Like, I tell you you need surgery and you're like, well, can't I try medicines? And I say, no, you have to have surgery.
Speaker 2:I mean, there may be our cases where that's true, but most of the time there's more than one, treatment option. And then of course, if the surgery doesn't go well, you're like, I hate that doctor. So I think, you know, I think, you know, you're a scientific inquisitive type person. And I think, you know, I keep saying, I mean, I've been doing, I've been doing treating childhood obesity for over twenty years now. And yes, I'm slightly, maybe smarter than I was when I first started.
Speaker 2:I mean, maybe not slightly. I've learned a lot, but I've also learned that there's a lot more that I don't know. And that I may never know because the field keeps evolving.
Speaker 1:Here's what I'm amazed by the field of medicine. Keep me honest, if you agree with this diagnostics, because I'm an engineer, I'm not a doctor. All my knowledge is from my wife and my parents, Despite, and I'm going to be a little brutal here, despite doctors not being a lot better than let's just put a leech on it and it will help, you know, don't have a lot more knowledge than that. Life expectancy has more than doubled. So we have such a fraction of the knowledge of let's say the human body and of medicine and all the processes that happen in the body, we almost know nothing, almost.
Speaker 1:But with that small, small percentage of knowledge that we've increased over the last hundred years, we've made a massive change. Now to me that is amazing because we know almost nothing but we've gained so much health by something as fucking stupid as wash your hands. Yep. Like that changed the world. Right?
Speaker 1:We're not, we're not surgeons aren't, you know, wiping their asses and then, you know, cutting you up and they, oh, by the way, just cut somebody's hair. Like that change changed the world. Right?
Speaker 2:Right. But as you probably know, like, even that simple step was met with It was met with You know what? This is
Speaker 1:a beautiful story you want to tell it? Doctor.
Speaker 2:Well, I don't want to tell it because I'm probably looking at wrong because I haven't thought about it in a while. But basically, every huge medical advance has been fought by the medical community each step along the way. Like, nothing comes easy. Right? Like, it's like, know, people but go ahead.
Speaker 2:Tell I mean, you go I mean, you should tell the story.
Speaker 1:So I'll tell it shortly, but the the initial thing was it was a and this is from my wife from her medical school, so this is like third hand, so you're gonna have to fix me on the way, but it was a prison and the theory was that it's bad air, right? That there was something about the air, the air was bad, so even the quote unquote, you know, theory was kind of wrong, but then the outcome was correct. So like, oh, we need to get good air into the prison. And then they saw the reduction in the cases, in the sickness. But at the end of the day, right, it was the freaking rats.
Speaker 1:It was the sanitation. It was all these things. So they kind of got to the right answer
Speaker 2:the wrong way. And that's, you know, that's how that's how Rogaine was invented. Know, Rogaine minoxidil was a blood pressure medicine, but then the people who they're giving the blood pressure medicine to start to grow hair. So like, oh, it's actually hair growth medication. So that happens all the time.
Speaker 1:The erectile thing.
Speaker 2:Yeah. The blood pressure, right?
Speaker 1:Viagra. That was the
Speaker 2:blood thinner blood pressure one was it? Same thing. Just like minoxidil. And then even these, the obesity medicines that everybody's talking about, they were originally designed as diabetes medications.
Speaker 1:Yes.
Speaker 2:Then when That's true. The people make the money, the pharmaceutical companies realize that the side effect of their diabetes medicine was weight loss. Realize that if we can, I don't think they used AI, but they should have because they had to go through all the different permutations of changing the structure of the protein until they found the one that allowed the body that kept the body from breaking it down and allowed the molecule to induce weight loss? So yeah, like lots of the great discoveries are by accident.
Speaker 1:By accident. Yeah. So I don't know if you know this one, I hope it's true again, this is third hand story, but the Viagra story, they kind of did the research. This was a clinical trial, some version of, I don't know what, which stage it was in. The patients didn't give the drugs back because at the end you kind of give what's left over.
Speaker 1:So they did a clinical trial, give us the drugs back that you didn't use.
Speaker 2:Nobody gave the drugs back.
Speaker 1:And then the researchers were like,
Speaker 2:what's going on here?
Speaker 1:Happening here? And then they did follow ups, and they're like, holy shit. We just made a shitload of money. Yeah.
Speaker 2:Well, that's
Speaker 1:Not for the reasons they were hoping.
Speaker 2:But, you know, well, I think, you know, they were probably probably don't care. They probably weren't hoping. They're probably just hoping to make money. They didn't really care which way.
Speaker 1:Well, I'm sure a lot of people did, but the exact the the.
Speaker 2:The, yeah, no, I, you know, and actually, so lots of people give a lot of grief to the pharmaceutical industry and the research and development that goes on there, but I actually I'm on the opposite side of that. Cause I've been, I've done a lot of hardcore science in my life and it is, it's hard to do. It's expensive. And these guys are actually really fricking smart and they come up with these things and, you know, like it takes the average drug, I think ten years at a minimum to go from like lab rat to human. And I believe it's $2,000,000,000 over that ten years.
Speaker 2:So like when people hate like right now, because everybody's talking about drug prices and most favored nation status and all that whatnot. Yeah. Again, I think people just don't understand that you could spend $2,000,000,000 on a drug and it goes nowhere and it could be a total dud. Ten years and $2,000,000,000 and you get nothing for it. So I try to get people to give the pharmaceutical industry a little bit of a break, but no one no one.
Speaker 1:I'm clearly biased because my work my wife works for pharma companies. Oh. Alright. Full disclosure, I'll say that in advance. Yeah.
Speaker 1:But here's my argument. Keep me honest here if this is look, there's a lot of corruption. I'll agree to that, right? That's why we have the Sunshine Act and it's a good thing. But here's my argument.
Speaker 1:If the American pharma industry is not going to make a lot of money and we're not going to have these long lasting patents and they're not going to get rich, why would they take the risk of researching for ten years and basically wasting ten years of their time and doing nothing if there's not a HuPay day at the end? And then for ten years later, countries like Canada to just replicate the generic of it and be like, oh, we have a great healthcare system. Well, why do you have those generics?
Speaker 2:Right.
Speaker 1:It's because somebody did the research. They figured out the molecule or whatever it is. Right? So that's why there are rip off generics in India and in Canada and in Mexico, because some American companies spent a shitload of money and guess what happens? Because they don't have patent rights, basically the American people to a certain degree are funding the healthcare of the rest of the
Speaker 2:world.
Speaker 1:Is that unfair?
Speaker 2:So that's what, you know, that's what the administration is arguing right now, is that that is unfair because US is paying for all the But what do
Speaker 1:we do? Do we stop do we stop solving diseases?
Speaker 2:Yeah.
Speaker 1:We stop building medicine?
Speaker 2:Like, how do you? Right. So the the it's not a simple answer. It's not a simple question to answer, but I think that what we need to if we can incentivize so obviously competition drives prices down, right? So the more drugs that do the same thing the more that drives prices down in general, but it also it also, you know, sort of strange way.
Speaker 2:It doesn't necessarily push innovation because you're just replicating what other drugs do. But if you can incentivize, like, so in England, for instance, read that in order for a drug to make it to the national health service formulary, it has to be actually better than what they already have. So that incentivizes innovation and could be one way to sort of, it could give me one way to get pharmaceutical companies to really focus on what we need and not just on making money and just not on, on, on, competitors that may or may not add the additive, but it's complex. I mean, I don't think so, whatever it was two weeks ago when Trump was sort of talking about most favored nation status immediately, Lilly, Eli Lilly, I think it was Eli Lilly. They just raised their prices over in England.
Speaker 2:Cause if if if we're gonna if we're gonna force America to have the same prices in the lowest countries out there, they just gain the system. And they're like, okay. We'll do that.
Speaker 1:I love that.
Speaker 2:And they just raise the price everywhere else in the world.
Speaker 1:I love that.
Speaker 2:Right? Exactly. I mean, it
Speaker 1:Guess what? Everything's okay now.
Speaker 2:Exactly. But I do wanna say one thing, though, about the Sunshine Act, because first of all, most of listeners aren't gonna know what the Sunshine Act is.
Speaker 1:Oh, yeah. Yeah. I apologize. I should have explained
Speaker 2:That's the, legislation that makes it basically, it doesn't allow industry to interact with physicians, which might bias how physicians prescribe medications or use different interventions or whatever, which is a good piece of legislation. Is. However, I live in Washington. I live in Washington, DC. And while there is legislation that doesn't let doctors interact with industry for the benefit of the doctors, there is no similar legislation that means that industry can't go to your congressman's office and bribe the not bribe.
Speaker 2:Influence their voting patterns with incentives. So it always makes me chuckle because, oh, doctors can't be trusted. They can't interact with industry because God forbid, they're gonna start prescribing more, you know, Wegovy or rather than Mounjoura or vice versa or whatever. But it's okay. I'm just gonna skip the doctor's office.
Speaker 2:I'm gonna go right to our congressmen because they can vote to make all And
Speaker 1:our politicians are to be trusted.
Speaker 2:Right. Exactly. They're more trustworthy than the docs. The docs can be easily influenced with money and and and perks. Like politicians choose Politicians are the altruistic, benevolent, altruistic center of our There
Speaker 1:is no way we get out of the rabbit hole of politics corruptions. That's never gonna end. But look, was some hairiness around, if you're familiar with Mallinckart, think it was, they basically bankrupted these small municipalities because the Mallinckrodt reps basically, the salespeople, they were basically you know buying expensive dinners and taking them to trips and then each drug, I can't remember, but it cost an insane amount of money for one pill. So they basically bankrupted these municipalities. So I mean it's true that there has been corruption historically and That's undisputable.
Speaker 1:But to put a broad brush on old doc, that's completely unfair.
Speaker 2:I mean, it's the again, I don't mind. I don't mind that
Speaker 1:That's statistics. Right? It's the some are some aren't.
Speaker 2:Yeah. And I don't actually mind the regulations. Right? Like, there's nothing inherently wrong with having to be transparent about your industry interactions. It just it just irks me that we're the only field that has that that that limitation, like, you know, like anybody else can basically be do whatever they want.
Speaker 2:But docs, you guys are the only ones. Like, again, would they
Speaker 1:Wouldn't that be wonderful though if a politician had to disclose every meal, every piece of every coffee that somebody That bought
Speaker 2:was the whole thing about the Supreme Court. Right? With all the, with all supposedly Clarence Thomas and San Alito and all this stuff. I, again, I keep bringing up politics, which don't mean to do. It wasn't like, I don't care if rich people take you on your, take you on a vacation and you're a Supreme Court judge.
Speaker 2:I care that you didn't tell us. I care that you lied about it or like, oh, I forgot to put it on my form. You're right. You forgot. You forgot.
Speaker 2:You just happened to forget about the, you know, the $100,000 vacation on the guy's boat or whatever it was. So again, I don't none of it bothers me. I'm just all about, I guess, in general, like, people just need the information and then they can either ignore it or not as is their as is their desire. But the lack of transparency, which is, I think goes back to your question about not trusting doctors anymore, is that there has been historically sometimes a lack of transparency about data or about things we know and things we don't know. But I don't, the whole influencer thing, like, it's just really, it's really bugs.
Speaker 2:I mean, it's, it's although I'm like, I'm trying to, what does it say? Feel like, if you can't beat them, join them. That's one of the sayings, but I I'm also trying to be like the enemy from within. I'm trying to be I call myself a de influencer front sometimes. I love that.
Speaker 2:Trying to be on the Internet, like, just pointing out the, you know, the medical misinformation superhighway. So I posted about last night because it is out there. Like, you can, you know, you can you can find if you want to believe that supplement x will make you live to 140, You will find someone out there who will, will say that and selling that supplement on their website right now.
Speaker 1:We, we are running out of time.
Speaker 2:We just got started.
Speaker 1:We do. We're not. We've been we've been recording for almost forty five minutes, and it's it's been a lot of fun. There's two questions I wanna ask. One is, what is the biggest misinformation that is out there about obesity today?
Speaker 2:So that's that's easy for me. And we didn't really talk much about obesity at all. You're gonna have to have me back on where we actually talk about the science of obesity. Done
Speaker 1:and done.
Speaker 2:You know, I sometimes make the analogy to how alcoholism was viewed. I don't even remember how long ago that was twenty or thirty years ago, where it used to be that people with alcoholism were just viewed as weak willed and just couldn't keep themselves away from the bottle. And then we figured out that it was actually a genetic disease that was passed on from parents to offspring. And it changed the way everybody thought about alcoholism and how we treat it. And the same is true for obesity.
Speaker 2:Like obesity is a disease. It's not a lifestyle choice. It's not, no one chooses. No one wants to be three hundred pounds, especially not the kids I would see. No one wants to go through adolescence as the social outcast weighs a ton.
Speaker 2:And again, it's a disease that you wear on your face or you wear on your body. Like you're not hiding it from anybody. So that would be the one if I had, if I could just change that one perception and that one drive home, take home point. This is a disease, not a lifestyle choice. It's a disease.
Speaker 2:Now it's probably multiple different diseases, not just one disease that all just look the same on the outside. So if I get into my medical speak, it's, it's a obesity is what we call a phenotype, which is what things look like on the outside, but it comes from a bunch of different genotypes, which just means the way things work on the inside. So that might be the second sort of thing that I want people to understand is that just because you can see somebody's disease doesn't mean you know how they got there. And it doesn't mean that you know how to treat it. And even if something worked for you, it doesn't mean it's going to work for that next person next to you or your neighbor or your friend or your family member.
Speaker 1:Difference between a symptom and a root cause and kind of everyday speak. The question we ask every single guest, and this is a hard one, if you had to go back to the most difficult point of your life, whether it's your twenties or last week, what advice would you give to yourself?
Speaker 2:That is a hard question. Well, I would probably give myself the advice that I give all my patients or often give my patients, but it's a lot easier to tell somebody else to do it than to tell yourself to do it, which is give yourself a break. Like, you know, like, don't be so hard on yourself. Like life is hard. Achieving things is hard for most people.
Speaker 2:Some people get lucky and stuff just happens to them. And like, I would probably tell myself not to be so hard on myself because I think especially in the, in the darkest moments or the hardest moments, I think it's really easy to get down on yourself and sort of not remember that, you know, most people are trying to do the right thing. Most people are trying to do good. Most people are trying to have healthy relationships, trying to be friendly, trying to be, you know, trying to love everyone as much as they can. You know, like most people are not out there doing ill.
Speaker 2:And so when bad stuff happens, maybe I should have told myself, you know, take it easy on yourself. Don't beat your out. Don't beat yourself up so much because, you know, sometimes things just happen.
Speaker 1:Doctor. Evan Nadler, thank you so much for joining the show. I appreciate you.
Speaker 2:My pleasure. And I will be hitting you up to come back. I promise.
Speaker 1:Done and done.