WEBVTT 00:00:00.000 --> 00:00:02.180 We are the guinea pig generation. The reality 00:00:02.180 --> 00:00:05.080 is as a medical field, as the best physician 00:00:05.080 --> 00:00:07.679 in the world, we just don't know. Do you think 00:00:07.679 --> 00:00:09.519 patients just don't know that we don't know? 00:00:09.679 --> 00:00:11.500 Most people understand what that is on the surface, 00:00:11.800 --> 00:00:13.820 but and I honestly just think that as physicians 00:00:13.820 --> 00:00:16.379 we probably don't say that enough. It's challenging. 00:00:16.620 --> 00:00:19.120 The problem is we have all this access to all 00:00:19.120 --> 00:00:22.480 these different tests and the imaging is only 00:00:22.480 --> 00:00:24.960 getting better and better. And so I think we're 00:00:24.960 --> 00:00:27.000 in this weird kind of bubble right now where 00:00:27.260 --> 00:00:30.300 We have this amazing kind of technology for testing. 00:00:30.559 --> 00:00:32.759 We don't have a way to truly interpret it yet 00:00:32.759 --> 00:00:34.979 because we don't have like the data for it. You 00:00:34.979 --> 00:00:37.200 know, I just had this itch to go into the startup 00:00:37.200 --> 00:00:39.780 world myself. Didn't have the courage to do my 00:00:39.780 --> 00:00:43.200 own startup, but wanted to join one. So I joined 00:00:43.200 --> 00:00:45.659 the company General Medicine. If I could go back 00:00:45.659 --> 00:00:47.700 10 years, I would have probably told that person 00:00:47.700 --> 00:00:50.799 to... Hi, Adam. Thanks so much for joining us 00:00:50.799 --> 00:00:53.420 today. Happy to be here, Rashad. Looking forward 00:00:53.420 --> 00:00:56.439 to the convo. So let's give our audience a bit 00:00:56.439 --> 00:00:59.340 of an intro. Could you tell us what do you do 00:00:59.340 --> 00:01:01.200 in your professional life today and how did you 00:01:01.200 --> 00:01:04.280 end up here? Yeah, happy to. I'm a physician, 00:01:04.359 --> 00:01:07.379 I guess, first and foremost, but didn't kind 00:01:07.379 --> 00:01:10.019 of land on that path. I'd say the traditional 00:01:10.019 --> 00:01:13.019 way. I started college thinking I would be a 00:01:13.019 --> 00:01:15.680 math teacher. We were just briefly chatting about 00:01:15.680 --> 00:01:18.980 math background and prowess. I was also just 00:01:18.980 --> 00:01:20.920 pretty good at math and it was just natural. 00:01:21.359 --> 00:01:24.640 I liked teaching people and helping my classmates. 00:01:25.760 --> 00:01:28.560 I picked that as my initial major, but I played 00:01:28.560 --> 00:01:31.359 basketball in college too. I was really into 00:01:31.359 --> 00:01:34.400 training and performance and making myself as 00:01:34.400 --> 00:01:37.200 best as I could be personally as an athlete. 00:01:37.779 --> 00:01:41.540 And I ended up pivoting to the exercise sciences 00:01:41.540 --> 00:01:44.099 for my undergrad degree. So, you know, which 00:01:44.099 --> 00:01:46.319 was, I don't know, it was sort of like a pre 00:01:46.319 --> 00:01:49.579 -med light type of major. I took an intro class 00:01:49.579 --> 00:01:52.019 and I realized, man, there's a lot of different 00:01:52.019 --> 00:01:54.219 aspects you can go into this. And, you know, 00:01:54.340 --> 00:01:55.680 selfishly in college, I was like, man, this is 00:01:55.680 --> 00:01:58.719 going to be helpful for me to know how to exercise 00:01:58.719 --> 00:02:02.239 and how to train and learn about the body and 00:02:02.239 --> 00:02:05.829 how it adapts and that sort of thing. I got really 00:02:05.829 --> 00:02:08.289 into that, really into strength and conditioning 00:02:08.289 --> 00:02:14.710 performance as well. As an athlete, I was good, 00:02:14.949 --> 00:02:17.370 obviously good enough to play in college, but 00:02:17.370 --> 00:02:20.930 I wasn't great. I had to really work hard to 00:02:20.930 --> 00:02:24.409 be that differential. I finished college thinking 00:02:24.409 --> 00:02:27.229 I would go into exercise sciences, but I wasn't 00:02:27.229 --> 00:02:29.810 sure which avenue because you can go consumer 00:02:29.810 --> 00:02:33.409 or more clinical type of roles. I just decided 00:02:33.409 --> 00:02:37.229 to try both of them. I worked in some gyms. I 00:02:37.229 --> 00:02:39.289 worked for some companies that had their own 00:02:39.289 --> 00:02:42.490 kind of fitness kind of program internally, did 00:02:42.490 --> 00:02:45.129 that out of college. But I decided to go to grad 00:02:45.129 --> 00:02:48.250 school. And in grad school, I dipped my toe in 00:02:48.250 --> 00:02:51.409 my first clinical kind of role, which was working 00:02:51.409 --> 00:02:55.030 in cardiac rehabilitation. And so cardiac rehab, 00:02:55.229 --> 00:02:57.669 I was like, man, this is fun. I got to do stuff 00:02:57.669 --> 00:03:00.389 in the hospital and bedside teaching, education. 00:03:00.719 --> 00:03:02.879 and then got to work with patients, you know, 00:03:03.000 --> 00:03:06.879 in the outpatient facility, crafting their exercise 00:03:06.879 --> 00:03:10.360 programs and nutrition and education. So I kind 00:03:10.360 --> 00:03:12.539 of always followed that like kind of teaching 00:03:12.539 --> 00:03:14.699 kind of arc. I thought I would be a teacher originally 00:03:14.699 --> 00:03:16.639 in college, you know, for high school and maybe 00:03:16.639 --> 00:03:19.379 coach. I had a mentor there and she was one that 00:03:19.379 --> 00:03:21.139 suggested, you know, have you ever considered 00:03:21.139 --> 00:03:23.360 medicine? And I was like, no, I haven't, didn't 00:03:23.360 --> 00:03:25.639 have any doctors in my family. So it really wasn't 00:03:25.639 --> 00:03:27.860 ever really on the radar, but I thought it was. 00:03:28.330 --> 00:03:30.789 interesting in a good way to kind of go forward 00:03:30.789 --> 00:03:33.030 with, you know, the way my life had been. And 00:03:33.030 --> 00:03:36.250 so that took me to medicine. And I think like, 00:03:36.289 --> 00:03:38.530 you know, I was in college in the late nineties. 00:03:38.569 --> 00:03:41.949 So right when, you know, the internet was really 00:03:41.949 --> 00:03:44.490 blooming, you know, and Napster was around for, 00:03:44.490 --> 00:03:48.889 you know, free MP3 downloading, obviously highly 00:03:48.889 --> 00:03:51.370 illegal, but everyone was doing it, you know, 00:03:51.370 --> 00:03:53.669 and I just got really into the technology stuff 00:03:53.669 --> 00:03:56.280 that was coming up. So that whole arc was kind 00:03:56.280 --> 00:03:59.620 of like woven in throughout and always thought 00:03:59.620 --> 00:04:02.300 technology and medicine was something that I 00:04:02.300 --> 00:04:04.759 was super interested in. And so I always gravitated 00:04:04.759 --> 00:04:08.280 to those types of things. And, you know, I think 00:04:08.280 --> 00:04:11.639 in residency, that's probably when I first started 00:04:11.639 --> 00:04:15.000 really getting involved when our hospital system 00:04:15.000 --> 00:04:18.379 was transitioning to Epic as a EMR going from 00:04:18.379 --> 00:04:22.000 paper to Epic. And so I was one of the resident 00:04:22.000 --> 00:04:24.680 representatives on that transition. That just 00:04:24.680 --> 00:04:27.199 kind of was the catalyst that led me down a path 00:04:27.199 --> 00:04:30.360 of like really wanting to optimize the systems 00:04:30.360 --> 00:04:33.379 that physicians and other care teams use. It 00:04:33.379 --> 00:04:36.660 just made my own life so much easier and better 00:04:36.660 --> 00:04:39.459 and more efficient. And I loved being able to 00:04:39.459 --> 00:04:42.220 help others do that. So that is kind of what 00:04:42.220 --> 00:04:45.379 led down the path of informatics formally. And, 00:04:45.379 --> 00:04:48.189 and so, yeah, so I just I did that internally 00:04:48.189 --> 00:04:51.209 at Kaiser for many, many years, ultimately becoming 00:04:51.209 --> 00:04:55.990 the CMIO for the Colorado region of KP. And, 00:04:55.990 --> 00:04:58.569 um, and really enjoyed it, but, you know, I just 00:04:58.569 --> 00:05:01.610 had this itch to go into the startup world myself 00:05:01.610 --> 00:05:03.790 didn't have the courage to do my own startup, 00:05:03.810 --> 00:05:07.410 but wanted to join one. So, um, in August of 00:05:07.410 --> 00:05:12.310 2024, I, um, I left KP and I joined the company 00:05:12.310 --> 00:05:15.029 general medicine, which was really early and 00:05:15.029 --> 00:05:17.959 incubating at that time, but. started with them 00:05:17.959 --> 00:05:21.339 part -time and have continued to work with them 00:05:21.339 --> 00:05:23.519 through today. That is an amazing journey and 00:05:23.519 --> 00:05:26.199 I have a million questions. Let's maybe go in 00:05:26.199 --> 00:05:28.660 chronological order. Sure. One thing I really, 00:05:28.740 --> 00:05:31.160 and my math journey stopped after first year 00:05:31.160 --> 00:05:33.139 of undergrad. The one thing I really enjoyed 00:05:33.139 --> 00:05:34.740 about math is you can test everything, you can 00:05:34.740 --> 00:05:37.860 prove everything as part of learning math and 00:05:37.860 --> 00:05:40.680 doing math. That doesn't exist in the real world. 00:05:41.139 --> 00:05:43.079 Often what I found when I was doing my pre -med 00:05:43.079 --> 00:05:45.819 courses, eventually the answer is we don't know. 00:05:45.899 --> 00:05:50.180 for I found most of the things. They come from 00:05:50.180 --> 00:05:53.579 physiology to biology to chemistry. Like often 00:05:53.579 --> 00:05:55.699 it's like, we just don't know why this happens. 00:05:56.240 --> 00:05:58.459 You know, good example, maybe the Lasix has no 00:05:58.459 --> 00:06:00.899 mortality benefit, but obviously it works. No 00:06:00.899 --> 00:06:02.279 one's going to not use it for heart failure. 00:06:03.100 --> 00:06:05.439 Is that something you struggle with, with having 00:06:05.439 --> 00:06:08.540 the very defined worldview in math, at least 00:06:08.540 --> 00:06:10.779 at the university first year level? And I'm sure 00:06:10.779 --> 00:06:14.009 it gets more vague as we go further along. versus 00:06:14.009 --> 00:06:16.709 kind of being in the real world and real working 00:06:16.709 --> 00:06:19.089 scenarios where most things are unknown. There's 00:06:19.089 --> 00:06:22.350 a lot more probabilities as opposed to determinism 00:06:22.350 --> 00:06:24.750 happening. And how do you kind of tie that into 00:06:24.750 --> 00:06:29.769 how we naturally want a deterministic model of 00:06:29.769 --> 00:06:32.350 the world, but the world exists in a probabilistic 00:06:32.350 --> 00:06:34.470 model? Yeah, that's a great question. You know, 00:06:34.529 --> 00:06:37.319 I don't think I ever made the connection. Between 00:06:37.319 --> 00:06:39.779 me liking math and like what you just said, but 00:06:39.779 --> 00:06:41.899 that it actually makes a lot of sense I've always 00:06:41.899 --> 00:06:44.019 been someone who when I'm learning something 00:06:44.019 --> 00:06:46.959 new I can typically grasp it pretty quickly and 00:06:46.959 --> 00:06:48.920 I think for math it was that was particularly 00:06:48.920 --> 00:06:51.139 evident and you know, so like we could learn 00:06:51.139 --> 00:06:53.939 a new concept and say high school and calculus 00:06:53.939 --> 00:06:56.480 and You know, it's like once it clicked and it 00:06:56.480 --> 00:06:57.980 clicked pretty quickly. I would be like, okay 00:06:57.980 --> 00:06:59.519 I know how to do this. Like I understand the 00:06:59.519 --> 00:07:02.160 rules. I understand the formula, etc I think 00:07:02.160 --> 00:07:05.019 what I quickly learned and would help me like 00:07:05.019 --> 00:07:08.259 Excel in math at an early age was I could then 00:07:08.259 --> 00:07:10.860 like translate that to other people pretty easily. 00:07:11.019 --> 00:07:13.000 But that was, I think something that was just 00:07:13.000 --> 00:07:15.220 like a natural kind of gift that I had. You know, 00:07:15.220 --> 00:07:18.420 I think that piece is probably the piece that 00:07:18.420 --> 00:07:21.560 I think transferred some like much more to medicine 00:07:21.560 --> 00:07:24.620 because as you know, you're always like learning 00:07:24.620 --> 00:07:26.660 stuff. You're taking in kind of, like you said, 00:07:26.860 --> 00:07:30.220 real, real concrete, possibly even deterministic 00:07:30.220 --> 00:07:33.519 things. And then. there's like that gray area 00:07:33.519 --> 00:07:35.959 where there's the uncertainty, the, you know, 00:07:36.459 --> 00:07:38.160 and so, I mean, I tend to write about this type 00:07:38.160 --> 00:07:40.899 of topical bit too, but it's, you know, for me, 00:07:41.000 --> 00:07:43.500 like in medicine, I think the way I see it is 00:07:43.500 --> 00:07:47.339 I want to optimize the crap out of the deterministic 00:07:47.339 --> 00:07:50.259 stuff. Like make that like just so foolproof, 00:07:50.300 --> 00:07:53.399 like super easy for patients, super easy for 00:07:53.399 --> 00:07:56.579 clinicians. Make that part as like automated 00:07:56.579 --> 00:08:00.379 and amazing as possible. Because then I think 00:08:00.379 --> 00:08:02.720 then it leaves like more of that kind of gray 00:08:02.720 --> 00:08:05.339 area to actually focus on. I don't know. That's 00:08:05.339 --> 00:08:07.360 the way I would kind of answer, you know, your 00:08:07.360 --> 00:08:09.480 question. I kind of took it my own way a little 00:08:09.480 --> 00:08:12.660 bit, but I think that's, um, that's kind of like 00:08:12.660 --> 00:08:14.500 been my approach. And that's the part where I 00:08:14.500 --> 00:08:17.439 see, you know, us being able to actually be able 00:08:17.439 --> 00:08:19.860 to care for more people with less human resource 00:08:19.860 --> 00:08:22.899 is to do that. We got to automate the automatic 00:08:22.899 --> 00:08:25.860 stuff and the easy, you know, easy in quotes, 00:08:26.879 --> 00:08:29.750 but the you know, the deterministic, the algorithmic, 00:08:29.750 --> 00:08:32.289 those types of things. We've got to make those 00:08:32.289 --> 00:08:35.629 really simple and easy so we can take care of 00:08:35.629 --> 00:08:38.029 more people. That's been, that would be my connection, 00:08:38.049 --> 00:08:41.230 I think, to kind of the math roots to where I 00:08:41.230 --> 00:08:44.370 am today. A lot of VCs in particular, but people 00:08:44.370 --> 00:08:47.129 in general have predicted the AI physician happening 00:08:47.129 --> 00:08:49.490 in our lifetime and recently within the next 00:08:49.490 --> 00:08:52.409 five years. I think the future is easy to predict. 00:08:52.429 --> 00:08:54.610 It's very hard to predict when it will happen. 00:08:54.950 --> 00:08:57.350 We'll have flying cars, I don't know when. at 00:08:57.350 --> 00:09:00.190 some point in the future, we will. When do you 00:09:00.190 --> 00:09:02.610 think the AI physician is happening? I know there's 00:09:02.610 --> 00:09:04.950 a very early bill in the Senate pushing this 00:09:04.950 --> 00:09:07.029 as well. When do you think that's gonna happen? 00:09:07.429 --> 00:09:10.389 Yeah, I mean, I think I generally say the similar 00:09:10.389 --> 00:09:12.570 thing that you just said, that I'm pretty confident 00:09:12.570 --> 00:09:15.289 it's gonna happen. And I think whatever time 00:09:15.289 --> 00:09:18.769 I'd say somebody with a more conservative estimate 00:09:18.769 --> 00:09:21.110 says, my general gut is that it will be quicker 00:09:21.110 --> 00:09:23.990 than that. But I still do think it's gonna take 00:09:23.990 --> 00:09:26.919 some time. Is that nebulous enough of an answer? 00:09:28.159 --> 00:09:30.919 I mean, I think it'll honestly be iterative and 00:09:30.919 --> 00:09:33.840 kind of progressive in a certain way. I mean, 00:09:33.840 --> 00:09:38.820 I see more of the kind of more innovative startups 00:09:38.820 --> 00:09:42.299 probably pushing the envelope and kind of pushing 00:09:42.299 --> 00:09:46.740 what different AI tools can do for care. And 00:09:46.740 --> 00:09:49.779 it'll be a much longer adoption curve for the 00:09:49.779 --> 00:09:52.139 traditional kind of legacy health systems, you 00:09:52.139 --> 00:09:55.210 know, that just have a lot of reasons why they 00:09:55.210 --> 00:09:57.710 can't change really quickly. But, you know, I 00:09:57.710 --> 00:10:02.029 think like anything, they'll probably be a disruptor 00:10:02.029 --> 00:10:05.210 or significant disruptors that I think will catalyze 00:10:05.210 --> 00:10:08.830 this and will kind of force it to spread. And 00:10:08.830 --> 00:10:11.850 I truly feel it's going to be something that 00:10:11.850 --> 00:10:15.110 truly patients gravitate towards and they demand 00:10:15.110 --> 00:10:16.870 it, right? I mean, I think that's the way it 00:10:16.870 --> 00:10:21.250 happens in all. aspects of our society is ultimately 00:10:21.250 --> 00:10:23.929 it's the customers that really will drive it. 00:10:24.110 --> 00:10:27.330 And so that's why I try and, you know, kind of 00:10:27.330 --> 00:10:29.990 beat the dead horse of like, I really feel strongly 00:10:29.990 --> 00:10:33.669 that physicians and other clinicians need to 00:10:33.669 --> 00:10:36.549 really be leading and pushing this forward and 00:10:36.549 --> 00:10:40.289 really testing and trying things and not being 00:10:40.289 --> 00:10:43.269 so guarded. Because I think if we protect the 00:10:43.269 --> 00:10:45.149 old ways, I think you're just, you're going to 00:10:45.149 --> 00:10:48.350 get usurped at some point. It seems like Chad 00:10:48.350 --> 00:10:50.970 GP and maybe OpenEvidence are sort of leading 00:10:50.970 --> 00:10:53.549 the forefront here from a consumer DTC perspective 00:10:53.549 --> 00:10:56.330 where there seems to be there will be a solution 00:10:56.330 --> 00:11:00.029 now where consumers and patients can upload their 00:11:00.029 --> 00:11:03.769 records into Chad GPT bleed records. Epic is 00:11:03.769 --> 00:11:06.049 building this as well with Cosmos and other tools 00:11:06.049 --> 00:11:09.850 where you can ask queries. from your records 00:11:09.850 --> 00:11:11.690 what are your general thoughts and that is an 00:11:11.690 --> 00:11:15.190 obvious fear that everyone ask do i have hypermaldia 00:11:15.190 --> 00:11:18.509 ADHD and not to say that you know those conditions 00:11:18.509 --> 00:11:20.509 are very real i treat a lot of patients with 00:11:20.509 --> 00:11:23.990 it but the social media push towards if you have 00:11:23.990 --> 00:11:27.730 these symptoms you have this. That sentence is 00:11:27.730 --> 00:11:29.789 as it can be very dangerous and that's a little 00:11:29.789 --> 00:11:32.830 bit of knowledge can be dangerous thing no physician 00:11:32.830 --> 00:11:36.029 diagnosis something from four symptoms. Right. 00:11:36.429 --> 00:11:38.590 I think you just need more information there, 00:11:38.590 --> 00:11:43.009 right? Correct. Yeah. Do you think this is good 00:11:43.009 --> 00:11:48.070 or bad? I think if the LLMs are tuned a little 00:11:48.070 --> 00:11:50.210 bit differently, not just tuned for validation, 00:11:50.809 --> 00:11:52.889 not just tuned to tell me I'm the smartest human 00:11:52.889 --> 00:11:55.169 being ever to walk on this planet, which I know 00:11:55.169 --> 00:11:58.009 I'm not, then I can see this actually being good. 00:11:58.350 --> 00:12:00.009 But the problem is then people won't use it. 00:12:01.190 --> 00:12:03.830 We're kind of in a catch -22. This could be really 00:12:03.830 --> 00:12:06.720 good, but then it... it won't get usage and that 00:12:06.720 --> 00:12:10.120 the quote unquote bad versions of this, the validated 00:12:10.120 --> 00:12:12.200 versions of this will probably get more usage. 00:12:12.639 --> 00:12:14.559 What are your thoughts here? Yeah. I mean, I 00:12:14.559 --> 00:12:16.460 think we're in this weird position right now 00:12:16.460 --> 00:12:19.080 where the tools, you know, like the consumer 00:12:19.080 --> 00:12:21.919 grade and just take chat GPT or Claude or Gemini. 00:12:22.039 --> 00:12:25.179 I mean, all of them are, they're extremely good. 00:12:25.360 --> 00:12:28.820 And like you said, like they're pretty darn good 00:12:28.820 --> 00:12:32.419 with clinical things. Like I think the challenge 00:12:32.419 --> 00:12:35.350 right now, yeah, is like, I think If you just 00:12:35.350 --> 00:12:38.470 use the generic model and just kind of upload 00:12:38.470 --> 00:12:41.389 your stuff, present your information, and ask 00:12:41.389 --> 00:12:44.509 it a simple question, I don't think it's going 00:12:44.509 --> 00:12:48.330 to generate something that is consistently accurate, 00:12:48.389 --> 00:12:50.429 because they really are kind of aimed to please, 00:12:50.470 --> 00:12:53.590 right? That's the way these models really function. 00:12:53.690 --> 00:12:55.470 I think OpenAI just recently published a thing 00:12:55.470 --> 00:12:58.250 where they said that's the reason why these things 00:12:58.250 --> 00:13:01.710 actually hallucinate, because it's actually designed 00:13:01.710 --> 00:13:06.259 to do that. It's designed to kind of give a convincing 00:13:06.259 --> 00:13:09.559 answer to something that may not actually be 00:13:09.559 --> 00:13:12.779 true. But I think, you know, there are ways to 00:13:12.779 --> 00:13:15.360 kind of make guardrails around these things too, 00:13:15.659 --> 00:13:18.559 even in the open kind of models that are out 00:13:18.559 --> 00:13:20.960 there for consumers. I think the challenge is 00:13:20.960 --> 00:13:23.759 like, either the consumer has to be savvy enough 00:13:23.759 --> 00:13:27.860 to put around their own kind of prompting guardrails 00:13:27.860 --> 00:13:30.179 around these types of things and use it in that 00:13:30.179 --> 00:13:33.529 way or they have to like constantly be fact checking, 00:13:33.710 --> 00:13:35.710 you know, everything with another source, which 00:13:35.710 --> 00:13:37.909 is obviously you don't know what to fact check 00:13:37.909 --> 00:13:39.710 when you when you have all that. And I still 00:13:39.710 --> 00:13:43.309 think though, from like, the standpoint of patients 00:13:43.309 --> 00:13:46.990 being able to kind of noodle on their kind of 00:13:46.990 --> 00:13:49.350 concerns, their health information, their data, 00:13:49.610 --> 00:13:51.789 their different studies and things in labs that 00:13:51.789 --> 00:13:54.870 have been done, and to potentially like poke 00:13:54.870 --> 00:13:58.129 and look for other potential explanations, I 00:13:58.129 --> 00:14:01.039 still think is overly positive. I encourage patients 00:14:01.039 --> 00:14:03.620 to do that. I think the part where you just have 00:14:03.620 --> 00:14:06.860 to be careful and stop is if it does say something, 00:14:07.279 --> 00:14:10.360 you really do need to get that validated by someone 00:14:10.360 --> 00:14:13.039 who knows, you know, or knows where to look up 00:14:13.039 --> 00:14:15.500 that information accurately. So I think like 00:14:15.500 --> 00:14:17.440 where things are right now, where I think these 00:14:17.440 --> 00:14:20.450 models are extremely good is On the clinical 00:14:20.450 --> 00:14:23.870 side, so someone who has a clinical mind or say 00:14:23.870 --> 00:14:26.710 like a lawyer, like someone who has law experience 00:14:26.710 --> 00:14:29.149 and knows how to infer which things are wrong 00:14:29.149 --> 00:14:32.669 and not. If you have that expertise and you have 00:14:32.669 --> 00:14:34.830 the right guardrails and prompting around these 00:14:34.830 --> 00:14:38.250 tools, they can be extremely, extremely accurate 00:14:38.250 --> 00:14:41.049 and powerful for what you're trying to use them 00:14:41.049 --> 00:14:43.350 with. So it's going to be wild. I think we've 00:14:43.350 --> 00:14:46.529 hit some crazy leaps and bounds with the LLMs 00:14:46.529 --> 00:14:48.970 that are out there. And maybe we're hitting a 00:14:48.970 --> 00:14:51.350 little bit of like, I wouldn't call it a plateau, 00:14:51.490 --> 00:14:54.149 but it's maybe a little bit of a flattening of 00:14:54.149 --> 00:14:57.070 the ascent. But I still think there's going to 00:14:57.070 --> 00:15:00.450 continue to be significant gains over the next 00:15:00.450 --> 00:15:03.129 few years that handled in the right way are going 00:15:03.129 --> 00:15:06.049 to be really powerful for both clinicians and 00:15:06.049 --> 00:15:09.159 consumers. From what little I know about athletic 00:15:09.159 --> 00:15:11.419 performance and kinesiology, and it is very, 00:15:11.659 --> 00:15:14.419 very little, it seems like we don't differentiate 00:15:14.419 --> 00:15:17.259 as much between physical and mental health as 00:15:17.259 --> 00:15:19.379 we do in medicine. Something I'm thinking about 00:15:19.379 --> 00:15:22.659 a little bit more recently. We seem to just look 00:15:22.659 --> 00:15:25.539 at them through completely separate lenses where 00:15:25.539 --> 00:15:27.559 it's part of the same human body. I don't know 00:15:27.559 --> 00:15:30.799 why we have this arbitrary distinction of mental 00:15:30.799 --> 00:15:32.720 health versus physical health. We're looking 00:15:32.720 --> 00:15:35.379 for an organic cause of mental health, right? 00:15:35.399 --> 00:15:38.159 Instead of just saying, this is health. And I 00:15:38.159 --> 00:15:42.220 think we would be much better off as a field, 00:15:42.379 --> 00:15:45.500 as a society, if we just got rid of the label 00:15:45.500 --> 00:15:49.000 of mental health. Because it's almost as if something 00:15:49.000 --> 00:15:52.220 is broken with you or in you. Whereas physical 00:15:52.220 --> 00:15:54.980 health, you know, no one says if you have diabetes, 00:15:55.200 --> 00:15:57.059 something's broken, you're broken, right? Whereas 00:15:57.059 --> 00:16:00.159 if you have depression, like people might say 00:16:00.159 --> 00:16:02.799 you're broken. Why do you think that is? And 00:16:02.799 --> 00:16:04.960 I kind of see this in the longevity space as 00:16:04.960 --> 00:16:08.600 well. It's all about physical health. You know, 00:16:08.679 --> 00:16:10.919 how do we get rid of this distinction? Can we 00:16:10.919 --> 00:16:12.820 get rid of the distinction? Why do you think 00:16:12.820 --> 00:16:15.320 it exists? And I have a follow up question I'll 00:16:15.320 --> 00:16:19.279 ask after. Yeah. No, I think humans love to compartmentalize 00:16:19.279 --> 00:16:21.659 things and traditionally in medicine, I mean, 00:16:21.820 --> 00:16:24.500 it's always been very compartmentalized, you 00:16:24.500 --> 00:16:27.379 know, over our careers. We've even just seen 00:16:27.379 --> 00:16:30.120 how much of an overlap there is, you know, across 00:16:30.120 --> 00:16:32.460 disease states. I think that just comes from 00:16:32.460 --> 00:16:35.279 historical context of why it is established that 00:16:35.279 --> 00:16:37.960 way. But like you were alluding to and what you 00:16:37.960 --> 00:16:40.980 were mentioning, physical problems can lead to, 00:16:40.980 --> 00:16:43.740 quote, mental problems in yourself. And mental 00:16:43.740 --> 00:16:45.879 problems can obviously lead to physical problems. 00:16:45.919 --> 00:16:48.879 So they're clearly tied together. I mean, I think 00:16:48.879 --> 00:16:51.159 what I a lot of times break down with patients, 00:16:51.700 --> 00:16:54.000 because I think, too, patients, if they come 00:16:54.000 --> 00:16:58.000 in with a symptom, say they come in with abdominal 00:16:58.000 --> 00:17:00.919 pain, And everything's been kind of ruled out 00:17:00.919 --> 00:17:04.579 from from a, you know, an actual digestive functional 00:17:04.579 --> 00:17:09.500 or a physical problem. And, you know, you ultimately 00:17:09.500 --> 00:17:11.920 arrive at something, you know, like, you know, 00:17:12.000 --> 00:17:14.779 IBS or something that's just, you know, this, 00:17:15.220 --> 00:17:17.799 and you start explaining it to them. And the 00:17:17.799 --> 00:17:20.099 way I always break it down is that, you know, 00:17:20.180 --> 00:17:22.480 our brain and our gut are like actually directly 00:17:22.480 --> 00:17:26.460 connected by the same nervous system. And Because 00:17:26.460 --> 00:17:28.740 if you just jump right to saying, hey, I think 00:17:28.740 --> 00:17:32.140 this is, is IBS and, you know, we should try 00:17:32.140 --> 00:17:34.660 X, Y, and Z that, you know, and then they go, 00:17:34.740 --> 00:17:36.099 wait a minute, those things you just mentioned, 00:17:36.180 --> 00:17:38.140 those are like, those are medicines that are 00:17:38.140 --> 00:17:40.519 used to treat depression and anxiety. Like, how 00:17:40.519 --> 00:17:42.420 is that going to help my gut? I mean, I think 00:17:42.420 --> 00:17:44.460 that's just like a perfect example in medicine 00:17:44.460 --> 00:17:46.599 of where there truly is that connection. But, 00:17:46.779 --> 00:17:48.359 you know, I mean, personal story for me, I mean, 00:17:48.420 --> 00:17:50.720 when I, I've had periods of my life where I've 00:17:50.720 --> 00:17:52.839 had some pretty significant orthopedic injuries, 00:17:52.839 --> 00:17:55.569 you know, from, from athletics. happened first 00:17:55.569 --> 00:17:58.069 in college. I broke my foot and had to have a 00:17:58.069 --> 00:18:00.809 screw put in there. That put me out a year. I 00:18:00.809 --> 00:18:03.269 was definitely depressed during that year. I 00:18:03.269 --> 00:18:06.269 mean, I clearly had some depression, but it was 00:18:06.269 --> 00:18:09.049 clearly related to, you know, a physical ailment. 00:18:09.150 --> 00:18:11.410 It happened to me again, you know, later in my 00:18:11.410 --> 00:18:14.849 adult year, you know, probably my 30s. I tore 00:18:14.849 --> 00:18:17.269 my patellar tendon and, you know, that really 00:18:17.269 --> 00:18:19.549 put me down and like even got me to the point 00:18:19.549 --> 00:18:21.170 where I was like, man, I can't play basketball 00:18:21.170 --> 00:18:24.250 anymore. And So there's been like these waves 00:18:24.250 --> 00:18:27.049 of things that have come and I think those two 00:18:27.049 --> 00:18:29.410 things really are connected and I'll flip it 00:18:29.410 --> 00:18:31.650 a little bit to like, I hate it in healthcare 00:18:31.650 --> 00:18:33.970 where things are compartmentalized too, right? 00:18:34.049 --> 00:18:36.430 I mean, we need specialties and specialists for 00:18:36.430 --> 00:18:39.369 different expertise, but like, I absolutely hate 00:18:39.369 --> 00:18:41.990 it when a specialist would be like, oh no, we 00:18:41.990 --> 00:18:44.569 can't talk about that because that's not my specialty. 00:18:44.849 --> 00:18:47.529 I think that's BS. Like every specialty has an 00:18:47.529 --> 00:18:49.549 overlap with something else, right? It's the 00:18:49.549 --> 00:18:52.559 human body. And then the terms we use in healthcare 00:18:52.559 --> 00:18:54.880 are also compartmentalized. Like, why do we call 00:18:54.880 --> 00:18:58.000 it telehealth or digital health or in -person 00:18:58.000 --> 00:19:00.740 health? Like, it's really all the same. I mean, 00:19:00.779 --> 00:19:03.920 the goal of it all is exactly the same. So, I 00:19:03.920 --> 00:19:06.460 don't know. I think it's just humans. We like 00:19:06.460 --> 00:19:09.140 to compartmentalize things and put things into 00:19:09.140 --> 00:19:11.819 a bucket. You know, I think the whole system 00:19:11.819 --> 00:19:14.980 has been set up that way, you know, from history 00:19:14.980 --> 00:19:17.440 until now. But I think there's a little bit of 00:19:17.440 --> 00:19:19.299 a shift. So much of the foundation is still. 00:19:19.589 --> 00:19:23.150 rock solid in that area. We know what we need 00:19:23.150 --> 00:19:25.569 for longevity and for athletic performance to 00:19:25.569 --> 00:19:27.569 an extent. We know we need to sleep seven to 00:19:27.569 --> 00:19:30.630 nine hours. We need to reduce our stress levels. 00:19:30.690 --> 00:19:32.509 We need to let go of thoughts that are harmful. 00:19:33.049 --> 00:19:37.250 We need to eat better foods. Ideally, a more 00:19:37.250 --> 00:19:39.130 plant -based diet. We need to lift weights. We 00:19:39.130 --> 00:19:42.089 need to do cardio. None of these things require 00:19:42.089 --> 00:19:46.029 any technology. Yet, it's technology and AI that's 00:19:46.029 --> 00:19:49.470 unlocking the longevity space. It's tests we 00:19:49.470 --> 00:19:52.470 don't need, it's more biomarkers we don't need 00:19:52.470 --> 00:19:57.309 to an extent. There is some role for imaging, 00:19:57.970 --> 00:20:00.269 for market detection of preventive health in 00:20:00.269 --> 00:20:02.470 general. I'm not saying preventive health shouldn't 00:20:02.470 --> 00:20:05.690 exist. But do I really need a biomarker for sleep 00:20:05.690 --> 00:20:11.730 or for lifting weights? Do you think we're at 00:20:11.730 --> 00:20:15.440 a point where... We are testing too much and 00:20:15.440 --> 00:20:18.440 not optimizing for what's needed. Or do you think 00:20:18.440 --> 00:20:21.200 given the way our human brains are designed for 00:20:21.200 --> 00:20:23.839 convenience and reward and scarcity and, you 00:20:23.839 --> 00:20:26.180 know, the principles of marketing, we need to 00:20:26.180 --> 00:20:28.640 do it this way? Yeah. I mean, I don't think it's 00:20:28.640 --> 00:20:31.599 like an either or. Um, it's one of those things 00:20:31.599 --> 00:20:33.440 that, you know, kind of like you just said, I 00:20:33.440 --> 00:20:36.119 can be on, I can be on both sides of the fence, 00:20:36.200 --> 00:20:39.180 you know, like, you know, I mean, I think, and, 00:20:39.180 --> 00:20:41.279 and I think there's a, there's a tug and a pull 00:20:41.279 --> 00:20:44.799 between traditional quality based health care 00:20:44.799 --> 00:20:48.279 and what consumers actually want and need to. 00:20:48.759 --> 00:20:50.960 So I think there has to be a balance between 00:20:50.960 --> 00:20:54.700 these things, you know, and that's, um, you know, 00:20:54.759 --> 00:20:57.579 so like I've had plenty of conversations with, 00:20:57.579 --> 00:20:59.900 you know, my neighbors who know I'm a physician 00:20:59.900 --> 00:21:01.779 and they'll just be like, you know, why wouldn't 00:21:01.779 --> 00:21:03.500 I go into the doctor? Like, why won't they just 00:21:03.500 --> 00:21:05.140 let me, why won't they just order everything? 00:21:05.400 --> 00:21:07.160 you know, to make sure everything's not right, 00:21:07.180 --> 00:21:10.660 wrong, right? Or, you know, we have several companies 00:21:10.660 --> 00:21:12.700 that are doing kind of whole body imaging, you 00:21:12.700 --> 00:21:14.640 know, to try and look and see if there's potentially 00:21:14.640 --> 00:21:17.680 anything. And, you know, on one hand, I totally 00:21:17.680 --> 00:21:19.599 understand that, like, right? I mean, you want 00:21:19.599 --> 00:21:22.279 to know, like, it's like this element of unknown. 00:21:22.740 --> 00:21:25.680 But I think, like, you know, if you go into the 00:21:25.680 --> 00:21:27.759 actual, like, statistical probability of these 00:21:27.759 --> 00:21:30.559 tests being positive, and you get into all the 00:21:30.559 --> 00:21:33.359 details of that, like, you quickly realize that 00:21:33.640 --> 00:21:37.079 it's not really good to just blankly do all of 00:21:37.079 --> 00:21:39.720 those. I think what we have to do is we have 00:21:39.720 --> 00:21:44.779 to find a way that these tests can actually be 00:21:44.779 --> 00:21:47.920 much more sensitive and much more specific, which 00:21:47.920 --> 00:21:49.980 is obviously the holy grail of any test, right? 00:21:50.299 --> 00:21:52.779 You have those both at 100%. You're like pretty 00:21:52.779 --> 00:21:54.720 much money. You can use it as a screening test 00:21:54.720 --> 00:21:59.299 and confirmatory test. And I think that's like 00:21:59.299 --> 00:22:02.339 where we just have to really push with these, 00:22:02.500 --> 00:22:05.539 you know, so -called biomarker tests, which I 00:22:05.539 --> 00:22:07.880 hate that term because really all of it, it's 00:22:07.880 --> 00:22:09.599 the same things we always have. They've just 00:22:09.599 --> 00:22:12.900 tagged on a catchy name. But, and then I think 00:22:12.900 --> 00:22:15.259 the other thing, obviously everyone wants to 00:22:15.259 --> 00:22:17.559 live a fruitful life and everyone wants to live 00:22:17.559 --> 00:22:19.119 a long life, right? I mean, unless something 00:22:19.119 --> 00:22:20.779 horrible happens to you that you're miserable. 00:22:21.240 --> 00:22:23.799 I think this whole rush for kind of longevity, 00:22:24.819 --> 00:22:27.220 I wish it wasn't called longevity because that 00:22:27.220 --> 00:22:29.859 infers that people just want to live longer. 00:22:30.119 --> 00:22:32.740 And I really think like, What people really want 00:22:32.740 --> 00:22:35.640 is they want to live the way they are right now 00:22:35.640 --> 00:22:38.380 as a younger person for a longer time. You know, 00:22:38.380 --> 00:22:40.680 and there's all sorts of obviously terms and 00:22:40.680 --> 00:22:42.140 things that are used for that. But I think it's 00:22:42.140 --> 00:22:45.420 like, if all of this is truly just allowing people 00:22:45.420 --> 00:22:47.660 to live a longer, fruitful life and be able to 00:22:47.660 --> 00:22:49.799 do the things that they want to do for the longest 00:22:49.799 --> 00:22:52.299 period of time, then I think that's good. But 00:22:52.299 --> 00:22:54.200 I think this whole like, I don't know, the whole 00:22:54.200 --> 00:22:56.859 industry around hacking different things and 00:22:56.859 --> 00:22:58.900 trying to find certain things that are going 00:22:58.900 --> 00:23:02.829 to degrade aging and uh, be able to prolong different 00:23:02.829 --> 00:23:05.269 cell life. I don't know. I just think that's 00:23:05.269 --> 00:23:07.569 we're like splitting hairs at that point. Cause 00:23:07.569 --> 00:23:10.589 like where you led with all those core tenants 00:23:10.589 --> 00:23:13.410 are really the things that if you do those, you're 00:23:13.410 --> 00:23:15.609 pretty much going to live a good healthy life. 00:23:16.029 --> 00:23:18.269 And I always tell patients, especially my older 00:23:18.269 --> 00:23:20.609 patients, you know, or that are patients that 00:23:20.609 --> 00:23:24.329 are approaching an older age. Like it's even 00:23:24.329 --> 00:23:26.210 just more important that you do those basics 00:23:26.210 --> 00:23:28.569 when you get older, right? Like you've got to 00:23:28.569 --> 00:23:31.109 preserve that strength. I mean, cause If you 00:23:31.109 --> 00:23:33.089 fall down or you slip and you're on the ground 00:23:33.089 --> 00:23:35.930 and you can't get yourself up, I mean, that's 00:23:35.930 --> 00:23:38.269 a problem, right? Like a little kid, I mean, 00:23:38.349 --> 00:23:39.930 they fall all the time, hit their face, they 00:23:39.930 --> 00:23:42.869 bounce right back up. But just getting on and 00:23:42.869 --> 00:23:45.390 off the toilet or slipping in the shower and 00:23:45.390 --> 00:23:47.769 not being able to get yourself back up, I mean, 00:23:48.130 --> 00:23:49.710 those are the things that can really do people 00:23:49.710 --> 00:23:52.549 in. I don't know, that was like a serendipitous 00:23:52.549 --> 00:23:54.829 answer to your original question, but I think 00:23:54.829 --> 00:23:56.329 all this stuff that's happening right now is 00:23:56.329 --> 00:23:58.849 very well intended, but I think a lot of people 00:23:58.849 --> 00:24:01.789 are jumping on the bandwagon of this term, longevity, 00:24:02.430 --> 00:24:04.769 to like promote stuff that we've kind of like 00:24:04.769 --> 00:24:07.390 already known or can already do. I haven't really 00:24:07.390 --> 00:24:10.650 seen a ton of net -net new things, but I think 00:24:10.650 --> 00:24:14.569 some of those are probably on the fringe of really 00:24:14.569 --> 00:24:17.130 coming together. Yeah, I think going a little 00:24:17.130 --> 00:24:18.869 bit deeper, you know, I had a patient who wanted 00:24:18.869 --> 00:24:22.089 a screening x -ray for no reason and ended up 00:24:22.089 --> 00:24:24.369 with a lung resection. But you know, these cases 00:24:24.369 --> 00:24:28.009 are rare. I can almost guarantee if we give you 00:24:28.009 --> 00:24:30.809 every single test we know, it will result in 00:24:30.809 --> 00:24:34.049 some invasive treatment for no reason. And the 00:24:34.049 --> 00:24:37.029 gap between what we know in medicine and medical 00:24:37.029 --> 00:24:40.369 knowledge and the appetite for knowing and optimizing 00:24:40.369 --> 00:24:44.829 our health is very wide. We know so little. about 00:24:44.829 --> 00:24:47.970 what to do with the test we order and even though 00:24:47.970 --> 00:24:50.890 the normal ranges are based on specific populations 00:24:50.890 --> 00:24:53.549 that maybe don't apply to other populations and 00:24:53.549 --> 00:24:56.769 they're based on gender and age and race and 00:24:56.769 --> 00:25:00.329 medical conditions. So I think there we are the 00:25:00.329 --> 00:25:03.210 guinea pig generation and I think collecting 00:25:03.210 --> 00:25:05.609 more data is good. We don't know what to do with 00:25:05.609 --> 00:25:07.750 it and I think patients should know that before 00:25:07.750 --> 00:25:10.509 signing up for these things. This is an amazing 00:25:10.509 --> 00:25:13.539 business opportunity. You feed people more uncertainty 00:25:13.539 --> 00:25:15.859 every time you order more tests because we don't 00:25:15.859 --> 00:25:18.240 know what to do with them. The reality is as 00:25:18.240 --> 00:25:21.200 a medical field, as the best physician in the 00:25:21.200 --> 00:25:24.440 world, you know, whatever the top doctors from 00:25:24.440 --> 00:25:26.240 wherever you think are the top doctors from, 00:25:26.420 --> 00:25:28.700 they don't, we just don't know. Like, I don't 00:25:28.700 --> 00:25:30.900 know if your sodium is 134, what does that mean? 00:25:31.480 --> 00:25:33.500 I know if it's under 130 that, you know, maybe 00:25:33.500 --> 00:25:35.519 we should optimize it a little bit because it 00:25:35.519 --> 00:25:38.119 can lead to bone demilitarization. And if you 00:25:38.119 --> 00:25:40.559 have a hyper, if your sodium is too high, Sure, 00:25:40.559 --> 00:25:44.420 I should look for maybe something called diabetes 00:25:44.420 --> 00:25:49.079 insipidus. But we don't know, there's no optimal 00:25:49.079 --> 00:25:52.460 sodium, right? Like a 137 versus 136, there's 00:25:52.460 --> 00:25:54.500 no difference. And I don't know if that's an 00:25:54.500 --> 00:25:56.900 answer people just aren't willing to accept. 00:25:57.299 --> 00:25:58.819 Or is it like, no, you know something, you're 00:25:58.819 --> 00:26:00.440 not telling me. Whereas I'm like, why would I 00:26:00.440 --> 00:26:02.960 hide it? Why do you think that? Do you think 00:26:02.960 --> 00:26:06.619 patients just don't know that we don't know? 00:26:06.759 --> 00:26:09.819 How do you kind of deal with the question? Well, 00:26:09.819 --> 00:26:12.359 why wouldn't you order every single test? Like, 00:26:12.400 --> 00:26:14.839 I want to know my complement pathway, right? 00:26:15.079 --> 00:26:18.900 I want to know everything, right? Like, all the 00:26:18.900 --> 00:26:20.940 genetic tests, you know, and all the tumor markers 00:26:20.940 --> 00:26:24.180 every single visit. Because if I get cancer now, 00:26:24.180 --> 00:26:27.960 I want to know now. I want to follow CA -99 hourly. 00:26:28.279 --> 00:26:30.160 And so the audience is not medical, the tests 00:26:30.160 --> 00:26:33.279 I'm measuring, mentioning CA -99 is a tumor marker 00:26:33.279 --> 00:26:35.180 for pancreatic cancer that we use in ovarian 00:26:35.180 --> 00:26:38.190 cancer. we use to monitor cancer, but not to 00:26:38.190 --> 00:26:40.170 detect it, because that's not what the test is 00:26:40.170 --> 00:26:41.869 designed for. And we just don't know what to 00:26:41.869 --> 00:26:44.730 do if it's a little bit high, because a pancreatic 00:26:44.730 --> 00:26:47.230 is not an easy procedure. But anyways, like, 00:26:47.410 --> 00:26:50.710 what is your kind of answer there? Yeah, I mean, 00:26:50.730 --> 00:26:53.250 my approach to it is generally like, just this 00:26:53.250 --> 00:26:55.970 true like shared decision making approach where 00:26:55.970 --> 00:26:59.049 I'll try and break it down to the patient of 00:26:59.049 --> 00:27:01.269 like, you know, this test or these tests are 00:27:01.269 --> 00:27:03.589 for X, Y and Z, but I usually will get a pulse 00:27:03.589 --> 00:27:06.259 of like, how much this person wants to dive in. 00:27:06.579 --> 00:27:08.859 Cause I can go into a whole deep dive of what 00:27:08.859 --> 00:27:11.339 sensitivity and specificity are. And I think 00:27:11.339 --> 00:27:12.980 people, most people understand what that is on 00:27:12.980 --> 00:27:15.319 the surface, but you know, when you specifically 00:27:15.319 --> 00:27:18.440 dive it in, dive into testing, I think that's 00:27:18.440 --> 00:27:20.720 when people really can kind of realize it. And 00:27:20.720 --> 00:27:22.859 then, you know, I'll flip and I'll start talking 00:27:22.859 --> 00:27:24.799 about positive predictive value and negative 00:27:24.799 --> 00:27:26.799 predictive value and like these types of things. 00:27:27.059 --> 00:27:29.859 And, and that all tests like vary and some of 00:27:29.859 --> 00:27:32.039 them, you know, like say, like those tumor markers 00:27:32.039 --> 00:27:33.579 that you're mentioning. I mean, those things 00:27:33.579 --> 00:27:36.359 can be really kind of horrible at some of those, 00:27:36.700 --> 00:27:39.000 but then also can be really good for some use 00:27:39.000 --> 00:27:42.160 cases. And so I think a lot of people think labs 00:27:42.160 --> 00:27:45.519 are very like black and white. And, you know, 00:27:45.519 --> 00:27:47.539 I think you asked the question specifically, 00:27:47.900 --> 00:27:50.480 why do patients have like maybe that skepticism 00:27:50.480 --> 00:27:54.339 around physicians and kind of the interpretation 00:27:54.339 --> 00:27:57.299 of these things? When in reality, a lot of these 00:27:57.299 --> 00:27:59.000 things, we don't know what they mean, right? 00:27:59.000 --> 00:28:02.000 I mean, it's And I honestly just think that as 00:28:02.000 --> 00:28:03.819 physicians, we probably don't say that enough. 00:28:04.259 --> 00:28:06.460 I think patients expect us to just know everything, 00:28:06.680 --> 00:28:08.839 but like, you know, I think family docs, you 00:28:08.839 --> 00:28:10.819 know, biously probably do this a little bit better, 00:28:11.480 --> 00:28:13.539 but I think we're well, we're generally better 00:28:13.539 --> 00:28:15.759 at like saying, yeah, I really don't know what's 00:28:15.759 --> 00:28:17.940 going on with you. I agree. Your symptoms, you 00:28:17.940 --> 00:28:21.140 know, are disturbing and we've checked X, Y, 00:28:21.140 --> 00:28:23.720 and Z and they've all been okay. But I think 00:28:23.720 --> 00:28:26.589 where this gets into trouble is when there are 00:28:26.589 --> 00:28:29.089 some practitioners out there that will start 00:28:29.089 --> 00:28:32.670 to say, oh, there's this optimized level of this 00:28:32.670 --> 00:28:34.650 and that. And, you know, I've encountered this 00:28:34.650 --> 00:28:36.650 as a doctor, patients will bring me these reports 00:28:36.650 --> 00:28:39.470 and, you know, it's like a standard Quest lab, 00:28:39.569 --> 00:28:42.029 but like it has this custom kind of interpretation 00:28:42.029 --> 00:28:44.990 of it. And, you know, patients are like, oh, 00:28:45.049 --> 00:28:46.849 they're telling me I'm not optimizing this and 00:28:46.849 --> 00:28:48.990 that. And I'm like, well, I don't know what to 00:28:48.990 --> 00:28:52.089 do about that. You know, like drink more water. 00:28:52.150 --> 00:28:54.799 Like if you're, you know, creatinine isn't dead 00:28:54.799 --> 00:28:57.319 in the center of, you know, the creatinine range 00:28:57.319 --> 00:28:59.839 or less water. I don't know. It's like, yeah, 00:28:59.839 --> 00:29:02.420 it's challenging. The problem is we have all 00:29:02.420 --> 00:29:05.619 this access to all these different tests and 00:29:05.619 --> 00:29:08.000 the imaging is only getting better and better. 00:29:08.599 --> 00:29:10.460 And so I think we're in this weird kind of bubble 00:29:10.460 --> 00:29:13.579 right now where we have this amazing kind of 00:29:13.579 --> 00:29:15.960 technology for testing, but like what you kept 00:29:15.960 --> 00:29:18.279 saying, we don't have a way to truly interpret 00:29:18.279 --> 00:29:20.440 it yet because we don't have like the data for 00:29:20.440 --> 00:29:22.920 it. You know, like I'll take whole body MRI. 00:29:23.470 --> 00:29:26.049 as an example, I'm like pretty bullish that that's 00:29:26.049 --> 00:29:28.230 going to be something in the future, like that's 00:29:28.230 --> 00:29:30.130 going to be pretty transforming to healthcare. 00:29:31.250 --> 00:29:34.170 I think right now most physicians are super skeptical 00:29:34.170 --> 00:29:36.589 of it because of the way we were trained and 00:29:36.589 --> 00:29:38.609 the way things are, right? I mean, cause you 00:29:38.609 --> 00:29:40.569 don't want to just find all these incidental 00:29:40.569 --> 00:29:42.750 things that you're chasing down and people are 00:29:42.750 --> 00:29:44.750 having biopsies of and all this follow up, you 00:29:44.750 --> 00:29:46.950 know, like that's especially if it turns out 00:29:46.950 --> 00:29:48.470 to be nothing. Now you just put someone through 00:29:48.470 --> 00:29:52.029 a bunch of risk, but I think if the imaging in 00:29:52.029 --> 00:29:55.049 these tests can continue to get better and better, 00:29:55.470 --> 00:29:57.750 and the technology that interprets them, including 00:29:57.750 --> 00:30:01.190 the physicians, gets better and better, we will 00:30:01.190 --> 00:30:04.150 reach this point where it's a really, like I 00:30:04.150 --> 00:30:06.869 said originally, where it's extremely sensitive, 00:30:07.190 --> 00:30:10.730 but it's also very specific, and being able to 00:30:10.730 --> 00:30:14.549 characterize specific findings and not just be 00:30:14.549 --> 00:30:17.880 that kind of... typical radiology read that like 00:30:17.880 --> 00:30:20.779 hedges on something like looks sort of concerning 00:30:20.779 --> 00:30:23.900 but not definitive. I think we need to get to 00:30:23.900 --> 00:30:27.259 a place where we can definitively characterize 00:30:27.259 --> 00:30:29.400 things better because I think that will ultimately 00:30:29.400 --> 00:30:32.779 lead to better outcomes and better prevention. 00:30:32.980 --> 00:30:35.059 Pulling on the whole body MRI thread and I do 00:30:35.059 --> 00:30:37.319 recommend it to some select patients who I think 00:30:37.319 --> 00:30:40.200 are a good candidate with family history of cancer 00:30:40.200 --> 00:30:43.059 or patients I know will be comfortable handling 00:30:43.059 --> 00:30:46.920 incidentalomas. From talking to a radiologist 00:30:46.920 --> 00:30:50.400 and an oncologist friend, what they kind of, 00:30:50.500 --> 00:30:53.380 their frame of reference is a whole body MRI 00:30:53.380 --> 00:30:55.539 will never diagnose cancer because we cannot 00:30:55.539 --> 00:30:58.839 see the pathology slides, right? Like we cannot 00:30:58.839 --> 00:31:01.579 see in a system, it's magnetic waves, right? 00:31:02.160 --> 00:31:06.279 Like we cannot see inside the detail because 00:31:06.279 --> 00:31:09.640 the technology is limited. The MRI technology 00:31:09.640 --> 00:31:11.990 itself, the way it works is limited. So you cannot 00:31:11.990 --> 00:31:14.630 see through a wall, no matter what the resolution, 00:31:14.869 --> 00:31:16.869 no matter how many pictures you take. You're 00:31:16.869 --> 00:31:19.029 never going to be able to see through a wall 00:31:19.029 --> 00:31:21.549 because you're using light and light does not 00:31:21.549 --> 00:31:25.269 travel through walls. That's kind of their analogy 00:31:25.269 --> 00:31:28.269 is MRI will never diagnose cancer. The only way 00:31:28.269 --> 00:31:31.230 to train a model is to take a biopsy of every 00:31:31.230 --> 00:31:33.269 single incidentaloma to then train a model to 00:31:33.269 --> 00:31:35.250 have enough data to say this is cancer, this 00:31:35.250 --> 00:31:37.890 isn't cancer. What are your thoughts there? Do 00:31:37.890 --> 00:31:41.009 you think we're... Doing cancer screening a disservice 00:31:41.009 --> 00:31:44.309 by leaning so heavily into MRI and because they 00:31:44.309 --> 00:31:47.210 have this mythical Connotation somehow that's 00:31:47.210 --> 00:31:49.470 developed that it shows all when you know, it's 00:31:49.470 --> 00:31:52.369 still a picture You don't see the actual tissue 00:31:52.369 --> 00:31:55.730 or the actual cells and cancer is for those that's 00:31:55.730 --> 00:32:00.329 in cancer is very fast dividing cells and we 00:32:00.329 --> 00:32:03.569 see them under a microscope on pathology slides 00:32:03.569 --> 00:32:09.140 we can see cells in an MRI no matter how much 00:32:09.140 --> 00:32:11.740 you want to, I don't know, whatever you want 00:32:11.740 --> 00:32:13.420 to do with MRI, just like we can't see through 00:32:13.420 --> 00:32:15.359 the wall, no matter what you want to do with 00:32:15.359 --> 00:32:17.799 the light, or you can't see inside a ball with 00:32:17.799 --> 00:32:20.740 light. Yeah. So like, what are your thoughts 00:32:20.740 --> 00:32:24.579 there? Like, should we be building a technology 00:32:24.579 --> 00:32:29.000 that allows us to see at a cellular level based 00:32:29.000 --> 00:32:32.259 on a non -invasive test? I think that's what 00:32:32.259 --> 00:32:33.980 we should be building, not wasting our time with 00:32:33.980 --> 00:32:37.990 MRIs. Like they have such a big commercial Tailwind 00:32:37.990 --> 00:32:40.089 that it's it's all it's easy enough to say well 00:32:40.089 --> 00:32:41.650 the outer hole better MRIs a lot of people get 00:32:41.650 --> 00:32:43.829 they will make a lot of money kind of thing Yeah, 00:32:44.230 --> 00:32:45.710 no, it's good question. I think we're gonna have 00:32:45.710 --> 00:32:47.690 to wait and see how the technology evolves I 00:32:47.690 --> 00:32:50.089 mean, I think I think in the MRI realm I think 00:32:50.089 --> 00:32:52.910 just what's improved significantly in the last 00:32:52.910 --> 00:32:57.630 few years is there the Obviously the quality 00:32:57.630 --> 00:33:00.430 of the machines continues to improve but I think 00:33:00.430 --> 00:33:02.970 the other piece that's really changed and improved 00:33:02.970 --> 00:33:06.799 is the quality and the configuration around the 00:33:06.799 --> 00:33:10.619 protocols of like how the image is rendered, 00:33:10.619 --> 00:33:14.380 you know, like on the actual screen. And so I 00:33:14.380 --> 00:33:16.519 mean, are we going to reach a point where like 00:33:16.519 --> 00:33:19.160 you can no longer improve what the image looks 00:33:19.160 --> 00:33:20.660 like and you got to look for some sort of new 00:33:20.660 --> 00:33:22.819 technology? Like you just mentioned, could there 00:33:22.819 --> 00:33:24.880 be some other sort of thing that could actually 00:33:24.880 --> 00:33:28.059 get to the level of like a pathology kind of 00:33:28.059 --> 00:33:31.160 evaluation through, yeah, some sort of light 00:33:31.160 --> 00:33:34.759 or image or something, you know, I mean, I think 00:33:34.759 --> 00:33:36.819 there's definitely a possibility that that could 00:33:36.819 --> 00:33:39.240 come about. Not aware of anything in the R &D 00:33:39.240 --> 00:33:41.180 area around that now, but I'm sure people are 00:33:41.180 --> 00:33:44.400 trying to look for those. I just think, you know, 00:33:44.740 --> 00:33:47.380 with what we have today, I think what will be 00:33:47.380 --> 00:33:51.480 interesting to show over time is if doing any 00:33:51.480 --> 00:33:54.819 of this stuff actually changes some sort of outcome. 00:33:55.119 --> 00:33:57.480 You know, I think that's going to be the most 00:33:57.480 --> 00:34:01.119 telling thing. Will there actually be positive 00:34:01.119 --> 00:34:04.529 outcome data from these types of things? And 00:34:04.529 --> 00:34:06.410 I think that's still to be told. And I think, 00:34:06.410 --> 00:34:08.849 you know, the emerging companies that are doing 00:34:08.849 --> 00:34:11.389 this, or that at least started doing this, I 00:34:11.389 --> 00:34:13.170 think that's why they're collecting this data. 00:34:13.389 --> 00:34:15.730 I think they're hoping to be able to show that 00:34:15.730 --> 00:34:18.670 sort of thing. Because yeah, as of right now, 00:34:18.750 --> 00:34:21.349 none of that stuff is, none of this can be covered 00:34:21.349 --> 00:34:25.070 by insurance yet until there's some sort of real 00:34:25.070 --> 00:34:27.170 substantial proof, you know, that it's going 00:34:27.170 --> 00:34:30.150 to change the outcome. I think we'll probably 00:34:30.150 --> 00:34:32.288 get there at some point. I just don't know what... 00:34:32.280 --> 00:34:34.300 timeframe that's going to be. And so for right 00:34:34.300 --> 00:34:36.280 now, I think these types of things are going 00:34:36.280 --> 00:34:39.119 to live in the kind of the cash -based business, 00:34:39.199 --> 00:34:42.059 you know, or companies will offer it as a perk, 00:34:42.059 --> 00:34:45.179 you know, as being a part of the company to get 00:34:45.179 --> 00:34:49.500 these not current evidence -based, you know, 00:34:49.840 --> 00:34:53.000 testing and exams done. I think time will show 00:34:53.000 --> 00:34:56.739 eventually it'll show either yes or no. And that 00:34:56.739 --> 00:34:59.420 could be kind of either the bloom or the doom 00:34:59.420 --> 00:35:02.000 for, you know, these types of things. I love 00:35:02.000 --> 00:35:03.980 the framing of focusing on the outcome. It's 00:35:03.980 --> 00:35:06.480 easy to get lost in the technology and the details, 00:35:06.900 --> 00:35:09.639 but what matters is outcomes. Yeah, so time will 00:35:09.639 --> 00:35:12.840 tell. What do you think went wrong or went right 00:35:12.840 --> 00:35:15.099 with the Brian Johnson experiment where he kind 00:35:15.099 --> 00:35:16.840 of launched this, grew it, and then it seems 00:35:16.840 --> 00:35:19.119 like he said maybe I've had enough or it's not 00:35:19.119 --> 00:35:21.239 working? Do you think that's kind of a case study 00:35:21.239 --> 00:35:23.980 and, you know, just sleep better, exercise more, 00:35:24.179 --> 00:35:26.099 lift weights so you're struggling a bit, doesn't 00:35:26.099 --> 00:35:28.139 matter how many reps you're doing or how much 00:35:28.139 --> 00:35:29.719 weight you're lifting as long as you're pushing 00:35:29.719 --> 00:35:32.329 yourself? that's what you want. And then tracking 00:35:32.329 --> 00:35:35.750 these things isn't the path to optimization, 00:35:36.030 --> 00:35:38.650 pushing yourself, sleeping better, being less, 00:35:38.690 --> 00:35:40.869 because you know when you're less stressed. I 00:35:40.869 --> 00:35:42.969 don't need anything to tell me if I'm not stressed. 00:35:43.110 --> 00:35:44.829 What are your thoughts on the Brian Johnson phenomena 00:35:44.829 --> 00:35:48.610 and then just the tracking all these things in 00:35:48.610 --> 00:35:51.130 general? Yeah, I mean, I think the tracking piece 00:35:51.130 --> 00:35:53.050 is like, you know, it's one of those things that 00:35:53.050 --> 00:35:56.880 I think is helpful for some and it can be very 00:35:56.880 --> 00:36:00.079 kind of anxiety provoking to others. And there's 00:36:00.079 --> 00:36:02.719 like a spectrum in between, you know, I think 00:36:02.719 --> 00:36:05.239 like so recently I've probably for the last six, 00:36:05.500 --> 00:36:08.679 six or seven weeks I've been using, you know, 00:36:08.800 --> 00:36:12.840 one of the, the Stelo CGMs, you know, just to 00:36:12.840 --> 00:36:15.639 track what my sugar does. I don't have diabetes. 00:36:15.719 --> 00:36:18.360 I don't have pre -diabetes, but, you know, I 00:36:18.360 --> 00:36:21.480 think what's been pretty eye -opening to me is 00:36:21.480 --> 00:36:24.139 just it's all the stuff that you kind of know, 00:36:24.320 --> 00:36:26.769 right? Like the more sugar you eat, like the 00:36:26.769 --> 00:36:29.250 higher your, the steeper your spikes will be. 00:36:30.030 --> 00:36:32.789 And then on the flip side, you know that, I mean, 00:36:32.829 --> 00:36:35.150 I guess my background in exercise, I know what 00:36:35.150 --> 00:36:37.590 happens from a, like a biochemistry perspective 00:36:37.590 --> 00:36:40.530 for exercise with blood glucose and, and that 00:36:40.530 --> 00:36:43.250 sort of thing. But to actually see like what 00:36:43.250 --> 00:36:46.139 happens, you know, when you just When you do 00:36:46.139 --> 00:36:48.380 any sort of exercise, whether it's in the morning, 00:36:48.739 --> 00:36:52.019 the afternoon, or in the evening, and when it's 00:36:52.019 --> 00:36:57.039 around food, you can visually see the changes 00:36:57.039 --> 00:37:00.039 that that does. I think for some people, having 00:37:00.039 --> 00:37:03.019 that data is really helpful. I've had plenty 00:37:03.019 --> 00:37:04.840 of people where I think they're just trying to 00:37:04.840 --> 00:37:08.320 get so much data and you become obsessive about 00:37:08.320 --> 00:37:11.019 it. I think if you can use it in the way that 00:37:11.019 --> 00:37:14.460 it will help you to make behavioral changes, 00:37:15.449 --> 00:37:18.429 I'm all for it. But I think that has to be framed 00:37:18.429 --> 00:37:21.190 up. And I think when patients ask me, oh, hey, 00:37:21.550 --> 00:37:23.789 should I get this sleep tracker and do this and 00:37:23.789 --> 00:37:25.650 that? I usually have a conversation with them 00:37:25.650 --> 00:37:27.329 a little like, what are you hoping to get out 00:37:27.329 --> 00:37:31.090 of it? And how do you plan to use the information 00:37:31.090 --> 00:37:35.469 to help yourself? And as long as they have a 00:37:35.469 --> 00:37:37.849 good thought process around what they're going 00:37:37.849 --> 00:37:41.900 to do, I'm usually supportive of it. If I can 00:37:41.900 --> 00:37:43.900 tell they're like a super anxious type and that 00:37:43.900 --> 00:37:45.440 they're just, this is probably just going to 00:37:45.440 --> 00:37:48.039 make them super, super nervous all the time. 00:37:48.659 --> 00:37:50.079 You know, I'll probably be trying, I'll try and 00:37:50.079 --> 00:37:53.280 steer them away from it if possible. But so yeah, 00:37:53.280 --> 00:37:55.260 I think it's like kind of like, I think it has 00:37:55.260 --> 00:37:57.840 to be adaptable to the type of person that they 00:37:57.840 --> 00:38:00.420 are, you know, if or when this is going to be 00:38:00.420 --> 00:38:03.780 helpful or not. Earlier, you said that you are 00:38:03.780 --> 00:38:08.000 excited about technology in healthcare and optimizing 00:38:08.000 --> 00:38:10.739 systems. If you could magically optimize our 00:38:10.639 --> 00:38:13.559 In one system and healthcare, what would it be? 00:38:14.239 --> 00:38:15.380 So, I mean, the thing that's been on my mind 00:38:15.380 --> 00:38:18.340 for a very long time is, you know, there's a 00:38:18.340 --> 00:38:19.820 lot of, I think if you ask that question to a 00:38:19.820 --> 00:38:22.280 lot of people, they'll say like Pyrros or the 00:38:22.280 --> 00:38:23.780 in basket or whatever. I mean, because I think 00:38:23.780 --> 00:38:25.739 a clinician that's like what we're so, and I 00:38:25.739 --> 00:38:27.760 agree technology can fix all of those things 00:38:27.760 --> 00:38:30.480 pretty well, but I would zoom out even further. 00:38:31.000 --> 00:38:34.460 And what I really want is like, I want patients 00:38:34.460 --> 00:38:39.239 to have the ability to really kind of. um, accurately 00:38:39.239 --> 00:38:43.239 kind of noodle on their concerns and really allow 00:38:43.239 --> 00:38:48.780 them to like frame it up. So the time spent face 00:38:48.780 --> 00:38:51.280 to face or whatever it is with, with the actual 00:38:51.280 --> 00:38:54.619 kind of physician or clinician is like extremely 00:38:54.619 --> 00:38:57.659 efficient. And so I guess the way I would like 00:38:57.659 --> 00:39:01.179 break it down is I think we need still need better 00:39:01.179 --> 00:39:04.719 ways kind of pre -encounter how for patients 00:39:04.719 --> 00:39:07.449 to really formulate. what their concern is and 00:39:07.449 --> 00:39:10.349 what's going on. Like we have pretty good stuff 00:39:10.349 --> 00:39:12.670 right now to be able to help within the encounter 00:39:12.670 --> 00:39:16.170 and like synthesizing and capturing. We need 00:39:16.170 --> 00:39:18.250 even better tools downstream, you know, like 00:39:18.250 --> 00:39:21.610 the post and across like between visits. I think 00:39:21.610 --> 00:39:24.449 right now, like patients have real, real concerns 00:39:24.449 --> 00:39:27.530 about themselves or their health. And what we've 00:39:27.530 --> 00:39:29.750 done is we've made it so they only get to spend 00:39:29.750 --> 00:39:33.489 10 minutes with the actual like expert for this 00:39:33.489 --> 00:39:35.789 like one for this problem. And I just think that 00:39:35.789 --> 00:39:38.250 is like, it's not right. I mean, it's like, they 00:39:38.250 --> 00:39:39.989 don't remember anything that's said during those 00:39:39.989 --> 00:39:42.829 10 minutes. It's like, I don't know that that 00:39:42.829 --> 00:39:44.530 was a kind of a long winded way to your question, 00:39:44.550 --> 00:39:47.909 but I really do think we just need to, we need 00:39:47.909 --> 00:39:52.130 to optimize that the whole process of From concern 00:39:52.130 --> 00:39:54.929 to the patient feeling like they're getting some 00:39:54.929 --> 00:39:58.349 sort of resolution or next steps. I think that 00:39:58.349 --> 00:40:01.409 is still fundamentally like the same as it was 00:40:01.409 --> 00:40:04.409 when I was a child. It hasn't changed. So I want 00:40:04.409 --> 00:40:07.269 technology to be able to fix that stuff. As clinicians, 00:40:07.670 --> 00:40:10.349 we often kind of forget the patient perspective 00:40:10.349 --> 00:40:14.769 of things. We're so entangled in our inbox and 00:40:14.769 --> 00:40:17.769 prior, as you said, that it's difficult to kind 00:40:17.769 --> 00:40:20.250 of see their experience. And we just want to 00:40:20.250 --> 00:40:22.690 kind of get to the bottom of the medical query 00:40:22.690 --> 00:40:25.389 and solve it. Yeah. Yeah. So I can definitely 00:40:25.389 --> 00:40:29.730 see, I'm not sure the business model or the business 00:40:29.730 --> 00:40:31.989 case there, but I think there's this fairly a 00:40:31.989 --> 00:40:34.670 need there. Last question, Adam, if you could 00:40:34.670 --> 00:40:36.969 go back 10 years in time and talk to yourself, 00:40:37.170 --> 00:40:39.329 what would you tell him? Well, I think like just 00:40:39.329 --> 00:40:41.650 what I went through last year, you know, I finally 00:40:41.650 --> 00:40:44.269 made this kind of proverbial leap to something 00:40:44.269 --> 00:40:46.679 that I wanted to do for a long time. If I could 00:40:46.679 --> 00:40:48.440 go back 10 years, I would have probably told 00:40:48.440 --> 00:40:51.940 that person to follow that, you know, desire 00:40:51.940 --> 00:40:54.719 and instinct. I had a lot of people telling me 00:40:54.719 --> 00:40:56.400 over the years, like, you know, you should start 00:40:56.400 --> 00:40:58.400 working in the startup space or you should, I 00:40:58.400 --> 00:41:01.019 can see you doing X, Y, and Z. And I just kept 00:41:01.019 --> 00:41:03.519 going, yeah, I do too. But I never took the leap. 00:41:03.599 --> 00:41:07.699 So I would honestly just go back and tell myself 00:41:07.699 --> 00:41:11.039 to take the leap earlier. Well, congratulations 00:41:11.039 --> 00:41:14.980 on taking the leap. And I'm happy to meet a fellow 00:41:14.980 --> 00:41:16.980 physician entrepreneur and a physician in the 00:41:16.980 --> 00:41:19.579 start. No, you bet. Thank you. I appreciate it. 00:41:19.579 --> 00:41:20.639 Great conversation.