Elon Musk Drug Use Concerns Business Leaders | Pivot

Kara Swisher 0:00 ... our first big story, and we've gotta get to it, uh, is a, uh, a Wall Street Journal piece. It's a new piece that came out last night. Um, Elon Musk has used illegal drugs, worrying leaders at Tesla and SpaceX. The article cites people close to Musk who say his drug use is ongoing and includes board members, it feels like, and, uh, and one, uh, one name specifically, but it looks like they were all talking. Particularly the ketamine, and there are concerns it could cause a health crisis or damage the business. Uh, Musk has a lot of business, um, with, uh, with the government and he's already... I don't know if he was sanctioned, but he had to do drug tests after he smoked weed on Joe Rogan. This is seemingly more serious and it's interesting that, um, you know, this has been around. We've talked about it, uh, Ronan Farrow wrote about it. Like, lots of people have cited this issue, not so much in Walter Isaacson's book, uh, which it should've, uh, had more about it. Um, but i- it's, uh, it's sort of an open secret a- about this and, y- the Wall Street Journal obviously has lawyered up to, to be able to say this. Um, in a minute we're gonna bring on, uh, my brother, Jeff Swisher, to help us talk through this one. Uh, just first reactions, Scott? And then I'll bring on Jeff.

Scott Galloway 1:08 First reactions. Uh, look, uh, we talk a lot about substances. Uh, the majority of people, I believe, who use substances, manage them. And I'm not an anti-substance person, but, um, along those same lines, there's just no free lunch. And when I saw, um, when I saw Elon Musk in that interview at the Times Deal Book, I'm like, "He, he's fucked up."

Kara Swisher 1:32 Yeah.

Scott Galloway 1:32 And, and there, th- th- it all comes back to one saying. What I tell young people around their use of substances is, "There's just no free lunch." There-

Kara Swisher 1:41 Yeah.

Scott Galloway 1:42 And what I have... and I'll s- stop here, but the thing that really struck me was when I was in Aspen this summer. Um, I was alone and I was bored and a friend said, "I have a bunch of friends there," and we all went to dinner. Like, 12 of us, bunch of-

Kara Swisher 1:54 Hm.

Scott Galloway 1:54 ... total players in technology and private equity. And we went to this lounge and I said, "What can I get everyone? I'm headed to the bar." And they said, and w- this guy goes, they all kind of nodded or laughed and said, "We're all on ketamine."

Kara Swisher 2:07 Yeah.

Scott Galloway 2:07 And I thought-

Kara Swisher 2:08 Yeah.

Scott Galloway 2:08 ... "Oh my God. Everybody?" This is like six men-

Kara Swisher 2:10 Right.

Scott Galloway 2:10 ... six women, and the tech, the tech community likes to believe-

Kara Swisher 2:14 Yeah.

Scott Galloway 2:14 ... they have found a free lunch.

Kara Swisher 2:17 Mm-hmm.

Scott Galloway 2:17 And, uh, uh, uh, and we said this before.

Kara Swisher 2:19 So no repercussions like with-

Scott Galloway 2:20 No such thing.

Kara Swisher 2:21 ... cocaine or...

Scott Galloway 2:21 There's no such thing.

Kara Swisher 2:23 Yeah.

Scott Galloway 2:23 I haven't found it yet.

Kara Swisher 2:23 Yeah.

Scott Galloway 2:23 Maybe caffeine. Caffeine's supposedly the f- the f- closest thing to a free lunch, but I haven't found it, I'm sure.

Kara Swisher 2:28 Yeah.

Scott Galloway 2:28 I'm curious what Dr. Swisher thinks.

Kara Swisher 2:30 Yeah. We'll bring him on. It was interesting because, uh, you know, this was the holiday season this came out, um, where he has some time off. Um, I had heard rumors. There was rumors running around Silicon Valley that they m- had him in Hawaii last year, same thing. Um, and obviously he's talked about it, let's be clear. He's talked about his use of ketamine, he's talked about his mental health issues, um, obviously smoked weed on Joe Rogan. And nothing wrong with that, excepting his government contracts, which is, is a big problem. And I think away from his own health, which makes you worry, um, 'cause there's been history of a lot of tech people like this getting into real trouble, like Tony Hsieh. Um, and, uh, you know, I think it's been an ongoing discussion among and between people in Silicon Valley. And this one example in the piece was him being incomprehensible during, uh, a SpaceX meeting, um, and I think you're right. That interview, I, I looked at it and I thought, "What? He's on something." I mean, I, I don't have any reported knowledge of it, but it really was such a bizarre, um, interview. It seemed either mental health or something else was happening. Anyway, we're not experts, so we're bringing on my brother, Dr. Jeffrey Swisher, to help us talk through this one.

Dr. Jeffrey Swisher 3:43 Hey, Kara. How you doing?

Kara Swisher 3:44 Good.

Scott Galloway 3:44 In the house.

Dr. Jeffrey Swisher 3:45 Yeah, what the...

Scott Galloway 3:45 By the way, whose idea-

Dr. Jeffrey Swisher 3:46 How are you?

Kara Swisher 3:46 Jay Swish-

Scott Galloway 3:47 Whose idea was it to-

Kara Swisher 3:47 Jay Swish.

Scott Galloway 3:47 ... bring on the good doctor? Whose idea was it?

Dr. Jeffrey Swisher 3:49 (laughs)

Kara Swisher 3:49 You. You.

Scott Galloway 3:50 That's right.

Kara Swisher 3:50 It was not my idea. It was your idea.

Scott Galloway 3:52 Mine.

Kara Swisher 3:52 But it's a good idea.

Dr. Jeffrey Swisher 3:52 Well, thank you, Scott, and it's good to see you when it's not scot-free August. And, uh-

Kara Swisher 3:56 Yeah.

Dr. Jeffrey Swisher 3:56 ... it's fantastic. You look great.

Scott Galloway 3:58 Thanks, man.

Dr. Jeffrey Swisher 3:58 Um, I do... Kara, I do have, unfortunately, one Scott joke for you.

Kara Swisher 4:02 (laughs) Oh God.

Dr. Jeffrey Swisher 4:02 So Scott, a Scotsman goes to the doctor's office, right?

Scott Galloway 4:05 Okay.

Dr. Jeffrey Swisher 4:06 And he goes into the doctor and he lifts up his, uh, kilt and he says, "Doctor, I don't know. I think I'm going crazy." And the doctor says, "I don't know about crazy, but I can sure see you're nuts."

Kara Swisher 4:16 (laughs)

Scott Galloway 4:18 (laughs)

Dr. Jeffrey Swisher 4:18 (laughs)

Kara Swisher 4:18 Oh my God.

Scott Galloway 4:18 O is like, O is like Swisher.

Dr. Jeffrey Swisher 4:20 Yeah.

Kara Swisher 4:20 Oh. Oh my God.

Dr. Jeffrey Swisher 4:20 O is like DC. Yeah, Scott, as Scotsmen goes... (laughs)

Kara Swisher 4:22 All right. Are you on ketamine, Jeff?

Dr. Jeffrey Swisher 4:24 (laughs) No, ma'am.

Kara Swisher 4:24 'Cause that's what it sounds like.

Scott Galloway 4:25 I am not.

Dr. Jeffrey Swisher 4:26 No.

Kara Swisher 4:26 No, you're not a ketamine user. Explain.

Dr. Jeffrey Swisher 4:28 No.

Kara Swisher 4:28 Uh, you use ketamine-

Dr. Jeffrey Swisher 4:29 I do use ketamine.

Kara Swisher 4:30 ... in your job.

Dr. Jeffrey Swisher 4:30 Uh, let me talk to you-

Kara Swisher 4:31 A lot.

Dr. Jeffrey Swisher 4:31 ... a little bit about ketamine. So-

Kara Swisher 4:32 Okay.

Dr. Jeffrey Swisher 4:33 ... ketamine is what's known as a dissociative anesthetic and that's really important to understand, you know, what it does. It, it dissociates you from, essentially, reality. Um, it was first, uh, synthesized in 1962, the year you were born, Kara.

Kara Swisher 4:47 Hm.

Dr. Jeffrey Swisher 4:47 And, um, it, um, was FDA approved in, around 1970 for use in anesthesia.

Scott Galloway 4:55 Hm.

Dr. Jeffrey Swisher 4:55 Um, and I use it, uh, really pretty much on a daily basis. It's a very, very useful anesthetic and, in fact, the World Health Organization lists it as one of the, you know, invaluable drugs, uh, in the world. It's really good because it has a lot of, um, beneficial effects from an anesthetic standpoint. It's not a respiratory depressant, uh, in usual doses. It's not a cardiac depressant. Um, in fact, it slightly increases blood pressure and heart rate. And it doesn't, uh, blunt airway reflexes. So it can be used, uh, in a pre-hospital setting, let's say in the emergency room, to sedate children. Uh, I use it as an adjunct anesthetic. Uh, I use it to, because it helps, uh, decrease the amount of opiates I use in the operating room. Uh, I use it for procedural sedation if I'm going to be doing something painful, uh, let's say a, a regional anesthetic block of the upper extremity. I will give somebody, you know, 30 or 40 milligrams of ketamine and it allows them to actually participate, but essentially not be there, um, uh, in the sense that they don't-

Kara Swisher 5:55 So they, they feel calmer, right? It, what's-

Dr. Jeffrey Swisher 5:57 Yeah.

Kara Swisher 5:57 ... what's the effect?

Dr. Jeffrey Swisher 5:57 Actually, they do, they do. Um, you know, depending on the person, they do sort of, you know, leave their, their body in a sense. In fact, some people describe a ketamine experience as similar to a near death experience where they can actually-... see themselves-

Scott Galloway 6:11 Mm-hmm.

Dr. Jeffrey Swisher 6:11 ... let's say, floating above their body.

Scott Galloway 6:14 Yeah.

Dr. Jeffrey Swisher 6:15 Um, uh, I, the best description of ketamine from a patient that I ever had was, uh, he told me afterwards, he says, "Imagine that you're driving a car toward a beautiful sunset and the Grateful Dead is playing on the radio and it's a fantastic, wonderful day, uh, with the breeze blowing through the window. Now, for a second, imagine that you're not driving the car but you are the car and you're driving. And all of a sudden, you're not driving the car, you're a passenger in the car." And, uh, and that's really, a really great description of ketamine. People describe a feeling of melting, uh, you know, you've heard the expression K-hole.

Scott Galloway 6:45 Mm-hmm. Mm-hmm.

Dr. Jeffrey Swisher 6:46 Um, kete- people sort of fall into this kind of warm molasses pit when they're on it, and, and it's a very pleasant experience for most people. Not everybody. Some people do get, you know, uh, you know, frightening dreams, et cetera on it, but for the most part, it's a great anesthetic and it's very short acting.

Kara Swisher 7:02 Have you had that happen with surgery, where they get dreams or anything?

Dr. Jeffrey Swisher 7:04 Oh, yeah. All the time.

Kara Swisher 7:05 Yeah.

Dr. Jeffrey Swisher 7:05 I mean, people describe, you know, uh, uh, one of the most common uses for it is, um, when I'm doing, let's say, a, a little old lady, um, with a hip fracture, and it's very painful to put someone on their side, uh, to do a spinal anesthetic. So I'll give them 10 or 20 milligrams of ketamine and they love it. I mean, they wake up afterwards and they say, "That's the best experience I've ever had."

Kara Swisher 7:27 Mm-hmm.

Dr. Jeffrey Swisher 7:27 Uh, so it's a very euphoric drug and I can understand why people would use it for recreational purposes. Uh, not that it's safe to do so, uh, because, you know-

Scott Galloway 7:36 But, but, but Jeff-

Dr. Jeffrey Swisher 7:37 ... of course

Scott Galloway 7:37 ... talk about- ... supervise. ... talk about it in a recreational context, out- outside of the medical-

Dr. Jeffrey Swisher 7:41 Mm-hmm.

Scott Galloway 7:41 ... context and that is-

Dr. Jeffrey Swisher 7:42 Sure.

Scott Galloway 7:42 ... my understanding is in contrast with alcohol or opiates, it's not physically addictive, but it can be psychologically addictive.

Dr. Jeffrey Swisher 7:50 Yep, that's exactly right.

Scott Galloway 7:50 And what we were saying before is that tech bros or the tech community or just successful people in general like to believe they found a better blueberry or a better solar panel. Like, their tech, their, uh, diet is better. And I have found the same thing is true here, that people feel that ketamine is a safer high. Talk about it in the context of addiction and, you know, recreational use.

Dr. Jeffrey Swisher 8:18 Sure. So, you know, ketamine, A, it's widely available. It's very inexpensive to make and therefore y- you can get it fairly easily, uh, on the street. Um, it is a, you know, relatively safe drug in, in the sense that, you know, as opposed to methamphetamine, which can be really dangerous if you have, you know, you know, cardiac issues, et cetera, or cocaine. Um, the, the problem is that like any recreational drug, uh, people tend to binge it. Uh, they like the feeling of it and then they need to start upping their doses, um, of ketamine. And, I mean, you know, the really unfortunate situation that happened recently is Matthew Perry, um, and Matthew Perry was legitimately getting therapy with ketamine for depression and we can talk about that if you want at some point. But, but the, uh, the problem is he, he also was using it recreationally and, and he also had other se- substances in his body on the coroner's report.

Kara Swisher 9:13 Yeah. So the piece quotes, uh, an attorney, uh, for Musk saying that he is quote, "Regularly and randomly drug tested at SpaceX and has never failed a test." But we don't know... Can you talk about... And the attorney said there were other false facts in the Wall Street Journal column but didn't have any details. So, um, this is Alex Spiro who, who's sort of Musk's lawyer front man. But, um, w- what do you... H- how do you think about drug testing on this, o- on this kind of thing?

Dr. Jeffrey Swisher 9:40 Well, you can... There are c- uh, ways of testing for ketamine. The, the metabolite... It's metabolized by the liver and there are several metabolites of ketamine which are detectable. Uh, it's cleared, uh, by the liver but it's excreted in urine and feces. So you can certainly test for it. Uh, the problem is it's a fairly short-acting medication and, um, uh, it depends when you use it and what the levels are. Clearly with Matthew Perry for instance they had it immediately because, you know, he wasn't metabolizing anymore after he died. But, uh, but, uh, for people who are using it, you have to catch it fairly soon after they use it to detect it, uh, which is one of the reasons, Scott, uh, you mentioned that I think a lot of these, uh, tech bros and stuff were using it. Um, but, you know, great caution because dosing is very important. The other thing about ketamine I wanna mention is that it can be given via a r- a variety of routes. Uh, so you can inject it intravenously, you can subcutaneously inject it, you can intramuscularly inject it. You can snort it, you can swallow it, you can put it up your behind if you want. Uh, there's a lot of ways of taking ketamine and so it's very, um, bioavailable, let's put it that way. You know?

Kara Swisher 10:46 Bioavailable?

Dr. Jeffrey Swisher 10:46 Intravenously... Yeah, bioavailable. 100% intravenously.

Kara Swisher 10:50 Yeah.

Dr. Jeffrey Swisher 10:50 Down to about 50% if you take it orally or, or-

Kara Swisher 10:53 Right.

Dr. Jeffrey Swisher 10:53 ... snort it, it's about 50% to 70%.

Kara Swisher 10:55 How do most people... When you, you give it, you do it intravenously 'cause you're in an operating-

Dr. Jeffrey Swisher 10:59 I do it both.

Kara Swisher 10:59 How do most people recreationally use it?

Dr. Jeffrey Swisher 11:01 B- when I give it, I give it-

Kara Swisher 11:01 Or, or therapy?

Dr. Jeffrey Swisher 11:02 ... intravenously and intramuscularly.

Kara Swisher 11:04 Okay.

Dr. Jeffrey Swisher 11:04 Uh, it's a very useful drug. Let's say if you have a person with, uh, um, you know, severe mental disorder who is combative, uh, prior to anesthesia-

Kara Swisher 11:12 Mm-hmm.

Dr. Jeffrey Swisher 11:12 ... and I wanna start an IV, uh, I can give people intramuscular ketamine in that situation. Uh, and it takes a little bit, but then they'll sort of fall asleep. But usually I give it intravenously, but I think most people who are using it recreationally are probably snorting it.

Kara Swisher 11:26 Snorting it, okay.

Dr. Jeffrey Swisher 11:27 Um, yeah.

Kara Swisher 11:28 So, um, let's talk about... Uh, w- the Matthew Perry you were referencing, he... The, the coroner said he died from the acute effects of ketamine. Um, uh, he was on ketamine infusion therapy as you noted. Um, talk a little bit about these therapies because, you know, I- I'm about to interview Jill Green tomorrow. There's a lot of people trying very hard to replace opiates and other things with ketamine and other psychedelics. Um, i- is it... uh, is that problematic or is just the abuse problematic?

Dr. Jeffrey Swisher 11:57 Um, I, I think it's the abuse that's a problematic. I mean, ketamine, um-... for, for depression is an off-label use. I mean, and not that off-label uses are wrong. In fact, we, we, every day doctors use medications in an off-label manner. It just means it's not FDA approved for that indication. Um, they actually did make, uh, what's called an en- an enantiomer of ketamine, uh, called esketamine, which is a nasal spray, which was, uh, approved by the FDA, I think, in 2019. Uh, it's, it's called Spravato and that's, that, that was the indication for that is depression. And it's an, and as I said, it's a mirror isomer of ketamine. It's the same drug, but the mirror isomer of it. Um, but ketamine clinics have popped up like kudzu, you know, all over the place and, uh, it's very, very expensive. I mean, thousands of dollars for, uh, a couple sessions of injecting. Now keep in mind that the injection of ketamine in these clinics is a very small dose. It's typically a half a milligram per kilogram, so usually 30 to 40 milligrams infused over about a 40-minute period. That's not a lot. That's not a lot to get you super high. Um, a little dissociative, but not super high. When you're using it recreationally, you know, who knows how much people are using. They, you know, you can't really regulate your dosage.

Kara Swisher 13:13 Right.

Dr. Jeffrey Swisher 13:13 Um...

Kara Swisher 13:14 Now, now one thing Elon tweeted about ketamine last June, "Depression is overdiagnosed in the US, um, but for some people, it is really brain chemistry issue." He went on to say, "Zombifying people with SSRI for sure happens way too much from what I've seen with friends. Ketamine, yeah, my best, some of my best friends use ketamine. Ketamine taken occasionally is a better option." Um, how do you, when you hear him say that, I mean, a lot of people have problems with SSRS.

Dr. Jeffrey Swisher 13:40 SSRIs, yeah.

Kara Swisher 13:41 SSRIs, sorry.

Dr. Jeffrey Swisher 13:42 Uh, seroto- yeah, selective serotonin reuptake inhibitors, um, is what that stands for. So ketamine is in the class of drugs that are called NMDA antagonists and there's a lot of, uh, of, um, very useful, uh, work that's being done understanding NMDA antagonists in general for depression. And the research on it is it's a, I wouldn't say it's definitive, but it's definitely statistically significant that ketamine definitely improves symptoms of both unipolar and bipolar depression, um, in the short term.

Kara Swisher 14:15 Mm-hmm.

Dr. Jeffrey Swisher 14:15 The question is, is it a lasting effect? Uh, that's hard to know and I think that's ongoing research. And, uh, personally, I think, you know, uh, Mr. Musk is correct in that sense. I mean, SSRIs are very different, uh, and, um, um, than ketamine. Still though, ketamine is not a firstline therapy for depression. It's probably like a third line therapy.

Kara Swisher 14:34 Right.

Dr. Jeffrey Swisher 14:34 But a lot of people-

Kara Swisher 14:35 And they're trying to get it to be one for people with post-traumatic stress, et cetera.

Dr. Jeffrey Swisher 14:39 Sure, yeah. PTSD is a good indication for it, um, and, you know, I personally know people who've had ketamine therapy who swear by it, who say that it's really improved them.

Kara Swisher 14:49 Mm-hmm.

Dr. Jeffrey Swisher 14:49 Um, and, uh, so I do think that, you know, shutting down any kind of research on this, that's why I don't really like that Matthew Perry article or even this Wall Street Journal article, 'cause it demonizes, uh, a very useful drug, uh, and ketamine is a very useful drug. Uh, I mean, similar, what happened with Michael Jackson and propofol. I mean, ev-, uh, every day people tell me, "You're not gonna give me that propofol drug." It's like, yeah, basically it's the most common anesthetic in the world. Yes, I'm gonna give it to you.

Scott Galloway 15:13 And by the way, it's amazing.

Dr. Jeffrey Swisher 15:13 But, you know, when-

Kara Swisher 15:15 (laughs)

Dr. Jeffrey Swisher 15:16 Oh, it's amazing. (laughs)

Scott Galloway 15:17 It is, it's amazing.

Dr. Jeffrey Swisher 15:17 Yeah, it is.

Scott Galloway 15:17 Whenever I've had a colonoscopy, I take that thing-

Dr. Jeffrey Swisher 15:20 Yeah.

Scott Galloway 15:20 ... and 30 minutes later, I'm, I'm, I- I mean-

Kara Swisher 15:23 Yeah.

Scott Galloway 15:23 ... it's amazing.

Kara Swisher 15:25 Yeah.

Dr. Jeffrey Swisher 15:25 Yeah. No, it's, it's, it's literally probably the greatest invention in anesthesia I- in its history. Um, but, but ketamine is-

Kara Swisher 15:31 But not for daily nightly use.

Scott Galloway 15:33 Yeah.

Dr. Jeffrey Swisher 15:33 No. So that's the problem is that you, you know, using propofol in your living room by someone who did not admit, you know. So they, they, it's not the drug that's the problem, it's the person giving it-

Scott Galloway 15:42 Mm-hmm.

Dr. Jeffrey Swisher 15:42 ... or the person taking it.

Scott Galloway 15:43 My sense is, more generally as it relates to drugs in our society, and I don't know if it's the far right or an attempt to use drugs as a tool to keep people of color down through incarceration and drug bill, whatever it might be, but we have a tendency to go very black and white. Uh, marijuana helps people sleep, helps people with anxiety, helps kids with glaucoma, but we just decided, oh, it was all bad. And it, it strikes me that no one wants to have a nuanced conversation around what is an appropriate use of a drug. And the fact that something like 85% of people who use alcohol and drugs are functioning. (laughs) And it's not impacting them in a terribly negative way. Having said that, alcohol is a menace and terrible for tens of millions of homes in America, but nobody wants to have really what I would describe as a thoughtful conversation. They want to assign something is only used in a medical context, but when it's used outside of a medical context, it's immediately, it must be all negative and all bad. And we demonize it, criminalize it, and in my view, just make, make things, you know, much, much worse. Anyways, it wasn't a question, it was a TED Talk.

Kara Swisher 16:50 Yeah, um-

Dr. Jeffrey Swisher 16:50 No, I mean, it's, it's, you're right, the most commonly abused drug, uh, by far and away is alcohol.

Scott Galloway 16:55 Alcohol, yeah.

Dr. Jeffrey Swisher 16:55 And, you know, more people drown because they, uh, are, you know, drunk and, you know, doing stupid things in boats than, than have ever been, you know, drowned by ketamine.

Kara Swisher 17:04 Yeah.

Dr. Jeffrey Swisher 17:04 I mean, it was not even close.

Kara Swisher 17:06 Right, right. But this creates a situation where they're trying to bring ketamine and other psychedelics into really good medical uses and then it gets, you know, either glamorized and demonized, both glamorized and demonized by people like, uh, Musk and others. Um, which is, you know, before, it's the cart before the horse 'cause I think they will be using these, um, it's an intriguing drug. Correct? Um, Scott-

Dr. Jeffrey Swisher 17:28 Yes.

Kara Swisher 17:29 ... what's, what's the responsibility of a board member in this situation? It looks like several board members talked or someone's worried, this is why I can't imagine the Journal would move forward this, uh, you know, Rupert Murdoch and the Murdoch family would move without some level of assurance that they... And I have to tell you, discovery would be fascinating because I don't think, you know, the stories of Elon's wild party life are really quite out there all the time and they just are, they just are.

Scott Galloway 17:56 It, the governance question here is complicated because supposedly, there was a director who resigned over concerns-

Kara Swisher 18:02 Yes.

Scott Galloway 18:02 ... of, of Musk-

Kara Swisher 18:03 Mm-hmm.... because they weren't doing anything about it.

Scott Galloway 18:05 But I would argue he doesn't... And this goes to a broader issue here.

Kara Swisher 18:08 She.

Scott Galloway 18:08 I, I would argue that he doesn't have any governance, that it's-

Kara Swisher 18:11 Mm-hmm.

Scott Galloway 18:11 ... family members and people who have made so much money because of his genius and his bold innovations, that effectively, they have no power. They're there to have dinner once every three months and collect a big check, because his behavior would not be tolerated across anything resembling what you would call a real board of governors who are supposed to represent fiduciaries. They just, they just wouldn't allow it. So, he doesn't have, uh, the- the- the duties, the- the- the duty and care that is levied on fiduciaries in the form of boards of directors does not and has not applied to Elon Musk for a long, long time. The fact that he's still on Twitter, that would never be allowed-

Kara Swisher 18:49 Mm-hmm.

Scott Galloway 18:49 ... of a CEO who had done what he has done. A CEO, uh, uh, incorrectly accuses former employees of being pedophiles-

Kara Swisher 18:56 Mm-hmm.

Scott Galloway 18:56 ... would never be allowed to be a CEO. He plays by a different set of standards, and whether you think he should be allowed to or not, but it goes to a much broader issue. And I think the key issue here, and what I would describe as the learning or the takeaway for young people, and that is the most important thing you can have in your life is people who love you and serve as guardrails. And to have people idolize you is different than having people who love you, and I think the guy has a lot of the former and not a lot of the latter. And as someone who's participated in interventions, they don't invite powerful, important people to those interventions. They invite people who love you, and th- uh, this is turning into a cautionary tale along the lines of Tony Hsieh, because you have a guy who, as far as I can tell, is living alone, doesn't have a close relationship with a romantic partner or his children, and is, quite frankly, just fucking off the rails. And if- if at the age of 52, you don't have people in your life who can sit you down and you listen to, 'cause you know that it's not that they got rich because of you. It's not because they think you're just so fucking awesome and can land rockets on two surfboards. It's because they just full-stop care about you. If you don't have that, especially men, you- you literally can lose it all.

Kara Swisher 20:16 What happens with extended use of ketamine? If you use it a lot and there's no guardrails, as Scott says there should be, and I agree, um, what happens over time to your mental state? Or do we not know this? I guess we probably do, right?

Dr. Jeffrey Swisher 20:32 Well, yeah, I mean, there's some research on l- chronic long-term use of ketamine, uh, effects on the liver and on the kidney. I mean, there are, there are, you know, physiologic effects of it-

Kara Swisher 20:40 Mm-hmm.

Dr. Jeffrey Swisher 20:40 ... which, you know, large, large-scale use of it can be toxic to your liver and kidney. More importantly, I think, though, is that-

Kara Swisher 20:47 Then what happens then? And-

Dr. Jeffrey Swisher 20:48 Well, you could get... I mean, anything can damage your liver. I mean-

Kara Swisher 20:51 Mm-hmm.

Dr. Jeffrey Swisher 20:51 ... there's- there's so many, like... Well, alcohol, number one, is the biggest. (laughs)

Kara Swisher 20:54 Yeah, yeah.

Dr. Jeffrey Swisher 20:55 But, uh, so the- the big problem, I think, with ketamine is, uh, the psychological, as Scott mentioned before, the sk- the psychological dependence on it. And it is a dissociative anesthetic, so you're not gonna behave normally if you're doing high doses of ketamine. It just will make you not functional as a, you know, human being. Uh, you'll be, you know, high and-

Kara Swisher 21:17 And then Scott, uh, Elon also has a lot of government contracts, which was mentioned in the journal article. As CEO and founder of SpaceX, and he's also the key man there, Musk has a security clearance that gives him access to classified information. I think the journal was trying to pin a, like, here's why we're writing this thing. Um, and obviously the government has already, uh, objected when he was doing the weed on Rogan. This is a quantum level of problem, I would think.

Scott Galloway 21:42 Yeah, but again, he's- he's an exceptional person that people and organizations make exceptions for. So for example, he can put a breakthrough heavy rocket, he can launch it, and it can blow up, and he just puts another one up in a few weeks. NASA could never do that. NASA could never send projectiles into space that blow up. He is willing to take risks and has access to capital such that he can put together communications, um, low orbit communications networks that the government, at least in this current infrastructure or current regulatory environment, isn't able to do. So, he plays a really valuable role, and I- I don't wanna be an apologist for the guy. But to think that he's going to be subject to anything resembling the same standards as other contractors, you might find it unfair, and it is. He- there- there are... (laughs) There are so many things he would have lost all security clearances for, that the government has made exceptions around. He just plays by a different set of rules and- and it- I don't- I- I'm not saying that's right or wrong, but you could never see the head of the Forestry Service or the CIA going on podcasts smoking a joint.

Kara Swisher 22:47 Yeah.

Scott Galloway 22:47 That person wouldn't be allowed-

Kara Swisher 22:48 Or having opinions.

Scott Galloway 22:48 ... in the government- a government building again.

Kara Swisher 22:51 I think it's... I think it'll be interesting to see how he reacts. So last question for each of you. Scott, how do you think a Musk is gonna react? I haven't seen anything yet.

Scott Galloway 22:59 I have no ability to predict his actions, Kara. I just don't- I don't understand-

Kara Swisher 23:04 He'll probably sue them.

Scott Galloway 23:04 ... um...

Kara Swisher 23:05 He'll threaten to sue them.

Scott Galloway 23:06 Yeah, but I- I don't-

Kara Swisher 23:07 That's his go-to.

Scott Galloway 23:08 ... I- a- and I think all his fans will come to his- come to his-

Kara Swisher 23:11 Oh, they have.

Scott Galloway 23:11 ... defense and say that he's being persecuted and it's bad reporting, but I don't... I, you know... A- actually, uh, when I read that, I felt bad 'cause I- I- I have had some people in my life who have an addiction, and I find they slowly but surely, when you know you've lost them, is when they choose... I remember one of the interventions I was in, uh, one of the most rattling moments I've ever had. Everyone went around, kid was addicted, um, to heroin. Everyone around said their piece, said, "Love you all. Your heart's in the right place. I know this is gonna kill me. I choose heroin." I mean, uh, no one knew what to say. So, uh, if he in fact is... I think he plays an important role. I don't like the man. I think he abuses his power. But as it relates to the government innovation, he does play an important role, and you just gotta hope a guy with 11 or 12 kids like that...... gets help, and you also hope that, uh, uh, the- the right way to react is if, in fact, he is struggling, that he's open about his struggles and people can learn from it. 'Cause I do think a lot of people are fighting these demons in quiet, and- and a guy like that-

Kara Swisher 24:20 Mm-hmm.

Scott Galloway 24:21 ... who is literally the idol of- of billions of people, you know, optimistically, you'd like to think he could play a key role in education about it. How he's-

Kara Swisher 24:29 Yeah.

Scott Galloway 24:29 ... what he's gonna- actually gonna do, I have no idea. You know him better than I do, Kara.

Kara Swisher 24:32 Uh, I-

Scott Galloway 24:33 I'll put it back to you.

Kara Swisher 24:33 ... I think his tweets have become, uh, I think this article means a lot of people close to him are worried again, as they were last Christmas time, um, uh, when there's a little downtime, and I think that's what it looked like to me when I was- I was like, "Oh, I know who that- who said that." You know what I mean? Like, I could guess. Um, so I think a lot of people are worried, um, and they're worried for a bad outcome in lots of ways, um, not just economically. And maybe this was their way of talking to him? Um, his tweets recently have been pretty unhinged, I- or- or juvenile recently. They're not- they've not been, "I'm spending some time thinking," or anything like that. And so Jeff, that's my last question. If you were e- uh, I know some of his doctors. Um, if you were his doctor, what would you say to him if he were to listen?

Dr. Jeffrey Swisher 25:21 Well, I would say that, you know, any kind of polysubstance abuse, uh, is not necessarily in your best health interests, and, uh, you know, clearly, you don't go around, uh, doing fairly powerful, um, psychoactive medications and drive a car, uh, or fly a plane or buy multi-billion dollar, uh, social media companies. Um, and I think that, um, that's what I would tell him is just, like, you know, like, the old adage, everything in moderation. I mean, uh, th- one thing I just wanna be clear that, you know, your listeners understand that ketamine is not a dangerous drug in the right hands. Uh, but like any drug, it can be misused, and it's a very useful drug, and I would hate to see a drug like ketamine, which is so useful, being demonized, and there'll be government reaction against it, et cetera, et cetera. That would be the worst possible thing that could happen, uh, because it is a very useful medication. But I would just tell him, you know, like, alcoh- I mean, it- the same thing that would- if somebody came in and they were showing signs of alcoholism. I would say, "This is really bad for you, uh, and this is why." You just give them information. He clearly is a very smart man, and, um, you know, you try to appeal to people's reason.