The science of living longer with Eric Topol | ReThinking with Adam Grant

1. 0:00 – 1:28

   Eric Topol’s early communication quirks and breakfast as a healthspan baseline

   1. ETEric Topol0:00

      When I was a little kid, you know, instead of, like, going to talk to my parents, I'd leave them a note under the door. I didn't even learn how to talk until I was three and a half. Um-

   2. AGAdam Grant0:09

      Wow.

   3. ETEric Topol0:10

      I mean, it took me a long time to learn how to, learn how to talk.

   4. AGAdam Grant0:13

      I mean, you're such a remarkably prolific scientist and communicator, I assumed you must have been a child prodigy.

   5. ETEric Topol0:20

      No, no, far from it. You know, I've, I, I've just been a writer [laughs] for my whole life. [upbeat music]

   6. AGAdam Grant0:30

      Well, Eric, I, I thought it would be fun for all of our listeners if we just went through all of your scientific publications one by one.

   7. ETEric Topol0:38

      [laughs] It's a new cure for insomnia. Yeah.

   8. AGAdam Grant0:42

      [laughs] Uh, no, I, um, I, I have so many things I wanna talk to you about. I find this to be an annoyingly boring question for almost everyone.

   9. ETEric Topol0:51

      [laughs]

   10. AGAdam Grant0:51

       But given all you know about diet and healthspan, what did you have for breakfast today?

   11. ETEric Topol0:56

       I had some, uh, non-fat Greek yogurt, you know, plain, with some, uh, blueberries and a little sprinkling of, uh, low-sugar granola.

   12. AGAdam Grant1:07

       I feel very validated right now.

   13. ETEric Topol1:09

       [laughs]

   14. AGAdam Grant1:11

       Non-fat plain yogurt with blueberries and strawberries this morning. Should I feel good about that?

   15. ETEric Topol1:16

       Yeah, absolutely. You got some good protein. You didn't hit on sugar. Uh, the berries are really healthy. That's as good as you can get for a healthy breakfast.

2. 1:28 – 3:28

   The ‘wellderly’ study: extreme health without obvious genetic advantages

   1. AGAdam Grant1:28

      Um, all right. I wanna, I wanna talk about, uh, about SuperAgers, of course. And the starting point for me at least is, uh, the welllderly research you did, and I wondered if you could just walk us through the idea behind the study, what you were hoping to find, and what surprised you.

   2. ETEric Topol1:46

      Yeah. Well, it was a big surprise, I can say that. So we, uh, had defined welllderly, uh, 85 years plus, up to 102 is the, uh, the range, but they had to be so healthy they had never had any medical condition and on no medications and be cognitively, uh, intact. So it took us seven years to find 1,400 such people who would participate and give blood for, uh, whole genome sequencing. We did the sequencing, and to our real, uh, surprise, we found nothing different about the welllderly as compared to the elderly, which is a control group of people over 65 with the usual chronic age-related diseases. So w- nothing like we had suspected, uh, and it really changed our whole view as to what are the determinants of, uh, healthspan, uh, particularly extreme healthspan.

   3. AGAdam Grant2:44

      So let me get this straight. You're saying that people who made it into old age with no major age-related disease were not genetically different from the people who were aging poorly?

   4. ETEric Topol2:56

      That's right. There were some m- minimal differences, but most of these people had their parents, their siblings die 20 years younger than them. So that a- alone gives you a familial pattern that doesn't support genetics.

   5. AGAdam Grant3:13

      And I take it you were stunned by this, given everything we know about genetics and health.

   6. ETEric Topol3:18

      Right. [laughs] To have every, you know, three billion letters, uh, of each of these pe- people's genomes and to see so little difference, it was really a stunner.

3. 3:28 – 4:19

   If not genes, then what? Immune aging, inflammation, and lifestyle’s limits

   1. AGAdam Grant3:28

      So once you've ruled out major genetic causes, that turns to lifestyle and the choices we make. I think the good news is it's controllable. Uh, it s- it suggests to me at least that a lot more of longevity is in our hands than we might believe.

   2. ETEric Topol3:44

      Yes and no, I would say. Um, yes, because lifestyle is a big deal for healthspan, but no, because even though we don't see it in the DNA, I think what we have learned is the immune system, uh, so-called immunosenescence and how that relates to inflammation. So that is likely the explanation.

   3. AGAdam Grant4:05

      Got it. So even if there aren't major genetic influences on healthspan, uh, there are important biological drivers which, in turn, are affected by lifestyle.

   4. ETEric Topol4:17

      Exactly.

   5. AGAdam Grant4:17

      Okay.

   6. ETEric Topol4:18

      Yes.

   7. AGAdam Grant4:18

      Good.

   8. ETEric Topol4:18

      You got it.

4. 4:19 – 6:23

   The longevity boom: real biotech progress mixed with rampant pseudoscience

   1. AGAdam Grant4:19

      So let's, let's talk about a healthy lifestyle then. I think it seems to me, you know, as an outsider, that the longevity industry has exploded.

   2. ETEric Topol4:28

      Mm.

   3. AGAdam Grant4:28

      And with that, [laughs] the number of people who are peddling snake oil, oil has just... I, it, it... I don't know if whether it's increased exponentially or whether their visibility has increased exponentially or both, but I, I feel like I'm bombarded with people hawking products, diets, habits that don't pass my non-expert sniff test of credibility. This must drive you mad as an actual expert.

   4. ETEric Topol4:55

      It does drive me crazy, and it was one of the, uh, real reasons, the impetus to write a book, uh, to get the story straight, to get the hard evidence out there. Because basically, so many people are interested in, uh, longevity and, and extending healthspan, and they become the prey, the prey for these longevity companies, longevity clinics, these anti-aging supplements. These are being hawked by, uh, so-called longevity [laughs] influencers. You know, this is a real problem, is that there's just so much, uh, complete, uh, pseudoscience not backed up by, you know, real data and evidence, and claims that are just, uh, you know, out there, uh, off the rails. So, um, it's a longevity moment in, in the respect of the interest, and part of that is fueled by there are some really good, uh, biotech companies that are trying to pursue reversing aging, and they're doing some really elegant science, so that's part of it. And then the other part is this huge investment by the billionaires. Who, when they were young, they wanted to be rich, but when they're, now that they're rich, they wanna get young. So the, there's so much going into this between the pseudoscience, the investment, some really, uh, exciting biotech. Maybe someday we'll reverse aging. But y- we, you know, we really wanna get this straight. And it, and, uh, a lot of things that are being, uh, promoted out there have no basis at all.

5. 6:23 – 9:21

   Topol’s debunking list: supplements, longevity clinics, full-body MRI, rapamycin, and protein hype

   1. AGAdam Grant6:23

      Okay. So I wanna give you your moment in the sun to be a professional debunker. What's on your top 10 list of pseudoscience and snake oil?

   2. ETEric Topol6:30

      Oh, gosh, there's so much. Um, let's see. Where to start. Uh, the supplements are pretty high up, the ones that claim anti-aging and health, uh, benefits. Uh, they, they haven't had any d- data, meaningful data to support them. So they're, uh, way up on the, uh, kinda irritant list of, uh, pseudoscience. Uh, the longevity clinics that charge up to $250,000 to go and have a plasmapheresis of blood from a young person, or hyperbaric oxygen chamber, or stem cells, they're up there. Uh, and they're all over the place. Next would be, um, the advocates for total body MRI. This is absurd because, you know, that's supposedly a way to diagnose cancer or prevent cancer. Well, sorry, but if you get a total body MRI and you have a, a, a mass that turns out to be, after biopsy, cancer, that's not catching cancer early. There's already billions of cells if it's showing up on an MRI. The problem is, most people who have an abnormality, it's not cancer, but they have to go through a rabbit hole, all sorts of, you know, invasive tests. And I've seen patients who've had, you know, bleeding in their liver that were very serious, uh, or a pneumothorax, collapsed lung from a lung biopsy. So you don't wanna have a total body MRI if you're healthy. Uh, another one is rapamycin, pushing rapamycin. This is crazy. It works well in mice, but there's no data to support in people. There's this leaderboard of all these longevity influencers that take this dose or that dose. So you could be taking what you think is a low dose, because everyone's variable, and you could wind up having very marked suppression of your immune system, which, what does that do? Well, you could get cancer. It could just bring it out. You've lost your ability to fight those, you know, uh, uh, early cancer cells and all sorts of bad things, no less infections. Um, so I could keep going. I mean, there's this protein craze, uh, many call it bro science, where you take these ridiculous amounts of protein every day.

   3. AGAdam Grant8:40

      To build muscle, right?

   4. ETEric Topol8:40

      It's not... Yeah, build muscle. Well, you know what? Uh, there are no data to support these crazy, uh, recommendations of one gram per pound or even more. The data supports, you know, one gram per kilogram, which is half, uh, and maybe slightly increased if you're older or you're trying to get some extra muscle mass. But when you get to too high a protein, especially when it's animal-derived protein, you're gonna get body-wide inflammation, and the experimental models show you're gonna promote atherosclerosis. You don't wanna do that. [laughs] So yeah, uh, I, I, I guess I could keep going. That's a starter list. Um, there's more, of course.

6. 9:21 – 12:12

   Vitamins vs. supplements: when (if ever) they’re worth it

   1. AGAdam Grant9:21

      I, I wanna come back to supplement. Can you talk to me a little bit about, like, should the average person be taking vitamins or supplements of any kind?

   2. ETEric Topol9:28

      Well, I did review that in the book and, like, where are the data. And so for healthy people eating, you know, a, a health, healthy diet, um, there usually is no reason to take any vitamin. However, um, there was one study that showed a very small benefit for multivitamins. Um, and there are people who turn out, when they get tested, they might have a very low vitamin D or they might be very low in vitamin B12. For, for specific... A- as it turns out, uh, eh, I wouldn't go a- after these blood tests when there's no symptoms and somebody's healthy and, and having a, a, a normal diet. But when it gets tested and a physician says, "You know, you're really, your, your vitamin D is very low, it's reasonable to supplement it," that's a different story. But for healthy people, they shouldn't worry about taking vitamins. If they want to take a multivitamin a, a day, it's not gonna hurt them, but, um, the benefit here is so marginal, and there's an expense attached to vitamins. They are generally different than supplements. Uh, you know, green powders and all sorts of other herbs and plants and whatnot. Vitamins are not nearly as, uh, incriminated for, you know, the kinda pseudoscience as the supplements per se.

   3. AGAdam Grant10:46

      Okay. That being said, I have, I have come across some randomized controlled trials suggesting harm from taking too many-

   4. ETEric Topol10:53

      Yeah

   5. AGAdam Grant10:53

      ... certain kinds of vitamins. W- w- where do you come down on that?

   6. ETEric Topol10:56

      It's hard to be sure of harm. There are many things that have been looked at. You know, like selenium was tested for prostate cancer and looked like it made it worse and... You know, so there's this stu- there's, there's specific studies. Um, in general, uh, taking some vitamins, um, it, it's... That hasn't been as incriminated as taking some of these supplements.

   7. AGAdam Grant11:19

      What about on the supplement side? It seems like there's some that might have small benefits and seem to be relatively harmless, like fish oil, for example.

   8. ETEric Topol11:27

      You know, fish oil [laughs] is an interesting one 'cause omega-3, uh, when you look at the studies from diet, it looks very good, very favorable. When you look at the supplement studies, it looks like you have to take an awful lot of fish oil. But as I tell my patients, uh, w- who ask me about this, they often come in with a list of all supplements they're taking, [laughs] said, "You know, it's gonna enrich your urine if you like that, but it doesn't really gonna do much to help you, your biology and your, your, you know, your health. So, you know, if you really wanna spend your money on that, it's okay, but we just don't have evidence for the benefit."

   9. AGAdam Grant12:04

      Okay. So it sounds like a lot of people are gonna be scaling back their supplement use and a fair amount [chuckles] of their vitamin consumption too.

7. 12:12 – 13:12

   Why people keep taking supplements anyway: distrust, placebo effects, and behavior change barriers

   1. ETEric Topol12:12

      Well, you'd think so, Adam, but there's a lot of rejection of the medical, uh, establishment right now, and that's a lot of reason why people are taking the supplements is because they have kinda given up on the medical community for giving them, you know, good information. So they're doing their own research or they're responding to, you know, the promotion of these things. So I find it hard when I look at these patients with their lists of supplements to get them to change. And basically we, we come back with a neutral zone, which is, "Okay, if you wanna [chuckles] take them, go ahead." But they usually don't give them up. Uh, it's surprising. They're, they get attached to them. And as you know, there's a lot of placebo effect because you take this thing and you feel better and you attribute it to this thing that you took and, you know, it's hard to undo this stuff.

   2. AGAdam Grant13:01

      Yeah, that makes sense. Yeah, I was, I was thinking a little bit about even if there isn't a placebo effect creating a benefit, removing the placebo can carry a cost. [chuckles]

   3. ETEric Topol13:10

      Yeah. Yeah. Exactly. Yeah.

8. 13:12 – 15:25

   A prevention-first blueprint: stopping the ‘big three’ diseases with a 20-year runway

   1. AGAdam Grant13:12

      So we've crossed out a bunch of things that are not that helpful and may even be counterproductive. What are your top recommendations evidence-based for extending our healthspan and/or our lifespan?

   2. ETEric Topol13:24

      Yeah. So I mean, I think the novel part of the book is about preventing the big three diseases, Alzheimer's, neurodegenerative disease, cancers, and cardiovascular. We've never done that in medicine. We've been talking about it, I think, for a couple of millennia, uh, but we've never done it, and we have a way to do that now, and it does bring in these lifestyle factors, which we, we will talk about, but it's not just that. It's identifying the high risk people for each of those diseases, and we have 20 years of, uh, runway. That's what a lot of people don't realize. They think, oh, well, this person just had a cancer diagnosis. It must have been brewing for the recent months. No, 20 years. Heart disease, the arteries are getting clogged, takes 20 years before a person's gonna have a heart attack. And the same thing for Alzheimer's, at least 20 years for the brain to get these misfolded proteins and all this brain inflammation and whatnot. So we have not paid enough respect to these two decades or more time. And in medicine, oh my goodness, if you have two decades to be able to get ahead of one of these diseases, that's amazing in itself. But the next thing is we have these new abilities through genes and proteins and markers. Define the high risk people. Uh, even an AI of the retina predicts almost most of these diseases. Uh, maybe not cancer, but the others. Um-

   3. AGAdam Grant14:51

      Wow.

   4. ETEric Topol14:51

      So we have new ways. We have new ways to nail down not just if you have risk, when this is gonna manifest if nothing is done. Then we bring in the lifestyle factors. But, um, of course, it does rely on the old stuff, the traditional risk factors which have been enhanced in recent times, and a lot of new stuff which is really, uh, understanding the science of aging, the biology of aging, which has made big advances, uh, in recent years, and that's kinda why we have this, uh, fixation more than ever on longevity and healthspan.

9. 15:25 – 18:21

   Early detection done right: why full-body MRI fails and blood-based cancer detection may win

   1. AGAdam Grant15:25

      It's interesting because if we had stopped where you were earlier on the total body MRI, it would be easy for someone to conclude that you're, you're not a big proponent of early detection, and in fact, that's exactly where you're landing to say, "Let's not wait until 20 years accumulation has happened. Let's, let's try, try to head this off as early as possible."

   2. ETEric Topol15:45

      Yeah, I mean, I think the total body MRI, it's not early detection. If you pick up a mass there, as I mentioned, you've already got a lot of cancer in your body, and it may well have spread to other organs. So there's microscopic cancer capability pick up now with, in a tube of blood to pick up tumor DNA in, you know, very small quantities. And what's really exciting there, uh, Adam, is it appears that in a high risk cancer patient, uh, who has tumor DNA you pick up really early, you-- some of these people, their immune system will squash it so that months later, three months later, six months later, there's no tumor DNA. And there's ways we can also rev up the immune system in that person so that they get rid of the cancer before it ever gets legs. So this is something that I think people just don't know about, and I rather have a microscopic diagnosis than an MRI diagnosis if I'm gonna prevent cancer, and I wanna know if I'm high risk before any of that.

   3. AGAdam Grant16:47

      Yeah. That sounds amazing. So how soon is that technology gonna be widely available, do you think?

   4. ETEric Topol16:51

      Well, you can get the multi, uh, cancer early detection test now. It can be ordered by any physician. I think the problem with that whole program is it's been mimicking how we screen for cancer using age. So for example, mammography, 88% of women will never have breast cancer in their lifetime. 12%, 11 to 12% will. Why do we put 100% of women recommend to have mammography, you know, every two years beginning age 40 or 45? Well, we can partition the risk. We can define who those 12% are. Why aren't we doing that? But instead we use this dumbed down age thing. So, uh, if you're using a smart way in high risk people where you have various levels, layers of data that supports that there could be a, a, a possibility of cancer emerging, that's when you get the bang for the buck of that test. And we sure wanna prevent rather than treat because prevention, you know, that's the, that's the real, uh, thing that has been, uh, outside of our reach, uh, until now really.

   5. AGAdam Grant18:01

      What's the Ben Franklin line? That an ounce of prevention is worth a pound of cure?

   6. ETEric Topol18:05

      Exactly. I would say hundreds of pounds of cu- cure 'cause we rarely get cures. We might get treatments. I mean, you know our treatments for cancer. They haven't changed for most types of cancer ... all that much. That, that's why it's still the second leading cause of death.

10. 18:21 – 21:02

    From age-based screening to risk-based precision prevention (and why medicine resists)

    1. AGAdam Grant18:21

       So how do you think about identifying high risk then, if you're not factoring age?

    2. ETEric Topol18:26

       Yeah, so that's where you go to getting these layers of data. Um, so everybody has electronic health records. Uh, everyone has lab tests, may have some scans. And in addition to the usual stuff, then you have a polygenic risk score, and that tells you for the various cancers, for heart disease, uh, for Alzheimer's, Parkinson's, what are the gene variants that you carry, um, that are, uh, uh, associated with, uh, risk in the top 5 or 10% of risk? So polygenic risk score is one. A genome sequence or particular gene markers would identify key, uh, mutations in cancer genes like BRCA1, BRCA2, so a genome would help. And now in cardiology, where I live, uh, as a, for the last, you know, three, pushing four decades soon, we have lots of ways to assess, uh, with lip- these lipids, new lipids like lipoprotein little A, with even drugs to counter that, bringing LDL down really, really low if we need to, uh, looking at inflammation markers that we haven't used. So we have lots of different ways to get on top of prevent- for prevention of heart disease, and I'm sorry to say that we don't prevent heart disease very well. We react to someone having a heart attack or a stent or a bypass, but before they ever get there, we don't do a good job.

    3. AGAdam Grant19:56

       So it sounds like there's a lot we could be doing that we're not doing, and I'm wondering, what do I do with this information as an individual patient?

    4. ETEric Topol20:05

       [laughs]

    5. AGAdam Grant20:06

       Like, am I supposed to go to my doctor and say, "I want a polygenic risk score. I want a genome sequence. I want proteomics, and I want biomarkers. Get on it, please."

    6. ETEric Topol20:14

       Yeah, and you know what the response would be of most doctors? What are you talking about? So this is where we need a gr- you know, kinda grounds up revolution, where the educated, savvy consumer can help drive this. Unfortunately, you know, the medical community takes a long time to change. Look how long these mass screenings for cancer have been going on. Decades of dumb cancer screening. We only pick up 14% of cancers through our current tens of billions of dollars that we invest for cancer screening. And there's resistance to change because the companies that do the cancer screening, you know, they're, they're gonna keep lobbying to do the cancer screening [laughs] a- and for everyone instead of for people of increased risk.

11. 21:02 – 23:06

    Exercise guidance without the zone wars: move more, and train strength + balance too

    1. AGAdam Grant21:02

       Would love to talk a little bit about exercise, which I think goes, no pun intended, right to the heart of your expertise as a, a cardiologist. I have heard so many disagreements about when it comes to healthspan, should I be, you know, doing lots of zone two exercise? Should I be doing, you know, zone four? Should I be doing zone three? What, what, what does the best evidence actually tell us?

    2. ETEric Topol21:24

       Yeah, the best evidence is just move. You know, physical activity is great, and whatever zone you wanna be in, um, you know, if you wanna be three, four, five, to go more vigorous, we don't have great data to show that you go, you know, to ultra levels of extreme physical activity, that you get ultra benefit. That, that we don't know. In fact, it's possible it's even harmful if you overcook your exercise. What we do know is that the aerobic exercise, which I've always been a proponent of, both for patients and myself, that's great, but you also need resistance training. You also need balance training, especially as you get older. You lose your, your brain perception and pr- proprioception, as it's called. So what you really wanna do is have a balance type of exercise. It's not so much the zones, because when you're doing resistance training, you're like in zone two. Your heart rate's not that fast, right? But you're getting really-

    3. AGAdam Grant22:21

       Yep

    4. ETEric Topol22:22

       ... important core and upper body strength you won't get from walking or bicycling or treadmill or whatever. So this is, I think, the new thing, exercise, is that getting a balanced, uh, uh, type of a program and trying to get as many days as possible that you're doing it, mixing it up, of course, uh, and making it pleasant, making it... Nobody, I think, absolutely loves to go do their exercise. But if you make it enjoyable with music or television or, you know, something, uh, friends that are working out together or whatever, then, you know, uh, you get in a groove, and you don't wanna get out of it. That's what you want and, and just make sure it's balanced and, and you include balance training, especially as you get older.

12. 23:06 – 27:21

    Scientific skepticism and the AI era: becoming an informed patient without drowning in misinformation

    1. AGAdam Grant23:06

       That sounds manageable for most people. I know that good scientists have a, a healthy doth of, dose of skepticism but also are open-minded, and I'm wondering how you walk that tightrope. Um, you know, I think we, we heard your healthy skepticism around supplements earlier, but you're also somebody who's excited about new possibilities and has published a lot of research around new discoveries. How do you make sure you don't fall off one or the other side of that tightrope?

    2. ETEric Topol23:33

       Yeah, I mean, you start off by don't trust anything, challenge all dogma, right? And you say, "I want definitive proof." And, you know, as you know, that requires not just one study. You gotta have independent replication and, you know, it's gotta be done right. So that old adage of science about, um, uh, proof and replication, transparency, you know, publish it. So, um, demanding for high rigorous work is what we need. That's how we get misled so much and we make big mistakes.

    3. AGAdam Grant24:07

       Well, I think that, that speaks to a dynamic that must be affecting you in every part of your life, which is we thought that the internet was going to give people access to information and empower consumers, and what it's done for a lot of people is give them access to misinformation and disinformation.

    4. ETEric Topol24:25

       Yeah

    5. AGAdam Grant24:26

       How do you think about being an informed patient and, you know, not over-relying on Dr. Google or Dr. Claude or Dr. ChatGPT, but at the same time not entrusting everything to the one or two experts who may primarily be overseeing your health choices?

    6. ETEric Topol24:43

       Yeah, it's a great question. Um, what I think, um, that the generative AI part is a bonus now just because you can not only go to ChatGPT more than once and go to Claude or, you know, go to, um, uh, you know, Copilot, whatever, you, you can get multiple opinions [chuckles] which is healthy. And nobody in anything serious matter in medicine should go with one opinion. Some of the AI work is very encouraging for promoting accuracy, diagnostic accuracy, so it's good, or reviewing all the data and not missing things. So to get to your point, it's gonna be taking advantage of the AI world we're in right now, which is gonna keep getting better, and having a doctor who we trust. Obviously, if you wanna do research, that's why I do my own research [chuckles] you can come up with any finding you want. Um, so that's why you'd like to have the human oversight of an expert, uh, of someone who you trust, someone who you know has your back. That's a problem is because most doctors are so busy they don't have the time to go over things. You know, a patient comes in and they've got seven to 12 minutes, they get interrupted after the first 15 seconds. You know, they just-- Uh, it's hard, and that's why, um, we hope that we're gonna get the gift of time back to physicians and patients to improve that relationship that's eroded, and that's the shortage we have today. That's how we've led to the concierge medicine practice, uh, because we didn't have enough physicians that had enough time to really dedicate and show that they, they really cared about their patients.

    7. AGAdam Grant26:23

       Yeah. It makes me wonder about [chuckles] you go to, you go to a physician for a checkup. Should you then be feeding your, your health data into an AI tool? Should you be taking your physician's summary and asking, you know, for an AI critique of it? Should you expect that your physician is doing all of that, uh, as, you know, sort of a, a, a check and balance on, on her or his own judgment? Where, where are we on that?

    8. ETEric Topol26:49

       Well, you wouldn't anticipate the physicians doing it at this point 'cause most are not. Um, I think it's very reasonable to take your data. Yeah, put that in. See what it says. Um, you have nothing to lose. Now, the problem is, you know, we have some people that are kinda cyberchondriacs to start with, and this could just make things worse, right? Uh, but as long as you're not in that crew where you're just, you know, hyper anxious to start with, it gives you an extra layer of review of your data, and I think that's gonna become common. What was missed?

13. 27:21 – 28:47

    AI autonomy in medicine: autopilot analogy, limits, and the need to restore clinician time

    1. AGAdam Grant27:21

       Uh, it does seem like we're rapidly approaching, though, a frontier that looks a little bit like a, an autonomous car, which is, like, for a long time people said, "I wouldn't trust the car," and now the error rate is so much lower that it almost seems unethical to let humans drive.

    2. ETEric Topol27:38

       What you're bringing up is a really important concept, and, uh, the autonomous cars, they function at a low level of autonomy, so-called levels one through three. You know, they know their, their region really well, and they only in good weather conditions, right? Everything's kinda ideal, right? But they can't take you out on the, um, uh, the highway or go in zones they're not familiar with or when it's raining or icy or that kind of snow. No. So that's level four or five, and I think that's what it is like i- in medicine. You get to a point where your autonomy can work to some degree, but it's never gonna c- be completely covering all p- aspects of medicine. It's gonna be a big a- augmenter, augmentative function, yeah.

    3. AGAdam Grant28:27

       So maybe the better analogy then right now is, uh, medicine is gonna approach where we are with flying an airplane.

    4. ETEric Topol28:33

       Yeah. Yeah. You have a tremendous amount of help, and you just are there to kinda oversee that autopilot. We're gonna be more efficient. We need it because we can't keep up with the, the level of the care and the burden that, that we face.

14. 28:47 – 32:59

    Reversing aging and living forever: why ‘immortality’ is unlikely and prevention is the pragmatic path

    1. AGAdam Grant28:47

       Okay. So Eric, I have to ask you, uh, you mentioned the possibility of reversing aging earlier. Uh, there's a lot of AI hype right now about these tools getting so sophisticated that we can essentially end disease and therefore not die.

    2. ETEric Topol29:05

       [laughs]

    3. AGAdam Grant29:06

       Do you, do you think it's possible for humans to live forever?

    4. ETEric Topol29:09

       No. Absolutely not. There is-- Aging is not a disease. It's a process, and if we ever are able to reverse it to some extent, which remains to be proven, there'll be some risks for that. There'll be trade-offs. When we, when we do epigenetic cellular reprogramming in the mouse, we can make a mouse look young inside. All their organs look young. Everything's great. But they get tumors. That's not good. So y- there is gonna be some risk involved. I want it to work, but, you know, what are we gonna get out of this? Three years? Five years? You know, it's not gonna be immortal. Maybe we'll see a, a way to get, uh, rejuvenated to some degree, uh, for a small period. Demis Hassabis said on 60 Minutes not long ago, uh, when prompted, uh, we'll be able to, uh, end all diseases in the next decade or so. Well, of course, I don't agree with that, and he, he's my friend. The issue, though, is that his strategy is I'm gonna use AI for much better drug discovery, right? And drug discovery's not gonna get us to end all diseases. [chuckles] I mean, the number of cures we have in medicine, like, you can count on, you know, two hands really. We have some really good treatments. We're getting better, like the GLP-1 drugs, but that's not gonna end all diseases. And even with AI discovering new ... treatments. They're not usually cures. And we can't do genome editing of everybody in the species either. So no, I, I think realistically that's why I take the path, let's prevent diseases. Let's work that way. Let's, let's deal with the age-related process that we all have. Let's find out who are vulnerable to what disease of the big three and prevent it.

    5. AGAdam Grant30:59

       Are you leaving us with the conclusion that even if we fast-forward centuries or millennia, that there's no hope for a field like cryonics?

    6. ETEric Topol31:08

       I don't see that, no. I think that, um, the way cells work, uh, the way organs and tissue in our body work, uh, we're not gonna, you know, be able to preserve people. And sure, you know, we give somebody, put somebody on a life support machine now, and we could probably get them to live on a machine for another 50 years. You know, that's possible. What good is it? You're on a life support machine [laughs] , you know? Yeah. So no, w- I don't see that as a likely scenario. I, I, I could be wrong of course, but I, I just don't... I, I'm an optimist, but that seems to go well beyond optimism.

    7. AGAdam Grant31:48

       Yeah, I guess hearing you think out loud about that, the, the only version of it that seems palatable based on the constraints that you're laying out is some kind of synthesis of organic and inorganic matter that makes the human brain less dependent on cells to begin with.

    8. ETEric Topol32:03

       That's a possibility. You know, if you could do that, um, that mean, that, the whole idea, uh, you know, is in, in the nascent phase of, you know, brain implants and that sort of thing.

    9. AGAdam Grant32:16

       All right. So I, I think we're gonna put you in the camp of [laughs] highly unlikely that humans become more immortal at any point, but if you had to bet on a path, it would be the cyborg path. Is that right?

    10. ETEric Topol32:28

        Well, uh, the cyborg path, uh, you know, it, I guess you, what's, what that really means, you know, what does it really mean to be cyborg? Um, because, you know, if we're walking around with, you know, artificial hearts and brains, and [laughs] I don't know if that's hum- you know, how much of the original human are we? So I, I don't even know if I'm all that excited about that prospect either. Uh, but it probably has a little bit more of a shot, uh, over the long haul.

15. 32:59 – 38:29

    Lightning round: worst advice, sleep as a lever, medical error prevention, and protecting science funding

    1. AGAdam Grant32:59

       Thanks for indulging the curiosity on that front. All right, let's, let's go to a lightning round. Uh, we'll do some quick-fire questions.

    2. ETEric Topol33:05

       Okay. [laughs]

    3. AGAdam Grant33:07

       Uh, let's see. What is the worst health advice you see dispensed regularly?

    4. ETEric Topol33:12

       In my field, in cardiology, the one that drives me nuts is that people are being told to get a, a calcium score for their heart with a CT scan, and I cannot tell you how many people I see every week that have got this calcium score and now are getting anxious and staying anxious no matter what you try to tell them, because they have some calcium in their arteries, which is meaningless. It makes me CAC, calcium artery, you know. So that's the one that in my life drives me cuckoo.

    5. AGAdam Grant33:41

       There we go. All right. What's your best health tip that we haven't covered?

    6. ETEric Topol33:44

       Well, we didn't really talk about sleep. So m- the vast majority of Americans are not getting good, high quality sleep. They're not going to bed on a regular time. And when I found out I was such a terrible deep sleeper, sleeper in, in general, you know, I did some tracking, and also about, you know, interactions with, uh, when, when I ate, when I exercised, all that stuff. I became a much better, uh, deep sleeper. So that is a, is a really important part for all of these age-related diseases, notably neurodegenerative. So I think that's the tip I would give, is y- know if you're getting good quality and regular sleep, because if you do that, everything's gonna be better.

    7. AGAdam Grant34:28

       Mm-hmm. Noted. What is something you've changed your mind about or re-thought lately?

    8. ETEric Topol34:33

       Well, I mean, until I did the research in the book, I wasn't convinced we could prevent these diseases, and now I'm totally, I'm confident we're gonna do this. The timing of all this that we talked about today is the, uh, uh, the fuzzy feature, but I'm really confident we are gonna go to a high power of flipping elderly to well-derly over the years ahead, and it won't be this rare person that's 85 without these diseases. It'll be much more common.

    9. AGAdam Grant35:04

       Love that. Who are your dream dinner party guests?

    10. ETEric Topol35:07

        Oh, gosh. I find the, the most stimulating conversations I have these days are people in the AI domain, like Geoff Hinton and Demis Hassabis, because they are really trying to get this right because it has such a two-edged sword, and I like talking to people that are much more thinking about it, um, in non-health medical world to try to exchange views and all that.

    11. AGAdam Grant35:32

        Those are the people we need you hanging out with, so I'm glad it's already happening. What's your question for me?

    12. ETEric Topol35:37

        Have you ever been roughed up by a doctor?

    13. AGAdam Grant35:39

        [laughs] Roughed up? No, thankfully.

    14. ETEric Topol35:42

        Yeah. [laughs]

    15. AGAdam Grant35:43

        No. I, I've, I've certainly encountered my share of arrogant so-called experts. Uh-

    16. ETEric Topol35:51

        Okay. But you n- you never, or your family never had, like, a, a wrong diagnosis or-

    17. AGAdam Grant35:56

        Oh, definitely family. Lots of family-

    18. ETEric Topol35:58

        Okay. Okay

    19. AGAdam Grant35:59

        ... misdiagnoses. I could, I could make a whole-

    20. ETEric Topol36:01

        Yeah

    21. AGAdam Grant36:01

        ... list for you.

    22. ETEric Topol36:01

        I include that in the roughed up category, because, you know, arrogance is one thing, but another is missing a diagnosis, and that's a really big deal, and there's like 12 million major diagnostic errors in this country a year, 800,000 people either disability or die from it. We gotta do better than this. I mean, we, it w- we don't admit to it in the medical community how, how frequent it is. And so for me, this is really impetus that we have to fix, get better. It's hard to make it worse, you know?

    23. AGAdam Grant36:33

        You know, Eric, I'm so glad you raised that because I, I feel like this is maybe [laughs] the only place I can add value to medicine as an organizational psychologist is to say we know a lot about error prevention. Um, my colleagues Amy Edmondson and Dave Hoffman, among others, have spent their careers trying to figure out what is it that causes an individual expert or a team to make a mistake, and then, you know, how do we intervene to reduce the likelihood that happens? And, um, it will not surprise you that one of the best interventions that we have to date is building psychological safety in a team, where you can speak up-

    24. ETEric Topol37:04

        Mm-hmm

    25. AGAdam Grant37:04

        ... without fear, which makes it easier to admit a, a mistake. It then puts other people in a position to, uh, to learn from what went wrong and then rethink their so-called best practices and find better practices. And I would love to see more interfacing between your world and mine around those kinds of interventions.

    26. ETEric Topol37:22

        We need that desperately, yeah.

    27. AGAdam Grant37:25

        Well, we all know that science funding in America is in jeopardy right now. Uh, what's your strongest case that this is a mistake?

    28. ETEric Topol37:32

        There's never been a more, uh, propitious, exciting time in life science and medicine. And what a time to gut medical research funding and public health agencies. I mean, the mismatch here, and that's a kind word, um, is incredible. I just hope that it's short-lived. And who would ever wanna wish for time to go faster so you get b- get back to normality? But in that gap of time, we're gonna lose a lot of momentum and precious, uh, you know, uh, improvements in human health.

    29. AGAdam Grant38:07

        Well, Eric, thank you for sharing your wealth of knowledge with us today. It's such a treat to finally meet you, and I'm looking forward to the in-person version.

    30. ETEric Topol38:16

        Yeah, so am I. That'll be great. Thank you so much, Adam. [upbeat music]

Episode duration: 38:39