313 | Eric Topol on the Changing Face of Medicine and Aging

0:00:00.4 Sean Carroll: Hello everyone. Welcome to the Mindscape Podcast. I'm your host, Sean Carroll. A couple years ago, 2023, I did a holiday message entitled "Reflections on Immortality" This was in response, or at least inspired by a workshop we had at Santa Fe Institute on immortality. What it would mean, how you might get there. And I mentioned there, that a lot of the people at the workshop basically said they don't want immortality, like that's too much. Either personally, they couldn't imagine what to do for all that time, or socially, they think that society would stagnate, if people just live forever rather than being replaced, that's fine. You can argue whether or not you'd want to live forever or not. Most people though, would wanna live a little longer, at least than they probably will live. We're very interested in longevity and aging and not only living, but living in healthier ways. I just now for this intro, looked up the graph of life expectancy in the United States for the last 100, 150 years or so. And it's been going up, that's the good news. It went down once in this particular graph shows five year bins. So only once in the 20th century did the life expectancy decrease from one, five year bin to another between 1915 and 1920.

0:01:22.7 SC: I'm not exactly sure why that was, the flu? The Spanish flu maybe, until 2015-2020. It also decreased. It only decreased a little amount. Okay? In 1920, it was 53 years old, the life expectancy from birth in the US. In 2020, it was 78.8. So it's gone up quite a bit. That's impressive. But in 2015, it was 78.9. It was a little bit bigger. And we can talk about why that's true. The healthcare system, nutrition, whatever, that is the kind of thing we're gonna talk about on today's podcast. Eric Topol is a leading medical researcher. Cardiovascular system is his specialty, but he's a broad thinker who's done a lot of work and has been thinking for a while now about medicine in a very broad way and been writing books about it. We will actually take a little bit, more than a little bit of a detour to talk about his previous book, which was called "Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again." He has this fascinating point of view that not only can AI be super duper useful in recognizing, diagnosing some medical conditions that human beings are not very good at, but in fact, it can be better than human beings in some very very important ways.

0:02:41.8 SC: And we think about how to make an ideal system where there be both humans and AI there. But one of the steps there is making the humans understand that the AI can actually be pretty good at some things. It's not about AGI or superintelligence, it's about pattern recognition, which is what AIs are very good at. But mostly in today's podcast, we're gonna talk about Eric's new book called "Super Agers: An Evidence-Based Approach to Longevity." And here we're not talking about modifying the human genome to live for centuries or anything like that. We're just talking about living a healthier life and preventing disease in ways that are very plausible, very down to earth, very tangible, and can actually add several years, maybe decade to an ordinary human healthy life expectancy. This is something which most people would sign up for, if they had that option. And it's a combination of understanding the diseases that tend to end our lives at some point. In particular, the fascinating thing that we learn is that, many different sounding diseases are all related to the immune system and inflammation, which might be promising for sort of treating or preventing them.

0:03:54.7 SC: And then of course, the other thing is that things that we individually can do, things that have to do with diet and exercise, as you might expect, but also mental health, mental acuity, social activity, these are all turn out to be really, really important for not only living a long time, but living a long time in a healthy way. So maybe this is a podcast which, unlike many Mindscape episodes, has a really tangible effect on how people live their lives. I hope it does. So let's go.

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0:04:41.3 SC: Eric Topol, welcome to the Mindscape Podcast.

0:04:43.5 Eric Topol: Great to be with you, Sean. Thank you.

0:04:45.6 SC: So we're gonna talk about a lot of things with medicine, aging, AI, things like that. But one thing, there's a little news item that struck me and I thought I don't wanna forget asking you about it while I have you here, which is, as a person of a certain age, I recently got the shingles vaccine and now I'm told that this might even have a positive effect on preventing dementia in the future. That doesn't seem what it's there for. Is this something that is completely weird and surprising or true and understandable?

0:05:15.8 ET: Well, it's a mixture of your questions about surprising and understandable. It's really fascinating because there are these two so called natural experiments, whereby huge numbers of people got the vaccine just because of a policy change or a date change. So it's like a randomized trial, in fact it's even better 'cause there's no selection criteria. And whether it was comparing the new Shingrix vaccine, versus the old live attenuated virus vaccine called Zostavax, or the vaccine, the old vaccine versus no vaccine, everything pointed to this about 20% reduction of dementia. And this is fascinating, because while other studies had suggested this, they weren't like this ideal natural experiment.

0:06:09.5 SC: Yeah.

0:06:09.9 ET: So it does look like there's a twofer. It helped me decide to get the shingles vaccine because I don't do well with these vaccines in terms of acute reaction.

0:06:19.1 SC: It's unpleasant. Yeah.

0:06:19.8 ET: And I was lucky because of all things, this vaccine didn't knock me out like some others do. But yeah, I think for people over 50 in the US, it's wise to get this because there really isn't... Appears to be an added bonus. It doesn't mean for sure that the virus herpes zoster causes Alzheimer's, but it could be that just revving up your immune system with this vaccine helps. So it isn't unequivocal proof that there's a root cause of a virus for Alzheimer's or dementia, but it does certainly suggest the immune system plays a role.

0:07:00.4 SC: So we're still pretty unsure what the root causes are for dementia, for Alzheimer's.

0:07:05.8 ET: Yes. The theory of a virus like for multiple sclerosis, Epstein-Barr virus, which is unequivocal, is very soft here. We don't have anything like the multiple sclerosis story, but there's still people who believe the virus plays an important role and perhaps in a subset of people, and even other viruses besides the herpes zoster, varicella virus may be invoked. So there's still work to be done on that one.

0:07:33.8 SC: Yeah. Okay. There usually is, especially medicine. It's very hard. Okay, thank you for indulging me with that. Now we can get into the work you've done, the books, et cetera. Part two of the podcast is gonna be about your most recent book on aging, which is something everyone cares about, but previously you talked a lot about the potential impact that AI can have on medicine. And I think this is perfect for this podcast, because I love the idea of AI. I'm very skeptical about some overblown claims about artificial general intelligence, but here is an actual use case where you don't need to worry that the AI is conscious or intelligent or anything. You can just use it. So why don't you give us the big picture overview of why AI might be helpful in medicine?

0:08:22.8 ET: Yeah. In some ways it's stunning, Sean. We're gonna get into some of the concerns, of course. But some of the things that AI is bringing to us, we couldn't even have conceived frankly. So perhaps the one that is just kind of knocks you out in terms of wow factor, is the so called machine or digital eyes, the vision that AI has. Which is so, it makes our vision, as physicians, experts in certain domains look weak. Because it turns out that the accuracy, once you train an AI to see things, if you will, is so much better. Not just for the things that you're supposed to be looking at, but for finding things that you can't even see. So for example, the retina is a perfect example because it turns out even ophthalmologists, the retina specialists, they can't see things that the AI can. So not just about retina disease, but about every system in our body essentially, not just the brain, but about risk for heart attacks and strokes and kidney disease and liver disease. And the list goes on and on. So the point being is, that there's this opportunistic aspect because the supervision of AI, is just extraordinary.

0:09:51.2 ET: And so, that is something that I think we're just starting to get in touch with. No one had anticipated the richness of ability to interpret medical images, which is a big part of practice of medicine. But then we're also seeing some things that also are surprising. That is, one of the most important parts of medicine is making the diagnosis. There was things that were listed as the three most important things, diagnosis, diagnosis, diagnosis. [laughter] It turns out, we have 12 million serious diagnostic errors a year in the United states. We see 800,000 Americans, either disabled or dead from these serious diagnostic errors. So it's hard to make things worse. Well, it turns out, even though the medical community doesn't like to fess up to these problem of errors, these errors, the AI is making a big difference because it is so good at coming up with a differential diagnosis from a person's data, much better than we expected. So the chance of it being as good as one of the experts for coming up with the diagnosis, like we see with the storied case presentations at the New England Journal of Medicine sort of thing. It's amazing.

0:11:16.5 ET: So this is another way, accuracy, not just medical images, but also for helping making the diagnosis through. What's really fascinating now, Sean, is this, we're not just seeing large language models, we're seeing large reasoning models. And so, this is really helping that reasoning and following the chain of thought. So you can just say, "How did you get there? How did you come up with these diagnoses?" And get the details of how the AI is thinking, if you will. Now the other thing that I think we wouldn't have expected, and again, some of these are really outgrowths of the transformer architecture of AI. But now when you go with a patient in a clinic visit or even at the bedside, that interaction can not only be transcribed, that's nothing. But what it can do, is do all the downstream tasks. So it would do, like if you need prescriptions, follow up appointments, procedures, labs, setting up follow up appointments for and nudges for things that were discussed during the interaction, like did you check your blood pressure, what are the values? Can you get it back to the doctor? And even pre-authorization to deal with the darn insurance companies.

0:12:35.8 ET: So what we're seeing, is average for those who are adopting these, two to three hours less data clerk work for doctors. And then, the other thing that's I think very refreshing is to see the patients getting empowered to make their own diagnoses through these tools. So whether that's for heart rhythm or skin lesion or ear infections in a child or urinary tract infection, so all around they're seeing effects and they're just real starting to take hold.

0:13:08.1 SC: I love the example that you already mentioned it briefly, but I saw you give it in a talk and it was, it really stuck with me of this retinal scan. So you're literally looking at a picture of someone's retina and you ask human doctors, okay, is this a man or a woman? And they have no idea. It's 50/50. They're just guessing. And the AI gets it right 99% of the time.

0:13:29.0 ET: Yeah, it's amazing. And we still don't really know why the AI is so good, but it just, that is perhaps the best single example of the gap between human eye discrimination and what an AI, when it's seen, trained with hundreds of thousands of images, it just, it's actually pretty mind boggling to me. And I've known about it for years and there's just now so many other examples, whether it's a cardiogram or a path slide, an X-ray, who would have thought you could diagnose diabetes from a chest X-ray? These are crazy things, so it's wild.

0:14:12.0 SC: But it kind of makes sense because you're kind of using the AI for what it seems like it should be good at, it's pattern recognition. And it's looking for differences. And human beings are okay at that, but they're not perfect. But you're not trying to shoehorn the AI into something that being something that is not?

0:14:29.9 ET: That's right. And what's really interesting is that capability was just an outgrowth of deep learning without the extra turbocharged capability of the newer models. So yeah, just think of where we're gonna go with the models that continue to get refined and improved on a weekly basis. It's just crazy right now.

0:14:52.8 SC: And it's a reminder I guess, probably as a medical doctor, you don't need to be reminded of this. But the human body is very interrelated. The fact that there is some subtle difference, even if human beings don't know what it is, between a male retina and a female retina, maybe makes sense if you tell it to me, but I wouldn't have been surprised if it hadn't been there. But, yeah, the body is, all the different parts are talking to each other all the time.

0:15:17.5 ET: That's right. Absolutely.

0:15:19.3 SC: And this is something where, again AI, is the AI able to tell us why it thinks that a certain retinal scan is man or woman?

0:15:30.3 ET: Well, this explainable AI is kind of a overarching goal and sometimes we do get a pretty good explanation. But in the case of the retina, it's still elusive. There's these things called saliency maps and masking and all these techniques that you can use to try to kind of reverse engineer what is this neural network doing. But it hasn't been as a good an explanation yet provided for the retina as it has for many other capabilities that were not anticipated.

0:16:07.2 SC: Okay, perfectly fair. I guess on the flip side, there are gonna be people who worry, that their medical care is going to be handed over to computers rather than human beings. And I suppose ideally it should be both. There should be both in the loop and there should be interactions. But like you said, with the paperwork, at least in principle, the existence of AI could give us more interactions with human beings.

0:16:32.0 ET: That's right. And there was something, another thing that caught us by a big surprise recently. And my colleague Pranav Rajpurkar and I wrote an op-ed in the New York Times about it. Six studies, now there's seven, where the AI was compared to a doctor with AI for various tasks, whether it's a diagnosis or images. And the AI was better, than the doctor with the AI. Okay? We would not have expected that.

0:17:05.7 SC: Okay.

0:17:06.3 ET: Everyone, including us, all anticipated that the AI and the doctor is the best winning combination. Now, what is the reason for this? Well, it could be because the AI right now, isn't in high regard for doctors. And so, they don't really take it seriously, or they could just have a bias against it and/or they're not grounded yet, on how to use it. But it's a little concerning that the AI could have this superior performance in various medical tasks that important tasks. We're gonna have to see how this plays out. But one thing for sure is, I think it's gonna be imperative that all physicians learn the nuances of AI. Not to immediately reject it, but to actually consider embracing it, 'cause it can help. But when the AI beats out the doctors. That's a flag right there. Yeah.

0:17:58.5 SC: Right. Okay, good. That is absolutely food for thought. But I would imagine that in some circumstances, like looking for polyps or nodules in some scan, if the AI could say, look here, it looks like there's something like that could, that just sounds unambiguously helpful to the doctor. [laughter]

0:18:16.4 ET: Yeah. The biggest study yet, you touched on one, which is the second biggest, which is colonoscopy cumulatively. But the biggest single study, over a hundred thousand women in Sweden, had either the doctors, the radiologists with AI interpret the mammograms, or doctors without the AI randomized. And what was amazing, of course, is that there was this 20-some percent better detection of important cancers, with the doctors who had the AI. So you would say now, in addition to other studies, that why are we doing mammograms in women without AI? Because now that's missing, one out of five. That's a lot of potential cancers.

0:19:03.9 ET: And we've known for years that mammography has lots of inaccuracies with false positives and false negatives. So there we're seeing, that should probably be universally adopted. The problem in the United States, is that the company, the big radiology company that's got scans all over the country, they're charging the women extra if they wanna have the AI reading, $35 or something like that. That's crazy. That should be part of a normal, and someday I guess it will. But we're in a transition zone right now.

0:19:37.1 SC: We are. Are the AIs that are being used are like off the shelf, GPT kind of things? Or do you need like A specially tuned medical AI?

0:19:45.9 ET: Yeah. These are commercially available software packages that have been FDA approved now, the ones that are here in the U.S, particularly one that RadNet uses is different than the one that was in the randomized trial in Sweden, but they're pretty similar. The point being is the good ones have all validated this 20% improvement of making the diagnosis. And so, for polyps, it's similar too. The gastroenterologists miss lots of polyps like about 20%. So the fact that AI can give us this boost of accuracy, who wants to go through a colonoscopy. [laughter] And have a tired gastroenterologist who's been working all day doing this stuff? Particularly that's when it happens, is later in the day, human eyes start to lose some of their... And who wants to go through all that and have a missed important Apollo.

0:20:43.0 SC: Yeah, I got that from your talk that you should always have your colonoscopy in the morning. The doctors are fresher. [laughter]

0:20:48.5 ET: I would. Plus it avoids you having a fast, after having gone through everything another day. So, yeah.

0:20:55.6 SC: And maybe other than diagnostics, are there other promising uses of AI?

0:21:01.2 ET: Yeah, I think it's across the board. It's just, you name it. There's, for years as a cardiologist, we had the electrocardiogram, had an overread or what do you call it, under read by the machine. And it was stupid. The readings were terrible. The error rate was really high. Well now, not only is the error rate really impressive low, impressively low, but also what we're seeing is making diagnoses that the cardiologist might not have come up with accurately. So for example, it can say, there's a low ejection fraction and say what? And in fact, Mayo Clinic has already made that routine for all of their ECG AI interpretation. But also things like, there's a risk of developing atrial fibrillation, even though there's no atrial fibrillation in this person.

0:21:58.5 SC: Okay.

0:22:00.3 ET: And there's a risk of stroke or this or that, kind of like the retina. So not only have we got rid of the error rate, that was kind of a major deal, but we're getting all this opportunistic readings that we never had before. Just a pretty... Again, I just don't see, don't expect this kind of thing. And it's just happening.

0:22:23.3 SC: And how prevalent is it right now, for these kinds of things. Is it yet to ask special and pay or is it already there?

0:22:30.8 ET: The ECG is not anywhere else that I know of yet, except for Mayo Clinic. I hope it will be universally used, because it's a sense, Sean, that we're just leaving all this stuff on the table that all these extra bonus interpretations that could be useful for a patient, they should be of no charge, it's there, it's in the data. It just we need the AI to extract it.

0:23:00.2 SC: Well tell me, as someone who's been around for a while, do you get the feeling that practicing clinical doctors are open to these kinds of changes in general? Or are they looking to be on the cutting edge or is it that they have a way that works and are kind of happy with that?

0:23:14.3 ET: Well, the older ones like me, are usually not too receptive. Younger digital docs, they kind of grew up in this environment, they're apt to be a little more willing. But overall, there's not an embracement eager to adopt AI. And it's because of the other concerns like the what is this gonna do with errors, hallucinations and privacy and security and biases which we know exist? There's many things that are deterrence. Perhaps the one that I think that doesn't get enough emphasis, is you really have to have compelling data to get the medical community to move. And the only compelling data we have, that when really compelling, is what we're seeing with the mammography colonoscopy perhaps. Certain things where it's just unequivocal benefit. But a lot of things that we're seeing evidence of, they're still looking for the proof points that are just so clear cut that it would be considered below the standard of care, which is kind of a bit nebulous term, but it's changed when the needle is moved, when the stuff, the data evidence is just overpowering.

0:24:35.3 SC: Well, it does seem to me like having better diagnoses of cancer or heart disease would help me live long, which provides a natural segue into our next big topic, which is your new book on aging. And again, let me just start at the very highest level, aging and especially extending human lifespans. This is a topic that gets a lot of talk. A lot of the talk is maybe not reliable. How do you feel wading into this area?

0:25:04.4 ET: Yeah, I felt, Sean, I had to wade in because of pseudoscience.

0:25:08.8 SC: Right.

0:25:09.1 ET: And the false claims are totally out of control. And basically it's kind of predatory. All these anti-aging supplements and stem cell clinics and peptides and you name it. It's just so much malarkey, so much hype of false you could say some of this is fraudulent. It's a shame. And it basically is playing into the interest that people not just wanna live longer, but live longer, healthier health span. And that's why I decided it was time for me to go deep on this, and write a book which is Super Agers, which is trying to set the record straight, to really put the excitement in context. And it isn't about reversing aging amazingly, it's about extending health span to quash age related diseases. So basically what this is doing, is taking the science of aging, which is formidable, big advances, and using that not to come up with some magical potion which doesn't exist for people, but rather to use those advances, so that we can take the big three, heart, cancer and neurodegenerative, mainly Alzheimer's. How we can apply these advances in science of aging to prevent these three major killers and major causes of losing one's health span.

0:26:44.5 SC: And just to be super clear, on the podcast, sometimes we talk about very science fictiony topics. So your focus is not on genetically engineering human beings so they live for 10,000 years. You're really thinking about, how we can just live a few more years in a more healthy way?

0:27:01.3 ET: Yeah, as I go through in the book, if you were to really work on this, you could eke out seven, perhaps even 10 years of health span. Health span meaning freedom from these three major diseases, age-related diseases. So yeah, that's exciting to me. It's not, we're not talking about a few weeks or months, we're talking about years. And the fact is that, we don't need a magic potion to do this. As we'll get into, we need lots of data on a person and we need AI, and we need to use the advances which are basically these clocks, molecular clocks. That's perhaps the biggest thing that's a shakeup in medicine that people don't realize right now. Biomarkers and clocks. And that's what's given us this newfound potential.

0:27:51.0 SC: Well, let's get into that right away. Where does human lifespan come from? It seems clear from even the most obvious data that people tend to live a certain amount and if they don't have something terrible happen to them, then they're gonna die. It's not an exponential fall off. It's not like the same fraction of people die every day. Our biology gives out after a point. Probably we can guess at evolutionary explanations for that, but maybe give us a clue as to what's going on.

0:28:20.4 ET: Well, everybody used to think it was the genes, and that was deterministic, and that turns out to be completely wrong. While it may be an issue in a very limited number of people, it's not really about our genes. And so, a lot of this is, it turns out it's a multidimensional, complex story about why we don't just have this, what's called compression of morbidity, where you live perfectly healthy and then you just fall off a cliff. That's just, it doesn't work that way. The way it works is, at some point, you're gonna start to see some frailty, some decline in capabilities, like whether it's cognitive or other. And so, the point being is, how can we extend that intactness, lack of this compromise or frailty. And so, what is the determinant of that? Well, we studied 1400 people, who we call the wellderly. And they had been over 85 and never been sick. They had none of these diseases. And what was interesting, we sequenced all their genomes, whole genomes. We found almost nothing from that. That is the genes worse than the story. And the protagonist patient of mine in the book, Mrs. LR, she's 98 and she has never been sick. I saw her for a trivial thing, as as a patient. But what's fascinating is, all her relatives, her brothers and sisters, her parents, they all died in their 60s, 50s.

[laughter]

0:30:07.0 ET: She's 98. Okay? So that's basically the story. It's not the gene. So like for me, I have terrible family history. But when I, as the more I've learned about this, the less worried I've been about the most of us have this overhang throughout our lives. Oh, my father had this, my mother had that, whatever. We don't need to succumb to those thoughts because there's so much we can do now, to find out our risk, individual at the individual level. And that's what's a sharp contrast to the way we used to think about this in the past.

0:30:42.3 SC: So specifically in this study, you had these people who were living long and they were healthy and I presume that you were hoping to see, oh, they all share this gene, or at least many of them do, but in fact, essentially no connection whatsoever?

0:30:56.3 ET: Just about no connection. Certainly nothing that had a lot of weight. So we were surprised. We were very disappointed at the time. But now in context, it's starting to come together, that we have to have a rethink about the gene story, because it just doesn't really click. There may be something to it, if you're over 110, there's not too many people.

[laughter]

0:31:22.9 SC: I'll get to that point. Yeah.

0:31:24.9 ET: They're called super centenarians, but there's so few of those, and even that's questionable.

0:31:31.2 SC: But is there something to the idea that once we're past our reproductive age, evolution is done with us and it sort of lets us decay?

0:31:40.3 ET: Yeah, we're in steady decay mode, sadly.

0:31:43.2 SC: Yeah.

0:31:43.9 ET: So what happens is, for these three diseases in particular, it takes 20 years for them to take hold, incubate if you will. So you don't have a heart attack without having your arteries getting clogged up with atherosclerosis for two decades or more. Cancer, you don't just all of a sudden show up with pancreatic cancer. This has been developing over more than two decades. These clones and their ability to eventually proliferate and spread throughout the body. And the same thing is for Alzheimer's. We now know it's 20, 30 years. You could predict ahead of time, if that is gonna be a risk. So these processes of our deterioration, the good thing is, they're really slow. It gives us a great opportunity to get ahead of them. Imagine if they took place over months or a year and then of course we wouldn't have that anticipatory runway to work with. So we're really lucky in that respect. And it's that combination of these long lag time periods and the tools that we have today that's making this exciting opportunity going forward.

0:32:53.8 SC: So you mentioned the big three. Let's dig into them a little bit more. Probably, if you ask people on the street, what are the three big diseases that will and your life, they probably would have come pretty close to saying like cancer, heart disease, brain diseases, are they related? Are they all completely different causes? What do we know about why these things start kicking in at a certain age?

0:33:15.8 ET: Great question. There is a common thread besides the fact that they each take 20 plus years. And the threat is the immune system and inflammation. So our immune cells can secrete all these, what's called cytokines, chemokines that are inflammatory mediators. And so, what's the problem with the three diseases, is that they all have a marked untoward inflammation. So inflammation in our artery wall or in our brain or the immune system not responding to the appearance of a tumor cell or tumor clone. So our immune system is the real problem for the three diseases. And that's one of the big deficiencies we have right now. We don't have a way like you can go to the lab and get a blood count kind of thing. You can't get an assay to tell you, what is the status of your immune system. And we really desperately need that. That's like the next frontier. And people say the brain is really complex. Well, I got to tell you, the immune system is right up there. It's very, I have a whole chapter about that in the book. And what's exciting, of course there is we're learning about how to rev it up and tone it down, suppress it like never before. So if we can start to get a routine way, people can get their immune system and inflammation markers assessed, that's gonna give us even better ways to prevent these diseases.

0:34:54.6 SC: We did recently do a podcast with James Allison, about using the immune system to fight off cancer. So this fits in very well. But let's assume that some of our listeners didn't listen to that episode yet and maybe explain more the details about how our immune system is supposed to work when everything's going well?

0:35:12.2 ET: Well that breakthrough that Allison had for immunotherapy was just the beginning of now a chain of many discoveries. And the point is, is that it's pretty hard to get cancer spread around the body if your immune system is completely intact. Cancer tries to hijack cells and suppress your immune system, but it's hard to get it rooted if your immune system is really high integrity. But the other thing we've learned, is that as we keep adding more different ways of revving up the immune system in people with cancer that aren't responding to the current therapies, we keep getting more successful of getting cures. So it's almost like we can't do enough with personalized neoantigen vaccines and tumor infiltrating lymphocytes and conjugate drugs. All these things are basically trying to get the immune system to go into high power mode. And that's a big learning. And the point being is, if I could say, well, let's say you, Sean, you have this significant risk of cancer in your lifetime. What I'd be doing is, maybe every year assessing your immune system and when it was showing signs of showing a bit of, we call immunosenescence aging, we would give you something like a vaccine like we were talking about at the shingles type vaccine. But we might give you a vaccine just to give you a higher gear of your immune system so that you are in defense mode.

0:36:51.0 SC: Yeah.

0:36:51.4 ET: And of course, we don't wanna go too exuberant 'cause we don't want you to go into self attack mode either and develop an autoimmune component at all. But that's where this is the cancer story that's unraveled since the great work of Allison and others, is really built on the fact that it's really an immune system defect that's allowing cancer to take hold and spread in our body. And we have got to prevail over cancer. This is a fundamental goal. We've been talking about this moonshot for years, for decades, but now there's a way to see through it.

0:37:35.0 SC: So tell me more about the cellular biology here. I understand that there's like T cells involved. [laughter] What is supposed to be happening in my bloodstream when my immune system is going great guns?

0:37:47.2 ET: Well, there's a lot of different components. The B cells that are known, of course they're making the antibodies, and the T cells that are kind of a primary way that we can kill cells that are troublesome, that are foreign, have foreign proteins on their surface. And of course there's so many other aspects. There's interferons and there's regular neutrophil white cells and there's natural killer cells and there's all this. It's a big system. But it comes down to when you're trying to deal with cancer, as an example, you really wanna have the ability to recognize these foreign antigens on surface of cells or cancer cells. And that's where the T cells really kick in. And so, what you can do now, which is really quite extraordinary, we're seeing like we've never seen before, small numbers of patients. But refractory cancer, they failed every therapy. Kidney cancer, pancreatic cancer. They had the kitchen sink of everything we got, and they couldn't respond. And then they got a so called neoantigen personalized vaccine for their cancer. That is, they were the cancer cells. They looked at these antigens taken out of the body, and then engineered T cells to fight them for that person's specific cancer.

0:39:16.3 ET: And guess what happened? That was melted away. Just now, the problem of course, it's not something that you could scale in millions of people who have cancer each year around the world. But on the other hand, if we can get off the shelf ways to do this, that's where the prospects lie today, is that we don't wanna have to necessarily make T cells that are individualized, but rather, if we can come up with the common antigens or proteins that are responsible, that can stimulate our immune system. That's what we want to do.

0:39:54.1 SC: And well, I don't know. Can we imagine some combination of AI and DNA robots and I don't know, that will sort of fix up our immune system in a kind of bespoke way for whatever it is that we're most in danger of?

0:40:11.2 ET: I wouldn't rule it out. It's certainly possible. I like your thinking.

[laughter]

0:40:16.4 ET: It's futuristic and...

0:40:18.9 SC: I'm very futuristic, yeah.

0:40:19.2 ET: Starting to bring in all this stuff together. I'm more kind of looking at the here and now potential, but you're right. Already AI is being used to determine the matchup of a person's antigens of their tumor cells and the T cells. We're already starting to rely on AI because in any given cancer, there's hundreds and hundreds of these particular proteins. And so, the finding, the ones that are to develop a vaccine against, is you can't do it against hundreds. You got to pick the most important ones. And AI is helping to do that.

0:40:56.9 SC: Okay, good. And I think I do see what we're talking about here vis-a-vis cancer, especially 'cause we did talk to Jim Allison before. So what's the analogous story for cardiovascular disease neurodegeneration?

0:41:12.1 ET: Yeah. So the Alzheimer's story is a lot of people don't realize this, how extraordinary change there is. So there's a blood Biomarker called P-tau217, and there's a couple others like it. And basically what they are is as good as a PET scan for the brain. Okay. So you just have simple blood test, it's available. It tells you your risk of Alzheimer's. And by the way, if that marker is high, abnormal, and you get another one in six months or a year, then you can say exactly when you might get mild cognitive deficit. So it stages the disease, no less makes the diagnosis of risk. Now, and get so, it used to be we have a genetic test and we'd say, oh, well, you have a higher risk of Alzheimer's. And we didn't know if it was at age 98 or 68. Now we know, very precise. Timing, not just the extent of the risk. Now, what's amazing here is that, you can do all these things that reduce inflammation in the brain, which we didn't know before. So for example, diet and exercise. The right kind of diet and the right kind of exercise can really help reduce inflammation in the body and the brain. Lifestyle factors.

0:42:35.2 SC: Okay.

0:42:35.8 ET: But also, what's really intriguing right now, is these GLP-1 drugs like Ozempic and Mounjaro, they reduce inflammation in the brain. It's one of the most important ways that they work. So that they're being tested now to reduce Alzheimer's in big trials that are due out in less than a year. So there are other ways to reduce inflammation. The point being is that, you might have some amyloid plaque in your brain, but if you are, if your brain is reacting to it and it's inflamed, that's the ticket to developing Alzheimer's. So knowing your risk and getting all over it with the lifestyle of preventable factors and likely drugs in the future, not the kind of drugs we have right now that are used for people who already have Alzheimer's, that are dangerous drugs and don't work very well. But this is the ability to prevent Alzheimer's in the future, which is really quite remarkable.

0:43:38.7 SC: I don't know a lot about Ozempic, the weight loss drug, or it's usually marketed as a weight loss drug, but I keep hearing how, oh, it has this extra unanticipated good side effect, which is kind of the opposite of what I'm used to hearing about all the deleterious side effects. Are we learning more about why this is so awesome? Does it have something to do with the immune system?

0:44:00.7 ET: Yeah. I think what's fascinating here, that if you take these drugs, so called GLP-1 drugs, they don't get into the brain very well. So people started to wonder, how do you see such great reduction of brain inflammation, no less? How do you see the reduction in appetite and desire for healthier foods and basically completely rewiring your reward circuits.

0:44:28.0 SC: Yeah.

0:44:28.4 ET: And it turns out, the gut-brain axis. So basically it's affecting the gut. There's a vagal nerve that connects the gut to the brain, and it's through this circuitry that basically, the brain is kind of the master regulator of our inflammation both in the brain and throughout the body, which we only learned about that in the last couple of years. We thought it was just the blood, but no, the brain's talking to the blood and the guts talking to the brain. And so, this is what is we're learning about these GLP-1 drugs that have had more impact across more diseases. Some of which have nothing to do with weight loss. The inflammation is reduced before anyone loses weight. Okay, so this is a whole new day for understanding these inter-organ connections.

0:45:25.6 SC: And okay, and then heart disease, this is your thing. It does sound different than the other two. Heart disease seems more sudden or maybe that's just my misimpression?

0:45:34.1 ET: Yeah, people think, oh, I had a heart attack and this was sudden. No, it's been brewing for at least 20 years. We have seen autopsies from 20 year olds, 30 year olds, that they already have plaque building up in their arteries, in the heart arteries, the so called coronaries. So no, this is something, the only sudden event is that finally there's a crack in the plaque.

[laughter]

0:46:00.5 ET: But that plaque has been growing and kind of inflamed. And here's another point, is that if it wasn't that the plaque got inflamed, we wouldn't have a heart attack. And that's in part why statins work. They not only lower the LDL, but they reduce inflammation. They're not as powerful as the GLP-1 drugs, but statins and anything that reduces your LDL cholesterol, will also reduce some inflammation for the arteries, 'cause those are a species of the fatty proteins in our blood that the artery does not like that having it in their wall, it just reacts to it. And so, years and years of accumulation of bathing your arteries and bad cholesterol. LDL and now there's another one that will become routinely measured and new drugs to fight against called LPa, which we never had anything for. But now we are seeing five different drugs that are emerging to tackle that one. So this is exciting too that we're coming up with new ways to prevent the toll of heart disease. People don't die of a plaque. They die of a heart attack or a stroke, for the arteries that go up into the brain.

0:47:17.6 SC: Sometimes informally, people talk about dying of old age. Is that a thing or is that just like a catch-all term for your immune system not doing what it's supposed to be doing?

0:47:28.8 ET: You don't die just of old age. You got to die of something. Because age itself isn't the killer. So there's got to be something else like explaining it. Could it be heart rhythm problem, could it be something that doesn't get diagnosed, an indolent infection many, many possible things, but you don't die just of old age.

0:47:53.3 SC: There is the idea that one's telomeres decay. As cells divide, our genetic code is sort of being eaten away from the ends. How relevant is that?

0:48:04.6 ET: Well, there's a lot of things happening as we age. Our telomeres, which the end of our chromosomes, they get shorter and shorter, but there isn't any good way of lengthening them or lengthening them safely because they are also connected to your propensity to develop cancer. You don't wanna muck around with them. And they're not nearly as good as the new clocks for telling you about your aging. So the new clocks, they include organ clocks. So what's amazing here is, I could get a tube of blood from you and I could check. It's kind of like going to your car for every system. It would tell me about your aging of your brain, your heart, your kidneys, your liver, your immune system, eight systems of your body from a tumor blood to say, is that organ in you, aging faster than your chronological age? You're actually.

0:49:03.3 SC: I see. Okay.

0:49:03.4 ET: And then I say, you know what Sean, I got to get all over this risk for your heart and I'm gonna check these other things. I'm gonna confirm that this is it. And now this is what we're gonna do for you. So you never, first of all, we're gonna slow your heart aging. We're gonna slow it. Here's how we're gonna slow it, and we're gonna measure it again, to prove that we slowed it. That's what's so different today. We didn't have organ clocks.

0:49:30.6 SC: Yeah.

0:49:30.9 ET: We didn't have epigenetic clocks that tell us our body wide aging relative to our actual aging. If we have all these ways to detect whether someone is not just the person, but the organ is off track. And this is the science of aging crystallized to make a difference.

0:49:54.6 SC: That's great. Yeah. And I do wanna get into sort of the nitty gritty of what an individual can do, to live longer and more healthy. But maybe we can sweep the deck of some of the crazier ideas out there first. If I got a blood transfusion from children's blood or something like that, would that clean out my system and help me live longer?

0:50:17.4 ET: Yeah. There's a lot of these things that are out there, certainly in mice and animals that if you take old, young blood plasma and put it in old, you can see some improvements and metrics. In people, it's never been established that it's safe or effective with any durable impact. And it's a very expensive procedure called plasmapheresis that these clinics, particularly out here in California.

0:50:49.1 SC: California. Exactly, yes.

0:50:50.6 ET: Which is horrible. [laughter] But they're around the country too. They're even in other countries. It's shameful, 'cause there's no data and very... This is not covered by any insurance. This is really expensive. And this is for the likes of these extremists like Bryan Johnson, the guy who had the Netflix special who takes hundreds of supplements a day and has a penile sensor and Naiden, this guy.

[laughter]

0:51:16.7 ET: And he had his blood transfused from his son.

0:51:20.9 SC: Yeah.

0:51:22.0 ET: This is crazy stuff. And he's kind of the one this "don't die" He's promoting this stuff and people believe it, which is a shame.

0:51:29.9 SC: When a 200 year old person starts promoting that, I'm gonna start believing them. But until then I'm gonna be skeptical. But I was shocked to learn recently that the supplement industry in the United States is several times larger than the entire prescription drug industry?

0:51:47.9 ET: That's a really sad fact. As far as I know it's true. And a lot of it, is anti-aging.

0:51:54.7 SC: Yeah.

0:51:55.1 ET: The other day I was in the airport in Oakland, and there was a vending machine of anti-aging supplements.

0:52:05.1 SC: Wow. [laughter]

0:52:06.3 ET: You said, "Wow" Wow. What are we doing here?

0:52:11.4 SC: Well, I happen to know that the anti-aging supplement industry is very fond of advertising on podcasts. So I don't do that. I don't actually, I turn those down. But...

0:52:23.2 ET: The sad truth about that, is that these longevity so called longevity doctors and scientists, they're the ones that are hawking the supplement. Horrible. None of them are proven and they're not have only lack of efficacy, but they're also questioning safety. And of course, they're a big dent in your finances. Everything bad about it. Everything.

[laughter]

0:52:44.9 SC: Okay, good. So you've gotten that off the deck a little bit. I guess there's things we can do individually and things we can do as a society. Let's talk about it as a society first. One cause of death is just a pandemic or an infectious disease or something like that. How good are we at? I Know this is a politically charged question right now, but how good are we these days at protecting against future pandemics?

0:53:12.4 ET: Not good. And the problem here is obviously we didn't do well for the COVID pandemic, but we haven't learned the lesson. So instead of taking advantage of things we learn, we're seeing gutting of our resources in the United States. Unbelievable take-downs of the programs at CDC, NIH, FDA, so this anti-vaccine, anti-science culture. So we're actually in much worse position than we were for COVID, because of this movement against science. And it's a shame because we learned a lot of what it takes to be ready. And now, even with threats that are out there, whether it's avian flu or others that we know are potential pandemic threats. There's reluctance, there's denialism to confront what we should be doing. And it's really sad.

0:54:19.9 SC: Do you find yourself personally involved in political discussions or strategic discussions, or is it something where all the scientists are already on one side? We sort of don't have to talk to them? [laughter]

0:54:31.5 ET: Yeah. No, and then the problem is that the people who are running the show now, you can't reason with them.

0:54:39.8 SC: Yeah.

0:54:40.6 ET: Because they were now empowered to take apart the systems that we had. And so, we're kind of in this auto destruct mode. And you're trying to, whether you're dealing with measles and you say you got to get everybody vaccinated and this is our best protection. And what you're hearing is, take cod liver oil and vitamin A.

0:55:02.3 SC: Vitamin A. Yes.

0:55:03.8 ET: You have children in the hospital because of liver toxicity. That has nothing, there's no data to support that for preventing measles, but there are data, obviously for the toxicity of taking these at high doses is really. This is a sad state. We're going backwards. It's almost like we're going in the dark ages here.

0:55:26.2 SC: Yeah, I figured that was true. I figured it was nevertheless important to get it on the record there. So thanks for that update. Let's instead ask questions about what you and I, can do a little bit. You have a really interesting section of the book where you talk about lifestyle plus, explain what that is.

0:55:44.6 ET: Yeah. So we used to think lifestyle was all about diet, exercise, and in more recent years, sleep health. Turns out that's missing about 10 other layers of lifestyle. They extend through things like ultra processed foods as a component of diet, no less, the protein component. And all the details of not just food but also beverages, alcohol and all that, caffeine. But then as you get into other layers, like exposure to air pollution, microplastics forever chemicals, social isolation, time in nature. It's a long list. Well, what we would consider lifestyle plus. You could say lifestyle, environmental, socioeconomic, all these other factors. But it's hard to, it's too many syllables and words.

[laughter]

0:56:43.0 ET: So I just call it plus.

0:56:46.8 SC: Okay, let's just... I know that some of these are kind of cliched and everyone is supposed to know them. What is a healthy diet and if for specifically aimed at the goal of being healthy and active for more years?

0:57:00.3 ET: Yeah, so this is really topical because very recently, there was a study, 30 years of follow up of over 105,000 people. And only 9% lived to age 70 without the chronic diseases we've been talking about, age-related chronic diseases, the big three. And so, they could zoom in on what did they eat, what were these 9% different than the rest of the folks. And what was fascinating is, it just confirmed everything we knew at this powerful study. Fruit, vegetables, the Mediterranean-like diet, reduction in red meat, animal fat, ultra-processed food. So it was confirming everything we've known, but now in a whole new study and it's called the Optimal Diet for Healthy Aging. So that's one thing.

0:58:00.1 ET: The other point about it is, we don't, as we get older, we don't wanna be light on our protein intake, but we don't wanna be too heavy either. You take too much protein, which you got to work at getting. But there's at least some people out there advocating these super high protein diets wrong. Because that promotes inflammation and promotes atherosclerosis. So you don't necessarily wanna be at the recommended dietary allowance of 0.8 grams per kilogram. You wanna be maybe around 1.2, but you sure don't wanna go to 2.0 or higher, which is what some of the people out there have been without data to preserve your muscle mass as you age.

0:58:46.0 ET: But then you go into other things like what type of exercise. Resistance training is really important. And it doesn't mean there's no such thing as 10,000 steps. It's like, no one ever. There's even less than that. Even weekend warrior exercise is great. And then sleep, the sleep thing is wild because, we used to always think that how many hours did you sleep? No, it's about how much deep sleep you got, which is reduced with aging. And also, people take drugs like Ambien, which backfires. They sleep, but turns out that sleep is how you get rid of all your toxic waste products in your brain that promote inflammation. So if you take Ambien, what's amazing is, you sleep more, but it blocks the efflux of these toxic chemicals from your brain. It's the worst thing you could do.

0:59:49.0 SC: I didn't know that.

0:59:51.2 ET: Probably extends to all the other drugs, because that's the only one that's been carefully studied.

0:59:55.9 SC: So I knew that sleep helped sort of rewire the connections in our brain a little bit, but I didn't know that it was literally cleaning out toxic chemicals.

1:00:05.3 ET: Cleaning out. That's what it's all about. And so, you don't get deep sleep. It's actually extraordinary. And there's interactions with our heart rhythm and the efflux of these waste. But drugs don't help at all. They seem to make things worse, especially the one that's most commonly used. So you can learn how do you get better deep sleep? You can, you get a smartwatch or a fitness band or the aura and other rings, and you can train yourself.

1:00:39.4 SC: Okay. So that's crucially important. So say more about that. 'Cause everyone says sleep is good, I like sleep. It sounds good to me. But this, the fact that the drugs are counterproductive and nevertheless, I can train myself in what sounds like a more natural way actually, and that the smart watches are actually helpful. That sounds important.

1:01:00.0 ET: Yeah, because turns out, if you start tracking it, like I've done, what you can see is, I had terrible amount of deep sleep. And of course it does reduce as you age and men are generally less than women. So I was kind of in a high risk group to start. But what was interesting is, by trying different things, I could see, oh wow, I'm getting more and more and more deep sleep. So, for example, I never was trying to go very precise about when I was gonna go to bed each night and try to get into as close to a ritual as possible. That makes a difference. Your clock, your biologic clock, other things like attending what exercise you're doing, what you're eating, how late in the day you're eating. And so, so many things interactions that you can start to see the pattern without AI and with AI, of course it even be better. We don't have that yet, but we will. Anyway, each person can learn about getting better deep sleep and it's really important.

1:02:09.3 SC: And I don't wanna skip over something you mentioned already, but it's worth emphasizing which is the ultra-processed foods. That's something that's hard to avoid in the United States of America in the year 2025.

1:02:22.3 ET: Hard to avoid, but easy to reduce.

1:02:24.8 SC: Okay. What counts as ultra-processed?

1:02:28.6 ET: Oh gosh. Anything that you don't have in your kitchen, that's normal ingredients for good home food. So you can tell pretty, you kind of do a smell test or a sight test. If you look at a package and you see lots of ingredients, that's a bad sign.

1:02:47.4 SC: Okay. [laughter]

1:02:49.4 ET: And there's different types of ultra-process bad things. There's some of these are emulsifiers like xanthan gum. But if you don't recognize this stuff, it's bad, it's bad. And again, it goes back to that theme we've been talking about, is promoting inflammation in our body, no less our brain and putting us at risk. It's like the opposite of what we've been talking about is increasing the risk of the big three age related diseases. Now the average American takes in 60% of their food is ultra-processed, which is the highest in the world.

1:03:25.6 SC: I'm sure.

1:03:26.8 ET: And a friend of mine who wrote a book, "Ultra-Processed People" Chris Van Tulleken, who's a UK physician scientist, he did a 30-day test of maximizing ultra-processed food intake and a brain scan before, and all these inflammation markers. And what happened was, he gained 20 pounds, he had big time inflammation in his brain in 30 days of this. And he had all these off the charts inflammation blood tests. So the point being is that, it makes you eat more, it creates much more inflammation. And if you just are careful about what the food that you intake and includes beverages that they have added stuff in them, particularly then you can reduce this. It's not hard to get it down to 20% or 30% instead of 60 or 70%. Kids eat, it gets up to 70% or 80% of their diet. Yeah.

[laughter]

1:04:30.3 SC: Do you have strong feelings about what are marketed as nutrition bars? These little bars that have everything good for you in them, but it seems like they're probably pretty processed?

1:04:39.3 ET: Most of them are horrible.

1:04:40.8 SC: Okay.

1:04:41.8 ET: Horrible. You look at them in the greens. The other day, person gave me one that I said, oh wow, this one's pretty good. It was just truly natural, nothing added. But you have to really read the labels and some of them that are widely used, marketed that you think, oh, these are great. Just be open minded 'cause you'll find that those labels are... The good thing is that labels exist.

1:05:07.8 SC: Yeah.

1:05:08.1 ET: And the bad thing is they got lots of ingredients that you don't recognize.

1:05:12.5 SC: Okay. [laughter] All right. Eat a carrot. I suppose, I guess I'm not gonna be surprised.

1:05:16.7 ET: Carrots are great.

1:05:17.6 SC: Yeah. [laughter]

1:05:22.5 ET: And fruits.

1:05:23.4 SC: Okay. Even though it is obvious, this is very, very good to be reminded. It's not obvious, but it should be well known that eating better, alcohol not actually good in anything other than the tiniest of doses. Right?

1:05:35.5 ET: Yeah, I think there's a lot of debate about that. The question is, what is a moderate dose? I recently had a patient and his wife are seeing them and just before we were wrapping up, the wife said to me, "Is it okay if he continues his moderate drinking?" And I said, well, what is the moderate drinking? And she said, "Well, he has two tequilas and six beers each night."

[laughter]

1:06:03.4 ET: I thought she was joking with me.

1:06:05.3 SC: Yeah.

1:06:06.7 ET: She was joking with me. Well...

1:06:09.1 SC: That's a lot.

1:06:09.5 ET: Yeah. So the question is, what is moderate? And if it's two drinks on each of a weekend day, because it's health, social interactions and it's enjoyable, there's probably little data to show that that's harmful.

1:06:25.5 SC: Sure. Okay.

1:06:26.2 ET: On the other hand, if you're drinking every day and you're having a fair amount of intake and usually it's more than people like to admit or think. Anyway that, when you start getting to high doses, as you pointed to, that's a problem.

1:06:43.6 SC: And I guess, the other thing, to sort of wrap things up, the other thing that struck me in the book, was your talk about mental health and social interactions. You have a very vivid graph that you reproduce that basically, if I read it correctly says, "After age 60, people are either alone or they're with their partner and they don't interact with other people that much." And that's a contributor.

1:07:07.8 ET: Absolutely. And it got worse during the pandemic. People just living in a cave, especially the older, the more likely. But it's still a big problem that antedated the pandemic. And this is really bad for your health. Really as it turns out, the connection of that, with bad outcomes is striking. So for mental health. But obviously, as you well know, everyone knows, there's a lot of interactions between our mental health, our stress, and our physical health. And for mental health, with the more social interaction, the less isolation, the aversion to loneliness, these are really important things to strive against. That again, going back to that feature patient of mine, she plays Rummikub for every week with eight of her friends.

1:08:04.5 SC: There you go.

1:08:05.5 ET: All in their 90s. And that's a good thing. And she frequently interacts with other people in her retirement community building. So these are things that are really much more, they seem like social science, but the data are striking, and so we really should pay attention to it.

1:08:25.4 SC: Is there any truth to the idea that if I solve puzzles, if I do the crossword puzzle, if I keep my brain active in that way, play video games, read novels, does that help at all with aging?

1:08:37.6 ET: Well, that's an interesting question. The studies are mixed. There's a new one coming out that says, the more you work as you get older with technology like iPads and computers, it's actually better, which is interesting.

1:08:53.7 SC: Okay. Good, I believe that.

1:08:56.6 ET: Brains, just like humans are meant to be interactive as we are really a social animal, even though people like to not be that way. The same thing is stimulating the brain has got to be good for you. Proving it, is tricky because we didn't have the right tests. For example, what I'd wanna know, is that biomarker we had for Alzheimer's, which is, can it be improved by exercise and diet? I wanna see that biomarker go down with this brain stimulation. But no studies like that have yet been done.

1:09:36.8 SC: Interesting. Okay. It seems like an obvious thing to do. Why haven't they done that one yet?

1:09:41.1 ET: Because these are new. We didn't have a brain organ clock, until the end of 2023.

1:09:48.0 SC: I see. Okay.

1:09:49.3 ET: So these are studies are gonna be. And then we can ice it, and we can say, hey, you know what? These things are really good for you. And the other thing, Sean, it might be really good for you, but not for another person.

1:10:00.3 SC: Of course, right.

1:10:01.8 ET: None of this stuff is all one size fits all. And we have to keep that in mind, too.

1:10:07.2 SC: And to bring it home, that's another place where AI might be useful. In personalizing your regimen, whether it's diet or exercise or mental activity.

1:10:17.2 ET: That's exactly right. So that we would know in general the things that would help. But then, by tracking these different metrics over time and people who are at high risk. The AI can say, "Well, this is what's working and this is what the gaps, and this is what's gonna change." I call it precision medical forecasting. You may know this, but AI is radically changed weather forecasting. It hasn't been implemented, but now you can have 99.99% accuracy in weather forecasting like we never had before. Most of the time, it seems like the weather forecasting is pretty far off, but that's gonna be changed quickly because, multiple groups have shown that now with these large language models, multimodal data, you can get such remarkably accurate weather forecasting. Well, we're about to do that for people, for their health. And that to me, is even more important than the weather.

1:11:17.0 SC: Recognizing patterns, that's what they're very, very good at. And I'm sure, so we can finally all agree that listening to the right podcasts is probably the best thing that can help you live healthier, longer life, right?

1:11:28.8 ET: You got it. No, this has got to be the one. This is definitely stimulating the mind. So let's do it.

1:11:34.0 SC: That's all we can ask for. Eric Topol, thanks so much for being on the Mindscape Podcast.

1:11:37.5 ET: Thanks for having me, Sean.

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