Jonathan Reisman: The Human Body - From Sex & Sperm to Hands & Heart

00:00:00.000 | We have two tubes that are right next to each other in the throat.

00:00:03.040 | One is for food, drink, saliva, mucus, snot, whatever you're going to swallow.

00:00:08.240 | All of that stuff must go down the esophagus, the food tube, and end up in

00:00:11.680 | the stomach. And right next to the esophagus,

00:00:14.160 | millimeters away, is the windpipe or the trachea, which goes

00:00:17.920 | down to the lungs. Throat, heart, feces, genitals. Every organ

00:00:22.560 | from moment to moment keeps us alive and ensures our survival. The genitals are

00:00:26.880 | in a way the opposite. How would you improve the penis and the vagina?

00:00:33.120 | The following is a conversation with Jonathan Reisman, a physician

00:00:37.280 | and writer of The Unseen Body, a doctor's journey through the

00:00:41.600 | hidden wonders of human anatomy. He has practiced medicine

00:00:45.760 | in some of the world's most remote places, including

00:00:48.720 | the Alaskan and Russian Arctic, Antarctica,

00:00:52.800 | and the Himalayan mountains of Nepal. This is the Lex Friedman podcast. To

00:00:58.800 | support it, please check out our sponsors in the

00:01:01.200 | description. And now, dear friends, here's Jonathan Reisman.

00:01:05.600 | You wrote a book called Unseen Body, all about the human body, the messy, the

00:01:11.680 | weird, the beautiful, and the fascinating details. So, from an

00:01:16.720 | evolutionary perspective, are most parts of the human body a

00:01:19.840 | feature or a bug? Is it like the optimal solution or just a

00:01:24.640 | duct tape solution? Great question. I think that most of the

00:01:28.960 | time, the way the body works is the best solution. I haven't seen many

00:01:33.280 | alternatives, so it's hard to compare. But I think, you know, there's some

00:01:37.440 | parts of the body that make more sense than others. You know, the way our hands

00:01:41.520 | work, for instance. You know, the muscles are up in the

00:01:44.720 | forearm and then the tendons kind of come down like

00:01:47.360 | strings on a puppet. And just the dexterity it gives our hands is just

00:01:50.960 | really amazing, and it's hard to imagine a

00:01:53.680 | better tool than the human hand to do everything from, you know, hold

00:01:57.600 | things to play piano and do a million other daily

00:02:01.280 | activities that we do. One thing I talk about in the book,

00:02:04.960 | there's some other body parts that seem to be lacking that kind of brilliant

00:02:08.960 | design, such as the throat, you know, where the

00:02:12.880 | food, drink are swallowed and air is inhaled, and they

00:02:16.560 | kind of, those two paths come within millimeters of each other.

00:02:19.680 | And you slip up once, you laugh while eating, or you

00:02:23.280 | speak while trying to swallow, and you die from choking. So it

00:02:27.040 | seems less than optimal, though I'm not sure it could be better from

00:02:30.400 | the way we're kind of formed in the womb, as a

00:02:33.600 | beginning as this tiny little tube. I don't think it could have been done any

00:02:37.280 | better or there's any other way to do it, but it is an unfortunate thing that,

00:02:41.040 | you know, does lead to some problems. So the hand, if I could just

00:02:44.480 | linger on that for a second, you talk about the wisdom of a design

00:02:49.440 | in the book. What are the important things about the hand? It seems like very

00:02:53.680 | useful for many things, and it seems to be quite effective.

00:02:57.280 | A lot of people think the thumb is foundational

00:03:00.960 | to human civilization. Is there any truth to that?

00:03:07.040 | I think that is true. Actually, one of the ways in which the importance of

00:03:10.240 | individual fingers comes to attention is when people have

00:03:14.080 | severe injuries to their fingers. For instance,

00:03:17.120 | I have a story in the book about a guy whose thumb is nearly ripped off

00:03:21.120 | by his dog's leash. And, you know, when plastic surgeons, who are often the

00:03:26.640 | ones to repair that--sometimes it's orthopedic surgeons--

00:03:29.600 | they will debate, you know, how important is it to save this finger, or how

00:03:34.320 | important is it to save, you know, let's say the kind of tip,

00:03:38.240 | the one-third, the tip one-third of one of your fingers. You know, it depends on

00:03:41.920 | the length that you'll lose, it depends on which finger.

00:03:44.640 | And so the thumb really is the most crucial,

00:03:47.840 | just, you know, for your occupation in most cases to

00:03:51.360 | just daily life and your ability to get around, take care of yourself and others.

00:03:55.200 | So, you know, they'll be more--they're

00:03:57.680 | willing to go further, do more surgeries, more aggressive therapy

00:04:01.280 | to save a thumb, let's say, than, you know, the tip of your pinky finger. So in that

00:04:05.760 | way, I do think the thumb, you know, does seem

00:04:08.160 | like the most important in many ways. It's nice that there's backups. I wonder

00:04:11.600 | if that's part of the feature, or is it just the symmetry that nature

00:04:14.880 | produces? You think the two hands is like--is it

00:04:18.960 | about the symmetry, or is it about backup? We'd be much less

00:04:22.560 | formidable hunters, gatherers, survivors in any way

00:04:27.840 | if we only had one hand. So I think that is important to have two, so we can,

00:04:32.800 | you know, even everything from kind of spearing an animal, to firing a bow and

00:04:36.560 | arrow, to butchering an animal, you really need two hands to do it very effectively.

00:04:40.160 | But can you do a better job with three? Great question, and we'll never know,

00:04:45.520 | perhaps. You tweeted--now I'm gonna analyze your

00:04:50.960 | tweets, like it's Shakespeare sometimes. You tweeted that, quote, "Millions of years

00:04:56.080 | of sex and death design the human body." It's like poetry.

00:05:01.520 | Are those two basic activities basically summarize everything that

00:05:07.200 | resulted in humans on earth? So is that a good summary of

00:05:12.400 | the evolutionary process that led to this conscious, intelligent being?

00:05:16.400 | Is death and sex? In a way, yeah. So sex is how more of us get made,

00:05:22.560 | obviously, and death is how we get weeded out, or the gene pool gets

00:05:27.200 | weeded out, and certain genes survive and others don't. And

00:05:30.640 | you know, the age at which we die, whether it's before we've,

00:05:35.120 | you know, had sex and reproduced ourselves, is a big factor in who

00:05:38.960 | survives, who doesn't, who passes on their genes, and what the future

00:05:42.640 | of the body looks like. You know, who lived and who died

00:05:46.320 | before they were able to be at reproductive age a million years ago

00:05:49.920 | was pretty important in what we look like now, and perhaps

00:05:54.160 | how we have sex and die now will determine what we're shaped like,

00:05:58.080 | unless technology has an even bigger role in that, you know, a million years

00:06:01.040 | from now. So you think that's fundamental to, like, if there's

00:06:03.680 | alien civilizations out there that have the same order of magnitude of

00:06:07.760 | intelligence or greater, do you think that we will see something

00:06:11.360 | like sex and something like death? So the reproducing and this

00:06:17.040 | selection process, plus the weeding out of the old to make room for the new?

00:06:23.120 | Is that kind of foundational to life? I would think so. I mean, it sure seems to

00:06:27.200 | be on Earth, you know, perhaps in some distant future when

00:06:30.800 | medicine is nearing, you know, perfection and people can live a really long time,

00:06:36.400 | maybe we won't even need to reproduce as much,

00:06:39.760 | or something like that, you know, it's hard to even know what

00:06:42.800 | life will be like in the distant future, but I would guess that any alien

00:06:46.320 | civilization will have the same dependence on

00:06:48.560 | who has sex and who dies. Well, that's the problem with immortality, how are we

00:06:52.160 | going to clear out the old to make room for the new, which is

00:06:57.840 | kind of a framework of adaptability to changing environments.

00:07:04.400 | So as long as the environment is changing, and it seems to always be,

00:07:08.960 | because this the entirety of the Earth system is a complex system,

00:07:12.800 | it seems like you have to adapt, and to adapt you have to kill off the stubborn

00:07:16.560 | old ideas, and unless there's a way to like not

00:07:22.400 | become stubborn and old, but it feels like the nature of wisdom

00:07:27.280 | is stubborn and old, like that's what wisdom is, it's like the

00:07:32.640 | lessons of life, the lessons of experience solidified,

00:07:37.200 | and the solidification is the thing that actually prevents you

00:07:41.120 | from reinventing yourself to adapt to the new

00:07:46.080 | changing conditions. But then again, why not have that both those modes, like have

00:07:50.160 | two minds in one person, one immortal person that like in the

00:07:54.240 | morning they act like a teenager, in the evening they act like an old wise

00:07:58.720 | man, that's possible. So you see you can imagine

00:08:02.320 | within one mind both modes, but those are required, you have to

00:08:08.800 | have the ability to completely reinvent

00:08:12.880 | yourself, which is what death does in an ugly way,

00:08:18.480 | or a beautiful way, depending on your perspective, depending whether you take

00:08:21.520 | the human perspective or the human, the nature's perspective, and then you

00:08:25.360 | have to have the selection, so competition, so sexual selection.

00:08:30.400 | It's an interesting little planet we got. What's the weirdest part,

00:08:34.800 | function, concept, idea about the human body to you? We'll talk about

00:08:39.680 | fascinating details, but what's, you, I should say for people that should

00:08:45.360 | read your book, they will come face to face with the fact that you do not shy

00:08:49.680 | away from the weird and the wonderful of the

00:08:52.640 | human body. It's like, it's fun, but it's honest.

00:08:58.480 | So given that, sorry to make you pick one of your children, but

00:09:03.600 | what's the weirdest one, would you say? The weirdest body part.

00:09:09.040 | Or concept, or function. So the chapters you divide up kind of

00:09:14.560 | into parts, but there could be a thread that

00:09:18.480 | connects all of them, the weirdness, maybe, or maybe the the texture of the

00:09:23.120 | substance, could be the liquids, the solids, I don't know.

00:09:26.880 | Definitely every body part and bodily fluid has their own

00:09:30.240 | kind of both gross and fascinating aspects. That's

00:09:33.520 | probably why I'm a generalist as a doctor and couldn't just,

00:09:37.040 | as you said, pick one of my children, become a specialist, because I like them

00:09:40.480 | all. I feel like one of the strangest

00:09:44.320 | concepts about the human body is that kind of the aspects of it that are the

00:09:49.440 | most universal, that we all do, are the most taboo

00:09:52.880 | socially. I wouldn't have expected that if I had,

00:09:56.080 | you know, just looked from the outside. Like what we do in the bathroom, what we

00:09:59.440 | do in the bedroom, what we do to our own genitals, what we do

00:10:04.080 | to our, you know, quote-unquote private parts,

00:10:06.800 | they're private, even though it's sort of the thing that we have all have in

00:10:10.320 | common, is the most we try to hide from other

00:10:13.120 | people and don't talk about in polite company.

00:10:15.360 | I mean, it makes sense as a human living in the society, but from the outside it

00:10:18.560 | sort of might be surprising. -How do you make sense of that if you put

00:10:21.440 | on your Sigmund Freud hat? The thing we all do, why do we make that

00:10:27.360 | a taboo thing? Is it because we like taboos?

00:10:30.720 | Maybe we get off, or maybe our kinks as humans is to have taboos,

00:10:37.120 | and it's kind of efficient to have taboos about the things that everybody

00:10:40.560 | does. Like you could make walking taboo or

00:10:44.400 | something, I don't know. But just maybe that's what we love, that's

00:10:48.480 | what's exciting to us, is the forbidden. -I think, yes, society

00:10:53.280 | loves rules for sure. They love some societies more than

00:10:57.440 | others, you know. They love controlling how you think and what you do

00:11:01.120 | in public versus in private. You know, there's a lot of societies where,

00:11:04.640 | for instance, parents have sex in front of children.

00:11:08.160 | For instance, in a traditional Inupiat Eskimo

00:11:12.080 | society, that was sort of normal. But what are you going to do, go

00:11:15.680 | outside in the middle of the winter in the Arctic and do it out there? Of

00:11:18.720 | course not. So there's different

00:11:21.600 | taboos in different societies. Some taboos make perfect sense.

00:11:25.200 | Some taboos are even public health measures, you know. Like

00:11:29.280 | as I talk in the book about in India where

00:11:33.200 | the hands are symmetric, as you said, but in Indian culture

00:11:37.040 | the left hand is taboo and the right hand is what you use for

00:11:40.400 | shaking hands, for eating, for other things. And the left hand is

00:11:44.720 | the dirty hand that you use for wiping your own bottom, you know, that's the

00:11:47.920 | toilet paper is your left hand. So while the body is anatomically

00:11:52.000 | symmetric, the taboo creates this pretty intense asymmetry. But for a good

00:11:56.800 | reason, you know, you probably shouldn't be shaking hands with other people

00:11:59.760 | with the same hand that you use to kind of clean your bottom. So in that sense,

00:12:03.520 | it makes sense. Yeah, maybe the roots of it make sense,

00:12:07.200 | but the way it propagates, especially as the times change, might not

00:12:11.520 | because you can wash your hands. But the

00:12:14.880 | taboo remains. Right, society is very slow to change.

00:12:18.960 | What is the most fascinating part, function, or concept in the human body?

00:12:23.760 | So, you know, something that fills you with awe.

00:12:30.240 | I guess the most obvious one is the brain, partly because it's so,

00:12:34.400 | you know, sort of poorly understood, though we

00:12:37.760 | understand more than we ever have in the past. There's still so much that we don't

00:12:40.880 | understand about how the lump of matter in our skulls

00:12:44.480 | kind of creates this subjective experience that we all

00:12:47.280 | kind of understand quite viscerally. That's an easy one. I would say the

00:12:52.160 | kidneys are an underappreciated organ. The way they tinker with the

00:12:57.200 | bloodstream, raise levels of this, lower levels of

00:13:00.560 | that, kind of our entire lives from inside the womb until we die is just

00:13:05.920 | really incredible. And when you look at how much

00:13:08.640 | energy different organs consume, the brain and the kidneys are

00:13:12.160 | two of the biggest ones, because the brain obviously in us is always active

00:13:16.480 | and controlling parts of the body, but the kidneys are just

00:13:19.600 | consuming a ton of energy to do what they do. They're kind of the unsung hero

00:13:23.120 | of the body, relegated to the back of the abdomen, like

00:13:26.160 | some forgotten organ, but they are great. I did consider being a

00:13:29.120 | nephrologist, which is a kidney specialist, because I was so

00:13:32.000 | taken with the kidneys, but, you know, decided I like all the organs, so

00:13:35.280 | couldn't pick just one. So your book is ordered in a particular

00:13:39.840 | way. It's throat, heart, feces, genitals,

00:13:44.080 | liver, pineal gland, brain, skin, urine,

00:13:50.000 | fat, lungs, eyes, mucus, fingers and toes, and blood.

00:13:57.120 | All right. First of all, great, great chapter titles. Is there a reason

00:14:03.760 | for this ordering, or is it all madness? There's a few different reasons that

00:14:07.760 | went into it. I did want to start with the throat for

00:14:12.880 | the reason that it kind of presents the topic of death, which is sort of

00:14:19.200 | obviously very important in the training of a physician, in the career of a

00:14:22.560 | physician. It's a big part of what I deal with.

00:14:25.200 | You know, on the first day of medical school, we started the dissection of a

00:14:29.440 | cadaver in the class called anatomy lab, and so

00:14:32.240 | in a way, we were kind of thrown right in there in the beginning,

00:14:35.520 | like, this is the end of the human story, you know,

00:14:38.720 | understand this, and then we sort of backed up to the beginning with

00:14:41.360 | embryology and reproduction and stuff. So it's kind of like we got, and I got

00:14:45.600 | thrown into that right away, right in the beginning, kind

00:14:48.880 | of like, here's a dead body, now start cutting it apart and learn the

00:14:52.000 | name and function of absolutely every bit of flesh.

00:14:54.800 | How did that change you, that first experience with the cold honesty of

00:15:00.320 | human biology? Right, that's exactly what it was, this

00:15:02.960 | cold honesty about the kind of the story of each individual human body. It has an

00:15:07.120 | end, and that's it. I think that, well,

00:15:10.960 | actually before the end of that first day, so what we did on that first day was

00:15:14.400 | study the superficial muscles of the back, like the lats or latissimus dorsi

00:15:18.240 | and some other muscles, you know, we cut through the skin of the back, my

00:15:21.360 | cadaver was laying face down on this metal gurney,

00:15:23.840 | we pulled back the kind of plastic sheets that would keep him moist for the

00:15:27.440 | next four months as we dissected him, cut through the skin on his back, and

00:15:31.040 | then started dissecting through the superficial muscles of the back,

00:15:34.000 | and that was really all we saw that first day. We didn't get any deeper,

00:15:37.440 | didn't enter the abdominal or chest cavity to see internal organs, but

00:15:41.760 | I was so fascinated with this sort of behind-the-scenes look at how

00:15:46.400 | things work in the body, how you move your arms, how you arch your back,

00:15:50.240 | you know, these are the muscles that do it, that I decided I wanted to donate my

00:15:54.240 | own body for the same purpose. So I made that decision literally before

00:15:58.160 | the end of that first day of class, and I'm still sticking to it.

00:16:02.800 | So someday there will be a medical student that can

00:16:06.320 | watch and listen to this podcast while dissecting your body.

00:16:11.360 | It could happen. They might not know that that person they're listening to on the

00:16:14.560 | podcast will be the carcass in front of them,

00:16:17.120 | but we never learned anything. The universe will know.

00:16:20.000 | The universe will know. And they will acknowledge the irony or the humor,

00:16:24.640 | the absurdity of that. The universe will chuckle, but the medical student won't

00:16:28.880 | know because they never, as I did not, learn

00:16:32.080 | any personal information about the person,

00:16:35.600 | only what I could glean from looking inside him, which actually tells you

00:16:38.400 | quite a bit. I knew he was a smoker, I knew he had coronary artery disease,

00:16:41.760 | you know, you get a window into--I knew he was overweight--you

00:16:44.960 | get a window into people's lives just by looking in their

00:16:48.080 | bodies after death. Other

00:16:51.520 | cadavers in the lab, not my own, or I shared one with three other students, but

00:16:55.920 | other cadavers, some had, you know, metal joints like a knee

00:16:59.200 | replacement, some had a kidney missing, so

00:17:02.000 | they probably--and we could tell it was surgically removed, not that he was born

00:17:05.440 | with one, and we could tell that he probably had a

00:17:08.240 | kidney tumor or cancer that was removed. So

00:17:10.400 | you do get an insight into people's lives from,

00:17:13.680 | you know, picking them apart after they're dead, but you don't know their

00:17:16.560 | name or what podcast they've been on. So as the book title says, "Unseen Body,"

00:17:23.680 | so it tells some kind of story of your life.

00:17:27.680 | So it does capture the decisions you've made in your life, the things you've done

00:17:32.320 | that might be kind of secret to that person and maybe to a few

00:17:38.400 | others that knew him or her well. It's so fascinating. So

00:17:43.440 | what kind of things can it reveal? Like, what kind of choices in terms of

00:17:48.000 | the injuries, the catastrophic events, the

00:17:54.800 | lifestyle choices of smoking and diet and all those kinds of things, what

00:17:58.960 | can you see? What kind of history can you see about the human

00:18:02.080 | before you? So all those things you mentioned are things you can see.

00:18:05.760 | You can, you know, take the skin for example, right? Most things that happen to

00:18:09.360 | us leave a mark, you know, as I say, a kind

00:18:12.800 | of a story written in the language of scar,

00:18:15.280 | where it tells you injuries you've had. And same thing with animals, you know, I've

00:18:18.960 | seen deer hides that have marks that look like they're made by

00:18:22.320 | maybe a barbed wire fence, something like that. You can tell,

00:18:25.600 | you know, sometimes it's conjecture, but you can sort of imagine what might

00:18:29.280 | have happened to cause that. Perhaps, you know,

00:18:31.520 | two bucks were fighting and one got injured with an antler.

00:18:34.640 | And the same with humans, you know, I have scars on my body and when I

00:18:38.560 | notice them I remember what happened. You know, I got a big cut on my hand when I

00:18:42.800 | was 13 and it's still there and I remember what

00:18:46.640 | happened, you know, every time I look at it. And so in that way,

00:18:51.280 | only I might know that story, but other people, you know, when they dissect me and

00:18:54.800 | notice the same scars, they can kind of, it can fire their imagination as my

00:18:58.320 | cadaver, you know, did for me. They know that there is a story

00:19:01.920 | there. That's such an interesting way that the skin does tell a story,

00:19:06.960 | both tattoos and scars. Right. Some of the fun you've had and some

00:19:12.400 | of the damage you've done. Right. And even when I evaluate a

00:19:16.240 | patient, I can use scars to help me make medical

00:19:19.840 | decisions. So for instance, someone that comes in with abdominal pain into the

00:19:22.960 | emergency room, you can see scars on their abdomen that

00:19:26.080 | tell you about, you know, the past kind of activities of a surgeon,

00:19:29.680 | perhaps. I know, I recognize the scars that are

00:19:32.960 | left when someone has their gallbladder removed, the scars when someone has their

00:19:36.160 | appendix removed, when maybe when someone's had a hysterectomy,

00:19:38.800 | and that can tell you what it might be or what it isn't. You

00:19:42.320 | know, if someone doesn't have an appendix, their abdominal pain is not

00:19:44.800 | appendicitis, end of story. So in that way, I'm sort of looking at

00:19:49.200 | these, the tracks or the footprints of past

00:19:51.920 | surgeries to tell me what might and might not be the cause of this

00:19:55.360 | patient's abdominal pain, which is kind of my main job

00:19:57.600 | in the ER is figuring out what's causing it and to help them.

00:20:01.600 | Is there ways to get more data about the human body as we look into the future

00:20:07.040 | of medicine, biology, that would be helpful to fill in some of the gaps of

00:20:11.200 | the story? So, you know, you have

00:20:16.320 | companies, you have research that looks at, you know, a collection of blood over

00:20:22.400 | long periods of time to see, sort of, you know, paint a picture of what's

00:20:26.800 | happening in your body, mostly to help with lifestyle decisions,

00:20:29.840 | but also just, you know, to anticipate things that can go

00:20:33.760 | wrong and all that kind of stuff. Is there, can you just speak to a greater

00:20:39.120 | digital world that we're stepping in, how that can help

00:20:42.560 | tell a richer story? I certainly think that we

00:20:47.520 | have more data than we know what to do with right now, especially with

00:20:51.600 | kind of direct-to-consumer medical devices, you know, smart watches, etc.,

00:20:55.760 | that are just collecting these reams of data. I have

00:20:59.040 | not seen them put to, I think, the eventual use that

00:21:02.560 | they will. I think that the potential is, sort of,

00:21:07.120 | just, you know, unimaginable, and I hope we're

00:21:10.320 | heading into a new age where, you know, you can determine,

00:21:13.440 | for instance, is a person going to have more of the dangerous side effects to a

00:21:17.200 | drug based on their genetics, or are they going to tolerate one drug

00:21:21.360 | better than the other, you know, based on their genetics? And

00:21:25.200 | we are slowly moving into that age, and especially

00:21:28.480 | the age of kind of completely synthesizing drugs

00:21:31.600 | in a lab, you know, much like, for instance, some of the COVID

00:21:37.120 | vaccines, actually, like Moderna never had a virus in their lab.

00:21:41.040 | They made that vaccine completely without ever having the virus themselves, just by

00:21:44.320 | having the genome, which is sort of astounding, and there's a lot of

00:21:47.680 | potential going forward, you know, based on that technology and some others.

00:21:51.040 | I didn't know that. So they, basically, it's all in the computer. It's

00:21:54.000 | computational. Right, you have the genetic code, you have tremendous power, even if

00:21:57.760 | you don't have the organism itself. What do you make of Elizabeth Holmes and

00:22:03.680 | efforts like that? First of all, I am a

00:22:09.840 | curious, I'm drawn to the darkness in human nature, because

00:22:16.480 | that somehow reveals the full spectrum of what humans

00:22:21.920 | could be. So there's a lot of sort of controversial

00:22:25.120 | thoughts about who she is and her efforts and so on. I

00:22:28.800 | think you may have even tweeted about it, but I've read a lot of your tweets, so

00:22:32.160 | I'm now forgetting. But what do you make of her and those,

00:22:35.840 | both those efforts and the charlatans that

00:22:41.600 | sort of snake oil salesmen that promised those efforts to do more

00:22:49.040 | than they currently can? I think that her, you know, that goal

00:22:54.080 | that she had, that she created Theranos to try to achieve,

00:22:57.920 | to use less blood in tests, is a very worthy goal

00:23:01.440 | and a huge frontier that we have not achieved, and that I hope

00:23:05.440 | we will achieve. So I understand why, you know,

00:23:09.120 | someone describes what a huge step forward that would be, and it would be

00:23:12.720 | indeed. I understand why people put a ton of money behind it.

00:23:15.520 | Can you describe what was the promise? What are we even talking about with

00:23:19.520 | Theranos, just for people who don't know?

00:23:22.160 | So Theranos is a company that was basically started to

00:23:26.000 | revolutionize the way medical blood tests are done,

00:23:29.680 | both to use a whole lot less blood in doing it, you know, if anyone's ever been

00:23:34.080 | to the doctor and had five to ten tubes of blood removed from

00:23:37.360 | them, it can be quite surprising how much they take out.

00:23:41.120 | And it's, you know, that's the limitation of our technology, that we

00:23:45.200 | need those volumes of blood to run all the tests that we want to. And so the

00:23:48.160 | promise of Theranos was that perhaps with a single drop of blood we

00:23:51.840 | would be able to know as much about the person's, the

00:23:55.040 | condition of their body, without drawing all that blood. And

00:23:58.800 | thereby, you know, there would be these devices she was

00:24:01.760 | going to create that would sort of do it. You put a drop of blood in and spits out

00:24:05.280 | everything you ever wanted to know about what's in your bloodstream, and

00:24:08.000 | in a way that would make it so much easier, you know, it could be, you could

00:24:10.800 | have one in your home, theoretically, and you, I don't know why you'd wonder what

00:24:14.320 | your potassium level is on any given day, but you could check if you wanted to.

00:24:18.400 | And so that goal is very worthy, you know, I put that goal up there

00:24:22.960 | with the frontier of making painkillers that

00:24:26.560 | are as good as opioids without the addictive quality, you know, that would be

00:24:29.520 | such a huge revolution if we did have that in medicine.

00:24:32.000 | But, and particularly for me, because I trained in both pediatrics and internal

00:24:36.800 | medicine, so I learned to care for both children and

00:24:39.440 | adults, in children we do draw much less blood, they have a much lower blood

00:24:43.280 | volume, and we use these tiny little tubes to draw their blood,

00:24:47.200 | and we seemingly get equivalent information out of the larger tubes we

00:24:50.960 | draw from adults, and I'm still unclear, to be honest, why

00:24:53.680 | we can't draw that little amount of blood from adults.

00:24:56.240 | It seems technically possible, I don't know what the barriers are, I'm sure

00:24:59.600 | there are, or else we'd be doing it, but I do think that that is a very

00:25:03.840 | important goal, and if Theranos had done it, they would

00:25:06.160 | have really revolutionized the practice of medicine.

00:25:08.880 | - So to return to that cadaver, that first day

00:25:15.680 | when you got to meet with a dead, with a

00:25:19.520 | human body that's no longer living, so how quickly

00:25:24.880 | did it take for you to get used to sort of, you said, looking at the surface

00:25:29.040 | muscles of the back, I mean, that can be overwhelming as a

00:25:34.480 | thought, and people listening to this that have never

00:25:36.720 | dissected anything might be overwhelmed by that thought, so like,

00:25:40.800 | how quickly were you able to get used to

00:25:44.640 | the brutal honesty of the biology before you?

00:25:48.400 | - For me, it did not take long at all. I guess I've never been a squeamish

00:25:52.480 | person, so for me, it was kind of riveting and fascinating right from the first

00:25:56.480 | moment, but I do know some of my fellow classmates did have some

00:26:00.800 | trouble with it. Some of them I heard had nightmares in the

00:26:04.720 | first few weeks of anatomy lab, but then everyone, as far as I know,

00:26:09.520 | got used to it, and that was also actually a big lesson

00:26:13.040 | for me, that it's pretty amazing what people can get used to in their daily

00:26:16.240 | lives, and I kind of extrapolated that to people living through war and through,

00:26:20.560 | you know, just terrible situations and living under, you know,

00:26:25.280 | oppressive regimes, and it really is amazing what

00:26:28.400 | people can get used to, almost anything. - But you know, in war,

00:26:33.440 | people often come back and they have nightmares,

00:26:37.120 | they suffer through it, there's PTSD, there's a lot of complicated

00:26:41.120 | feelings with that. Are echoes of those same complicated

00:26:45.600 | feelings possible in the case of training to be and

00:26:49.680 | becoming a doctor? - It's a good point, yeah. I think, you

00:26:53.200 | know, sometimes, just as, you know, a barbed wire fence can

00:26:56.320 | leave a scar on your skin, you know, emotional, psychological

00:27:00.320 | experiences can leave a mark on your brain or your memory, and I

00:27:04.160 | think that that definitely could be,

00:27:08.640 | could be a problem in medical training. You do see a lot of things that are

00:27:13.200 | very shocking, very repulsive, things that you never forget. I know one of those

00:27:18.000 | students that had nightmares initially went on to be a surgeon,

00:27:21.360 | so I imagine she's not having the PTSD of kind of seeing inside her first dead

00:27:25.280 | body, because she sees inside them all day,

00:27:27.360 | every day now, but I'm sure it could. You know, we go on to see so many

00:27:32.880 | kind of grosser or more shocking things in medical training through medical

00:27:37.600 | school, and then by working with actual living patients, not just dead and

00:27:41.680 | embalmed bodies. So I do think that things can leave a

00:27:46.080 | mark, but I don't think that initial cadaver

00:27:48.880 | would be the most traumatic. - Yeah, but maybe some of that trauma,

00:27:54.560 | the demons make you a better surgeon, just like

00:27:58.320 | some of your own psychological trauma might make you a better psychiatrist.

00:28:03.040 | Returning to the ordering, is it order or is it chaos, the ordering

00:28:08.480 | of the chapters from throat and heart and feces and

00:28:13.200 | genitals all the way to fingers and toes and blood?

00:28:16.640 | - So I did mention that, you know, throat was the first one, because I kind of

00:28:20.000 | wanted to throw the reader right into the brutal

00:28:22.960 | honesty of death, and I followed it up with feces as the

00:28:26.400 | third chapter, and in a way partly to also throw them right into the deep

00:28:31.200 | end of how I like discussing parts of the body

00:28:34.640 | and revealing their gross and fascinating aspects. So I didn't want to

00:28:38.720 | hide anything. You know, when you train to be a doctor, everything is

00:28:42.160 | on the table, literally, in the cadaver lab, but also just,

00:28:45.520 | you know, you deal with blood and piss and vomit and feces, and that's kind of

00:28:49.680 | the medium of your craft. - Yes, the medium of the craft, that's right.

00:28:54.720 | Like if you're a painter, this is the paint.

00:28:59.200 | - Exactly. - And then you have to create a masterpiece with it.

00:29:03.680 | Like almost like a dance, because there's multiple painters. One of the painters

00:29:07.600 | is the biology. So let's return to throat. You mentioned

00:29:10.800 | it's a weird one. So first of all, a friend of mine said, "I just see humans

00:29:16.480 | as a bunch of holes that just walk around."

00:29:23.200 | - Not untrue. - It's a funny way to look at humans.

00:29:27.280 | So we have ears, we have nose, we have mouth,

00:29:31.680 | we have the sexual holes, vagina, penis, and then, you know, what's the

00:29:39.760 | medical term for your asshole? - Anus. - Anus, thank you.

00:29:45.360 | - This is a very technical discussion. - The rectums further in, don't confuse the

00:29:49.040 | two. - Oh, that's very important. Is there a

00:29:51.840 | difference between throat and mouth? By the way, so when you say throat, are

00:29:56.080 | we talking about when that hole actually becomes tubular?

00:30:00.720 | - The throat I would count as just sort of the very back of the,

00:30:04.800 | you know, the back of the mouth, where the nose also comes down and meets it,

00:30:08.400 | where the tonsils are and the uvula. But you're right that, you know, we are a

00:30:12.560 | bunch of holes, but more accurately, we're a tube, right? We start in the womb as

00:30:16.560 | kind of this microscopic little disc, almost like a,

00:30:20.880 | you know, a flatbread, and then we roll in almost like a burrito into this

00:30:25.280 | tube. And we're a simple microscopic tube, and

00:30:27.680 | from there we grow into this bigger and bigger tube, and we

00:30:30.400 | become more complicated. And each end of the tube does split into

00:30:34.320 | various holes. So all the holes you mentioned at the front end of the tube,

00:30:37.040 | the front end of our body, right? It splits into the nose,

00:30:39.920 | the mouth, the ears, the sinuses, the tube to the lungs, which is the windpipe,

00:30:45.920 | the tube down to the stomach, which is the esophagus.

00:30:48.640 | And then the other end of the tube splits as well. You know, men end up with

00:30:52.720 | two holes, and women end up with three holes. You

00:30:56.480 | know, the urethra, the vagina, and the anus, and men just, you know, the urethra

00:31:00.480 | and kind of the reproductive system, they share a hole.

00:31:03.280 | - I'm learning a lot today. It really is incredible that you start

00:31:08.480 | from sperm and an egg, and you have some DNA information,

00:31:12.240 | and from that, the building project begins.

00:31:15.440 | And then what that leads to is like a pizza dough, and then you roll

00:31:21.680 | it into a tube, and that tube then

00:31:27.280 | eventually sort of becomes more and more complicated, and gets eyes and a brain,

00:31:34.640 | and then can create a Twitter account. So from, it's really incredible

00:31:41.440 | that we're just a fancy tube. - Right, we are. And we sprout eyes and a

00:31:46.480 | brain, and a sense of smell and taste, pretty much to regulate what comes in

00:31:50.640 | the front of the tube. You know, we don't want to eat anything

00:31:53.600 | dangerous or poisonous. You know, we want to choose what we eat,

00:31:57.280 | even choose who we kiss. - Well, we seem to be motivated by what comes out of the

00:32:01.200 | tube as well, in part. That's not just output. It's a

00:32:05.840 | feedback mechanism, seemingly. Like, we're also monitoring the

00:32:09.360 | functioning of the output. We're not just obsessed about the input.

00:32:14.080 | - We're very obsessed with the output. You're absolutely right about that.

00:32:17.760 | People, you know, have medical complaints about their output very often that are,

00:32:22.560 | you know, I never cease to be surprised by a new kind of complaint

00:32:26.160 | or observation about the output. - I think people have gone to wars over

00:32:31.120 | the output, and maybe sometimes the lack of the output, or the desire for output

00:32:36.560 | for the particular other humans that you fancy. The brain and the eyes

00:32:42.960 | that sprouted somehow convinced the rest of the body that this one

00:32:48.640 | particular other tube is fanciful, so you're going to go to major

00:32:52.960 | wars and lead global suffering because of the fancy

00:32:57.360 | and the desire for additional output with the other

00:33:00.880 | tube. Okay, so that's, so on the throat, that part of the tube,

00:33:09.360 | is it, you said the design is not, you could have thought of maybe a little

00:33:14.640 | bit better options because it's too multifunctional. Is that,

00:33:19.360 | can you sort of elaborate on the multifunctional nature

00:33:22.480 | of this part? Are a lot of parts of the human body multifunctional,

00:33:26.240 | or do you find that more specialization is going to get the job done better?

00:33:32.160 | - There is a lot of organs, for instance, do have multiple functions, you know, the

00:33:35.840 | pancreas is, has two, it's like two organs in one. One, you

00:33:40.000 | know, secretes hormones like insulin into the bloodstream, and the other aspect of

00:33:43.520 | it secretes digestive enzymes into the gut to help

00:33:47.040 | you digest and absorb food. The liver is like 15 organs in one, it's

00:33:51.120 | just amazing how many different things it does.

00:33:53.760 | But the throat, you know, so basically the problem with the throat is, as I said,

00:33:58.800 | we have two tubes that are right next to each other in the throat. One is for food,

00:34:03.120 | drink, saliva, mucus, snot, whatever you're going to swallow,

00:34:07.040 | all of that stuff must go down the esophagus, the food tube, and end up in

00:34:10.480 | the stomach. And right next to the esophagus,

00:34:12.960 | millimeters away, is the windpipe, or the trachea, which

00:34:16.480 | goes down to the lungs. And your throat does these daily

00:34:20.720 | gymnastics to keep everything but air out of the

00:34:25.600 | windpipe, because, you know, you slip up once and you can

00:34:29.040 | die. You can choke, you know, you laugh or speak while eating,

00:34:32.720 | and it's curtains, unfortunately. So it seems like, you know, every aspect of the

00:34:36.960 | body, when I was learning about it in med school, seems so

00:34:39.760 | brilliant and so perfectly designed by evolution, or

00:34:43.920 | whoever you might think designed it, to, you know,

00:34:47.440 | favor survival, to enhance life. But the throat seemed the opposite. It

00:34:53.680 | seemed set up almost for failure. And, you know, we developed all these

00:34:58.400 | mechanisms as a compensation, right? We have the gag reflex whenever

00:35:02.560 | food or something is headed towards your

00:35:05.600 | airpipe, your windpipe, or down to your lungs, your throat has this sort of, like,

00:35:09.600 | rejection of it, it pushes it away in a gag reflex.

00:35:13.040 | At the same time, we have a cough, which is something our body does when

00:35:16.560 | something inappropriate does get down the windpipe, you know, when we

00:35:19.600 | get a little food down the wrong pipe, we end up coughing, and the coughing does

00:35:24.720 | usually flush it out and get rid of it. We even have something called the mucus

00:35:28.960 | elevator in our lungs, which is this constant

00:35:32.480 | flow of mucus up the airways, up to the trachea,

00:35:35.760 | dragging with it all kinds of particulates that we've inhaled, and

00:35:39.040 | perhaps some food that went down the wrong pipe, and drags it up into the

00:35:42.400 | throat, and we swallow it kind of unconsciously all day, every day,

00:35:46.080 | is the truth. Even the mechanism of swallowing is super complicated,

00:35:49.760 | you know, it uses a number of cranial nerves, it uses over 15 different

00:35:53.840 | muscles, it's this coordinated act to

00:35:57.680 | keep food out of the airway, you know, you can see someone's Adam's apple in their

00:36:02.080 | neck kind of jump upward when they swallow,

00:36:05.040 | which helps lift the airway up against this kind of, the epiglottis,

00:36:09.120 | which plugs it closed and allows food or swallowed drink to kind of skirt

00:36:14.160 | just past it. But every time we swallow, those things do come within millimeters

00:36:18.400 | of going down the wrong pipe, and it's just thanks to these kind of

00:36:21.360 | compensations, these adaptations we have to the danger of the throat that

00:36:25.040 | keeps us alive. As I actually took a sip of water, it's

00:36:30.400 | kind of, it makes you appreciate the wonderful

00:36:34.720 | machinery of it all. By the way, we have pulled up your

00:36:38.640 | Instagram that people should follow. You have a post about the throat,

00:36:44.080 | and just showing so many different components from the tongue

00:36:49.040 | to the trachea, the esophagus, just the entire machinery of it all.

00:36:56.320 | The teeth for the chewing, it's so interesting. And so a lot of

00:37:01.680 | the structure of this, the anatomy and the physiology,

00:37:05.360 | does it echo other mammals? Are we just basically borrowing a lot of

00:37:10.960 | stuff from evolution and maybe making small adjustments, maybe due to

00:37:15.280 | the fact that we're not using our mouth to murder things as other predators

00:37:21.040 | might? We use our thumbs? -Exactly, we have hands. We don't need

00:37:25.200 | to bite them. Yeah, there's a lot of overlap between

00:37:28.960 | different animals, which I find very comforting and fascinating.

00:37:32.560 | You know, someone asked me, "Is there any animal in which the throat is better

00:37:36.000 | designed?" And my first thought was whales, because the blowhole's kind of

00:37:39.520 | up on the top of their heads. I was thinking, "Oh, maybe

00:37:42.240 | they are more separate." But when I looked into it, actually, no.

00:37:45.760 | You know, the paths do come very close, just like in us. And

00:37:49.920 | I saw a paper about some new discovered organ that actually helps

00:37:54.080 | keep food and drink out of the airway in whales that they hadn't ever noticed

00:37:57.680 | before. So it's a different mechanism, but the same

00:38:00.480 | kind of basic problem is that, you know, we're tubes, and the air tube

00:38:04.400 | and food tube are right next to each other.

00:38:06.400 | -How well do we understand, so just even link your hand, this little part,

00:38:10.240 | is there still mysteries about the complexity of the system? Because you

00:38:13.920 | mentioned, just even for swallowing, all these parts

00:38:16.800 | in the brain that are responsible and all the different things that have to,

00:38:20.480 | like an orchestra, play together. Do we have a

00:38:23.600 | good sense from both a medical perspective and a biology perspective,

00:38:27.600 | or is there still mysteries? -There's definitely still mysteries. We understand

00:38:30.960 | a lot about, for instance, how the swallowing

00:38:33.120 | mechanism, you know, is coordinated in the brainstem, sometimes using

00:38:37.760 | some higher levels of the brain. But it is a very thoughtless thing, as

00:38:42.080 | you mentioned when you drank the water. You know, it's not something we have to

00:38:44.720 | think about, thankfully, or we'd be thinking about it all day.

00:38:48.880 | There's a lot we don't understand about the basic mechanisms, perhaps about

00:38:52.240 | how the nerves fire and how they kind of, you know,

00:38:56.080 | coordinate on the microscopic level, how ions rush into and out of

00:39:00.400 | nerve cells to kind of create that electrical signal. But

00:39:03.840 | we sure understand a heck of a lot, and it's very fascinating.

00:39:07.840 | -So, moving on to chapter two, we'll jump around.

00:39:11.680 | And you actually said the liver does a lot of things. I also saw you

00:39:18.160 | retweet something where it said, you know, showing that the

00:39:23.920 | liver is bigger than the heart, which is the body or the universe's way

00:39:27.920 | of saying you should drink more and care less.

00:39:30.960 | It's a good line. So you give props, like you said, to the kidney, to the

00:39:37.680 | liver, to the organs, to the parts that don't often

00:39:43.120 | get as much credit as they deserve. But let us go for a time

00:39:46.960 | to the human heart. We get chest pain. We talk about it when we talk about

00:39:54.240 | love, for some reason. Why do we talk about the heart when we

00:39:57.440 | talk about love? -There sometimes can actually be some chest pain involved in

00:40:01.440 | love. I remember when I was a med student,

00:40:03.600 | I was very smitten with another medical student who was totally brilliant and

00:40:07.840 | beautiful. And it actually does cause this kind of

00:40:11.040 | burning in your chest. I don't know what that is.

00:40:13.760 | I don't think it's from the heart itself. I don't know if it was like acid reflux

00:40:17.520 | because I was so nervous. I'm not really sure.

00:40:19.840 | But I definitely felt something in my chest whenever I saw her.

00:40:23.600 | I don't know what that is. But you could see why someone might think, oh, you know,

00:40:27.120 | maybe it is your heart. That's kind of the most prominent organ

00:40:29.600 | in your chest. When people come to the ER with chest pain, you know, the big

00:40:32.480 | question is, is it my heart? And that's my main job, is figuring out if it is or

00:40:35.760 | not. So I could see why. You know, the way

00:40:39.680 | ancients saw the functions of different organs is fascinating, but often

00:40:44.560 | hard to explain. -Would it be fair to say that if you look at the entirety of

00:40:49.680 | human history, the way most people die has to do with the

00:40:54.160 | heart? -Well, like in America today, cardiovascular

00:40:58.800 | disease and coronary artery disease is one of the

00:41:01.760 | most common, perhaps the most common cause of death.

00:41:04.640 | You know, 100 years ago, 200 years ago, it was probably not. People were not

00:41:08.880 | living as long and people were dying of infections that we tend to

00:41:12.320 | die less of these days. -Sure. That's true. But

00:41:15.840 | in terms of things to stab, so I'm trying to sort of

00:41:20.160 | introspect, like, why talk about the heart and love?

00:41:25.520 | My thought would be that is because the heart was seen as the most important

00:41:31.040 | organism. It would be like the origin of life comes from the heart.

00:41:35.600 | The originator of life and the way you figure that out from sort of an ancient

00:41:39.280 | perspective is when you stab things,

00:41:43.760 | what is likely to lead to issues. It's like,

00:41:46.960 | it's possible to imagine that the brain is not as special as we might think

00:41:50.960 | from when you don't understand modern biology

00:41:54.560 | or physiology or neuroscience, all those kinds of things.

00:41:58.560 | Especially because pain, you know, it's painless too.

00:42:02.400 | If you stab it, the brain, I mean. -Yeah. -Yeah, anyway, so that's really

00:42:09.440 | interesting. I'm sure there's a kind of a poetic answer to maybe

00:42:13.600 | the way people wrote about it, but what to you is the wisdom in the

00:42:18.640 | design of the heart? -I mean, the main function of the heart

00:42:21.920 | basically is to push blood through the cardiovascular system, through the

00:42:25.520 | branching blood vessels to feed every cell in the

00:42:29.680 | body. You know, when I believe our ancestors

00:42:32.720 | started off as single-celled organisms floating in some ancient brew,

00:42:37.280 | and they were surrounded by the medium that would bring them all the nutrients

00:42:40.480 | they needed, so there's no issues there. And then once you start getting

00:42:43.520 | multicellular organisms that are thicker and the ones on the

00:42:47.200 | inside aren't in contact with that sort of nutritious brew that they're

00:42:50.800 | growing in, you kind of need a way to distribute

00:42:53.680 | those nutrients to every cell. And so that's what the heart and the

00:42:56.720 | branching vascular tree do. So the heart, you know, it's the most, the

00:43:01.440 | biggest disconnect between how the organs talked about in poetry and

00:43:04.560 | through history versus its actual function is probably the

00:43:07.440 | heart, because we ascribe all these things like love and passion

00:43:11.040 | and life itself sometimes to the heart. But actually it's just a simple

00:43:14.480 | mechanical pump, you know, that's all it is. I don't want

00:43:17.360 | to downplay it, it's amazing. But, you know, it just pushes. It fills the

00:43:21.280 | blood and then squeezes it, fills the blood and squeezes it, and just that

00:43:23.920 | squeezing, that pushing creates the blood pressure that you need to get

00:43:27.920 | blood to every cell in your body, especially when you're standing upright

00:43:31.040 | to get blood to your brain, you need a certain amount of pressure to

00:43:34.080 | get it up there. -Isn't it amazing to you how much volume

00:43:38.640 | of blood just gets pushed through by this pump?

00:43:42.000 | -Absolutely. They say every red blood cell takes about five minutes to

00:43:46.320 | circulate and come back to the heart. And that circulation kind of, you

00:43:50.160 | know, starts in the womb and continues and kind of until the moment that we

00:43:54.240 | die. But the volume is tremendous and it can never, you know, take a break

00:43:59.200 | basically. -And it's sort of propagating all kinds of stuff throughout the

00:44:04.080 | body. It's a delivery mechanism, blood for all kinds of good stuff and bad

00:44:09.120 | stuff. Nutrition, drugs, all that. -Right, medications too. -Medications.

00:44:17.360 | Such a fascinating design. -And it also takes the waste away, you know, it

00:44:21.280 | kind of brings the nutritious stuff, brings the nutrients, especially oxygen

00:44:24.400 | but many other things. And then it also, as it passes the cell, takes the

00:44:28.160 | cell's waste. So it's sort of the fresh water and the sewage system in

00:44:32.720 | one. -So about blood, what to you is fascinating about blood? So we talk

00:44:39.520 | about the pump that spreads the blood, but the blood itself? -Right, so the

00:44:43.520 | blood itself is sort of, I mean, it's the most important bodily fluid of

00:44:46.800 | course. You know, from moment to moment every cell in the body needs a flow

00:44:51.200 | of blood to bring it, most importantly oxygen, but also again all the other

00:44:56.400 | nutrients and to take away waste. And if that stops for even a few moments,

00:45:00.080 | you can be in big trouble. So blood is sort of, you know, the most important

00:45:05.280 | medium. It's also, doctors use it to kind of evaluate the body. It does have this

00:45:09.840 | kind of all-seeing quality to it where, you know, we can evaluate organs

00:45:16.000 | through the blood. I can tell you about your liver, your heart, your kidney just

00:45:18.960 | by taking a sample of your blood. So it's sort of like this crystal ball in a way

00:45:23.680 | and we use it kind of all the time, you know, to assess someone's health, to

00:45:26.960 | assess their disease. -Is it also the attack vector for diseases, for bacteria,

00:45:35.440 | for viruses and all that kind of stuff? So viruses seem to attack either the

00:45:39.680 | throat, maybe you can correct me, but they seem to attack different parts of the

00:45:42.880 | body depending on how easy it is to access and how easy it is to get in deep

00:45:50.400 | depending on what you prefer. If you want to do a little bit of hard work but you

00:45:54.480 | get in deep or you don't want to do the hard work but you don't get in deep,

00:45:59.680 | those are the choices viruses have. But is blood one of the sort of attack

00:46:03.760 | vectors? What's like, if you were trying to break into the human body, like a

00:46:08.640 | parasite, a virus, a bacteria, how would you do it? Like what would you, what would

00:46:13.840 | be the attack vectors you would explore? -Right, so you got to look for the body's

00:46:17.440 | weaknesses of course. You know, we have inherent weaknesses, for instance, like

00:46:21.760 | our respiratory tract. We have to breathe, we have to get air in from the outside,

00:46:26.400 | and so that's one of the entries into the body. And so, you know, when we inhale,

00:46:30.320 | let's say a poisonous gas, you know, it's an easy way in. You have to breathe,

00:46:34.080 | you can't hold your breath very long, but you know, air in our lungs is still kind

00:46:38.720 | of contiguous with the external atmosphere. It's not really inside the

00:46:42.320 | body until it does cross across the lining of the alveoli into the blood, as

00:46:47.440 | you said. That's when it really gets inside. And the other, besides the

00:46:50.640 | respiratory tract, the gastrointestinal tract is another way,

00:46:53.840 | kind of a chink in the armor. You know, we have to eat, we have to drink,

00:46:57.360 | and therefore we're taking the external world into ourselves, into our gut,

00:47:01.200 | in order to extract from it what we need and let the rest kind of flow out.

00:47:05.280 | So those two, the gastrointestinal and respiratory tract, you know, there's a

00:47:08.400 | reason that, you know, respiratory tract infections

00:47:11.200 | and gastrointestinal infections are kind of the most common that

00:47:14.480 | afflict us, because those are the ways in to the body. So I would definitely pick

00:47:18.560 | one of those. Not just be a lazy cold in the nose, but

00:47:22.160 | really a more aggressive pneumonia down deep in the lungs and get across that

00:47:25.600 | barrier into the blood. But also the whole sex thing

00:47:30.640 | that humans do. So speaking of which, let us go

00:47:34.720 | for time to the genitals chapter. So what are genitals? I think I've heard

00:47:41.760 | of those. I think I've read about a penis and a

00:47:45.120 | vagina. Can you explain to me how those work? Just asking for a

00:47:49.680 | friend. But also, what do you use fascinating about it?

00:47:54.160 | And maybe what's misunderstood or little known about them?

00:48:00.080 | Sure. So they're very unique organs, I would say.

00:48:03.280 | One of the things that I like to point out is that, you know, while every organ

00:48:07.360 | from moment to moment keeps us alive and ensures our survival, the genitals are

00:48:11.600 | in a way the opposite. We don't need them from moment to moment. You

00:48:15.680 | don't even have to use them at all. And in fact, they often make us do stupid

00:48:19.600 | things that are the opposite of enhancing survival.

00:48:23.840 | And they've affected the brain, and you can become sort of focused and

00:48:28.480 | nuts based on those desires that kind of stem from the genitals. So

00:48:32.240 | they can be dangerous organs too. But you know, I mean,

00:48:35.600 | sexual dimorphism helps with genetic variability,

00:48:39.120 | as it does in so many other organisms. You know, you take two people and mix

00:48:42.880 | them together, their genetics, you just get a lot more variation

00:48:46.000 | and more opportunities to try different genetic codes and see what will

00:48:51.040 | enhance survival, as we talked about sex and death.

00:48:54.160 | I talk about in the book a lot of, for instance, the female genital tract,

00:48:57.680 | how the uterus is very unusual because, you know, it doesn't even sort of wake up

00:49:02.640 | and start doing its thing until the second decade of life.

00:49:05.360 | You know, it's even though babies, female babies are born with all of the

00:49:11.680 | eggs they'll ever have in their ovaries already, they're just sort of

00:49:14.960 | in this stasis until they start waking up kind of once a month.

00:49:18.800 | And it's this cycle, you know, there's so much in our bodies that are cyclical

00:49:22.320 | and rhythmic, the heartbeat, the breathing. But menstruation is kind of a very

00:49:27.360 | strange rhythm that takes over a decade to start, and

00:49:31.840 | only, you know, the rhythm beats once a month, which is very slow compared to

00:49:35.680 | every other rhythm of the body. The other unusual thing is, you know, in

00:49:39.520 | medicine, when rhythms of the body cease, when they stop,

00:49:43.120 | those are emergencies, right? When your heart stops, that's a cardiac arrest,

00:49:46.880 | you need CPR, maybe an electric shock to restart it.

00:49:50.000 | When your breathing stops, you know, you need a breathing machine to breathe for

00:49:53.440 | you or something to reverse whatever might be causing the suppression of your

00:49:56.800 | breathing. But when menstruation stops, it's the

00:50:00.480 | point of menstruation in the first place. The whole reason that the uterus grows a

00:50:05.760 | lining and sheds it each month is to one day, you know, get the ovum to

00:50:10.960 | get fertilized and for it to implant in the lining,

00:50:13.280 | and then the rhythm ceases. And that's obviously not a medical emergency, unlike

00:50:16.960 | most other rhythms, you know, cessations. It's the point of the whole thing in the

00:50:20.640 | first place. So these particular penis and vagina are

00:50:24.880 | that whole thing, the uterus, whatever. Am I not using the wrong terms?

00:50:28.800 | I don't know. I'll just keep saying... You use those terms.

00:50:32.080 | There's more technical, there's parts, various, various parts.

00:50:35.200 | In medical school you learn every bump and, you know,

00:50:38.880 | every little part of every little organ, including the genitals.

00:50:43.840 | I never really thought of it this way, as you said,

00:50:47.840 | is that most organs are kind of full-time employees,

00:50:51.440 | like 24/7 they're doing something. And then there's some organs,

00:50:56.080 | penis, vagina being representative of this, they're not

00:51:01.680 | functioning all the time. They're only functioning every once in a

00:51:05.040 | while and then get us to do stupid stuff or awesome stuff and all

00:51:08.640 | that kind of stuff. But they're not essential for human survival on a

00:51:11.920 | second by second basis. And that the whole cyclical nature of

00:51:16.720 | the human body... How many other cycles are on a monthly

00:51:20.400 | basis, like that far apart? That's a fascinating

00:51:24.720 | design that the human body would do that and

00:51:27.520 | wouldn't start until the second decade of life.

00:51:32.400 | It's almost like... What do I want to say?

00:51:35.680 | There's some kind of meta-planning going on.

00:51:39.840 | Like this is the optimal solution for the sexual selection mechanism

00:51:44.400 | among like somewhat intelligent species. Like it's useful to, after the brain has

00:51:51.920 | developed sufficiently long, to now be making

00:51:57.120 | sexual selection decisions. Like you need time for this

00:52:00.720 | computer, this really powerful computer, to load in the info.

00:52:05.760 | Interesting. You also need the body to develop, you know, a child

00:52:09.200 | simply isn't big enough to be pregnant and deliver

00:52:12.880 | another baby. I wonder if there's animals in which this happens at a

00:52:16.560 | much more accelerated pace in different stages. Definitely, especially

00:52:20.160 | certain kinds of insects, you know, like Drosophila,

00:52:23.920 | a lot of the fruit fly, a lot of experiments are done on because their

00:52:26.800 | life cycle is so rapid. A lot of insects

00:52:30.560 | and other creatures are almost ready to mate as soon as they're born.

00:52:34.480 | Not us. Not us. Is there any

00:52:39.520 | improvements to the design? So a lot of people are

00:52:44.320 | very interested in these particular body parts.

00:52:47.680 | If you were to sort of step back as a geneticist, biological designer, or maybe

00:52:53.600 | a computer scientist, computer engineer, trying to build

00:52:56.960 | a human 2.0 or maybe a robot, how would you improve

00:53:02.400 | the penis and the vagina? Well, the penis for starters, I mean,

00:53:07.360 | let's also discuss the testicles, you know, they're very important too.

00:53:10.640 | I mean, okay, so they're fragile and they're important and yet

00:53:15.200 | they're hanging off the body in danger, basically. So,

00:53:18.640 | does that make sense? You know, they begin in the womb, they begin inside the

00:53:22.880 | abdomen and they slowly descend and sometimes before birth, sometimes

00:53:26.960 | in the first year of life, sometimes never,

00:53:29.040 | they pop out of the body and end up hanging in the scrotum.

00:53:32.560 | There's a reason, because the chemical reactions that create sperm

00:53:36.720 | function best at a few degrees cooler than body temperature.

00:53:40.720 | And so that's why you might notice in the warm weather

00:53:44.480 | they might hang further down and in the cold weather they scrunch themselves up

00:53:48.640 | to get closer to the body to maintain that ideal temperature a

00:53:52.000 | few degrees cooler. So it's hard, you know, if you could

00:53:56.560 | create a sperm production mechanism that did not rely on that lower temperature,

00:54:00.000 | that would be great, keep them inside the body protected like

00:54:02.560 | the ovaries are. But, oh, then you wouldn't rely on the

00:54:06.240 | lower temperature. I thought you meant create some kind of weird internal

00:54:10.720 | cooling mechanism. No, well, I guess that would be one

00:54:14.000 | solution, but just maybe a different type of chemical reaction, you know, would

00:54:18.240 | not be reliant on the lower temperature, let's say.

00:54:21.760 | You know, it'd be great to design a sperm metagenesis or sperm production

00:54:26.160 | process that would function best at body temperature

00:54:29.200 | and then we can keep those delicate organs inside the body

00:54:32.480 | and not have them hanging out in danger. Or maybe the argument for this design

00:54:37.760 | is maybe it's nice to put them in danger so you

00:54:43.360 | are constantly concerned about it. Could be.

00:54:46.480 | Maybe that's beneficial for male psychology, I'm not really sure.

00:54:50.000 | There's a psychological element here about the evolution that could be.

00:54:53.200 | So that's the testicles. Penis? A better way to do it, you know,

00:55:00.560 | I mean, it's pretty good as it is, you know, it kind of,

00:55:03.840 | when it's time for it to work, it grows and stiffens and when it's time for it

00:55:08.240 | not to work, it kind of shrinks and hangs out.

00:55:12.960 | I saw this on a Seinfeld episode, so I know how it works.

00:55:17.200 | Shrinkage. Yeah, that was a good one. But, you know, that's also a bit

00:55:22.240 | unique, I suppose, that, you know, the way it has this erectile tissue.

00:55:26.560 | Actually, they're similar. In the mouth of certain baleen whales,

00:55:30.640 | there's a certain similar kind of erectile tissue that

00:55:34.240 | helps cool them off because they have so

00:55:38.320 | much blubber and create so much heat in moving

00:55:41.760 | around and feeding that they have actually a similar, similar to the penis

00:55:44.800 | organ in their mouth that helps cool their bodies because it's a big problem.

00:55:48.000 | They have to store all that blubber for fuel, but it makes them too hot. So as a

00:55:52.400 | compensation, they have this kind of erectile organ in their mouth.

00:55:55.280 | Okay, what about vagina? You know, the fact that miscarriages

00:56:01.840 | sometimes happen because of sexually transmitted diseases,

00:56:05.680 | because of trauma, you know, it'd be great if the uterus,

00:56:09.280 | where the growing fetus is, is sort of even more protected from those things.

00:56:14.240 | You know, I guess that's a side effect of the fact that

00:56:19.120 | people still have sex when they're pregnant, are still, you know, exposed to

00:56:22.080 | injury. If there was a way to make it more

00:56:24.720 | protected, perhaps that would be even better.

00:56:27.280 | I did see an article recently about artificial wombs, which are

00:56:31.680 | rapidly becoming a reality. And in animal studies, they're able to prolong the

00:56:36.480 | gestation of a fetus by a month in an artificial womb. Can you explain

00:56:41.520 | the artificial aspect of the artificial womb? Sure, it's,

00:56:45.280 | I believe it acts almost like a heart-lung bypass machine. So when

00:56:49.280 | someone's getting like bypass surgery, their heart is stopped. Literally, they

00:56:53.840 | throw ice in the chest and they give a potassium infusion through

00:56:58.240 | the blood, which stops the heart. But the blood is run through a machine

00:57:04.160 | that basically does the work of the heart and lungs together, gets oxygen

00:57:08.720 | into the blood, and then pushes it back into the body.

00:57:11.600 | So I believe it's a sort of similar mechanism to keep blood and

00:57:14.880 | nutrition flowing to this fetus. And so it's just not inside the body

00:57:20.160 | of a parent, it's in some kind of other device. But I think

00:57:23.840 | that science is going to rapidly improve. One benefit is, you know,

00:57:28.240 | babies are born premature, and while, you know, neonatology is able to

00:57:33.200 | continuously kind of lower the age of viability

00:57:36.000 | through better technology and understanding how, what you can,

00:57:39.520 | medicines and other things you can do to premature babies when they're born,

00:57:42.800 | you know, ideally, if let's say premature labor

00:57:45.760 | begins, you can't stop it. That baby's coming out one way or the

00:57:49.360 | other. If you could just then stick it into an artificial womb where it can

00:57:52.160 | continue its development, that would save a whole host of problems

00:57:56.000 | off. And those babies born very early suffer from

00:57:59.040 | damage to various organs, including the brain, you know, for the rest of their

00:58:02.160 | life. So that could be a very important technology.

00:58:04.800 | So some aspects of the human body, we can develop technologies that outsource

00:58:09.920 | them, sort of

00:58:12.560 | offload some of the stress and the workload from the human body

00:58:18.160 | to do it elsewhere. Like dialysis does that for kidneys, you know, people can

00:58:22.240 | live decades without kidneys as long as they

00:58:25.760 | get dialysis, which does the work for them.

00:58:28.880 | Not every organ can do that. For instance, the liver, there's no

00:58:32.320 | dialysis version for the liver. Like if your liver fails, you need a liver

00:58:36.240 | transplant and that's the only thing that's gonna

00:58:38.400 | do it for you. So that's the world's first artificial womb for humans

00:58:45.600 | and we're looking at a picture of what looks like gigantic balloons.

00:58:50.240 | Matrix, here we come. This is very matrixy.

00:58:53.680 | How are they floating? What are we even looking at?

00:58:57.120 | There's giant red spheres. This really looks like the matrix.

00:59:03.680 | I wonder where it's from. So there seems to be a paper on this too.

00:59:07.120 | I don't know too much about it, but I did see that

00:59:10.240 | it's advancing very rapidly. The world's first artificial womb for humans.

00:59:14.960 | Scientists in the Netherlands say they're within 10 years of developing an

00:59:19.200 | artificial womb that could save the lives of premature

00:59:22.000 | babies. Premature birth before 37 weeks is globally the biggest cause of death

00:59:26.480 | among newborns, but the development also raises ethical

00:59:30.800 | questions about the future of baby making

00:59:34.240 | and so on and so forth. Wow. We're going to be facing a lot of ethical

00:59:39.520 | questions as we start to mess

00:59:44.000 | with human biology. In an effort to help human biology, we might start to mess

00:59:51.440 | with it. And it's going to be very interesting as

00:59:54.560 | we take steps towards the matrix.

01:00:00.880 | All right. What about the neighbor's poop feces? There seems to be

01:00:09.360 | a lot of interesting stories in that particular output as well.

01:00:16.640 | What to you is fascinating?

01:00:23.920 | What to you maybe is misunderstood or little known about

01:00:28.480 | poop? Well, it's hilarious for one thing. Yeah. That we do it. Oh, okay. The word is

01:00:35.600 | great as well. Yes. There's so many different words.

01:00:37.920 | I do, you know, when I'm talking to the parents of pediatric patients, I use the

01:00:41.760 | word poop. I don't often when I'm talking to adult

01:00:44.080 | patients try to choose a more mature word. But

01:00:48.960 | poop is amazing. I mean, I guess it's, you know, it's sort of the most,

01:00:52.880 | the dirtiest, the most vile, the most hated aspect of our bodies. It's the

01:00:58.160 | grossest. We don't want to think about it, talk

01:01:00.720 | about it, have it anywhere near our, you know, food or in social

01:01:05.200 | interactions. With good reason, you know, I mentioned

01:01:08.880 | gastrointestinal infections are one of the most common infections the human

01:01:11.840 | body suffers from. And, you know, what we call the way they

01:01:15.760 | spread from person to person, grossly enough, is referred to as the

01:01:19.120 | fecal-oral route, which means a bit of someone's stool is

01:01:22.800 | getting into your, you're swallowing it, you know,

01:01:25.760 | through the water supply. For instance, diarrhea is actually quite

01:01:29.840 | a brilliant mechanism of these microbes, right? If you, let's

01:01:33.280 | say you're in the intestine of one person,

01:01:35.600 | your goal is to get into the intestines of another person.

01:01:38.880 | Brilliant to just trick their intestines into secreting all this fluid

01:01:43.360 | into the intestines to increase the volume of stool and its runniness

01:01:47.680 | so that when they do poop it gets into the water supply and then everyone else

01:01:50.720 | kind of ends up getting infected as well. Wow, that's brilliant.

01:01:54.320 | Just the same way, like, you know, tuberculosis or coronavirus

01:01:57.840 | kind of infects your lungs and makes you cough and you send it out into the air

01:02:01.200 | and it ends up in other people's lungs. And that's all

01:02:03.440 | evolution. Yeah, it's brilliant. So diarrhea

01:02:07.040 | is intelligent, is a big takeaway lesson. It's one of the most intelligent things

01:02:12.640 | we can do as an entirety of an organism, not just

01:02:16.320 | the particular cognitive organism, but there's,

01:02:18.880 | you know, we're made up of bacteria and viruses and

01:02:22.720 | there's a lot of visitors and so on. As the entirety of the system, diarrhea is

01:02:26.240 | one of our better accomplishments. It's fascinating.

01:02:30.800 | Well, I wonder, why is poop funny? I think a lot of that is socially

01:02:36.160 | constructed, just how it's sort of supposed to be hidden away, yet something

01:02:40.080 | we always do, something, you know, we chuckle about as children.

01:02:43.920 | But even in healthcare, you know, it becomes this big topic of conversation

01:02:48.000 | because you end up talking about it constantly. Like, in the

01:02:50.880 | ER, people come in, they're complete strangers, sometimes like

01:02:55.840 | a nice old lady who resembles my grandmother and all of a sudden I have

01:02:59.280 | to ask her all about what's happening in the bathroom, like

01:03:02.320 | is she straining, what color is it, what, you know,

01:03:05.760 | what's the consistency, does it float on top of the water more than it should, is

01:03:10.320 | it hard to flush? I mean, there's a million different questions you learn

01:03:13.600 | as a medical student and you're like this poop detective when people

01:03:17.760 | come in with issues. And so it's funny, I guess, you know,

01:03:22.240 | in the exam room with the doctor-patient relationship, there's sort of no

01:03:25.760 | barriers, you know, you talk about everything and you're talking about the

01:03:28.400 | most intimate details of a person's life, even though you just

01:03:31.920 | met them a second ago. It's so different than normal social

01:03:35.520 | interactions, yet there is this social aspect. A lot of

01:03:39.200 | what I do is social, you know, it seems like doctors, what they do is mostly

01:03:42.560 | scientific, but actually it's just relating to

01:03:45.280 | another person and you have to maintain, you know, your

01:03:48.640 | professional demeanor and this normal human level interaction, even though

01:03:52.000 | you're talking about poop. And that's a skill, that's an art and a

01:03:56.480 | science. Well, okay, actually I want to linger on

01:03:59.280 | that because I'm a fan of just diving into conversations right

01:04:03.280 | away with strangers, just getting no small talk.

01:04:08.160 | And this is like the ultimate, I don't know if it's the ultimate, but it's one

01:04:13.040 | version of no small talk. You get right to the point.

01:04:18.000 | That's really powerful from a psychology perspective. You're a kind of therapist

01:04:22.400 | or you have the power to be a therapist. I don't mean

01:04:26.720 | just about the medical condition of the body, but

01:04:29.040 | the psychological. There's so much fear connected

01:04:32.640 | to this concern. Also self-doubt,

01:04:39.920 | insecurities, even sort of existential thoughts about your

01:04:45.360 | mortality, all of those things are right there in the room. So I think one

01:04:50.640 | way doctors deal with that is they kind of have

01:04:53.120 | this cold way about them. They almost have that dual mode. One is

01:04:57.120 | like, I'm going to be friendly on the surface and cold

01:05:01.600 | about the brutal honesty of the biology.

01:05:05.840 | But I wonder if there's like a skillful middle ground,

01:05:11.760 | this dangerous place where you can help people

01:05:15.680 | deal with their psychological insecurities, concerns,

01:05:19.280 | fears, all those kinds of things. Is that just really tough to do?

01:05:23.040 | Yeah, it's a huge part of being a doctor is

01:05:26.080 | dealing with the psychological aspects of whatever's going on with the patient's

01:05:29.840 | body. I mean in the ER you deal with psychiatric emergencies kind of left and

01:05:33.520 | right more than ever these days. That's a huge

01:05:37.040 | issue, not to mention drug use, alcohol-related stuff,

01:05:41.440 | that gets into psychology and the human love of intoxicants and

01:05:45.360 | changing the brain's chemistry. And habit, of course, we're

01:05:49.760 | creatures of habit and that plays in as well.

01:05:51.840 | I mean a big part of, for instance, pediatrics is reassuring parents

01:05:56.080 | and kind of convincing them, giving them the confidence that what's going on with

01:06:01.200 | their child is not serious, will go away on its own, does not need any particular

01:06:05.280 | intervention. But adults too, you know,

01:06:08.560 | reassurance is a huge part of the game. Yeah, you know, in the ER

01:06:14.720 | you see humanity at its most raw. I feel like you get

01:06:18.400 | this tremendous insight into people, how they live, what they worry about, what

01:06:22.400 | they think about, how their body works, and also how their mind works that

01:06:26.400 | you almost don't see anywhere else. It's a really interesting

01:06:29.600 | place to work. And also the way our society is shaped, the ER is where

01:06:33.760 | people go for almost everything. When they're suicidal, they come to the ER.

01:06:37.760 | When they're too high on drugs to walk, they come to the ER. You know, children

01:06:41.040 | who have been abused, sexually abused, physically abused, come to the ER for us

01:06:44.400 | to investigate. It's sort of like the all-purpose

01:06:47.840 | wastebin for the dregs of society, what people do to themselves and what they do

01:06:51.840 | to other people. You know, you mentioned your interest in

01:06:54.240 | the darkness of humanity. It made me think of the ER, where you really see

01:06:58.320 | what human life is like in the ER. Okay, you've, you tweet about, you write

01:07:04.000 | about, you think about the emergency room ER.

01:07:07.520 | That's really fascinating. Just the little window you

01:07:11.760 | give to that world is fascinating.

01:07:15.840 | What lessons about humanity do you draw from this place where you're so near to

01:07:23.280 | death, there's so much chaos, there's so much variety of what's wrong,

01:07:29.040 | so little information, or the urgent nature of the

01:07:35.680 | information inflows such that you can't really reason

01:07:39.280 | sort of thoroughly and deeply and collect all the data, all those kinds of things.

01:07:42.720 | You have to act fast and then everybody's freaking out. Can you

01:07:46.000 | just speak to the human condition

01:07:50.080 | that you get a glimpse at through the ER experience?

01:07:54.960 | Yeah, I think you do see all those things. I think on

01:07:58.000 | on one end of the spectrum, it is this very unique place where you get all

01:08:02.640 | these unique insights. On the other end, it can become a ho-hum workplace just

01:08:07.360 | like any other, which is sort of surprising. As I

01:08:09.760 | mentioned before, humans seem to be able to get used to almost anything,

01:08:13.200 | and doctors can get ho-hum used to, oh, dying of a heart attack, oh,

01:08:17.280 | actively in labor and the baby's half out, oh, just

01:08:20.880 | ho-hum, I know what to do, going about my job and go home and

01:08:24.320 | have dinner with my family and not think too much about it. That's amazing.

01:08:28.480 | I do try to maintain both my fascination,

01:08:32.640 | as I think writers in general tend to think more about what they see,

01:08:36.400 | write more about what they see, maybe draw connections with what they see to

01:08:39.440 | other things. So I do think that writer's perspective

01:08:42.240 | does help me kind of maintain my fascination and my

01:08:46.240 | kind of more of an insightful perspective than just a ho-hum,

01:08:50.080 | water cooler conversation. But you do see a lot.

01:08:54.240 | In a way, medical problems are sort of the great equalizer,

01:08:59.120 | right? Class, race, culture, background, you know, the failings of the

01:09:04.080 | human body, the way it fails, and what we can do to help

01:09:07.360 | in those situations is almost universal. I always like this quote from, you know,

01:09:11.760 | Chekhov was a doctor and a writer, and he

01:09:16.320 | treated a lot of peasants, very low class, and also treated a lot of

01:09:20.000 | aristocrats. And he wrote that they all have the same

01:09:23.360 | ugly bodies, basically, which I think is really

01:09:26.640 | right on. And, you know, it's sort of, you can see people

01:09:29.840 | underneath a superficial layer of clothing, maybe it's the most expensive

01:09:33.520 | clothing bought from the fanciest places, but

01:09:36.080 | underneath their body is still failing in the same way, and they still have the

01:09:39.040 | same anxieties, the same worry about mortality,

01:09:41.760 | the same concerns about why their poop turned green today,

01:09:45.440 | all these things that they bring to the table. So in a way, it is this great

01:09:48.720 | equalizer where people are kind of all the same in

01:09:51.760 | some ways. Yeah, I feel like people sometimes,

01:09:56.480 | class, money, fame, power, makes you for a time forget that

01:10:02.960 | you're just a meat vehicle, and

01:10:07.840 | you're just as good and just as bad as the other meat vehicles

01:10:12.160 | all around you. In that sense, there's this question sometimes raised,

01:10:18.080 | "Are some people better than others?" And I usually answer no to that question

01:10:23.120 | because of that. Yeah, some people might be better at math,

01:10:26.560 | some people might be better at music, but in the end, we're just

01:10:30.800 | meatbags. Beautiful as we are. There's a

01:10:35.920 | poem that just, a small tangent I want to take, I just

01:10:41.440 | saw it, "Just Acting," that you have written. I have to,

01:10:48.320 | would you classify it as a poem? Yeah. "At first,"

01:10:51.840 | if I may read it, "At first you enter the clinic, shoulders weighed down by white

01:10:56.320 | coat pockets, book stuffed, timid. You act out a role,

01:11:01.680 | your white coat a costume, your questions a script,

01:11:05.600 | your demeanor a rehearsed act. No one is going to buy this.

01:11:10.480 | But then, as you play the role again and again,

01:11:13.840 | repeating the lines and the motions, the script slowly dissolves,

01:11:17.920 | and the interaction becomes thoughtless, and the rehearsed act slowly fades into

01:11:22.960 | a profession. You suddenly find yourself unable to tell

01:11:26.880 | if you're still acting or if you're doing it for real.

01:11:31.040 | And now you're a doctor. Jonathan Reisman, MD, Harvard, Massachusetts General

01:11:37.120 | Hospital of Medicine, Pediatrics Department."

01:11:40.000 | Beautiful. So that is what it is to be a doctor. You're just acting.

01:11:45.360 | Fake it till you make it. Exactly, fake it till you make it. And I think,

01:11:48.800 | I imagine every medical student has this feeling when they first go into a room,

01:11:52.960 | like I talked about asking this nice old lady

01:11:56.000 | about the color of her poop for the first time, and you're just

01:11:58.720 | like, "What am I doing here? Does she believe I'm a doctor?"

01:12:02.560 | You know, this just feels absurd. But then it's, again,

01:12:06.000 | ho-hum becomes normal. Now there's not a sperm chapter in your book.

01:12:13.680 | You mentioned offline that this is the second and the third

01:12:17.520 | book that you're working on all about sperm. No, I'm just kidding.

01:12:21.280 | Or maybe I'm not. Humor tends to make way for reality.

01:12:28.720 | So the tweet was that an average human male produces

01:12:33.440 | 500 billion sperm, I believe, which is about four to five times

01:12:38.000 | more than the number of people who have ever lived.

01:12:42.720 | And each of those sperm is genetically unique, so you can

01:12:46.560 | think of them, you can kind of imagine the possible humans they could have

01:12:50.240 | created, and they're all different. They have

01:12:53.360 | similarities, of course, but they have peculiarities that make them different.

01:12:57.600 | And you can think of all the different trajectories, all the Einsteins, the

01:13:00.560 | Feynmans, the Hitlers, and all the people who have died,

01:13:05.040 | who would have died during childbirth, who would have died early in their years

01:13:09.920 | given the different diseases. It's fascinating to think about.

01:13:13.120 | An average human, yeah, we're all winners of a very competitive race.

01:13:18.960 | So the people who make it, we're winners, hashtag winning. Is there

01:13:24.160 | something that you find

01:13:29.360 | fascinating, interesting, beautiful, ugly, surprising about sperm?

01:13:38.320 | I think sperm is, yes, it is a very interesting

01:13:42.320 | bodily fluid. Maybe I'll write about it in a second or third book, we'll see.

01:13:45.760 | But I guess sperm is interesting because it's kind of the only

01:13:51.040 | projectile bodily fluid from the body.

01:13:55.200 | Vomit can be projectile. Usually that's a disease state. That's not the

01:13:59.440 | expected kind of normal healthy state. Oh, sneezing, would you classify that or

01:14:03.440 | no? True, I guess there's some particles in the air. I guess it's

01:14:07.280 | not a fluid, I mean not a liquid, but true. I

01:14:11.760 | mean, cough in addition to sneeze, right? Sneeze is how

01:14:14.640 | our nose gets rid of something that shouldn't be there. Cough is how our

01:14:17.440 | lungs get rid of something that shouldn't be there.

01:14:19.360 | Vomiting is sometimes how our stomachs get rid of something that shouldn't be

01:14:21.920 | there. All projectiles sometimes in their own

01:14:24.480 | way. Sperm is sort of interesting. It's created with the food for its journey.

01:14:28.800 | Sperm mostly feed off of fructose, a kind of sugar,

01:14:31.680 | for the few days that they live inside the female genital tract.

01:14:35.680 | But I like comparing our genitals to the genitals of the plant world,

01:14:39.440 | which is flowers. And in the same way that a

01:14:42.960 | touch-me-not, for instance, the kind of flower where when you brush up against

01:14:46.480 | it, it sort of launches seeds into the distance to

01:14:49.520 | try to survive in a way, kind of the sperm is doing something similar,

01:14:54.720 | launched into the female genital tract, and then all trying to find this,

01:14:58.800 | competing against each other to find this egg. It's really amazing.

01:15:02.240 | And when you learn about it from the biological perspective, the most amazing

01:15:05.760 | thing is how many things can go wrong, you know, just in

01:15:09.920 | the sperm not surviving long enough for it making it to the egg, and then

01:15:13.920 | some genetic abnormality causing a miscarriage.

01:15:17.680 | It's sort of astounding that it works as often as it does, and I think

01:15:21.920 | the lesson there is just that people have a lot of sex, and so statistics just

01:15:26.080 | favor it's going to work out a good number of times.

01:15:29.200 | Yeah, and there might be intelligence in the design of just the sheer number of

01:15:32.960 | sperm. Maybe that's yet another way to inject

01:15:36.080 | variety into the system. And redundancy, I guess, you know, we have

01:15:40.640 | two kidneys, we have two hands, if we lose one we can still go on.

01:15:44.400 | We have, you know, however many millions of sperm get sort of launched

01:15:48.800 | in every ejaculation is, you know, if a bunch fail or don't

01:15:53.360 | make it inside. There's papers on this, by the way, that

01:15:56.400 | I read for some reason, not read, but skimmed

01:15:59.440 | for some reason, which is talking about which

01:16:02.640 | sperm usually wins, like what are the characteristics of sperms that are

01:16:06.320 | winning, and it's not the fastest. So it's

01:16:10.640 | apparently there's some kind of slaughter that happens early on, people

01:16:14.720 | will correct me, but it's not the fastest.

01:16:16.560 | There is an aspect of it's the luckiest. It really is,

01:16:20.320 | like the body tries to make it a random selection.

01:16:23.280 | It tries to make it fair in making it as random as possible.

01:16:27.920 | Interesting, and also interesting that they're fueled by fructose. I didn't

01:16:30.880 | really think about that. So they're a carb-loaded athlete.

01:16:37.120 | Right, with food for the journey. Food for the journey, because I'm somebody that

01:16:40.640 | actually does a lot of running on, I guess you would call me a fat

01:16:45.040 | adapted athlete, so I do sort of

01:16:49.040 | meat heavy diet, and so you could do a lot of endurance kind of stuff

01:16:53.840 | when you don't eat any carbs, any glucose, any of that kind of stuff,

01:16:57.920 | and you're very low. It's interesting to think that sperm are like, nope,

01:17:02.720 | they're total bros. Let's go to the gym, sprint, performance, short-term

01:17:09.040 | performance is everything. All right, well,

01:17:13.600 | that's sperm. Returning to the liver, the place

01:17:17.440 | that deals with all our poor decisions. No, many of them, many of our poor

01:17:23.440 | decisions. You said that the liver does

01:17:28.240 | quite a few things. What to you is fascinating, beautiful about the liver?

01:17:32.800 | I'd say its primary function seems to be as the sort of gatekeeper for what we

01:17:38.080 | eat and absorb. The entire gastrointestinal

01:17:42.400 | tract, from the esophagus to the rectum, the

01:17:45.920 | blood flows from it, not back to the heart, but to the liver,

01:17:49.760 | where it's first examined, things are evaluated, packaged,

01:17:55.120 | processed, detoxified, perhaps. It's kind of this great overseer

01:18:01.120 | of what we digest and absorb, and so it kind of keeps

01:18:05.760 | track of what's coming in, the outside world that comes in and

01:18:09.680 | will become part of us. That's why

01:18:13.200 | partly the liver suffers sometimes the injury from

01:18:16.560 | certain toxins like alcohol, but beyond that, the liver is also the place,

01:18:21.600 | as I said, it metabolizes things too. So it metabolizes alcohol

01:18:25.600 | and why it can be injured by alcohol. It metabolizes drugs like Tylenol, which is

01:18:29.600 | why Tylenol can be very toxic to the

01:18:33.040 | liver when taken as an overdose. So the liver,

01:18:37.360 | you know, even beyond that, the liver produces a lot of different

01:18:41.680 | things that float in the bloodstream. It packages

01:18:44.640 | cholesterol and fats and sends them to where they're needed.

01:18:48.000 | It deals with protein in the blood. It deals with clotting factors in the blood,

01:18:51.840 | helping the blood clot. It processes things like bilirubin

01:18:56.640 | and other things that really, as I mentioned, is like 15 organs wrapped

01:18:59.760 | into one. Maybe that's why it's sort of the biggest internal organ.

01:19:02.800 | The skin's bigger, but it's not an internal organ.

01:19:06.320 | - Right. The biggest organ in the human body is the skin.

01:19:10.320 | - Right. But the liver is the biggest internal organ, and it really is a

01:19:13.920 | powerhouse and does a lot, which is why when people

01:19:17.280 | suffer from liver failure, kind of everything goes wrong in a way.

01:19:21.360 | - And in terms of replacing organs, what are organs that are easily

01:19:27.520 | replaceable, which are not? Like on the list of things that are hard

01:19:31.200 | to replace and not, where would you put it number one? Where

01:19:34.880 | would you put it like at the bottom? - Well, let's say the kidneys are, you know,

01:19:38.720 | nothing's easy, but kidneys are easiest in a way.

01:19:41.680 | Partly, I mean, maybe a big factor there is that other people have two of them

01:19:45.360 | and can give one to you, so you don't have to wait for people to die, which is

01:19:48.160 | the case with hearts and livers. Sometimes you can take a part of a liver

01:19:51.840 | from someone who's alive, and the liver does have this kind of

01:19:55.760 | mythological ability to regenerate itself.

01:19:59.120 | In the myth of Prometheus, he's, you know, chained to a rock,

01:20:02.960 | and the bird eats his liver every day, and it grows back every day.

01:20:06.800 | And that's actually biologically accurate. It's not that you can

01:20:10.640 | completely get rid of it and it'll appear again, but when

01:20:13.200 | pieces of it are removed or injured, it does regenerate itself pretty amazingly.

01:20:17.920 | So I'd say the kidneys, the fact that they're more around.

01:20:21.840 | Also, it's, you know, the kidney is a smaller organ. It's often just, you don't

01:20:25.120 | have to put a transplanted kidney where the kidney should be in the back

01:20:28.640 | of the abdomen. You can just kind of stuff it into the pelvis there,

01:20:31.440 | because it's a smaller organ. The liver would be hard because it's huge.

01:20:34.960 | And I guess we just have the most experience with

01:20:38.320 | kidney transplants, because they are the most common.

01:20:41.760 | And the heart and the brain are probably quite difficult.

01:20:46.240 | Brain, as far as I know, hasn't been successfully done. The heart is done.

01:20:52.000 | And definitely, I've evaluated a lot of patients with a heart transplant.

01:20:56.720 | It does work pretty well. The mechanical heart substitutes are also

01:21:01.280 | advancing quite rapidly these days. For a failing heart, there's certain kinds

01:21:05.360 | of devices they can surgically implant. Like when a failing heart isn't able to

01:21:09.840 | push hard enough, you know, that's the heart's job is pushing blood with

01:21:13.120 | sufficient pressure to create blood pressure.

01:21:15.440 | When it fails, there are actually these devices you can strap onto the heart

01:21:19.360 | to help it pump harder. Those are rapidly advancing. Many of those were not

01:21:23.920 | available even 10 years ago when I was a got out of med school, and now they're

01:21:27.920 | commonly used. So maybe heart transplant won't be as

01:21:30.560 | necessary in the future if those mechanical things do advance. And as I

01:21:34.640 | said, the heart is basically a mechanical pump.

01:21:36.960 | So perhaps it would be the easiest organ to replace with some mechanical device.

01:21:41.840 | Now for something completely different, returning to testicles for a time. You

01:21:45.040 | posted an Instagram post of testicles as

01:21:49.760 | food. Perhaps eating them doesn't help

01:21:53.520 | libido because ingested testosterone is totally

01:21:57.360 | metabolized in the liver, returning to our liver,

01:22:01.040 | leaving none to reach the bloodstream. That is why testosterone only comes as

01:22:05.280 | injection or topical foam, not as pills.

01:22:10.240 | On the other hand, estrogen and progesterone

01:22:14.160 | can be absorbed orally, hence the pill. But

01:22:17.600 | testosterone is mostly responsible for libido in women too.

01:22:21.280 | I was not expecting for this biology lesson when I was

01:22:24.400 | looking at an Instagram picture of... Are we looking at testicles?

01:22:29.920 | Yeah. Are these like which species? I believe all those are from cows.

01:22:36.240 | From cows. Cows, technically females though, bulls.

01:22:39.760 | Yeah, well, speaking of which, just we'll jump around a bit, but you've also

01:22:44.480 | traveled the world quite a bit.

01:22:49.440 | What have you... what is the craziest food you've eaten

01:22:55.040 | across the world? What have you learned about the extremes

01:22:58.720 | of the culinary arts by traveling the world?

01:23:03.600 | I would say, I guess I've always been extra fascinated with the diets of

01:23:09.280 | natives of the far north. I spent some time there in Russia

01:23:13.200 | and in Alaska and always loved their diet. So when I worked in

01:23:19.680 | Alaska in an emergency room and did some other

01:23:22.160 | travels in Arctic Alaska, and you know, they eat a lot of fat

01:23:27.680 | traditionally before contact, you know, more than half of all calories in the

01:23:31.600 | Inupiat Eskimo diet came from blubber, marine mammal fat, or you

01:23:36.400 | know, also fat from fish, fat from ducks, and other

01:23:39.200 | other birds that go up there to mate in the summer. So things like raw whale

01:23:42.800 | blubber was especially interesting for me and

01:23:46.640 | very exciting. You know, I had some beluga whale

01:23:51.040 | chowder, things like that. There's just all these

01:23:53.520 | very unusual dishes. You know, there's a dish called mikiyuk,

01:23:58.640 | which is whale meat fermented in whale blood,

01:24:03.200 | which is quite delicious actually. So is it cooked? Is it eaten raw?

01:24:07.680 | How do they like their fat? Like in

01:24:11.280 | in the same way up north in Russia, as you mentioned.

01:24:14.640 | So they often eat it raw. So the raw whale blubber is called mukduk,

01:24:19.360 | and it's often just sliced thin, and it's like it's sort of cold but not

01:24:23.840 | frozen often when they eat it, and they slice it

01:24:26.400 | thin. And a lot of people assume it would be very

01:24:29.600 | chewy, but it's not that chewy. It's quite pleasant actually, and has this kind of

01:24:33.200 | sea smell to it as you're eating it. I quite like it.

01:24:37.920 | And what's the culinary culture like? Meaning is it just source of energy or

01:24:44.160 | is it art? Well, there's, you know, traditionally

01:24:47.360 | there's not a lot of cooking in the Arctic. A lot of things

01:24:52.400 | are eaten raw, partly because there's not a lot of

01:24:55.200 | fuel for making fires. So they will, you know, some in some of the

01:24:59.200 | big rivers in Russia, for instance, that flow north, they will bring

01:25:02.960 | trees, you know, dead trees and logs up to the north, and they can get some wood

01:25:06.720 | that way. And same thing in some of the rivers

01:25:09.440 | kind of flowing northward from the Brooks Range of Alaska.

01:25:12.720 | You do get some trees, but just not enough to really produce a

01:25:16.800 | culinary art that requires cooking with heat. You know, they do have

01:25:22.400 | traditionally blubber lamps where the blubbers of seals and whales are used to

01:25:26.560 | create a little flame. Often that's for light and for a little bit of heat,

01:25:31.520 | and less for cooking. But eating things raw is definitely a huge

01:25:36.800 | part of the culture there. And while I was, I went on a whale hunting trip out

01:25:40.240 | on the spring ice in the Arctic Ocean by Barrow, Alaska,

01:25:44.560 | and two of the guys, the Inupiat guys who had invited me,

01:25:48.720 | were kind of talking about how eating things raw is sort of the most essential

01:25:52.640 | characteristic of Inupiat culture. And the one guy who's half white, half

01:25:56.240 | Inupiat, said people often doubt his ethnicity because he looks like a white

01:25:59.920 | guy. So he'll, you know, bite the head off of a

01:26:03.200 | raw bird to show them that he is truly Inupiat, is what he said.

01:26:07.120 | That's how you prove you're legit. We're looking at an Instagram pic.

01:26:10.960 | "As a doctor, I was used to knowing fat as the most maligned of all body parts

01:26:16.960 | and the culprit in an obesity epidemic. But in Arctic Alaska, fat has always meant

01:26:22.960 | health and survival. In fact, the entire story of life in the Arctic, especially

01:26:27.600 | human life, is basically a tale of fat. And in Barrow,

01:26:32.800 | what's it called? Alaska. Alaska, okay. A lawn covered with a whale blubber is

01:26:39.200 | still equivalent of a plush green lawn in temperature

01:26:42.960 | suburbia swelling in its owner with pride." And that's what

01:26:47.280 | we're looking at, is a lawn full of whale blubber.

01:26:53.440 | A beautiful. And this, so this is, I mean, there's a lot of calories there.

01:26:56.720 | Oh yeah. And this can feed a lot of people. A lot of energy, a lot of warmth.

01:27:01.120 | Absolutely. And it's delicious. This was like a,

01:27:04.880 | I was a kid in a candy store, basically. I rounded a corner in Barrow. So when

01:27:08.720 | people do get a whale during the spring whaling season, they raise a flag or the

01:27:13.200 | whaling captain raises a flag over his house and everyone in town is welcome to

01:27:16.960 | come try some. And so before I went inside

01:27:20.880 | to try some, I was kind of playing around with blubber and I saw the,

01:27:24.560 | this is a bowhead whale. I saw its heart, which was huge, like the

01:27:29.440 | size of a yoga ball. And that was, for me, just like amazing.

01:27:33.680 | I spent probably the next 45 minutes just looking at all aspects of it. And

01:27:37.280 | the stump of aorta that was attached to it was the size of my thigh.

01:27:41.760 | That was really fascinating. It's similar, Alaska and northern Russia, like Siberia

01:27:47.280 | out there. So where were you? I think you have some pics

01:27:52.320 | of from that time. Where were you in Russia?

01:27:55.440 | So I spent a lot of time in kind of western Russia as well, but I did

01:28:00.080 | take two trips to Kamchatka, including northern Kamchatka.

01:28:03.920 | I didn't go far enough, nor, I didn't go to Chukotka, for instance, until more

01:28:08.800 | recently when I was a ship doctor on a wildlife cruise

01:28:12.960 | that sailed from Anadyr, Russia, up to, through the Bering Strait into

01:28:17.440 | Wrangel Island. And we stopped in some villages in

01:28:20.800 | Chukotka and I got a chance to to try some whale and stuff like that.

01:28:25.120 | Northern Kamchatka, where it's more the Koryak,

01:28:27.600 | are the indigenous people, they do a lot of seal hunting. So I had a lot of seal

01:28:31.200 | blubber, but I don't believe they do any whale hunting

01:28:33.920 | quite there. But the Chukchi, in a way, are sort of, you know,

01:28:38.000 | similar to the Inupiat in their diet and their life ways.

01:28:42.240 | Of course, everyone's diet, all these people's diet, has changed dramatically

01:28:45.600 | in the last hundred years, as it has for actually everyone living in

01:28:48.880 | kind of modern societies. But for them, perhaps more than anyone

01:28:52.240 | else, since their diet was the most extreme,

01:28:54.560 | I think, of any human culture on earth. Just to stay

01:28:58.400 | on the wild travel you did. And I should say, I'm using the word travel, but

01:29:03.840 | it really, you were a doctor there.

01:29:09.600 | Well, first of all, can you just comment on the decision to go to

01:29:14.320 | such places and to help people to be a doctor there? What was the motivation?

01:29:19.360 | What was the thinking behind it? Well, I think I got the travel bug before I ever

01:29:23.840 | went to medical school and even wanted to be a doctor. So right after

01:29:28.000 | college, I kind of wasn't very into college, didn't enjoy

01:29:32.160 | things, kind of wanted to get out there and see the world,

01:29:35.360 | get out of New York City where I was a student at NYU.

01:29:39.680 | The first thing I did after finishing college was, I was invited to be an

01:29:44.240 | intern at a research center in St. Petersburg, Russia. I spent six months

01:29:48.160 | there my first trip and went back four more times to Russia,

01:29:52.480 | traveled all over, including to Kamchatka twice and other

01:29:56.800 | parts of the country I'd never heard of, cities like Petrozavodsk and Siktifkar

01:30:01.760 | and Pskov. I didn't even know a word could start with P-S-K,

01:30:05.680 | like the city of Pskov, but it can. And I was sort of fascinated. I was

01:30:11.040 | actually studying the international environmental movement

01:30:14.880 | and how it came to Russia after the fall of the Soviet Union

01:30:18.400 | and how organizations like Greenpeace and World Wildlife Fund

01:30:22.240 | and the World Bank are trying to kind of push the

01:30:26.240 | timber industry, which is huge in Russia, toward a more sustainable path. And so

01:30:30.160 | sort of evaluating how is it working, if not why

01:30:33.440 | not. And that seems like such a little niche,

01:30:36.320 | such a small detail about Russian society, but

01:30:39.200 | in a way, researching that in depth was almost this window

01:30:42.960 | into the entire country and the history in a place I knew nothing about. And I

01:30:47.040 | learned the language, traveled all over the country, you know,

01:30:50.640 | got to know the food, the history, the literature. It was just an

01:30:53.600 | immersive and amazing and life-changing experience that made me

01:30:57.520 | want to see every spot on the globe, basically, and learn about every

01:31:01.600 | culture. So I took that desire with me to medical

01:31:05.200 | school. I decided I would go to medical school,

01:31:08.320 | and from the very beginning, I was intent on traveling around the world.

01:31:13.280 | So a lot of my career has been fashioned so that I'm practicing medicine in a

01:31:17.920 | place with an interesting geographic context, an interesting place

01:31:21.600 | with an interesting cultural context. And that just makes it more interesting, I

01:31:26.720 | find. Not only are medical services often more

01:31:29.440 | needed in these remote and rural parts of the country and world,

01:31:32.720 | so I feel like I'm, you know, taking my knowledge and education experience to

01:31:36.880 | places where it's needed, but also for me, it's just such an

01:31:40.080 | enlightening experience. The way culture, history, geography,

01:31:44.080 | climate affects medical disease, but just getting to

01:31:47.200 | know the people, getting to know their culture,

01:31:49.600 | being a very useful traveler by providing medical services in that

01:31:53.840 | place. And that's taken me to Arctic Alaska,

01:31:57.200 | to Pine Ridge Reservation, South Dakota. I currently work in

01:32:00.400 | a few different parts of Pennsylvania, Appalachia, which,

01:32:03.440 | you know, for me is a unique geography and culture that I didn't grow up with,

01:32:07.920 | wasn't familiar with. So in some ways, it's exotic for me as

01:32:11.680 | well. I worked in other places too, like

01:32:13.920 | Kolkata, India, Nepal. Just, I think my love of travel has

01:32:19.280 | shaped my medical career, and being a doctor does give you these

01:32:22.720 | opportunities to go to places and travel in a unique way, you know,

01:32:27.040 | through the medical profession. You know, there's a documentary, Happy

01:32:31.680 | People, here in the Taiga or something like that.

01:32:35.600 | I think Warner Herzog voices it. It tells a story of a simple life of

01:32:41.360 | survival in the Taiga, and I think they're trapping

01:32:45.760 | for food, and there's a lot, there's an alcoholism

01:32:50.560 | problem too as well. There's like a very basic

01:32:55.200 | life of survival, of loneliness, of desperation, but also there's a,

01:33:01.280 | I think the underlying claim of the documentary is that

01:33:09.840 | that simple life actually has a kind of simple happiness to it.

01:33:16.560 | Hence the name, Happy People. Is there, can you speak to the life that people

01:33:22.560 | live in in those places, when it may be simpler

01:33:27.280 | than you would in a sort of big city life?

01:33:32.480 | It's definitely very different, for sure. You know, I guess I found, like in some

01:33:38.640 | of the remote villages of Kamchatka, I was actually surprised how similar

01:33:43.760 | they were in that, you know, there was, I saw the

01:33:46.720 | same family strife, the same fights, the same,

01:33:51.520 | you know, kind of pairing of relationships and

01:33:55.760 | bickering and politics, and you know, in a way,

01:33:58.960 | I'm from the New Jersey suburbs, and yet being

01:34:02.000 | in this remote, you know, village of northern Kamchatka, I remember writing

01:34:06.240 | an email to my friend about how just it seemed so similar, even though on the

01:34:09.520 | surface it was this exotic other world. The incredible material know-how they

01:34:14.880 | must have to get their food from the land, you know, that,

01:34:18.480 | the number of animal species, plant species, the behaviors of the animals,

01:34:22.320 | seasons, how to live that way. In a way, it's more complicated, in a way that I

01:34:27.200 | find fascinating, how people live on the land,

01:34:29.520 | and the knowledge and experience it takes to do it well and survive.

01:34:33.280 | You know, obviously other aspects of modern life in a city are

01:34:36.720 | much more complicated than they would be there, but I guess it's,

01:34:40.960 | that was something that struck me too, that it's simpler in some ways, but more

01:34:43.920 | complicated in other ways. -So some of the complexity that

01:34:47.360 | happens in life is from, originated from humans, not from the

01:34:51.280 | technology or the, all that kind of stuff around us. -You can

01:34:55.600 | take the human out of modernity, but they're still human. -They're still human,

01:34:59.360 | and they fill the empty space with their own human complexities.

01:35:02.880 | -Are there people that just stand out, memorable people, memorable

01:35:09.360 | experiences from those places?

01:35:13.200 | Some people that maybe made you smile, made you cry,

01:35:18.960 | change who you are as a man, change who you are as a doctor,

01:35:22.400 | anything jumps to mind? -I think, you know, when I was, it was interesting when I was

01:35:26.480 | in Russia, I found that most of the people I hung out

01:35:30.240 | with were old women. I'm not sure why, I mean, they're,

01:35:33.600 | actually I didn't meet a lot of old men in Russia, which might speak to kind of

01:35:37.280 | life expectancy there for men in particular,

01:35:41.040 | but I found women, older Russian women, including, you know,

01:35:45.200 | Russian from St. Petersburg or some of the elderly women

01:35:48.880 | in Kamchatka who were, you know, some were Koryak, some were half

01:35:52.400 | Koryak, half Russian, some were Chukchi. I just found them to have,

01:35:56.720 | to be so enlightening the way they talked about

01:36:00.080 | history, about people, so insightful about humanity, you know, all they've lived

01:36:04.480 | through in the last 50 years in some of these parts of Russia,

01:36:07.920 | like the upheaval, societal upheaval, the destruction,

01:36:11.440 | the building up, it's just something I could not even imagine.

01:36:15.680 | And I think their insights were just very, I'm not thinking of anything in

01:36:19.360 | particular, but I just remember I could listen

01:36:21.760 | to some of these elderly women talk about their lives for hours and hours.

01:36:25.280 | I remember there was this older, elderly blind Koryak woman

01:36:29.840 | who you would have thought was the, you know, most country bumpkin of country

01:36:33.600 | bumpkin, and yet she couldn't stop talking about how much she loved reading

01:36:36.400 | Dostoyevsky and Tolstoy, and which might also speak to the Soviet

01:36:40.000 | education system. And it's just sort of surprising and

01:36:43.040 | fascinating, and just those stories and perspectives on life

01:36:46.800 | really stayed with me. Yeah, with Babushki,

01:36:53.600 | there's a wisdom, there's a kindness.

01:36:58.880 | I mean, I suppose that's true for older people in general,

01:37:06.000 | but there's something about, it's not just Russia, it's Eastern Europe,

01:37:11.760 | it's like this kind of look of wisdom, and not just like

01:37:19.520 | sort of middle-class wisdom or something like that.

01:37:23.680 | It's like, I have seen some shit, wisdom. I've seen it all. And on the other side,

01:37:31.760 | I'm left here with a pragmatism and a compassion, and also an ability to

01:37:38.240 | cook really well. That's for sure, absolutely. There's just

01:37:42.320 | this balance of just deep intelligence and deep kindness,

01:37:45.760 | and yeah, I mean, much of who I am is because of the

01:37:51.200 | relationship I had with my grandmother, who is

01:37:54.080 | a Russian, Ukrainian-born Russian grandmother.

01:38:01.760 | Did you learn the Russian language? I did. It's quite rusty at this point, but

01:38:06.800 | I did. One of these wonderful elderly Russians in

01:38:10.720 | St. Petersburg sort of adopted me. I think that was another thing that

01:38:14.080 | a lot of these elderly women on every side of the country

01:38:18.080 | kind of adopted me or saw me as this real curiosity.

01:38:21.360 | It's sort of just not, I mean, this was around 2002, 2003, it just wasn't

01:38:25.760 | common for this sort of strange American to suddenly show up in the middle of

01:38:29.840 | Kamchatka or even St. Petersburg, and just absolutely ravenously

01:38:34.320 | curious about everything they had to say.

01:38:36.400 | So I often got adopted, and one of them taught me Russian and how to ride a

01:38:40.800 | horse. So the same babushka taught me both of

01:38:45.440 | those things. And like you said also, I should mention

01:38:48.560 | that there's something about the Soviet education system where, yeah, everybody

01:38:52.080 | reads Tolstoy, Dostoevsky. It's exceptionally well read, no matter

01:38:57.040 | where life has taken you, no matter where you come from,

01:39:00.320 | the literature, the mathematics, the sciences, they're all like

01:39:05.120 | extremely well educated, and that creates a fascinating

01:39:09.760 | populace. Like, then you take that education, that excellent

01:39:16.560 | early education, and you throw a bunch of hardship

01:39:20.480 | at those people, and then they kind of cook in that hardship and come out

01:39:26.960 | really fascinating people on the other end.

01:39:30.400 | It makes me surprised sort of that, for instance, like Russian medical science

01:39:34.400 | is not, doesn't, you don't see a lot of sort of studies,

01:39:38.560 | medical studies, advancing of medical science come out of Russia,

01:39:42.160 | which is sort of, I'm surprised sort of, I wish that it would. You know, I visited

01:39:46.800 | Akademgorodok outside Novosibirsk, which is an entire city the Soviets created

01:39:51.200 | just for the study of science, and it's like

01:39:53.120 | there's the geology building, and there's the biology building, and there's the

01:39:56.480 | chemistry building, and I just feel like Russia has this

01:39:59.760 | potential to be a science powerhouse, or even in the medical sciences, but

01:40:03.920 | I guess you just, I don't see it. I'm not sure why.

01:40:07.520 | I mean, you can certainly guess as to why, and I see the same thing in the

01:40:13.280 | other, in the sciences. I hold the dearest sort of

01:40:15.840 | in computer science, in engineering fields.

01:40:20.640 | I kind of long held this desire by long, I mean, last couple years,

01:40:26.960 | because a bunch of people reached out to me

01:40:29.360 | from Yandex and Moscow State to give lectures there,

01:40:33.040 | to sort of connect, you know, why so little science is coming out of

01:40:37.280 | there? Why so little that we hear about, and it feels like

01:40:42.000 | we should be able to bridge the scientific community.

01:40:44.800 | Like, science, let's even say, even in turmoil of

01:40:50.720 | geopolitics, even in global conflict, I feel like science

01:40:54.400 | should be bigger than that, but why do we not hear from the

01:40:59.680 | scientists is because of the limitations on human freedoms, on scientific freedoms.

01:41:04.960 | I feel like in China, in Russia, in any regime of its sort,

01:41:13.040 | you should give freedom to scientists to

01:41:16.480 | to flourish, and to interact with others, and you can only grow from that.

01:41:20.800 | You shouldn't suppress that. The sort of Cold War ideas,

01:41:25.360 | we should put those aside. As somebody who spent time in Russia, as somebody

01:41:32.160 | who learned Russian, do you have some thoughts that you want to

01:41:38.240 | say about the war in Ukraine currently? It's tragic, of course. Seemingly

01:41:45.200 | pointless to watch the destruction of a country

01:41:48.000 | in real time. I guess it's, you know, when you read

01:41:52.800 | Russian history and Ukrainian history, I guess it just,

01:41:55.680 | it's sort of, you know, destruction is a big part of it.

01:41:59.920 | The populace being beaten down is a big part of it, you know, from the

01:42:04.080 | Mongolian hordes, through the Tsar and the Soviets, and Putin. I guess,

01:42:10.320 | you know, it's just in science, in particular medical science, it feels

01:42:13.840 | like this sort of unrealized potential, you know, the culture is so beautiful,

01:42:18.000 | the people are so smart and well-educated.

01:42:20.560 | I think the word unrealized potential is kind of how I feel. That's why I wanted

01:42:24.960 | to celebrate that part of the world, is there's so

01:42:28.000 | many beautiful people, so many brilliant people. And I just

01:42:32.240 | happen to know the language, so I'm able to appreciate the beauty of those people.

01:42:36.400 | I'm sure the same is true in China. I'm sure that that's one of the things that

01:42:40.000 | makes me sad, is there's all these cultures that I don't know about, I can't

01:42:45.040 | fully appreciate their brilliance. Even Japan

01:42:47.600 | and places like that, there are sort of, there's

01:42:50.960 | channels of communication wide open, and there's a lot of interaction. It's still

01:42:55.200 | not knowing the language, I feel like I miss some of the culture.

01:42:58.560 | Or Portuguese, and you know, looking at South America, and all that kind of stuff.

01:43:04.320 | But anyway, in Russia there certainly is that unrealized potential. In Ukraine,

01:43:10.000 | so many brilliant scientists, engineers came from Ukraine, from Russia,

01:43:14.400 | and I hope they get to flourish soon. And I hope we put this,

01:43:21.840 | I hope we stop this war, because all war is hell.

01:43:27.520 | Is there something to comment about the biology of war?

01:43:34.160 | Is there echoes of the emergency room experience?

01:43:39.920 | Have you dealt with patients that have been touched by wartime?

01:43:48.240 | Definitely, war and medicine has a very intricate and complex relationship.

01:43:54.800 | I don't know if it was Walt Whitman who said it, though he was a nurse during the

01:43:58.240 | Civil War, that war is the best medical school. But

01:44:01.600 | some people have said that. And you know, even advancements in

01:44:06.240 | medicine come from war. You know, the wars in

01:44:09.520 | Iraq and Afghanistan have, in some ways, really revolutionized

01:44:13.200 | certain aspects of the way we treat trauma patients in the civilian world as

01:44:16.800 | well. The importance of tourniquets, the

01:44:20.160 | importance of transfusing whole blood instead of,

01:44:22.720 | you know, red blood cells isolated from serum and platelets, etc.

01:44:26.880 | The importance of pain control in the battlefield, that's changed dramatically.

01:44:30.400 | Everything from ketamine injections to fentanyl lollipops

01:44:33.760 | in the battlefield. So war has really improved medicine in many ways.

01:44:39.120 | In another way, you know, the Department of Defense spends a lot of money on

01:44:43.520 | medical research and kind of really pushes the envelope. You

01:44:46.560 | know, DARPA is one aspect of the military budget that really funds

01:44:50.880 | these moonshot experiments that are really fascinating and

01:44:54.640 | really push the frontiers more than seemingly most, you know, kind of

01:44:59.920 | universities doing it, doctors and researchers doing their

01:45:03.200 | research. So in a way, you know, the space program,

01:45:06.800 | which sort of was military initially, then became civilian under NASA,

01:45:10.320 | also led to a lot of advances and understandings of

01:45:14.080 | health, you know, on Earth and in space. So the military is, or war in general, is

01:45:19.760 | a huge way that medicine advances, not to mention

01:45:23.440 | the epidemics that come. You know, my grandmother was from what's

01:45:27.360 | today Moldova, what was then Romania. She got typhus during the

01:45:31.760 | World War II. So there's typhus outbreaks, there's cholera outbreaks, you

01:45:35.520 | know, all these, even infectious disease things can

01:45:39.040 | advance in war, which you wouldn't expect. You expect sort of trauma to be the

01:45:42.560 | sort of main problem, but actually infection is a huge problem

01:45:45.840 | throughout history and war. So we can learn a lot. It's this

01:45:49.200 | kind of horrific natural experiment in medical

01:45:52.960 | care. -Yeah, and I've recently been reading about some of the horrific

01:45:57.760 | medical experiments performed by Nazi scientists, Nazi Germany.

01:46:02.800 | I'll talk about it another time perhaps, but

01:46:07.120 | nothing reveals the honesty of human biology like

01:46:10.560 | war. Just to stay on your wild journeys for a little bit longer,

01:46:17.520 | you have a tweet about Shackleton saying, "Here's a photo of Shackleton's medical

01:46:21.760 | kit from his storied expedition to Antarctica

01:46:24.560 | in the 1910s. Some paragoric for pain, some laxatives,

01:46:31.840 | only the essentials." Would you put laxative under the essentials?

01:46:36.960 | Anyway, sorry to interrupt. When I worked as a

01:46:41.040 | ship doctor in Antarctica in 2018, I had a huge cabinet full of meds and even

01:46:47.040 | EKG machine. So if you can comment sort of on that

01:46:52.720 | contrast, first of all, your own journey, how

01:46:55.600 | harsh was it, how difficult was it, and given that context,

01:47:01.680 | can you think about how hard Shackleton's journey was?

01:47:06.240 | -I think the difference is unimaginably stark.

01:47:09.600 | One thing I do want to point out is that the use of laxatives early in the 20th

01:47:13.680 | century and before that, they were used for a surprising

01:47:17.760 | number of ailments where they probably did not help at all.

01:47:21.040 | But I think that was a holdover from sort of the old theory of medicine, the

01:47:25.040 | humoral theory, where you have to balance the fluids in the

01:47:28.240 | body. And so causing people to vomit, causing them to have diarrhea, or

01:47:32.720 | purposely taking blood out of them in bloodletting

01:47:35.920 | was a big part. And I think that crazy use of laxatives was

01:47:39.440 | maybe a holdover from that time. But that being said,

01:47:43.600 | they were probably not eating very high fiber food on that expedition, so perhaps

01:47:47.520 | laxatives could have been helpful. You know, there's a lot of seal,

01:47:52.240 | penguin and seal meat being eaten, which is not super high in fiber.

01:47:56.800 | So I don't want to discount the importance of laxatives in that setting.

01:48:00.240 | -But that wouldn't be the essential thing if you're thinking of a

01:48:04.000 | tiny kit that has only the essentials. I mean, pain,

01:48:08.560 | yes, laxatives, maybe not. -I think the medical kit possibilities were

01:48:13.840 | much narrower back then. You know, this was

01:48:17.040 | before antibiotics, before, I think, germ theory might have been,

01:48:22.160 | you know, it was known, but there wasn't much to do about it.

01:48:25.360 | So the availability of medicines, I mean, that's something that exploded over the

01:48:29.200 | course of the 20th century. So what I can put in a backpack today, filled

01:48:33.360 | with modern medications, whether injectable or to be taken orally, is

01:48:37.200 | just many orders of magnitude greater than what they had back then.

01:48:41.840 | So when I went, my expedition was nothing like Shackleton's. I

01:48:46.480 | was on a huge cruise ship with 160 Japanese passengers

01:48:51.520 | who came with their own translators. And

01:48:55.600 | as I said, I had a cabinet, not just one cabinet, many cabinets full of

01:48:59.280 | medications, both injectable, some patches, some pills.

01:49:04.640 | I was very impressed, actually, with what was available there.

01:49:07.920 | And I didn't have to use a lot of it, thankfully, though I did use some of it

01:49:12.080 | for people. But, and I slept and, you know, I got

01:49:16.880 | free room and board on the ship. So every southern summer,

01:49:21.040 | cruise ships go take people to Antarctica, the

01:49:24.640 | southern Atlantic islands, like the Falklands and other

01:49:27.120 | parts of the South Pacific. And then in the northern summer, the same kind of

01:49:31.360 | cruise ship explosion happens, you know, going to

01:49:34.400 | Greenland and Iceland and Svalbard and Franz Josef Land and

01:49:38.000 | other parts of the North Alaska. So, and every ship needs a doctor.

01:49:42.480 | So it's a great opportunity. They want specifically ER doctors, you know, to deal

01:49:47.040 | with emergencies. But you're really working in the middle

01:49:51.200 | of nowhere, and all you have is the medications there on the ship and

01:49:55.120 | supplies and your knowledge and experience. And so it's

01:49:58.240 | it's a very different experience than working in a high-tech modern hospital

01:50:01.840 | with every bit of technology and every subspecialist consultant available.

01:50:06.000 | But I sort of like that challenge. I mean, I like going to the ends of the

01:50:09.280 | earth. It's beautiful, it's exciting, it's

01:50:10.960 | fascinating. Practicing medicine in those settings is

01:50:14.560 | extra challenging and really makes you hone some of your

01:50:18.160 | skills, which is part of the reason that I sought them out.

01:50:22.320 | Do you see echoes of some of that same effort? I've gotten a chance to interact

01:50:26.240 | with astronauts and those kinds of folks working on space

01:50:30.320 | missions. Do you see some of those same echoes of challenging efforts going out

01:50:35.200 | into space and maybe landing on Mars and maybe

01:50:38.080 | beginning to build a small colony on Mars? Yeah, I think the

01:50:42.960 | health care that is needed will be a big part of that.

01:50:45.600 | You know, obviously we're probably going to send overall quite healthy people,

01:50:49.760 | but there's a lot of medical decisions to make about what should be brought,

01:50:52.880 | what should be expected. You know, to some extent, I've had a lot of

01:50:56.640 | doctors say, "Oh my goodness, I can't believe you work in the middle of

01:50:58.960 | nowhere. What do you do if someone, you know,

01:51:01.200 | gets a brain bleed, like falls, hits their head, needs a neurosurgeon?" I mean, the

01:51:04.800 | obvious answer is they die. You know, when you're in

01:51:08.000 | the middle of Antarctica, things kill you that wouldn't if you're

01:51:11.600 | inside a university hospital that's fully equipped to help with

01:51:14.800 | every problem that arises. Mars takes that to a crazy extreme,

01:51:18.640 | obviously. I know that even going to Antarctica,

01:51:22.080 | different countries have had different strategies. I believe it was Australia

01:51:26.160 | used to kind of just in anticipation remove people's gallbladders

01:51:31.280 | just so that it wouldn't get inflamed, because that is a

01:51:34.400 | very common medical emergency. So they would just remove it beforehand, even

01:51:38.000 | though it was not diseased at all, just so that while they're stuck in

01:51:40.800 | Antarctica over the winter, for instance, that wouldn't be a problem. You know,

01:51:44.720 | there's many other issues that can arise. But so those are some decisions to make.

01:51:49.600 | Maybe the people who go into Mars should have their appendix removed, their

01:51:52.400 | gallbladder removed. Maybe they should have a cardiac cath

01:51:55.120 | to see if they have coronary artery disease, just to know their chances of

01:51:58.000 | getting a heart attack there, though it's not always predictive.

01:52:00.560 | You know, it's hard to predict who's going to get a heart attack, but maybe

01:52:03.760 | with all the data around today, we'll get, you know, better at predicting. But that

01:52:06.800 | will be a huge part. You know, we can't have people,

01:52:09.120 | the few pioneers in a Mars colony dying of heart attacks and things like that.

01:52:12.960 | Anticipate stuff. Would you go, you've gone to some harsh conditions to be a

01:52:18.000 | doctor. Would you go to Mars to be a doctor?

01:52:20.640 | It would definitely be amazing, I think, because I have a wife and two small

01:52:25.920 | children, probably not in the cards for me at this

01:52:28.320 | point. But you humans with your human

01:52:32.320 | attachments. Sex and death.

01:52:35.760 | If you just put more priority on the death than the sex, I think we would be

01:52:40.800 | better off. No. I would love to go to Mars. And actually,

01:52:45.600 | you know, I practice high altitude medicine in Nepal. Space medicine is sort

01:52:49.440 | of an extension of that. You know, the air is just

01:52:51.440 | much thinner, like non-existent. You know, as you go higher in the mountains,

01:52:54.800 | the things that happen to human physiology are very bizarre and

01:52:58.240 | strange and still not well explained by science.

01:53:01.840 | And in space, it's just like a crazy extension of high altitude.

01:53:07.120 | If I could just return to the, we didn't really, I think we mentioned a little bit

01:53:11.680 | about the food you had. Just, if we could, high level, say,

01:53:15.520 | what is the greatest meal you've ever had? So, your last meal. Let's go.

01:53:20.880 | If one more meal, I get to murder you after this,

01:53:25.920 | this is your last day. We get to spend it together. Where in the world would you go?

01:53:29.520 | What would you eat? I would say the most delicious thing

01:53:34.560 | is bone marrow. And I would love a full meal of bone marrow for my last

01:53:39.200 | last dish. I did, on my birthday in 2002, eat a kilogram and a half of crab meat

01:53:45.440 | in Kamchatka. And that was also amazingly delicious.

01:53:50.160 | The king crab they have there is incredible. But

01:53:53.680 | I would go with bone marrow, which is, I think, just one of the most delicious

01:53:57.440 | foods. And it's sort of this weird body part.

01:53:59.680 | You know, it's basically all your stem cells, not all of them, but the stem cells

01:54:03.200 | that produce all your blood cells. So, they

01:54:05.600 | are spitting out billions of white blood cells, red blood cells, and platelets

01:54:08.720 | every day. And there's a bunch of fat in there as

01:54:11.200 | well. Just one of the places the body stores fat. And so,

01:54:15.120 | you basically add heat and that's all you need. It's like the perfect food.

01:54:18.640 | You add heat, the fat for frying the stem cells is already there.

01:54:22.080 | There's a bone, naturally a bone vessel to contain it all.

01:54:25.440 | Probably add some flavor too. It's like the perfect food.

01:54:29.040 | Does it matter which animal? I prefer a larger animal, just so

01:54:34.880 | there's more of it. I actually like, oh that's true, I actually really like sort

01:54:38.400 | of bone marrow from like chicken bones. Right, just sucking it out of the bone.

01:54:42.480 | Yes, I'm known for leaving absolutely nothing

01:54:45.920 | edible on the plate except bone itself. There's one

01:54:49.440 | other human I know that loves bone marrow as much as you do, and

01:54:55.440 | that's Joe Rogan. So, it's unnatural how much that man

01:55:00.320 | loves bone marrow. I understand why. I love the steak part.

01:55:04.640 | You know what, let me argue with you because,

01:55:08.560 | I don't know, it could be an acquired taste,

01:55:12.160 | but there's just too much, it's like too much with too little work for it.

01:55:20.320 | Like it's as if you gave me lobster meat without the lobster

01:55:25.120 | having to clean the lobster. I just feel like I'm spoiling myself.

01:55:30.480 | So, it's very fatty. I don't know, maybe I want to work for something that

01:55:35.200 | tastes like that. Well, if you start from the whole animal, you do have to work to

01:55:38.320 | get at it, right? A lot of animals have the teeth and the

01:55:42.320 | jaw muscles to chomp through bone. We do not.

01:55:44.960 | So, you know, when you buy it from the store, it's already sawed up,

01:55:49.200 | but I've definitely gotten marrow out of deer bones, you know, with a hatchet.

01:55:52.800 | Just chop off the fat end and start spooning it out.

01:55:56.400 | Or maybe I'll revisit it. That's fascinating. And where?

01:55:59.920 | Where would you eat it? Where in which place of the world?

01:56:04.160 | Is there something about who cooks it, who you eat it with?

01:56:10.560 | You're not allowed to pick your family.

01:56:14.480 | So, like which place in the world, rural or in the city,

01:56:21.200 | those kinds of things. You've been to so many fascinating places.

01:56:25.680 | I would say Antarctica is one of the most picturesque

01:56:30.160 | places I've ever been. I really did not. I didn't know how mountainous it was.

01:56:34.800 | And I guess I knew there'd be ice, but just I didn't know how much ice it was.

01:56:39.440 | You know, it's ice and mountains, just overwhelming.

01:56:42.000 | It just, you know, as kind of overwhelming bone marrow might seem to you,

01:56:46.000 | sort of that feast for your eyes. And just ice in general is amazing.

01:56:51.600 | Like the icebergs floating around Antarctica is just astounding.

01:56:55.200 | Like the different shapes, the sizes are incredible.

01:56:59.440 | There's actually a, I believe it's a U.S. Navy website that tracks the largest icebergs.

01:57:03.840 | And you can read about each of them and how big they are.

01:57:06.400 | And just the formations you see, similar up near Greenland,

01:57:09.920 | though I have not been to Greenland.

01:57:12.480 | Just ice in general is just amazing. So I could just look at its different forms

01:57:16.160 | while eating bone marrow forever, until you kill me, that is.

01:57:19.200 | Yeah. And afterwards we go. It's back to the death of the death and sex.

01:57:23.760 | I, what is it about the ice? Is it sort of the enormity of nature?

01:57:29.600 | It just reminds you that it's going to be there before you and after.

01:57:35.040 | And then you get to partake in the eating of the thing you need

01:57:39.520 | for maintaining of your biological, temporary biological organism.

01:57:44.160 | Yeah, I think it's a few things. One is just the shapes that you see,

01:57:48.880 | you know, the wave action, just eating away at these pieces of ice.

01:57:53.360 | You get these arches and just these shapes. I mean, it's just like...

01:57:56.560 | Geometry.

01:57:57.360 | The geometry alone is amazing. I studied math as an undergrad,

01:58:01.040 | and I've always appreciated geometry. And just the shapes alone are just,

01:58:06.720 | look like brilliant works of modernist art. And just obviously no two are ever the same.

01:58:11.680 | Not to mention a lot of them are this unearthly blue color

01:58:15.920 | that is just really startling and fascinating. The same color of glaciers,

01:58:21.520 | in various parts of the world, that blue color is just really amazing.

01:58:25.280 | And I also just love how it's sort of this constant shedding

01:58:28.960 | from our Antarctic continent, from Greenland. It's this constant process of snow falling inland

01:58:34.320 | and pushing the glaciers further out to sea and then breaking loose. I mean,

01:58:38.640 | obviously it seems to be happening faster these days, but it's sort of this constant shedding.

01:58:43.120 | I always like thinking about how the body has something similar. We're constantly shedding

01:58:47.600 | and renewing and rebuilding everything. And so ice is sort of this constant similar process.

01:58:54.720 | Yeah. I did not know you were a math undergrad. So that, I mean, you just keep getting more

01:59:02.960 | fascinating. Can you maybe take a small step into that direction? What do you find beautiful

01:59:10.400 | about mathematics? Why did you journey into that part of the world for a time?

01:59:15.440 | I liked math. I especially liked, so college math, I did some calculus in high school.

01:59:20.480 | When I got to college math, I was amazed that there were no more numbers. The digits

01:59:25.840 | disappeared. It was just variables, concepts. There was almost no more numbers at all. It was

01:59:32.400 | like this totally abstract kind of way of thinking, but that sort of reflects the natural world and

01:59:40.080 | teaches you about the natural world. Though it's sort of this perfect platonic ideal, perhaps,

01:59:45.360 | of the natural world that can still sort of help explain what happens in the natural world. But

01:59:50.160 | just these concepts are so abstract from life and from the natural world. I was actually getting

01:59:57.840 | interested in the natural world at the same time when I was at NYU studying math. I took a tour of

02:00:04.560 | Central Park that was pointing, the guy, Steve Brill, was pointing out these wild edible plants.

02:00:09.600 | And I was learning to identify the first plants and knowing what's edible, what's not. That was

02:00:14.640 | totally fascinating. And sort of this kind of thing that I felt like was connecting me to nature.

02:00:19.120 | And it was balanced with this utterly abstract science, you know, or utterly abstract lessons

02:00:25.520 | I was getting in math class where I was thinking through series, you know, as we approach infinity,

02:00:30.160 | what happens to these equations and concepts of like rings and abstract algebra. I don't know,

02:00:35.440 | it was just this dichotomy that I enjoyed both aspects of.

02:00:40.000 | Yeah, the concepts, but so different, this kind of logical,

02:00:46.240 | rigorous view of the world and the world of biology. How did that feel to take the leap into

02:00:55.840 | the biological, the mushy mess of the human body from the mathematical, which is all very clean?

02:01:04.640 | Right. It does feel like a big step. I think there's more connection than you think. You know,

02:01:09.600 | we talked about symmetry of the body earlier. That is a real thing. You know, fluid dynamics of how

02:01:15.920 | our various bodily fluids flow and what makes them not flow as well and what makes them flow better.

02:01:21.280 | And, you know, all these different aspects of science go into the body.

02:01:27.760 | You know, everything from hard bone to softer kind of flesh to liquids of various consistencies.

02:01:34.800 | You know, a lot of science and math does teach you about kind of how the body works,

02:01:40.320 | how it can work better, what happens in sort of disease states.

02:01:43.440 | Yeah, I suppose there's a connection. There's also kind of a

02:01:52.000 | sort of computational biologists, this computational equivalence of each of the

02:01:57.840 | disciplines, which are becoming more and more fascinating with all the work that DeepMind is

02:02:02.160 | doing and the work of genetics, all that kind of stuff, simulating different parts of the body

02:02:06.800 | to try to gain an intuition, understanding of it. That to me is super fascinating,

02:02:12.640 | but sometimes it does feel like an oversimplification of the way the body really

02:02:16.160 | does it because the body is an incredibly weird, complex system. And it finds a way.

02:02:24.880 | The adaptability, the resilience, the redundancy that's built in, it's weird.

02:02:30.800 | And it's incredibly powerful and so unlike the kind of computer-based systems that we build,

02:02:38.480 | at least we engineer in the software engineering world, which kind of starts to make you think,

02:02:43.680 | how can we engineer computer systems in a different way that make them more resilient

02:02:49.600 | in the real world? That's sort of the robotics question. What do you think about that?

02:02:54.720 | What does it take to build a humanoid robot or robots that are as resilient as the human body?

02:03:01.520 | How difficult do you think is that problem? Having studied the human body,

02:03:05.760 | how hard is the engineering problem of building systems like that guy over there, the legged

02:03:12.560 | guy that is as resilient as the human body to the harsh conditions of the real world?

02:03:18.080 | I think it's very hard and we definitely haven't gotten there yet. I think we could probably learn

02:03:23.280 | lessons from people who are trying to grow artificial organs in the lab to eventually

02:03:28.000 | transplant into people, which would solve the huge problem of needing to get those organs

02:03:32.560 | from others and the rejection of putting a foreign material inside your body.

02:03:36.960 | Your immune system tends not to like that. That has advanced a lot recently. I think

02:03:43.360 | some advances actually have been where we pay a lot of attention to stem cells, stem cells,

02:03:49.200 | stem cells. We can grow whatever we want out of stem cells, but now there's sort of a recognition

02:03:53.440 | that what we call the extracellular matrix, which is sort of the foundation of the body,

02:04:00.000 | the thing that holds all the cells into their proper shape and keeps them where they should be,

02:04:05.760 | that is actually crucial. There's probably a lot of signaling that goes on. You stick a

02:04:09.760 | stem cell on the right extracellular matrix, it will turn into the kind of cell that you want and

02:04:14.800 | take the right shape and position and start functioning. I think that's been a huge advance,

02:04:21.120 | knowing that it's not just these celebrity stem cells that are the answer. It's this kind of

02:04:26.400 | part in the background, this sort of just like laying the foundation, the system that you put

02:04:30.560 | these cells onto. We're not there yet, but there's definitely a lot happening, a lot of research

02:04:36.080 | happening. I think there'll be some advances probably soon. - Now on the topic of interaction

02:04:42.320 | of computational systems with biology. If you look at a company like Neuralink or the whole effort of

02:04:50.880 | brain-computer interfaces, now there's a neurosurgery component there. We have to connect

02:04:58.320 | electrical systems with biological systems. So just even the implanting is difficult,

02:05:07.600 | then the communication is difficult. But what would you say, from what you know about the brain,

02:05:13.440 | what you know about the human body and all the beautiful mess that's there, how difficult is

02:05:19.040 | the effort of Neuralink? Do you think it's feasible? - I think it's definitely feasible. I

02:05:24.880 | think we need to probably know more than we do and know how to connect it in all these ways. I think

02:05:31.920 | some advances, for instance, much less sexy, but really already impacting medical care is something

02:05:38.560 | called deep brain stimulation, which is done for Parkinson's disease and others, where

02:05:42.400 | neurosurgeons implant this device that electrically stimulates the part of the brain

02:05:48.000 | that is not functioning in Parkinson's disease. And it's quite dramatic how effective it works.

02:05:53.600 | And I remember as a med student watching a neurologist literally turn the electricity up

02:05:59.040 | on this handheld thing, and you could see the person's Parkinson tremor go away, and you could

02:06:03.280 | see them start to walk in a more steady fashion. And I know there's actually studies, or there may

02:06:10.480 | be studies in the future studying the same deep brain stimulation for everything from eating

02:06:16.480 | disorders to severe OCD, like paralyzing OCD, not just like, "I want to wash my hands three times."

02:06:23.120 | But, and so I think the, you know, the potential is there, but I guess connecting the brain in a

02:06:32.080 | microscopic way, in sort of a multifaceted way, you know, there needs to be sort of a million

02:06:36.560 | connections or some very high number of connections for them to work fluidly, as far as I know. I'm

02:06:41.280 | not an expert in the area. - First of all, I believe and I trust in the adaptability of the

02:06:46.720 | biological system to whatever crazy stuff you try to shove in there. So it's going to potentially

02:06:52.640 | reject things, but it's also going to, if it doesn't reject things, adapt. And if we can create

02:06:59.200 | computational systems that also adapt, AI systems that adapt, and can kind of, both of them reach

02:07:06.320 | towards each other and figure stuff out. But actually, our current AI systems are not very

02:07:11.120 | adaptable to the, like, in the wild way that biology is adaptable, like adaptable to anything.

02:07:19.360 | And if we can build AI systems like that, I feel like there's some interesting things you could do.

02:07:23.840 | But of course there's ethics and there's real human lives at stake. And there you can't quite

02:07:31.840 | experiment. You have to have things that work and maybe simulation can help, but reality is,

02:07:37.440 | it's a dangerous playground to play on. - It is messy.

02:07:44.640 | - You tweeted that quote, "If you look back from far enough into the future,

02:07:49.680 | every doctor today will look like a total quack."

02:07:52.560 | First of all, that's humbling to think about. Like, we don't know what we're doing in the great,

02:08:02.800 | like, there's been so much progress that we kind of have this confidence that we figured it all out.

02:08:08.640 | If you look at history and you read how people thought, I mean, there's so many moments in

02:08:14.240 | history where people really thought that they figured it all out. It's almost like there's

02:08:19.360 | nothing else left to do at every stage in history. And then you realize, no, progress often happens

02:08:27.280 | like exponentially. And every moment you continue to think you figured it all out.

02:08:32.880 | But if you're being honest, if you're being humble, then you realize we're just shrouded in

02:08:38.880 | mystery. So what do we make of this? Like, how should we feel that? How should you feel as a

02:08:43.840 | doctor? How should we feel as scientific explorers of the human body? The fact that we're probably

02:08:51.120 | going to be wrong about everything we currently know. - Right. There's a saying, actually,

02:08:55.920 | by the time you finish med school, half of what you learned is wrong, which is quite illustrative.

02:09:02.400 | And becoming more true as time goes on, you know, so much medical research going on,

02:09:07.200 | so much learning going on, it's really wonderful in a way. But in some ways, we still learn these

02:09:12.640 | concepts, you know, from the past. And I know when you take a test as a medical student, sometimes

02:09:18.000 | you know they want you to give the old answer, but you know there's a new answer because of

02:09:23.520 | recent science, but you know to give the old answer that's now incorrect to get the question

02:09:27.680 | right on the test. That happens actually quite a bit because things change so quickly.

02:09:33.200 | - Yeah, you know, when I look back at doctors from centuries past, I mean, it's absurd what they were

02:09:38.400 | doing to their patients. I mean, probably for most of human history, they were doing more harm than

02:09:42.720 | good. You know, they're draining people of their blood. That was, you know, bloodletting was a

02:09:47.600 | huge part of medical care. You know, George Washington died of a paratonsillar abscess,

02:09:55.120 | an abscess right next to the tonsil, which has the great name of Quincy, and they bled him to death,

02:10:00.160 | you know, I mean, kind of adding insult to injury. Doctors are a menace and do a lot of harm. I mean,

02:10:06.160 | hopefully not intentionally. You know, even medical errors are still a huge problem,

02:10:10.640 | cause of death and morbidity. So we do a lot of things that are not great, but you know,

02:10:16.880 | our knowledge, yeah, it's very imperfect at this point. I do have some confidence. You know, I guess

02:10:21.920 | perfect scientific studies that try to get at the reality of the universe are essential because when

02:10:29.840 | I think of why a certain medication works for a certain condition, it might make perfect sense

02:10:35.440 | in my head, knowing the biology, the biochemistry, the anatomy. It makes perfect sense. It must work.

02:10:40.640 | I gave it to the patient, they got better, and that's happened 20 times in the last year.

02:10:44.000 | But it's, you know, I'm wrong. Like, when you actually do a study, it actually doesn't help.

02:10:49.360 | Maybe it hurts. And that's really, I think the way we explain medications working in our minds

02:10:56.880 | is often wrong when you end up finally doing the study. And some of the most interesting experiments

02:11:02.960 | involve what we call sham surgery. So for instance, people who injure their knee,

02:11:08.320 | you know, arthroscopy, where an orthopedic surgeon goes in there with a scope,

02:11:11.760 | gets bits of bone out, shaves down the cartilage, you know, cleans things up,

02:11:16.880 | and it helps some people. But they actually did some studies where one group of people got the

02:11:21.680 | true arthroscopy and others just got sham surgery, where they put them to sleep, made little cuts in

02:11:26.800 | the skin so they woke up with scars, and then it turned out that it's not clear arthroscopy's

02:11:32.240 | actually helping. And the same, there was a recent huge study of doing, putting a stent in someone's

02:11:39.520 | coronary arteries if they have stable chest pain. Not like, I'm having a heart attack, you need a

02:11:43.520 | stent, like, right then. But, you know, kind of chronic coronary artery disease where every time

02:11:48.480 | I run up the stairs I get chest pain, and then when I rest it goes away. Like, obviously, you

02:11:53.680 | put a stent, you increase blood flow to the heart, like, how could that not work? But then when they

02:11:58.000 | did the sham catheterization, it actually looks like it might not actually help better than the

02:12:03.600 | sham. So I think those placebo-controlled studies are essential. I mean, it is shocking, and this

02:12:09.280 | has been driven home during the last two years, how hard it is to figure out what the hell's going

02:12:14.080 | on in the universe, and especially with our bodies. Like, it is really hard to get at the truth, and

02:12:18.960 | what you think makes sense, like, often turns out, I mean, the history of modern medicine is littered

02:12:23.680 | with examples where it made perfect sense and it seemed to help some patients, and it turns out

02:12:28.400 | it's not doing anything, or it's harmful. - Yeah, there's all kinds of narratives swimming

02:12:32.880 | around. We convince ourselves as a human civilization that something is true. There's

02:12:38.160 | propaganda machines, there's just self-delusion, there's centralized communities, like, there's a

02:12:46.000 | scientific community that believes a certain thing, there's the conspiracy theories that believe a

02:12:49.600 | certain thing. Sometimes the scientific community are right, sometimes the conspiracy theorists are

02:12:55.600 | right, throughout human history, I mean. And we now think the scientific community, well, now

02:13:00.960 | the science has really figured it out, we're way smarter than we were in the past. And then there's

02:13:05.120 | these, like, interesting studies that I've seen, I think Robin Hanson mentioned it to me, that if

02:13:12.800 | you look at the entirety of medication, like, the effect of medication on human health, if you do

02:13:19.680 | those kinds of broad studies, does it actually help? Like, does quality of life, lifespan,

02:13:27.520 | certain measures of the well-being, does, and you look at human society as a whole,

02:13:33.280 | does taking medication or not actually help? And those studies find there's no positive or

02:13:39.840 | negative effect with medication. And that's a very kind of interesting perspective, I mean,

02:13:46.880 | you could probably argue a lot of ways, but the point is, 'cause you can bring up

02:13:55.040 | literally a billion cases where medication has significant positive impact on a particular

02:14:01.280 | patient, but you have to kind of zoom out and honestly look at the positive effects of medicine,

02:14:07.920 | of lifestyle choices, diet choices, of exercise or not, you know, maybe we'll find eventually

02:14:13.600 | that exercise is actually bad for you. (laughs) But maybe, like, there's all kinds of things that

02:14:20.000 | we're going to, I feel like we're going to figure out. One of the things I think we're going to

02:14:25.520 | figure out, everything I've learned about my body, is that aside from it being adaptable,

02:14:34.480 | there's a lot of very unique parameters that are opaque to me that I'm measuring through this

02:14:40.080 | feedback mechanism by trying stuff and learning about it. And one of the things we might learn

02:14:46.480 | is that medicine cannot be done without collecting a huge amount of data about each individual human.

02:14:53.200 | So like, it's absurd to be, like, if I show up and see a doctor, it's absurd for that doctor to

02:15:00.640 | have just a couple of minutes with me. Like, just, like, looking at basic symptoms, looking at such,

02:15:08.720 | like, crappy data. Like, first of all, no long-term data, no longitudinal data,

02:15:18.880 | no historical data, no detailed analysis of all the possible things, not just the related to your

02:15:26.960 | symptoms, but related to other things that you're not complaining about. Just giving you a full

02:15:32.240 | picture of the data, and then using AI to help the human doctor highlight the things that you should

02:15:38.640 | perhaps pay extra attention to. I think we'll look back at this time as ridiculous that doctors

02:15:44.800 | were expected to help anybody whatsoever without having the data, without having a huge amount of

02:15:50.480 | data about the human body. Like, you have to do so much with so little data. - It's very 19th

02:15:56.400 | century. - It's very 19th century. So it relies on the brilliance of doctors, and of course,

02:16:01.360 | the intuition, the instinct you build up over time. And that's quite powerful. The human brain

02:16:07.280 | is pretty damn good for using experience to teach you how to make good decisions, but still,

02:16:12.560 | you might as well be bloodletting. Like, it's humbling to think about that. It's humbling.

02:16:22.000 | - It is humbling, and it's important. I think doctors sometimes lose that humble perspective

02:16:28.880 | on what they do, and I think it's very important, because as I said, medical history is just,

02:16:34.000 | medical dogma has been tossed into the trash bin so many times. Something doctors were sure of

02:16:39.120 | was the case is not, and it's important to be cognizant of that. - You tweeted about somebody

02:16:48.800 | that had a big impact, just by reading about him, on my life as well. I still think about him.

02:16:57.040 | Rest in peace, Dr. Paul Farmer. A big inspiration to me. His medical career was a testament to what

02:17:04.320 | one person can do to improve the world. So, who was Paul Farmer, and what made him a great doctor

02:17:11.200 | and a great man, and somebody who was an inspiration to you? - So, Paul Farmer was a kind

02:17:18.080 | of pioneer of global health. He started Partners in Health, which is kind of an international health

02:17:24.880 | organization that operates originally in Haiti, also Rwanda and elsewhere. And I think he was just

02:17:32.640 | so a zealot for getting healthcare to some of the poorest people in the world. And he, I remember

02:17:39.920 | reading some of his books, and a book about him by Tracy Kidder that's really great, Mountains

02:17:44.400 | Beyond Mountains, about how even when he was a medical student, he was flying back and forth to

02:17:49.040 | Haiti in between exams, and just with this really intense focus and interest in getting healthcare

02:17:56.960 | to where it's not. And I think traveling around the world, especially to poorer places like India,

02:18:03.440 | Calcutta, Nepal, you really see how unevenly the benefits of modern medicine are spread over the

02:18:09.440 | surface of the earth. Not only if you're, because if you're in Antarctica and have a heart attack,

02:18:13.440 | you're in serious trouble, but just medications that cost pennies a day can help people. A lot

02:18:21.600 | of children in India under five die of diarrhea, and all they need is oral rehydration solutions to

02:18:27.760 | stay hydrated. Most of them can't afford IV fluids, for instance, to get admitted to the hospital. And

02:18:33.840 | really, dehydration just kills hundreds of thousands of kids throughout the world,

02:18:38.800 | not to mention bacterial pneumonia also is a major cause of death in children under five,

02:18:44.560 | and many of them, not all, would be saved by amoxicillin, which is just pennies.

02:18:48.960 | And for me, you know, I took a, had a path, and I wanted to have a career in global health,

02:18:56.320 | and I started traveling abroad to India and elsewhere when I was a medical student, and I

02:19:00.320 | continued doing that. Paul Farmer was sort of one of the first to kind of open everyone's eyes,

02:19:05.280 | I think, about the good you can do with just money that we would, you know, change that we would

02:19:11.680 | throw away, just, you know, put in a purse and forget it, or wherever we accumulate change these

02:19:16.000 | days. So that's very eye-opening. And while medical science advances, and that's good, you

02:19:21.680 | know, we shouldn't forget that hundred-year-old treatments could save lives in parts of the world

02:19:25.760 | where they're just not available. - People should definitely read "Mountains Beyond Mountains."

02:19:30.960 | Just, for me at least, sort of a person from outside all of it, it was the first person to

02:19:38.560 | make me realize how difficult, and the amount of humanity that's involved in being a doctor.

02:19:45.120 | So it's not some kind of cold, economics-based argument about where to send treatments and so on.

02:19:52.160 | That is there, too. Like you said, basic treatments can help hundreds of thousands,

02:19:59.280 | millions of people in many parts of the world. But it's also,

02:20:03.600 | when you have a patient in front of you, there's some aspect of you that's willing to give a lot

02:20:11.680 | of your time, a lot of your money, a lot of your effort to saving them, even though it doesn't

02:20:17.760 | make any sense. It's irrational in some sense, but it's also human. And that's the struggle of

02:20:24.720 | every doctor, when you have to choose how to allocate your time, how to allocate your mental

02:20:29.200 | energy. It's a tough choice that a doctor has to make, and it's a human choice. It's not some kind

02:20:36.880 | of cold, game-theoretic choice. It's also a human choice, and it can be irrational in some sense.

02:20:43.360 | - Right, people are asking you for help. That's basically what every patient interaction is.

02:20:48.160 | Someone's asking you for help, so your inclination is to help them. And even if it means going above

02:20:53.280 | and beyond, I mean, a lot of factors affect how compassionate a doctor might be on any given day

02:20:59.600 | or point in their career, their own stress and burnout, et cetera. But it's someone asking you

02:21:06.160 | for help, and so you do what you can to help them. - You've done quite a lot of things in your life.

02:21:15.120 | It's been an interesting journey. Of course, there's a lot of story yet to be written.

02:21:20.960 | But what advice would you give to young people today in high school, maybe undergrad, college,

02:21:28.160 | starting out on that journey? Maybe trying to pick majors, trying to pick jobs, careers,

02:21:35.520 | dreams, and goals they can pursue. What advice would you give them to have a career they can

02:21:40.960 | be proud of or to even have a life they can be proud of? - Well, I think having passion, which

02:21:48.400 | isn't always a voluntary thing, you just have it or you don't, perhaps, but becoming passionate

02:21:53.760 | about something and following it, wherever it takes you, I think is really important.

02:21:58.800 | When I finished college and sort of went to Russia for the first time, that was, in some ways,

02:22:04.880 | the beginning of my whole career and passions in my life. And I didn't know what I was going for,

02:22:11.520 | what was gonna happen, what kind of career it would turn into, what kind of job would it help

02:22:14.960 | me get when I got back. I wasn't thinking about anything like that. I'm very fortunate I got that

02:22:19.040 | opportunity. I was very fortunate to be able to go and see those places and have my mind opened.

02:22:25.600 | And I think that really just the fuel from that passion that was created during that time is still

02:22:30.880 | 20 years later going strong. I'm partial to healthcare. I love being a doctor. I think it's

02:22:37.280 | the perfect combination of kind of intellectual problem-solving, being a detective while also

02:22:43.280 | working with your hands when you do procedures, especially in the ER. It's sort of the perfect

02:22:47.760 | combination. I'm not a surgeon, but I do use my hands quite a bit for a variety of reasons. And so

02:22:56.000 | I always loved working with my hands. I loved crafts, especially prehistoric crafts,

02:23:00.560 | before medical school. And I just love kind of problem-solving, getting clues, figuring out

02:23:07.360 | what's going on, following your nose, using your instincts, your knowledge, and also just keen

02:23:13.200 | observation of the patient. After seeing patient after patient, hundreds of patients, maybe thousands

02:23:18.320 | over years, you do get this sort of innate kind of sense, this gestalt about what might be going on.

02:23:24.080 | And it's not always a numbers thing. That's the thing. Gestalt is actually a big part of medicine.

02:23:30.400 | You often in ERs or in hospitals hear a nurse or a doctor say something like, "This patient just

02:23:36.560 | doesn't look good." And it's sort of, you can't point to a number, a value, a level in their blood,

02:23:41.920 | you know, a test, but something about them. And a lot of that I think has to do with the color

02:23:47.920 | of their skin, believe it or not, which can change in certain disease states. But I think that

02:23:53.760 | it's just medicine combines this observation, the skills, the knowledge, it's art and science,

02:24:01.680 | it's human and it's robotic, you know, algorithmic at the same time. And I think it just,

02:24:07.600 | yeah, combines kind of all my passions all in one. And I would, you know, if anyone's going

02:24:13.280 | into healthcare, I'd strongly encourage them to do so, but I'm very biased.

02:24:16.240 | So with that early passion, whatever that little flame was that brought you to Russia,

02:24:21.600 | were you able to vocalize it or was it just something like a gut that pulled you towards some

02:24:29.920 | exploration of the unknown or something like this?

02:24:32.240 | I think it was a combination of things. One was just going to a different place that was

02:24:37.120 | different from where I grew up, you know. The suburbs, you know, when you're in high school,

02:24:42.080 | you hate them. Later on, they don't seem so bad. But, you know, I just wanted to get, I mean,

02:24:46.080 | I'm very fortunate how I was raised and never wanted for anything that wasn't rich. But just

02:24:52.320 | to get out and see a different place, a different people with a different culture and history and

02:24:57.120 | language and literature and to see different climates and geographies and ecosystems, I just

02:25:01.520 | wanted to see something different. And that, I guess that's what I've, you know, sought after

02:25:06.720 | ever since. So just that was just so fascinating. Like my trip to Kamchatka in 2003, where I was

02:25:12.800 | there for four months, and I didn't speak English for, I think, two months out of it. And just,

02:25:18.640 | I remember lying on the floor, some wooden floor in a hunter's cabin in the middle of northern

02:25:22.880 | Kamchatka, just being like, "What am I doing here?" I was just so grateful for the experiences I was

02:25:28.800 | having, what I was seeing and realizing and learning. I was just so grateful, even though

02:25:33.680 | I was lying on this hard, uncomfortable floor. It was just like, "This is so amazing." And that,

02:25:37.920 | I don't think I'll ever have another travel as meaningful and life-changing as that particular

02:25:42.960 | trip to Kamchatka was, though I'm still striving after it. You know, you never replicate that first

02:25:49.280 | high, but you always try. So I just think that seeing something different is kind of the game.

02:25:55.920 | And there wasn't really a plan. Because I got a chance to talk to the CEO of Qualcomm recently,

02:26:01.280 | and his advice is, "Always have a plan." And it sounds like you're saying,

02:26:10.800 | "Don't have a plan. Don't need to have a plan. Just listen to your gut, your passion,

02:26:18.560 | and follow that and see where that takes you." Because it's telling you something.

02:26:22.560 | Yeah, I think, you know, I guess the plan could be specific or could be as general as,

02:26:28.000 | "I just want to go far away and see something very different. That's my plan."

02:26:31.360 | That's one line.

02:26:33.440 | Yeah, just followed my nose from one thing to the next, just being interested,

02:26:37.520 | following my passion. And again, very fortunate I could do that.

02:26:41.360 | Are there places in the world you're kind of thinking about that your life might take you at

02:26:48.800 | some point to be a doctor there for a time, to explore for a time that you haven't yet?

02:26:58.160 | You know, I have some colleagues who do kind of global health work in various countries in Africa

02:27:03.280 | and Central and South America. I would really love to go to some of those places, not just for a

02:27:10.560 | short trip, but hopefully for an extended period of time with sort of the healthcare being the

02:27:16.160 | ticket in, but then maybe even bringing my children or just, you know, I guess at this point, some of

02:27:22.160 | the travel I dream about is sort of replicating what I did and showing it to my kids in a way.

02:27:26.400 | But there's still a lot I haven't seen and would love to see as well. But I think those

02:27:32.080 | opportunities sort of lend themselves well, you know, as a doctor with kind of the ability to go

02:27:37.600 | there and sort of help patients, but also teach medical students and residents. Teaching is

02:27:42.960 | actually a huge part of being a doctor that's underappreciated, but that's actually part of

02:27:47.760 | the fun of being a doctor is that you're also a teacher. Of course, the word doctor means teacher,

02:27:52.000 | but it's come to mean something else. But, you know, in some of my jobs, I'm working alongside

02:27:59.200 | medical students and residents, and I'm giving them my knowledge, my wisdom, sharing with them

02:28:03.680 | stories. And so that's a very satisfying part of the job. - If we could take a brief step into a

02:28:12.080 | dark place together for a time, is there, what is a dark place you've gone in your mind, in your life?

02:28:22.960 | What would be the darkest place you've ever gone for a time, for a moment?

02:28:29.680 | And how did you survive? How did you overcome it? - That's a very good question. I would say

02:28:39.760 | I haven't had as dark moments as many of the people who I care for in the emergency room.

02:28:49.440 | I'm fortunate in that way. I've had a pretty, you know, enjoyable, satisfying life. You know,

02:28:56.000 | I think everybody has dark moments, though, including me. One of the most shocking things,

02:29:02.080 | I feel like, becoming an adult, my two big realizations have been, one, no one knows what

02:29:07.840 | they're doing, and two, suicide is incredibly common, like, in all humans, in all societies.

02:29:14.240 | That I just find shocking. I mean, I've never seriously contemplated it myself, but

02:29:18.560 | I wouldn't say it hasn't crossed my mind during some more stressful times of life.

02:29:24.080 | I think it crosses everyone's mind, and it sort of, as a kid, I found that I never would have

02:29:30.560 | guessed how common suicide is. - It's an important question to sort of the Camus question, like,

02:29:37.920 | why live? Why? Why? 'Cause, like, life, especially when you're struggling,

02:29:45.040 | especially when life is shit, like, why am I doing any of this? And then, on top of that,

02:29:52.400 | chemistry of your brain, it could be as simple as diet and nutrition and aforementioned exercise

02:30:01.040 | and things like this that affect the chemistry, such that you're more predisposed to go to the

02:30:06.640 | places of asking the question why, and maybe struggling to find a good answer. 'Cause it's

02:30:14.800 | actually a question with no good answer, except something in your chemistry says, "Well, I kinda

02:30:22.000 | like it," but there's no good intellectual answer. And especially if day-to-day it's pain.

02:30:28.560 | You get to see these stories of, you know, Robin Williams, these people that are on top of the

02:30:36.000 | world from an external perspective, but from an internal perspective, it's struggle. Every day is

02:30:43.920 | pain. It feels hopeless. And yeah, that's a question we all have to struggle with, or learn

02:30:52.080 | how to ignore. Maybe because if you ask the question too much, you're not gonna, you're not

02:30:57.120 | going to find a good answer. That's a choice you make. I personally think you should ask that

02:31:01.680 | question a lot. But maybe because I have the luxury of the chemistry I have where I'm not in danger

02:31:10.000 | of seriously contemplating suicide. But why live is an important question to

02:31:16.960 | answer constantly, and struggle to answer that constantly.

02:31:19.600 | But people, I've been extremely fortunate to meet people over the past couple of years that are

02:31:29.680 | really struggling. And you have probably met people who are really struggling, like orders

02:31:41.680 | of magnitude more people who are really struggling. Some of it is psychological, a lot of it is

02:31:47.440 | biological. And man, life is a motherfucker. It's pretty tough.

02:31:54.000 | Very true. I do think also past trauma plays a big role there. Like we talked about, you know,

02:32:01.040 | war wounds and PTSD. And a lot of people grew up, I mean, with just horrific childhoods. They were

02:32:07.440 | abused in one way or another. And I think a lot of people who have, not a majority, I'm not saying a

02:32:13.280 | majority, but a lot of people, for instance, who I see in the ER coming in for threatening suicide,

02:32:19.280 | or actually trying and failing and being brought to the ER, you know, a lot of them just have

02:32:23.520 | really traumatic experiences. You know, saw their parent commit suicide, were abused. You know,

02:32:30.000 | these leave scars in the human brain and mind. And a lot of their subsequent lives of,

02:32:36.320 | whether it's substance abuse, alcoholism, etc., is almost trying to escape from their own memories.

02:32:40.560 | It's sort of such this overwhelming battle sometimes. Like sometimes people get ruined,

02:32:48.000 | it seems, and just can't be fixed. You know what I mean? Yes, you can improve diet and health,

02:32:53.040 | and your life choices, and seek out your passion and exercise, and those definitely will help.

02:32:58.960 | But sometimes just like, you know, you bear the scars of the past and there's no getting rid of

02:33:02.960 | them. - Yeah. I think it's possible to live with them. - I think so too. - Because of the struggle.

02:33:09.760 | - I would never say give up, you know. - Keep fighting. - It is a constant,

02:33:14.480 | it can be a constant battle for some people. - I know it can be, and I've talked to many of

02:33:19.600 | those folks. I know it can feel hopeless, but keep up the good fight. - Hopelessness is kind

02:33:26.960 | of one of the big suicide risk factors that you sort of ask about as a doctor, you know,

02:33:32.240 | do you feel hopeless? And that sort of can be a harbinger. - I have quite a few dark moments, so

02:33:39.840 | if you're listening and you're struggling, we're in this together, brother and sister.

02:33:47.360 | Keep up the good fight. - Life is a motherfucker, as you said. It's really harder, I think as a kid,

02:33:55.920 | you know, in a joy-free childhood, you don't realize, like, obviously there's a ton you don't

02:34:00.320 | realize about life, but then when you get to be an adult, you realize just how complex and

02:34:05.520 | hard it is. Is it this hard for adult animals? I don't know. I don't think it is. - So I haven't

02:34:13.680 | seen the honesty of biology before you. Do you think about your own death? Do you contemplate

02:34:24.560 | death? Are you afraid of your own death? How do you make sense of it? - I've definitely thought

02:34:30.880 | about it, especially maybe while doing certain risky things, ice climbing and others, where

02:34:36.880 | every time I look down, I thought about my own death. But I think having kids changes the equation

02:34:44.400 | for sure, should change the equation perhaps. So I think a lot of now when I think about what will

02:34:52.080 | happen when I die, there's a lot of worrying about what will happen to the people I care for. You

02:34:58.800 | think about things like insurance policy, life insurance, and disability insurance, that's not

02:35:05.200 | related to death, but more just injuries. And that's part of the weight, I guess, that you feel

02:35:11.920 | as an adult that I think grows rapidly when you have kids. Though not only, there's other people

02:35:18.240 | you can care for, your own parents and loved ones. A lot of people depend on individuals,

02:35:23.600 | and so you think about what will happen to the other people when you die. - But also, to push

02:35:29.280 | back, that weight might be something you've convinced yourself to think about, it's an

02:35:35.760 | important way to think about, but you focus on that weight to escape the other weight, which is,

02:35:43.840 | at one point, this consciousness just comes to an end. And it's hard to make sense of that.

02:35:54.560 | We kind of delude ourselves in thinking, okay, it just, yeah, it ends, that's the natural way

02:35:58.800 | of things and so on, that makes sense, or okay, that's the way of life. But I don't think it's

02:36:04.880 | cognitively easy to just realize how terrifying that is. We love life so much that the end of it,

02:36:18.400 | it just, it's something that makes no sense. And if you linger on that thought, I think it's a

02:36:26.800 | painful, I would say even terrifying thought. Not scared of like, in a way that's almost like

02:36:34.640 | philosophically terrifying. It just reminds you, maybe humbles you that you don't know anything

02:36:41.440 | about anything. But one of the things we do as humans really well is we, especially with kids,

02:36:49.360 | you realize, okay, we start caring for others in the community, in the family and so on,

02:36:54.640 | and that distracts us. Because then we can at least focus on other people's problems and not

02:36:58.720 | deal with our own. -

02:37:00.200 | When I was a medical student, I was particularly fascinated with kind of what actually happens as

02:37:07.760 | people die, like in the last minutes, seconds of life. It's sort of surprising sometimes,

02:37:12.080 | like what actually kills people. You can get, let's say, a bad head injury, and what kills

02:37:18.640 | you sometimes, it's just your consciousness decreases and you become kind of comatose.

02:37:25.120 | You aspirate, your oxygen plummets, and you get cardiac arrest. That kind of sequence of events.

02:37:30.880 | Or a heroin overdose, let's say you stop breathing, similarly, your oxygen goes down,

02:37:37.440 | then you get a cardiac arrest. So I was really fascinated with what actually happens,

02:37:41.280 | what makes people die. And it was sort of a morbid fascination, obviously, like most of med school is.

02:37:46.960 | And I had many instances where I've had patients pass, and as a medical student, I was sort of

02:37:54.000 | learning what's actually happening, watching it happen, and not always being able to prevent it.

02:37:59.840 | It was sort of a scientific exploration. Then the patient's family comes in and are just devastated.

02:38:06.160 | And then it rips you out of the scientific perspective, and you just realize how horrible

02:38:12.000 | death is. But the person's fine. It's the family, I guess. And that's why, I guess,

02:38:17.840 | that pointed out just how what people leave behind is often kind of the horribleness of death. Like,

02:38:23.040 | just becoming unconscious and staying that way doesn't seem, I guess, to me personally, so bad.

02:38:27.920 | It's sort of like going to sleep, not waking up, not counting the pain and stuff that precedes it.

02:38:32.800 | - So the actual pain, the actual suffering is often felt by the people who love the person

02:38:37.760 | who died. So both financial pain, psychological pain, for years missing them, all those kinds

02:38:46.160 | of things. - Right. Never forgetting. The anniversary of their death, you know, just

02:38:50.880 | having flashbacks or something reminding you. That sort of brought home to me sort of what

02:38:56.960 | death means. And it was more about what people leave behind than what happens to them specifically.

02:39:01.440 | - See, I like those concerns, because I feel like I can do a lot about those. Those make sense to me.

02:39:09.040 | Then just be, if you're a father, just be a good father. You mentioned sort of insurance. Yeah,

02:39:16.000 | there's like financial stuff to take care of. What I don't know what to do with

02:39:19.760 | is the philosophical existential crisis of the fact that this freaking thing ends.

02:39:28.880 | It doesn't, I don't know how to deal with the mystery that's beyond death. Why are we here?

02:39:36.480 | Why are we born at all? What is consciousness? And you just look at yourself. What is this?

02:39:41.840 | Why do I have the capacity to suffer? Why? Why? All these kinds of why questions that

02:39:47.920 | don't have answers. Speaking of which, let me ask you a why question.

02:39:51.200 | The biggest ridiculous one. What do you think is the meaning of life?

02:39:58.160 | Having with this book studied the incredible, beautiful biology of life,

02:40:03.360 | the components, the engineering components that make up this human body. But when you look at

02:40:10.720 | the entirety of it, what is why? Why are we here? - Sometimes, probably more often than not,

02:40:17.840 | feel like the question of why is a trick of the human brain. And outside of our thoughts,

02:40:24.320 | there is no why. Why is not something that's in the universe. It's just this trick happening

02:40:29.120 | inside our brain. - So, why is a game that the human brain plays on itself? And then

02:40:36.480 | the reality of life doesn't have whys. - I do wonder if asking why is sort of an

02:40:43.520 | evolutionary adaptation. Like, you know, maybe hunting, gathering, why does this plant grow

02:40:49.920 | there and not there? Why do I see the same deer tracks by the same tree every three days? Why is

02:40:56.720 | this? Why is that? Why does this plant make me vomit and that plant doesn't? I guess those whys

02:41:04.960 | are very practical and oriented towards survival. But then obviously, you know, we not only use why,

02:41:11.360 | you know, we use it to maybe hunt better, gather better, survive better, but then we sort of

02:41:15.920 | extrapolate it into these unanswerable questions, you know, about why. Like, why does life exist?

02:41:23.680 | - And it's possible that they're not unanswerable in the long arc of science and history.

02:41:29.200 | It's we're just striving for the really difficult questions. Right now, we just don't know much

02:41:35.360 | about anything. And so, we're striving. But there's long, so most of human history,

02:41:41.120 | you were asking why questions for which we now have very precise answers, including with biology

02:41:48.320 | and physics and all those kinds of things. And maybe the why is this cutting edge of science,

02:41:53.840 | of the explorer of the curiosity of the human mind. Like, man's search for meaning is the sort

02:42:00.480 | of the ultimate driver of the why. And it's almost like it could be an evolutionary adaptation

02:42:07.760 | of asking exceptionally hard why questions that will never get answered. Like, so you should

02:42:16.160 | always have, like, it's like a queue. It's a stack of questions, why questions, and that thing should

02:42:22.480 | never come to the bottom. Should always be striving. And that's useful for humans to come

02:42:28.240 | up with better and better ways of survival. And maybe in a bigger perspective for the universe

02:42:34.640 | to figure out something about itself. And it's just humans, just a useful tool for that.

02:42:39.520 | Or life on earth as a useful tool for that. Well, John, you're, for people who should know,

02:42:48.800 | you're from Philadelphia. I'm from Philadelphia. So, it's an honor that you would travel all this

02:42:54.000 | way from a place I love to the new place I love. And that you write this really incredible book

02:43:00.320 | that celebrates the human body in the most honest of ways. And thank you for everything you do,

02:43:05.600 | for being a great educator, for being a great doctor, for being a great person,

02:43:09.200 | and for spending your really valuable time with me today. Thank you, John.

02:43:12.640 | Thanks for having me, Lex.

02:43:13.680 | Thanks for listening to this conversation with Jonathan Reisman. To support this podcast,

02:43:18.640 | please check out our sponsors in the description. And now, let me leave you with some words from

02:43:23.440 | Paul Farmer, a doctor who has inspired both Jonathan and me with the way he practiced medicine

02:43:29.360 | and the way he lived his life. The idea that some lives matter less is the root of all that

02:43:36.800 | is wrong with the world. Thank you for listening, and hope to see you next time.

02:43:42.400 | Bye.

02:43:43.940 | you

02:43:44.020 | you

02:43:45.480 | you

02:43:45.980 | you

02:43:46.480 | [BLANK_AUDIO]

Jonathan Reisman: The Human Body - From Sex & Sperm to Hands & Heart | Lex Fridman Podcast #297

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