Fireside Chat with Dr. Sanjay Gupta, Chief Medical Correspondent, CNN #212

Fireside Chat with Dr. Sanjay Gupta, Chief Medical Correspondent, CNN #212


At StartUp Health we are trying to look at
what issues are facing, not just us in America, but globally that we need to focus a spotlight
on and our next guest has done exactly that on so many topics. Is focusing a spotlight on it. Most of you I know are familiar with him as
the Chief Medical Correspondent for CNN. He’s a multiple Emmy award-winning journalist. He is a practicing neurosurgeon, and when
I say practicing, sometimes I call him and Ursula will answer and he’s in the OR. So, when he’s not on TV, he’s actually practicing
medicine, keeping his finger on the pulse of what’s going on. He served as one of fifteen White House fellows
and was a medical advisor to Hillary Clinton. He’s written multiple books and happens to
be writing, which hopefully maybe he’ll tell us a little bit about the book he’s writing
now. So just to set it up, as we launch this addiction
moonshot, opioid and addiction moonshot, we, it really is a result of the challenge that,
actually I should say, teaches me not to ask a question to Sanjay when we’re at a conference
because he challenged me and this literally did grow out of that challenge. But I wanted to share with you just a brief
little introductory video to sort of help us understand his dedication and his, his
passion for what’s going on with addiction and opioids. So if we can roll the video. We’ve been investigating the impact of prescription
drug overdoses in America for some time on this program. As you may know, someone dies every 19 minutes
in this country because of such an overdose. It’s the number one thing, somebody under
the age of 35 is going to die in my state. It beats car accidents. If you’re not paying attention to that, then
you have no right to represent anybody. If you go by the street names, China White
or China Girl, or the more scientific names. Actiq. Duragesic. Most know it as fentanyl. So powerful that just a quarter of a milligram
can be fatal. You know, it’s interesting, this, this whole
issue that seems to have stirred up a lot of controversy. [inaudible] your own advisory panel voted
11 to two against it. Um, what, what are we missing here? Why are those folks wrong on this issue? What you’re looking at is pretty shocking. A heroin addict overdoses. Her name is Liz. She’s been using drugs since she was 11. Another sternal rub, Another shot of NARCAN. And finally Liz begins to come to. Nasal naloxone or NARCAN. The overdose reversal antidote is available
weekly at all LTC meetings. One of those things that you know, you can’t
believe that you’re signing up for this, but the reality is if you have an addict, you
should have NARCAN. Consider this. In 2012, there were 259 million prescriptions
written for opioid painkillers. Nearly enough for every American, adult and
child to have their own bottle of pills. Look, we need to treat pain, but we also don’t
need to treat everything with the pill. All Right. So ladies and gentlemen, please help me welcome
my friend Sanjay Gupta. Appreciate it. Thank you. Oh my goodness. I am excited to be here. Thank you. We are so excited to have you. Thank you. You know, you guys get to do some really good
work and the fact that we would have this conversation and then it might lead to something
like this with all of you is, it’s very gratifying. Appreciate it. Thank you, and it really was. I mean when we were at that conference and
I actually stood up, asked the question, we talked about the question and I sat back down,
and I don’t know if you remember you said, “Dr Krein, stand back up” and I had a little,
stand back up? And he’s like, I’m going to challenge you. I said, “You got this thing called StartUp
Health. There’s some like really big health problems
and I hear people talking about them all the time, but it seems to me that you’re the guys
that actually want to then try and fix them or do something about them. Here’s one that you can really sink your teeth
into.” So I, I, again, it’s very gratifying. I think these are the things will remember
as we get older for sure. Absolutely. Absolutely. Well, thank you for inspiring us to do this. The amazing thing is as a practicing physician,
I have to say, this is actually embarrassing to admit. I thought I understood what was going on. Um, and it wasn’t, it was after that conference
and uh, I went home and I started really researching out and trying to better understand what’s
going on with the opioid crisis and addiction. It’s staggering. I didn’t know that much about it either. It was about 10 years ago I think. And it was interesting because as you mentioned,
I used to work at the Clinton White House and I actually got a call from the former
president who said that he had two of his friend’s sons, had died of a drug overdose. Of opioid overdoses. And did I, did I know how big a problem this
was? And I said, I, you know, I’ve heard it’s a
problem. I’m not sure how, how big. And he said it’s the number one cause of unintentional
death in America today. More so than car accidents, more so than homicides. You know, all these things that you start
to add up. And I started looking at the CDC data and
he was right. Number one, cause of unintentional death in
America today, drug overdoses, and the majority of them are opioids. So that, that, you know, as far as, you know,
we, we try and tackle the big problems in healthcare. You’re, you’re a cancer surgeon, you’re taking
care of the most complicated sort of cancers around. And here’s this thing that, you know, we could
be addressing in a meaningful way that would save far more lives than I think either one
of us could do as, as practicing doctors. So that’s, that’s what really ignited it. Yeah, it, it, it’s amazing. So as a physician, so you, let me just take
a step back for a second because I don’t know how many people know. Everybody knows you as truly as, as the face
of medicine. You’ve, you are just that trusted face and
voice that brings so many important things into our lives. Puts it in the forefront so we can think about
it and try to try to understand what’s going on in our world and in our communities. But what they don’t maybe understand is, is
a little bit about you, about your passions, that you’re a practicing neurosurgeon still,
that you literally do show up, see patients operate still. He was operating yesterday. That’s why he wasn’t here on Monday. But can you just tell us a little bit about
your, I know you grew up in Michigan, just what brought you into medicine and, and how
you got here? Yeah. You know, it’s, it’s interesting. Uh, neither one of my parents are physicians,
which was a bit unusual because most of my friends, especially Indian descent, their
parents were physicians. A lot of them came to this country as physicians. My, my dad was a mathematician. My Mom’s an engineer, first woman ever hired
as a woman, first woman engineer hired at Ford Motor Company back in the mid sixties. Yeah. Quite quite an accomplishment. Yeah. It’s kind of amazing, you know, just as an
immigrant, still wearing a sari, not complete mastery of the English language. Hearing a talk about Henry Ford when she’s
living at that time in a refugee camp in, in eastern India and says, I want to, I want
to go do that one day, and she does it. So very inspiring., obviously. I have a younger brother. I got into medicine. My Mom’s father got sick. I was 12 years old. He had a stroke and I would go to the hospital. Then he was my favorite sort of, you know,
grandparents and we spent a lot of time together and I think it was the first time I realized
that the people taking care of them, that was their job, right? I, I didn’t realize that could be a profession
and I asked a lot of questions and I think that sort of inspired me at that time to get
into it. I love being a doctor, I have the, I have
the good fortune I think in some ways of straddling two very interesting worlds in medicine and
media and I think when you straddle two worlds, regardless of what they are, you get both
an insiders and outsiders view simultaneously. And it’s very hard to do that as much as you
might analytically sort of approach it. If you’re actually in it you truly get the
insiders and outsiders view. And what I realized is that, you know, I,
I probably love being a doctor more than if I was just being a doctor. Because I see the sense of purpose in it. I see the, the impact that can have on people’s
lives, you know, all that. It’s very, it’s very, very gratifying. So as a journalist, I think it’s informed
my journalism. Working in a hospital talking to people every
day, really understanding what’s happening in their lives. I think being a journalist has also helped
my medical career because I think I care more deeply about story. I really want to know my patients. Everybody has a story. I mean that’s, that’s what we journalists,
you know, that’s, that’s what’s in our DNA and medicine is I think the most, has the
most intimate stories of all. And so I think both these careers that sort
of reinforced each other for me. Yeah, it is interesting, as I feel fortunate
as well. As a practicing physician, as Chief Medical
Officer for StartUp Health, I sort of straddled these two worlds of practicing medicine, seeing
patients and like you said, hearing these stories every day. Um, and then being in the entrepreneurial
world, in the business world and being able to see how these worlds actually need to intersect
and the importance of intersecting. And it really does, I think make me, obviously
a better entrepreneur, but a better physician because you, do you think outside the box
in? I think in both worlds a little bit. I think you’re absolutely right and I know
this isn’t the whole point of discussion, but I just want to say something about that. I think when I got into journalism, I think
that was part of it. I, I, I know many people in this room are
entrepreneurs. You know, I think in medicine there’s a sense
oftentimes that things do move slowly and maybe that’s obvious for people who are in
healthcare, the healthcare entrepreneurial world and for a lot of that makes sense for
a lot of reasons for it to move slowly. You want to approach things very methodically,
you want to have a sort of preponderance of evidence before you make decisions, all of
that, but at the same time there are things that we know to be true. There are ways that we can iterate to improve
people’s lives now. We all know that within institutionalized
medicine. I think as a journalist to be able to to,
you know, sort of light a fire underneath some of those things to make it clear for
the mass public what was happening and let people see what was possible I thought was
really, really important. We can accelerate some of these things through
obviously StartUp Health, but also, you know, through journalism. Yeah. Well absolutely. I think by raising the awareness you actually
sort of forced the change, right? We’re both in the medical community, but also
letting patients know what’s available and what they should be sort of requesting or
insisting on. I’m saying like there’s a better way. Let’s do it that way. Right, absolutely. Interesting. So I wanna, I wanna talk about one of your,
one of your passions, which is the opioid and addiction issue. As I said, I thought I knew what was going
on, but I really didn’t. And as a physician I, again, I’m, I’m a little
embarrassed because, you know, I wonder, and I want to get into the conversation of, you
know, are we partially to blame for this crisis? But just to throw out some statistics, I don’t
know, I don’t want to steal any of your thunder, roughly 21 to 29 percent of the patients prescribed
opioids, misused them. Eight to 12 percent of these users develop
a opioid dependence. Four to six percent of all the opioid prescription
prescriptions that are sent out, um, ended up transitioning to heroin or a stronger,
as a stronger drug. And 80 percent of heroin users started on
opioids. Staggering. We prescribe the vast majority of opioids
in the world in this country. We’re not even five percent of the world’s
population. And with regard to some of these classes of
opioids we’re taking 80 to 90 percent of the world’s supply. Um, there’s, there’s a lot of blame to go
around, I think, no doubt, but, and I think one of the hardest pieces I had to, I wrote
an op-ed some time ago about this and I, you know, when you really start to look at the
data but also be a little existential about this, you realize that, um, you know, the
medical community must shoulder a lot of the blame here. Even though, um, you know, you and I went
to medical school and training around the same time, I think I’m a bit older than you
are, certainly look a little bit older. I’m older. Are you really? I am older. Wow. You have such a youthful visage about you. I don’t know about that. Really, I was looking at you saying, what
am I, what am I doing wrong? But I, I, we, we, we were taught that nobody
should be in pain and that it was the fifth vital sign. You always asked about it. Just like you would check heart rate and breathing
and blood pressure. You would ask about pain and people would
get opioids and there was no risk of addiction. That was sort of the conventional wisdom. I think we should have asked more questions. We should have, we should have realized, okay,
well how do you know that? The data was based on primarily chronic cancer
pain patients that were terminal and really most of the studies, we’re no longer than
six months. So the idea of someone taking this for non
cancer pain for long periods of time, months and months and years and years, we just didn’t
know. We just didn’t have the data. So nobody could have made those statements
about the low risk of addiction, low risk of abuse. And now we see obviously what has happened
with this. So I think the medical community certainly
place has to shoulder some of the blame. But I think also, you know, in the United
States we’ve had this culture of consumption for so long. There are countries around the world, I dare
say, have the same levels of pain that we do, right? We have no, we have no sort of monopoly on
pain. Uh, so how do these other countries treat
it? They’re treating it obviously in very different
ways, pain, than we are. If we’re taking 80 to 90 percent of this stuff
in a country that’s 4.7 percent of the world’s population, what’s the rest of the world doing,
getting by with? And I think that that, that, that ended up
being a big question that we started wanting to dig into as well, but the medical community
I think in addition to many others does have to take some responsibility. It’s still an issue, right? Even as we talk about reimbursements and as,
as the satisfaction rates for physicians are now very public physicians start to worry
about, well, how am I going to make sure I get a good satisfaction rate and the patient
comes in asking whether it’s antibiotics or opioids or things. There’s, there’s a really fine line that we
have to balance it. And it’s still happening. I mean, you know, some, some of the reimbursement
programs for hospitals now are based on the satisfaction scores from patients for these
physicians. Um, many hospitals, I don’t know how your
hospital handles it. For us, for example, at the Emory Clinic,
there are pain clinics now that are totally separate. So as even as a neurosurgeon who takes care
of patients who do have pain, we have the pain clinic manage all of their, you know,
whether it be opioid or any other interventions with regard to pain. So there’s a single doctor who manages that,
but that can be frustrating too. It can take time to get into the pain clinic. They’re very, very busy as you might imagine. And you know, Howard in the midst of all this
are patients who have real pain and you know, you’ve got to be very, very careful not to
demonize them either because they have found relief through these medications. They’ve been able to use them responsibly,
but, but they, in the midst of all this, sometimes they run the risk of actually losing access. And, and, and in addition, the pain is real. I think that part of it was also that we,
we, as you mentioned, really underestimated the addictive potential of these medicines
that we didn’t do the proper studies maybe before we started prescribing all of this
and actually sort of led them down the path without really understanding it. You can, you can develop physiological changes. Now, I learned this, we studied this as one
of our films that we did. Roni Selig is here, who’s my executive producer. We worked on this for for some time. Um, but within five days you can start to
see physiological changes in the body. So these are physical changes, meaning that
once you remove the substance, in this case the opioid, you will see, you know, accelerations
in heart rate, blood pressure, people will start to develop early signs of withdrawal
as early as five days. Which postsurgery we both know, especially
in neurosurgery, it’s very, very common to be in the hospital more than five days. And so we put them on the pain meds saying,
well, we’re just going to do this while you’re in the surgery. And the funny thing is, and then we say, well,
we’re cutting everything off, go home and then what happens? They seek it out in different ways, right? Yeah. Like you said, these patients who are then
abruptly cut off of their opioids after being, becoming dependent on them will seek out cheaper
and frankly more accessible opioids, which things like heroin. Heroin, these are the same ingredients. They all come from the poppy plant. Morphine, Percocet, Dilaudid, hydrocodone,
Oxycontin, heroin, fentanyl. It’s all part of that same molecule. Either synthesized or natural, that same molecule,
so it’s no wonder then people will find some satisfaction for their withdrawal by, by seeking
out one of these other meds. Right. And then, as you mentioned, all coming from
the poppy plant, but all very different in their effects and in their strengths, right? And that’s where we’re getting into why the
death toll, why this is such an epidemic, right? You hear these stories, uh, you know, in Ohio
over the weekend, you know, you had 30 people who overdosed, you know, six of them died,
whatever the numbers may be. What typically is happening in these situations
is that you’ll suddenly have an influx of a much more powerful synthetic. They talk about fentanyl and they talk about
Carfentanil. They’re adding different molecules to essentially
make this more powerful. Um, and, and people who are used, you know,
frankly, addicts who are used to taking a certain dose, think that they’re taking that
same dose and all of a sudden they get something that is 10 times more powerful or 100 times
more powerful and that’s when you’re seeing these overdose deaths. So it’s, it’s really frightening. And as you might imagine, you know, for people
who are using this stuff they’re worried that every time they take some of that they could
be ending their lives. Right, right. And the scary thing is, and the thing, I think
really one of the take homes is, this isn’t just and I don’t want to use this as a derogatory. This isn’t just drug addicts, these are, these
are teenagers, brothers, sisters, mothers. I mean, they, that maybe you’re just doing
this once in a while or trying it and dying from this. I, I, um, I have, I have three kids, uh, you
know, and I, this is a conversation I have with them all the time and you know, it’s
people talk about, okay, experimentation, I’m gonna, try something. Once, you know, or people are talking about
it and schools lately it’s been the jewel, you know, which is the, the vaping of things. Not opioids but, but just the idea of experimentation
and that mindset with regard to opioids you can’t do it anymore because the, the, the,
the types of dosing that we’re talking about, the type of dose that might get into a high
school nowadays in terms of the potency of this is, is I mean it’s catastrophic. I mean it’s unlike anything you’ve ever prescribed
in your entire career, it’s probably greater than what you would have given 100 patients
at any given time in your career. So it’s, it’s really, it’s really remarkable. And again, that part of it that, that has
to stop. I mean they, these are, as you say, these
are not addicts. These are people who are now maybe saying,
what’s the fuss all about? Let me, I’ll try it once and they’re dying
and that, that, that is happening tens of thousands of times a year. It’s amazing. So we touched about, touched on one of the
reasons that this is becoming an epidemic, or is an epidemic now. Um, do you think, is it just the access in
the United States or in other countries that is sort of fueling this epidemic? What is it? I think certainly that’s a big part of it. You know, they just basically flooded the
United States with, with these opioids. Here was a place that was willing to prescribe
it. There were people that were making a lot of
money on it and it became a sophisticated thing where you could anticipate markets where
opioid consumption would go up and opioid manufacturers, and then subsequently heroin
dealers would show up in these places even before the people realize that they were going
to need it. That’s how sophisticated this market became. What I find interesting, and we, we’ve been
digging into this for this film for HBO for a couple of years. I got this um, documentary coming out. It’s a film, March 25th. It’s called, “One Nation Under Stress.” And the reason we decided to look at this
was because of a study that I read that came out of Princeton that I found quite startling. It’s by a couple of economists, husband and
wife, Angus and, Angus Deaton and Jean Case. And typically economist studies are kind of
kind of dense, slow, boring, but this one was fascinating and the, the conclusion that
they made was that if you look at every demographic in the developed world since World War II. So every demographic in the developed world
since World War II, all of them have increased in life expectancy except for one. And the only one that has not increased in
life expectancy is the white working class in the United States. Flat, even dropping, plateaued, dropping in
some counties now across the country. It’s a startling, startling thing. Again, think about it, dedicated our lives
to try and push back the frontiers and boundaries of life. And we’re, we’re actually going backwards
for the third year now in a row. The United States has actually dropped in
life expectancy overall because of the impact of these, what are called deaths of despair
among the white working class. Three years in a row, we’ve dropped in life
expectancy. That hasn’t happened since we’ve been in the
midst of either a plague or a world war, so the impact. What is, what is causing these premature deaths
in the white working class? Number one, opioid overdose, number two, suicides
which have gone up 30 percent since 1999, and number three, liver cirrhosis, typically
due to alcoholism. So deaths of despair being a very apt title
and we’ve been working on this, Howard, for some time. If we can I’d just love to show you a little,
a little clip of this. This is the first time we’re actually showing
this where I spent some time with somebody who’s really been at the forefront of this,
a coroner named Cyril Wecht, who, who talked me through some of what was happening. Michael, can we show that? So why are people taking as many opioids? Part of it’s prescribing, part of it is becoming
addicted, but why are so many people drinking? Why are so many people dying by suicide? We’re operating at a time where we were very,
very good at learning about and treating diseases. I think we are less good and less proficient
at understanding health. Are we going to be remembered to be, to have
been physicians at a time when life expectancy actually dropped? That’s a little bit of an existential pain. There’s probably nobody better in the country
that has seen the ups and downs of American culture from a medical perspective than Dr.
Cyril Wecht. He’s the guy that most of us turn to when
we have questions about pathology, but he’s also the guy that can help really solve a
mystery. Hello. Good doctor. Pleasure to see you. Really exciting. I get the reports back from national medical
services on three. I felt they were drug deaths, I, you know,
and so all three were only fentanyl. It’s unbelievable. Crazy. Have you been. You’re looking well, thank you. Did you hear the story when my office called
you? I think it was around the time prince had
died. When prince died. Yeah. Yeah. And then. And then somehow the message got miscommunicated
that I had died. I said, you know, I cannot tell you how sad
it is, but to whom do I submit my application to become the Medical Director of CNN. You know, there’s no sense wasting any fucking
time. Right. I appreciate the pragmatism. The morning did not last that long. Thank you for your time. You know, you’ve, you’ve always taught me,
you’ve taught me a lot. Not only did you teach me forensics, but I
think you, you taught me a way of thinking about things. Uh, you know, a methodical way of thinking
about those. Very gracious of you. There’s a few things I want to ask you in
that regard. Liver cirrhosis, drug overdose, mainly opioids,
and suicide. They are called deaths of despair and it seems
to be the symptom of an underlying problem as opposed to the problem itself. What is your sentiment in that regard? I think what we’re looking at is an increasingly
stressed society. I think a society in which the pressures become
greater and greater and in all respects, in making a living, depersonalization of society,
the robotization of society, families breaking up, splitting off. These are all things that I think play a role
in leading to this stressful society that we have. And then you have changes on the medical side,
the idea that people should not have to suffer. We’re going to take care of it and it’s very
easy. You’re going to write the prescription. It seems to be that we are self medicating. We are four point seven percent of the world’s
population. We take 80 to 90 percent of the world’s opioids. I’m pretty sure we don’t have 80 to 90 percent
of the world’s pain in this country. How about when I’m looking at a 62 year old
woman lying on the table and you know she’s perfectly healthy looking and I’m thinking,
my God, this could be somebody’s mother. This could be somebody’s grandmother and
most Americans I think do not yet understand, is proportionately white between 35 to 55. Do you think there should be this idea of
stress being an actual diagnosis? Because it seems like it’s a very nebulous
term. You have A: is the immediate cause of death
and then you have another box of contributing causes. That is certainly where stress should be listed. Awesome. [applause] Yeah, we’re, we’re talking about
something that’s happening in real time. You know, I think people will look back on
this time in our history and we’ll get a little bit of a reflection of, of how we were approaching
this issue, you know, through people like Cyril, but that’s partly why we wanted to
do this. One thing I just want to say quickly because
stress again, as I said is a nebulous term, but when you look at the white working class
and the population that’s been predominantly affected here, as we get into this, this film,
it’s worth remembering that it’s hard to define stress sometimes, but these were the sons
and daughters of the greatest generation, right? They are the, they were, they were supposed
to inherit the earth. They were supposed to inherit the United States
for certain and instead they found jobs going elsewhere. They found themselves obviously dying at faster
rates, not living up to the dreams of their, of their parents, and and that, that dashed
expectation from an evolutionary biology standpoint turns out to be incredibly stressful. And so dashed expectations may be fueling
the deaths of desperation which may be causing, you know, the opioid, the suicide, the, the,
the liver cirrhosis. I don’t want to overly simplify, but you know,
as we’ve looked for these unifying theories, that’s one of them that, that I think really
came to the, came to the top. Yeah. Yeah, and it really is a unifying theory because
all three of those are really interrelated into relationship. Relationship with yourself, relationship with
others and how, if you’re, if you’re not able to have some way of relieving or releasing
some of this stress, whether it’s through exercise, through talking, through therapy,
whatever, you’re going to find some way of, of sort of dealing with it. Yeah. I mean we like the quick fix. We like the immediate sort of relief. Even if we know that it’s toxic and doesn’t
last very long. Like you, I’ve had the privilege of getting
to know Dean Ornish over the years and I think Dean is here probably, but the, the, the types
of interventions that people like Dean talk about take, they take time and they take,
frankly, someone like Dean to actually be a champion of them. They’re not a trillion dollar opioid industry,
you know. They’re, they’re about love and connection
and being social with people. Frankly, things that in the rest of the world,
including the developed world people have done for a long time. We know that they work and they’re not taking
nearly the amount of opioids that we’re taking or they’re not drinking. They don’t have the same suicide rates. So, suicides going up 30 percent in this country
since 1999. Yeah, It’s interesting. Dean mentioned this morning. We had a great talk with him and, Anne, but
he mentioned that one of the changes as the United States developed, is we’ve gotten rid
of multigenerational family, family homes, were in, uh, in other countries it’s a little
bit more common, but that being one of the reasons is because you don’t have this outlet
and these relationships through multiple generations. Right, yeah. We wanted to live with my parents. My wife absolutely vetoed that. That would be far more toxic. Absolutely. Um, so as we talk about addiction, and we
said we started talking about some of the different causes of this epidemic. Where do you see technology fitting in to
it? Is this just a, hey, we got to fix our relationships
and we have to stop prescribing? I think what’s interesting is I think from
a, from the opioid thing in particular, I think most of the reporting, and even if you
look at a lot of the, the scientific articles that are written are really looking at this
from a social, cultural sort of prescribing standpoint. One of the things that I think bears mentioning,
and again you and I’ve lived through this, is that we haven’t had many other options
in terms of actually treating people’s pain in a way that would not require opioids. I mean there are other things out there, non
narcotic based therapies, noninvasive therapies, whatever they may be. I think that the, the idea that there’s going
to be some, some significant innovation with regard to, A, how we define it, pain, how
we measure it, it’s still very, very subjective in terms of how we measure it and how we treat
it I think is fascinating. There was a story that we’ve been sort of
looking at a little bit that focuses on a type of, a type of technology called DREAD. I don’t have anybody in the room is familiar
with that, but basically it for designer receptors enabled by activated designer drugs. DREADD, and, and think of it like this. You have these pain receptors in your body. Think of that like the end of a train. Now you take another receptor or something
that you create genetically and create a new caboose for the train. Okay, so now you’ve essentially created a
new receptor for that pain and in order to actually activate that, you know, from a therapeutic
standpoint, you could, you could create a molecule or using an existing molecule that
is relatively inert, doesn’t do much in terms of side effects in the body, but actually
will target that particular receptor and help treat pain without side effects. That is a, that is a genetic, that is a chemo
genetics sort of innovation that could be huge with regard to pain and also help us
get a better sense of actually how to, how to assess pain as well by looking at how upregulated
these receptors are. That’s just an example. But I think, you know, when you have something
like this that’s been such a problem for so long and you say, well, what are, what do
people really do then if they are suffering from chronic pain? We keep telling them that, look, opioids can
be very effective, you know, for, for pain, uh, but you can’t take them for too long. But then they have chronic pain. They’re going to live a long time. What do they do? Why haven’t we innovated more in this area? I think part of the reason is obvious is that
there’s been just so much money in that opioid area that that’s been a big, big umbrella
for a lot of people in the pain world to, to get under for a long time, but now you’re
starting to see these pockets of innovation in terms of assessing, in terms of treating,
in terms of thinking about pain and totally, totally different ways. Yeah, it’s interesting and besides the big
money of it, it was a simple fix, right? We want to do things quickly and yeah, you
take a pill, it’s going to be better. Um, first off, the DREADD. It’s an amazing. The potential there is mind boggling because
if you could a quell somebody’s pain without giving them the side effects of the opioids. What a huge thing. The other thing that you mentioned, um, how
do we, how do we measure pain? Pain is so subjective and we know from treating
patients you can do the exact same thing to 10 different patients and they’re going to
have 10 different replies on how uncomfortable it is. Some people going, Eh, was one out of 10 and
other people saying I was an 11 out of 10. Right. Yeah, no, I mean, and usually men do worse
by the way, which is true. 100 percent. Yeah. Women are much stronger and just put it out
But I think that’s a really, the idea of being able to be empathetic objectively about one’s
pain, about a patient’s pain, a colleague, a loved one, whoever’s pain and, and, and
the idea that there are, there are ways to maybe get a sense of, of the true impact on
someone’s brain in terms of their brain waves, what is actually been transmitted to the brain
from a toxic stimuli. You know, whatever it might be is becoming
increasingly real. But I am amazed as we talked about innovation,
that we have innovated so well in so many different areas. Oftentimes these innovations come, frankly,
without a clear cut problem that they’re trying to solve. Right? Here is a clear cut problem. One of the biggest social cultural medical
problems of our time. Causes more unintentional death than anything
else and they’re, I think there should be incredible innovation around all aspects of
this. Measuring it as a, as a, as a starting thing,
which I don’t think would be that hard to do. I mean, I’m not going to figure it out with
you right here on the stage, but I bet you if we sat down we could probably figure out,
you know, reasonable ways that are, that are accessible to people to measure pain, to really
get an objective measurement of their pain and then figure out what really works for
treating it. Uh, and those therapeutics maybe things that
we haven’t even thought of yet. Speaking of different therapies, we are in
San Francisco, California. Medical marijuana has become a hot topic. People are talking about it. People are trying to understand it better. Does that have a role in opioid addiction? I, I think it does. I really do. You know, I, I’ve, this is another topic that
I’ve been reporting on for some time and you know, we’ve done, we’ve done several films
on this and the last one that we did was specifically looking at what is happening with opioids
and this interplay between opioids and cannabis. First of all, I will say that it’s hard to
get the randomized clinical trial that again, everybody wants and understandably so in a,
in a place where the substance that you’re trying to test is also illegal at the federal
level. Very hard to get those, that sort of data. So you start to look at clues. For example, in states where you had medical
marijuana legislation and you had functioning dispensaries, you saw several things start
to happen. You saw that opioid prescription rates went
down, you saw that opioid usage went down, perhaps understandably and most importantly,
you saw that opioid overdose rates went down by 23 percent for example, in Colorado. Really significant. So we started to really dig into that. Like why would that be, how would this work? And I think there’s sort of three things I’ll
just tell you quickly. One, is that could cannabis be used instead
of opioids initially for treatment of pain and you find that there’s, there’s actually
pretty good data now from, from, you know, big trials, most of them, again, outside the
United States looking at the use of cannabis for pain and you find that it can be very
effective, especially for what’s called neuropathic pain, which is a sort of nerve pain. Two, is that if you’re on opioids trying to
get off, you’re gonna withdraw. And that’s awful. I mean, I’ve seen this. It’s like it, you, you feel like you have
the worst flu of your life. Everything hurts. You become hyper anxious. Your heart rate accelerates, you’re sweating. Withdrawal from opioids is a miserable experience. Something nobody wants to go through, which
is why people will then seek out other other drugs. Much in the way that cannabis can help treat
the symptoms of, of side effects from chemotherapy, you find that cannabis can also help treat
the withdrawal effects from, from opioids. And finally, and this is the most interesting
to me, I think from a neuroscience perspective, is that what happens? Why does someone become an addict? Right? It’s not really. I think what the data is showing is that there
may be people who are predisposed to this, but with regard to opioids, it seems to affect
a part of your brain in the frontal Cortex, an area that I guess best be described as
as reducing your perception of harm. If you don’t perceive things as harmful, you’re
willing to take risks. You take the opioids and that is suppressed. So you’re just, you’re like, eh. So you keep taking it. People say it’s bad for you. Some of the rational thought. Yeah, I don’t. I don’t perceive the harm, harm perception
is affected. And, and, and what you find is that CBD, which
is a component of cannabis, a non psychoactive component, can actually help heal that part
of the brain. It can help correct what’s known as the glutamate
transmitter system in that part of the brain. There’s very few things I can do that. CBD can do that. If you continue to take opioids, even as agonist
therapy, which can be effective, Suboxone, buprenorphine and things like that, they can
be very effective. But the problem is that people recur often
because that harm reduction part of the brain is not healed if you continue to take opioids. So do I think cannabis and CBD can have an
impact? I think it can have a real, a real impact. And, and frankly, I think it’s a much less
toxic drug. I mean, you know, you can’t, you can’t overdose
from it. Um, if you’re taking the CBD, it’s not even
psychoactive. I mean, it’s, it’s, um, I think it’s a pretty
remarkable potential solution that’s been around for a long time. But again, it takes, takes people. I just want to say, I think several years
ago during the debate, I heard there was, there was something that I saw that said how
many, um, how many, uh, overdose, death overdoses from cannabis have there been and they’re
literally Really, zero. Yeah, zero. The thing is that why does someone overdose
and die? It’s typically because whatever the, the drug
or the molecule specifically is affecting the brain stem and it’s affecting one’s ability
to drive their own breathing. So someone who dies of an opiate overdose,
they are okay if they are awake, they are, they breathe, they think to breathe. When you go to sleep and you’ve had your brainstem
affected by the opiates, your drive to breathe may, may go away and that’s why people overdose
and die in their sleep. Cannabis doesn’t affect that part of the brainstem. So just from a physiological standpoint, you
don’t overdose and die from this. People can have bad reactions to it. People may have terrible side effects, you
know, I’m not condoning this, but as a medicine I think it’s potentially really effective,
especially against this, this new problem. Are we doing enough as a society with. So you said part of the, part of the issue
with the deaths is the suppression of the breathing and we know that there is a reversal
agent. Are we doing enough to make sure that that
is available and in places whether, a public place should be pretty much available in every
public space, shouldn’t it? Yeah, I’ll tell you this. So NARCAN is what you’re talking about. And naloxone. This was one of the interesting sort of tale
for me as a medical journalist because I think, you know, especially as a surgeon and I think,
you know, maybe you feel the same way. I mean we’re, we’re used to basically finding
things and if there’s something that works, you know, really getting behind it and making
sure that it’s used and, and can help people. NARCAN is one of those things. I mean, the woman that you saw briefly in
the video, she was someone who was in the throes of a heroin overdose, would have likely
died, got two shots of NARCAN and is, you know, and survived and is still doing well. Um, what, what critics will argue and, and
it’s worth hearing the whole debate. And it’s not just about NARCAN but other things
is that at what point does something become a tool that actually empowers more drug use? Does it become a safety net where people say,
well, now we have the NARCAN, therefore we don’t need to worry about overdosing and dying. I can take these opioids, you know, at will
now because I’m not worried about that. People raise these same arguments around harm
reduction with regard to needle exchanges, for example. We’re gonna use needle exchanges to decrease
the rates of infectious disease. But is that going to be sort of a green light
to drug users saying, Hey, I’m not gonna, you know, get an infectious disease now, what’s
the problem? I, I, um, personally I think to your question,
I think NARCAN should be widely available. We have people dying right now. Nobody obviously wants to die of this. We have something, a tool that can work and
you are seeing cities across America that are making it more widely available. Leana Wen, who used to be the boss, I’m sorry,
the Baltimore City Health Commissioner. What she did very interesting when she was
a health commissioner was basically wrote a blanket prescription for every pharmacy
in Baltimore. So anybody that went into to a Baltimore pharmacy
could get NARCAN with the, with the health commissioner’s signature on a prescription. So that’s how she sort of combated it, but
it’s still very, very patchwork. It is. And it’s a shame because it really is a, and
I don’t want to say an easy solution. But it is a nice guard because these are generally
accidental overdoses. People don’t know that the drug that they
happen to be taking might have fentanyl in it. And the next thing you know, innocent people
are dying. Yeah. Yeah. That, you know, I, I think, I think what is
driving a lot of this and, and again it’s a more philosophical question that perhaps
spurns ideas around innovation, but we still think of this very much as a, as a moral failure
for people when they do this. There’s a lot of stigma around this. Certainly I think when I say and I explained
even that this is a brain disease. We know that it’s a brain disease. I can show you in the brain which part of
the brain has been diseased and I can show you what that part of the brain does and here’s
why that leads to addiction and why that cycle of addiction is hard to break. Um, it doesn’t still always, always resonate. And I think that if you really, if you’re
serious about it as a medical community or just a community as a whole of, of treating
addiction, again, these drug overdoses being number one cause of unintentional death in
America, uh, then, then if you really truly explain it from a medical standpoint, then
I think everything else sort of follows. NARCAN becomes less objectionable. The idea that you’re going to put research
into addiction funding. Only 10 percent of people right now who need
addiction treatment are getting it in the United States. 10 percent. So, you know, talk about low hanging fruit. Places where you can go out, leave the doors
today and make a huge impact. You know, there, there, there is an example,
but I think the reason that is, is because of the stigma, because of the perception still
that this is more and more moral failure than a brain disease and I think that that causes
all these sort of strange reactions to this problem. So how do we fix it? And I think that’s also a common theme in
mental health, right? This stigma of mental health. It’s one of the things we are trying to approach
with our mental health moonshot to is how do you change that stigma? So as we, you know, we brought you here and
I’m so excited you know, the work that you’ve done in raising the awareness for opioids
and addiction and frankly so many different medical topics. We wanted to bring you here also to give you
the platform. So just like you challenged me and you said
Dr. Krein, what can, what can you and StartUp Health do? I’m going to challenge you to come up with
some solutions. We’re here in a room of entrepreneurs, people
who think outside the box. Investors, payors, providers, um, we’re online,
on a live feed. What, what can you challenge the world and,
and this community to do? It’s a real, it’s a real opportunity, real
honor to be able to speak to a group like this. I mean, I, I, first of all, I’ve always been
somebody who, who people think, look, I want to transform healthcare. I want to do something big within healthcare. I think being able to first define a problem
really, really clearly and then figure out how best to address it is important. And I think the opioid one is, is one that
sort of fits that criteria. It is a well defined problem that we have
not had a lot of innovation around. I think that the the biggest goals I think
going forward, one is that you’re starting to see policy changes already with regard
to prescription rates, but I think the biggest goals going forward, which I find very exciting,
are this idea of can we finally take something that has been as obscure and subjective and
vaguely described as pain and really start to define it. To be able to measure it objectively. It’s kind of remarkable to me that we haven’t
done more of that already. There are some people who are starting to
get into this space. Looking at how your brain waves change in
response to different stimuli, but to really make that something that is part of how we
take care of patients. It is why people come to the doctor, it is
why people suffer, it is why people have bad relationships, is typically there is some
sort of pain that’s driving that. I think then the idea, whether it’s DREADD
or whether it’s something else, to finally come up from this country that has been so
adversely affected by the opioid epidemic, to come out with new strategies to treat pain,
I think would be a place where I would probably spend a lot of time, if I was an innovator
and an entrepreneur. I would really think about how does pain really
work in the body, why have we always treated it with this gigantic sledgehammer? Are there ways to really start to address
people’s pain syndromes in a much less toxic, much more effective way. I think it would save lives and improve countless
lives as well. Do you think, we talk a lot about what’s going
on in America. Do you think that these, these, these treatments,
these, um, these transitory management mechanisms will be sort of able to be used across the
globe too? Yeah. I think And do you think, what, what do you
think we can learn from other countries because they’re clearly doing it a little bit better. We can definitely learn a lot from, from,
from other countries. I mean, you know, I, I think that um, many
of these other countries have not been forced to innovate because they’ve never really had
the same opioid problem as we do. I spent a lot of time in Turkey this past
summer. Turkey is the largest producer of licit or
legal opium in the world. Most of the pills, you know, not not heroin,
but most of the pills and things like that are coming from poppy that has grown in Afyon,
Turkey which, which translated means land of opium. And, and they export 96 to 97 percent of it. So they, so they’re the world’s biggest producer
and then they export it. They export it. Most of it to this country, sadly, but, but,
but to your point, there are countries like that around the world that are using all sorts
of different therapies. I mean when I was there, and it’s going to
sound a little off the beaten path, but one of the big things that is happening in Turkey
now and it’s being practiced in hospitals is what’s called Api therapy, which is essentially
bee sting therapy and they’ve come under this belief that ultimately pain is really being
driven by the underlying amount of inflammation that you have in your body that is then triggered
and made worse by something. It could be a toxic stimuli, it could be a
food you ate, it could be whatever, something in the environment now takes that baseline
level of inflammation that you have and amplifies it. Uh, what are things that can be used to lower
your baseline rates of inflammation, again, something that Dean Ornish talks about, but
the, the, the idea that that is a underlying problem when it comes to pain as well I think
is very real. And, and again, they have great success rates
with treating pain in these ways that we might find strange and, but we have just never really
thought about. Right, strange, well, alternative therapies,
right? America is sort of slow sometimes to, to,
to accept them, but you know, they, they work, whether it’s acupuncture, meditation, spirituality,
things like that. They’re finally, I think catching on and sort
of becoming more mainstream. I think that’s the most exciting thing that
I’ve seen now probably in almost 20 years of living these two worlds between medicine
and media is, you know, you tell the stories of people in this country and people want
to take better care of themselves. They, they, they, they really do. There’s been a dissatisfaction at times with,
with mainstream medicine and some of it very understandable. I, you know, I mean, it’s become a political
debate often, but when you tell people that, look, we’re not just talking about disease,
disease detection and treatment, we’re not even just talking about wellness and prevention. We’re talking about human optimization here. Yes. We’re saying that no matter where you are
in your life today, whether you just won your age group for a triathlon or you’re in the
throes of chronic disease, you can be better tomorrow. You can be better, you can be stronger, faster,
a better husband, better wife, better son or daughter, whatever it might be, because
we’re not nearly optimized enough. And I think part of the reason we don’t feel
that way is because of this, these, these levels of inflammation and, and, you know,
uh, due to toxic stress, environmental triggers, whatever they may be in our bodies. Yeah, and I was going to say these levels
of inflammation, but also as Dean had pointed out, um, you know, we have to decrease the
stress levels. We have to exercise, which, which definitely
helps us blow off a little bit of steam. We have to love more too. Right? We have to. We have to sort of. It’s a little bit hokey, but we have to love
more. You have to. You got two surgeons up here talking about
love. You’ll never see this any anywhere else. Give us a bad, bad reputation. Some people have been raising their hands. Is it okay If we take just a question or two? Yeah, Esther Dyson. Hi. Hi Sanjay. I’m just. Can you just introduce yourself? So I work. I work in Wellville, which is a nonprofit
ten year project and I’m just, it’s just sort of like talking about measles without talking
about the vaccines. Does your movie talk about adverse childhood
experiences at all and that the people’s vulnerability, you sort of mentioned stress, but it’s not
just the stress of the adults. It’s childhood trauma. Sure. Yeah, we, we, we, we do, we do talk about
adverse childhood experiences and we do follow a couple of people along to try and really
try and get it, you know, what might be driving there. So I, you know, I mentioned I didn’t want
to overly simplify with regard to deaths of despair with regard to the existential problem
of dashed expectations. It was something that we found novel and they
talked a lot about in this particular paper with regard to these, these, this recent uptick
in suicide and opioid overdose. But yes. Um, I hope you’ll watch it. I’d be really curious to see what you, what
you think when you watch it, but no question there’s a lot of things that are, that are
fueling that. Anybody else? Yes. Yep. Hi, my name is Luis Montes. I worked for Casamba, EMR company, but I’m
a physical therapist by background and I guess I just want to put a quick plug in for my
profession here because I do think that we’re considerably under utilized in this whole
pain management scheme and I think as physical therapists we can really prescribe the right
exercises and manual therapies and electro therapies to really help with pain management. And I would encourage, you know, every physician
out there, you know, before prescribing medication to think about physical therapy when it’s
appropriate because we can really help. Yeah, that’s a good point. Yup. [applause] I’m just curious, have you
found that with everything that’s happening with opioids have, have you seen more patients? Are you getting more referrals? Yeah, certainly the American physical therapy
association, um, is, um, is leading this as well and we have seen a lot more reception,
um, and a lot more patients, I don’t want to say a lot more, but at least an uptick
in patients that are coming to therapy for pain management control, whether it’s acute
or chronic pain. That’s great. Yeah. Thank you. You know, I wanted to just step back to, you
had mentioned at, uh, at Grady that you now use pain management services more. Was going to say, we started that at Jefferson
as well, um, which this is ,really I think, a change over when, as we trained and when
we first started practicing, um, because there was no coordinated effort, a, for the pain
and there was no way to monitor. And finally in the United States we’re having
centralized databases that say, Hey, this patient just got three scripts from three
other people in the last 24 hours or the last two weeks. It’s hard to believe that we actually up until
very recently had none of that. I feel like we’ve turned a really blind eye
to this at every aspect. You know that the idea that people would would
go to multiple pharmacies, multiple doctors, whatever it may be, just didn’t seem reasonable. And if they were doing it, what was the problem? Right? This stuff wasn’t addictive. It wasn’t going to cause problems. It’s been a big game of catch up since then. So. Hello? Hey. Hey. I was actually at the conference when that
happened with the family. I just want to say David is, is one of the
results of our, of your challenge. He is the CEO of inRecovery, which specifically
deals with addiction. Thank you so much. Good to see you again. Sanjay. You know, I’m, I’m really happy that we’re
doing this with Startup Health first of all. But one thing that I would like to challenge
you Sanjay as well and the and, and ask maybe of this in the film, is that recovery is possible
and there’s too much focus in the media on death and I think that causes a lot of the
stigma as well. And if we focused more on recovery, on the
fact that people do get better. You know, as a recovering addict myself and
you know, I found that in recovery as a result of my own addiction. Uh, I would like to challenge you as well
as the media to focus more on recovery and get, and give more and more of a shining light
that there is hope. You know, yes, really good point. And I kind of, I kind of wish both to Esther’s
question and yours David as well. I wish, I wish I could show you the film now. I can’t. But you can’t Ronnie. HBO, they’re very. But the um, we did I, I’ll just give you a
little bit. I mean, I’ll tell you as a journalist as well,
you know, I think that we have found most effective when we do not simply define, redefine
and define once again, the problems. I think it’s very hard to, to galvanize movements
or power or whatever behind things when you’re simply defining problems. You show people that there are effective strategies,
there is a way out. We saw this even with HIV aids, it was, we
see this with, with childhood hunger in East Africa. When you just simply show the problems, people
kind of tune out to it after awhile. You actually show people coming out the other
side and the way that they got there. Um, it, it, it sticks in people’s, interviewer’s
minds in a different way and I think it makes them much more likely to be compelled, connected,
feel compassionate, whatever it may be, you know, to, to do something about this. So I’m really glad you brought that point
up. I’m really, I’m glad to see that. And you have our commitment at StartUp Health
to do our best with this. Thank you very much. Appreciate that. Yeah. [applause] One more, while. while we’re getting, getting you the mic,
speaking of recovery and you traveled around the world, you really have, have focused the
spotlight on this very heavy, sad thing. Um, what stories of inspiration come out of
this? I think most of the stories that I do actually
focus on things that I find very inspiring. I think people who may have had something
happen to them and were able to turn their lives around in some way, but also cultures. You know, one of my favorite stories I did
recently, and this is probably going to air sometime over the summer, I think Ronnie probably
knows better than I do, but I spent a bunch of time going and visiting several countries
around the world and really embedding myself in their healthcare systems to see how their
healthcare systems really worked. I mean, people talk about this, you know,
and write about it in journals like the economist and things like that, but to actually live
it was totally different. One of the places I went, I don’t know if
I told you about this Howard, I went and basically embedded with an indigenous tribe in, in Bolivia,
in the Amazon rainforest called the Chumani tribe. The Chumani indigenous tribe. Is that where you get all your tattoos? Right? I cover that up. The, um, the Chumani indigenous tribe and
it was like crazy to get there. And the reason I wanted to go visit them was
because there was an article in the Lancet, small one that basically said that this community
of people seem to have no evidence of heart disease at all. No evidence of heart disease, kind of incredible,
right? We spend a billion dollars a day in the United
States on heart disease. And here you have a tribe living in the middle
of the rainforest where the most mechanical thing that I saw was the pulli for a well
and they have no heart disease. It’s a longer story in terms of how they figured
this out and maybe more than we have time for, but just take my word for it. They have no evidence of heart disease. So I wanted to, to just go and understand
their lives and selfishly in part, you know, I was just to say I wish I could have come,
I have a history of heart disease in my family. I wanted to learn and was just fascinating
to see. And, and there’s a lot to it. I mean, you take the big three, you know,
the, the diet, the rest, the exercise. You know, in terms of exercise what you find,
and it’s true of many indigenous cultures, is that they are active, but they’re not intensely
active. We found that because we track this, they
walk about 17,000 steps a day. They hardly ever run, even when they’re, even,
when they’re hunting, they tend to outlast their prey, not outrun their prey. They track them, they hardly ever sit. They’re always standing or they’re lying when
they sleep. When you’re awake, you stand. And we saw this paper subsequently that found
that people say sitting is the new smoking. And, and, um, you’ve heard this as they’re
all sitting for a long time. But the, the idea that, that from an evolutionary
standpoint, we only sat as human beings when we got old and we were ready to die and you
find that people who sit a lot actually release these, these chemicals into our body that
actually decrease our body’s own natural protection devices. So it’s almost like a self destruct button. When you start to sit a lot. It’s like you’re telling yourself, hey, you
know what? My time here is done. And you find in these long lived disease free
cultures, they simply don’t sit a lot and there’s a mechanism for that in terms of what
they eat. And Dean Ornish will love this again, but
70 percent of what people who are true hunter gatherers who are living off the grid who
have no sort of outside influences, 70 percent of what they eat is carbs. Really? Unprocessed carbs. Because if you’re a hunter gatherer, farming
food is like putting money in the bank. You may have bad hunting days, bad fishing
days, but if you farm cassava, plantains, whatever it may be, you’re getting healthy
carbs into your diet. So 70 percent carbs, 15 percent protein, 50
percent fat. They rest a lot. You know, I, I put a little tent in the middle
of their encampment. Um, you, you hear the, you hear, without devices
to look at, people start to sleep that you hear the snoring about nine, 10:00 at night,
and then people wake up to the call and answer of the rooster. They’re getting about nine hours of sleep
a night. So it was kind of remarkable and very inspiring
to see this, this culture and how they were able to combat heart disease. I’ll tell you one other thing about them because
you may be thinking, okay, I can do all that and that’s seems pretty reasonable. Sleep more, eat better exercise, right? So far it sounds like Dean’s book, right? Exactly. Dean’s onto something here I think. But the thing that was sort of a little bit,
the secret sauce that Dean may or may not agree with was, was the vast majority of the
people who are part of the Chumani tribe also lived their entire lives with chronic parasitic
infection. You get a parasitic infection, usually hookworm,
roundworm, giardia, something very early in life. You typically get a few days of illness. If that happens in the United States or the
developed world you’d treat that aggressively, Right? Yeah. But you know, most of our existence, again,
as humans, we did co evolve with these parasites. Parasites were part of us. We were part of that parasitic world and the
idea that our immune systems, again, either ignite or worsen, so many of the diseases
that we’re talking about, uh, and that parasites could somehow be an immune modulator giving
our immune system something else to focus on besides turning their attention inward
could be real. So the idea that you eat right, you exercise,
you sleep better, and you have a parasitic infection. [laughter]. So, and I think if you’re gonna, if anyone’s
gonna take this and create the new like measurement, I would, my only suggestion was don’t call
it a parasite. Give it a different name, that would actually
be okay. But there is something to say, right? Autoimmune disease is on the rise. Like why is this? Why, why in in a, in a country where we strive
to take such good care of ourselves and try to, like you said, almost sterilize our bodies
that we’re having these, these different issues that are coming up. I think that the thing that the folks in Bolivia
taught me in the subsequent interviews that we did with scientists is that, you know,
in an effort to be hyper sterile, an effort to live in these self imposed hygienic bubbles,
we may have been doing more harm to our bodies than we realized. Our immune systems. They exist. They’ve existed, you know, throughout our
existence. And the reason was to, to, to basically fight
off whatever infections, outside influences, like the parasites that they could. When they, when we’re, when we’re so hygienic,
the immune system may be actually starting to turn its attention inward and these inflammatory
cell levels may be rising. I deal with this in my own family with my
wife. She suffers from autoimmune disease and we’re
constantly on this journey to try and figure out what is causing inflammation levels to
rise. What is her baseline level of inflammation? How do we tamp these things down? It is, it is difficult, but if you take it
as a class, autoimmune diseases are the most common diseases in America. Graves’ disease, rheumatoid arthritis, psoriasis,
all these things in aggregate have, are the largest and they’ve been increasing for some
time now. Yeah. And, and so much work to do. Now we know maybe, maybe just a parasite. It could be the parasites. Yeah, exactly. Call it something else, a biosite or something
or something. Yeah. Well I have to say, um, first off, what, what
an amazing, amazing conversation it was to have you. On a personal note. I mean, truly, we’ve been friends for for
a few years now, but I feel like I’ve known you as most people probably here do, you feel
like, you know Sanjay, right? He’s, he’s like, he’s a, he’s our friend. He’s our old friend, Sanjay. Just who I am. Really, you’ve, you’ve changed the way, for
me personally, I’m sure for the world, but for me personally, I look at the world. I look at the issues that go around both in
my, um, my community, my country, but really globally, and you’ve opened my eyes, you’ve
taught me how to look at things objectively, fairly, and with an open mind and I’m excited
to see what you do, you know, with the, with the documentary and just over the next few
years. And again, thank you for being part of our
lives. That means so much. Thank you very much, Howard. I really appreciate that. Thank you.

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