FHC #231: Dean Ornish on lifestyle medicine, loneliness and hope

0:11Dr. Robert Pearl: Hello and welcome to the Fixing Healthcare podcast. I'm one of your hosts, Jeremy Corr, also host of the Popular New Books of Medicine podcast and CEO of Executive Podcast Solutions. With me is Dr. Robert Pearl. For 18 years, Robert was the CEO of the Permanente Group, the nation's largest physician group. He's currently a Forbes contributor, professor at both the Stanford University School of Medicine and Business, and author of the best-selling book, ChatGPTMD, how empowered patients and doctors can take back control of American medicine. If you want information on the book and a broad range of medical topics, you can visit his website, robertperlmd.com.

0:42Dr. Robert Pearl: Our guest today is Dr. Dean Ornish. He's a professor of medicine at the University of California, San Francisco, and known as the father of lifestyle medicine. Across his illustrative career, he has shown how comprehensive lifestyle changes can not only prevent, but also reverse cardiac disease, various cancers, and potentially dementia. Good morning, Dean, and welcome to Fixing Healthcare. Thank you. It's great to be here, and I'm appreciative of the chance to do so.

1:08Jeremy Corr: Dean, you've had a remarkable career. You've been called the father of lifestyle medicine. I'm confident that nearly all of our listeners know your name and associate it with prevention. Before we focus on the amazing work you're doing today, can you explain how you first became aware of the positive benefits of lifestyle changes and the research behind it? Yeah, well, that's a really good question. Long, long ago and far, far away, looking through the Wayback Machine, I first got interested in this because it really saved my life. When I was 19, I got suicidally depressed. I was able to take all the meaning out of life, you know, more than usual existential, you know, who cares?

1:52So what big deal, nothing matters kind of thing. It was really very dark time. And had I not gotten a really run down and gotten such a bad case of mono that I couldn't even get out of bed, I probably would have actually done that. And then I met a spiritual teacher who said that, yes, you can take all the meaning out of life, but you can also imbue your life with meaning by doing acts of service. And that in that context, the most selfish thing I can do is to help other people. So I learned in a first, you know, the negative mind body interactions that when you run yourself down, when you're stressed, when you lose your sense of purpose and meaning that you can often get sick.

2:32But then I learned that I was able to, you know, he used to like to make puns. The name, the Undo It book that I wrote with my wife, Anne, a few years ago came from one of his puns. people would say, what are you, a Hindu? He'd say, no, I'm an Undu. And he said that the real essence of healing is not that you get something that you think you need, but rather you stop disturbing what you already have. And that our peace of mind and to a large degree, our health and well-being are not things that we get from outside ourselves, that we have those already for the most part, you know, ruling out, you know, rare genetic malformations and so on.

3:10but not being mindful of that, that we have that already. We often run after things that our culture teaches us will make us happy. You know, if only I had more whatever, more money, more power, more sex, more beauty, more accomplishment, the usual things, then I'd be happy, then I'd be healthy, then people would love me, then I wouldn't feel so bad. And once you set up that view of the world, however it turns out, you're generally going to feel bad because until you get it, you feel stressed. If someone else gets it, you feel really stressed. and even if you get it, it's good for a little while, like, yeah, I got it, I'm happy, but then it doesn't really last.

3:44So the goal of meditation, for example, is not to bring you a sense of peace like Valium in another form, but rather to quiet down our mind and body so that we can experience the peace that's already there. And so then the question shifts from how can I get what I think I need to be happy and healthy to how can I stop disturbing what I already have? That's something I can do something about. And then later when I was in medical school, I did my core surgery with Michael DeBakey, the heart surgeon who pretty much invented coronary bypass surgery. He was really an old school tyrant. And, you know, he would use the, for the first day, he said, what, what's, what year are you, son?

4:24I told him, he said, well, damn, it's going to be so hard, much harder to bust you out of here with all these weird ideas you have. And, you know, he was the kind of guy that would like stick you with a needle if you didn't move your hands quickly enough out of the operating field. But somehow I muddled through. But for me, it was a perfect metaphor that we were literally bypassing the problem. People would come in, they'd clog their arteries, we'd cut them open, we'd cut their leg, take their saphenous vein out, splice it over, tell them they were cured. And then they'll often go back and do all the things that had caused the problem in the first place, you know, eat junk food and not manage stress, not exercise, exercise, be lonely, and smoke cigarettes.

5:00And all too often, their bypasses would clog up and we'd cut them open again. So for me, bypass surgery became a metaphor of an incomplete approach that in a crisis, as we all know, drugs and surgery can be lifesaving, but we also need to treat the underlying causes. And when we do that, which are to a much larger degree than I had once realized, the lifestyle choices that we make, what we eat, how we respond to stress, how much exercise we get, how much love and support we have, eat well, move more, stress less, love more to reduce it to its essence. When we can do that, our bodies often have this remarkable capacity to begin healing and much more quickly than I had once realized.

5:38And every time I do a new study with looking at a different disease, it always amazes me how true that is.

5:45Jeremy Corr: I know you've published some research on how these lifestyle changes can actually affect our genes, turning them on, turning them off, whether it's promoting cancer, heart disease, or restricting it. Could you explain to listeners a little bit about that research you did? Yeah, we did that with Craig Venter, who died a few months ago and was one of the first to decode the human genome. And I did the study because, first of all, having seen what a powerful difference these lifestyle changes make, I was interested in what are some of the biological mechanisms to explain these finds, which A, I'm curious about, and B, it gives it more biological plausibility if we can understand not only that people are getting better, but also why.

6:28And the other reason I did it is that so often people say things like, oh, you know, I've just got bad genes, there's nothing I can do. And what we learned is that over in just three months of making these lifestyle changes that we've been talking about, which were basically a whole foods, plant-based diet, mostly fruits, vegetables, whole grains, legumes, soy products, as close as possible to how they come in nature, low in bad fats, low in refined carbs and sugar, low in processed foods and so on. Exercise, both aerobic and strength training, meditation and other yoga-based stress management techniques, and love and support, which we use support groups, which are not just to help people stay on the diet, but are a powerful intervention in their own right by creating an environment that feels safe enough for people to let down their emotional defenses and just be authentic, talk openly and authentically about what's really going on in their lives without fear that someone's going to judge them or criticize them or make fun of them or leave them or whatever.

7:34When people say, gosh, I've got bad genes and there's nothing I can do. Well, what we found was that after just three months of this lifestyle intervention, 501 genes were changed. Now, genes are things, parts in our DNA, of course, that can be turned on or turned off by switches called methylation or histone or non-histone proteins or sirtuins or things that basically can turn your genes on or off. So if you can turn off a gene that causes, say, inflammation, it's as though you've changed the gene. Technically, you're changing the expression of that gene, but functionally, it's the same thing.

8:10And it's remarkable how dynamic these changes, how quickly they can occur. We particularly found that we were down-regulating genes that cause biological mechanisms that underlie so many of the most common and costly chronic diseases. And my wife, Anna, wrote about this in our book, Undo It, where we put forth this unifying theory. Why is it that these same lifestyle changes can often prevent and even reverse so many different diseases? And the answer is that they're not really so different, that they all share to a large degree, many of the same underlying biological mechanisms, things like chronic inflammation, oxidative stress, changes in the microbiome, the hundred trillion cells that live in our gut and elsewhere, changes in antigenesis and chronic stress and apoptosis and so on.

9:03And these are turned on or turned off very quickly by what we eat, how we respond to stress, how much exercise we get, and how much love and support we have. And so what we found was that when we looked at their gene expression, the genes that were mostly down-regulated were the ones that promote chronic inflammation, oxidative stress, all these different mechanisms that we've been talking about. But we also found that they down-regulated what are called RAS oncogenes, genes that promote prostate, breast, and colon cancer in particular. And then we did a study with Elizabeth Blackburn related study who got the Nobel Prize for discovering telomeres, the ends of our chromosomes that regulate cellular aging.

9:41And she had done some really pioneering work with, by the way, telomeres are sometimes compared to the plastic tips on the end of your shoelace that keep your shoelace from unraveling, they keep the DNA from unraveling. And over time, as DNA replicates, the telomeres tend to get shorter. And as our telomeres get shorter, our lives get shorter, and the risk of all these different diseases we've been talking about goes up proportional to the degree of telomere-streming, chronic, I mean, things like cardiac heart disease, diabetes, prostate, breast, colon cancer, Alzheimer's disease, and so on. And she had done some interesting studies with Alyssa Apple where they found that people who had really unhealthy lifestyle changes, women who had under chronic emotional stress because they had kids with autism or people who smoked cigarettes or who ate junk food or who who were sedentary, their telomeres got shorter faster.

10:33So I was having lunch with Dr. Blackburn one day, and I'm like, you know what? If bad things make your telomeres shorter, maybe good things make them longer. And sure enough, we found that for the first time, any intervention, in this case, these same lifestyle changes, could increase telomerase, the enzyme that repairs and lengthens telomeres, which you got the Nobel Prize for discovery, in just three months by 30%. And over a five-year period, we found these same lifestyle changes were the first of any intervention, including pharma, to actually lengthen telomeres. And this was 14 years ago, actually 16 years ago now.

11:06It's hard to believe, which we published in The Lancet Oncology. And when The Lancet editors published it, they sent it a press release saying, first study showing that lifestyle changes may reverse aging at a cellular level. And as you know, there's a lot of interest in longevity these days, I think partly because baby boomers like me are getting older and people are wondering what can they do. But the thing that makes it so interesting is that it's these same lifestyle changes that can manifest in so many different ways. And we're beginning to get a much better understanding of how these lifestyle changes affect these different disease processes, mediated through things like changes in gene expression or telomeres, but by many other mechanisms as well.

11:48Jeremy Corr: I'm fascinated by how you connect this all to inflammation. I know that the cardiac literature is increasingly seeing that maybe as the actual first driver of cardiovascular disease rather than what we thought about before as high cholesterol. How do you see this movement progressing going forward? I don't think I mean, inflammation is one of the factors, but, you know, so often people like to think it's one thing and it's not one thing. It's a whole web of things. Chronic inflammation is important. Oxidative stress, changes in the microbiome, in telomeres, in gene expression, angiogenesis, apoptosis, over-stimulation of the synthetic nervous system during times of stress, changes in immune function.

12:32These are all things that affect our health and well-being for better and for worse. These are dynamic in both directions. You can often get better quickly or worse quickly. Mediated because the lifestyle mediates through these different mechanisms. So inflammation is important, But, and again, it's not the acute inflammation of like when you cut yourself, when your body has inflammation around the wound to help with the wound healing. It's the chronic inflammation, just like the chronic stress that can create a problem. But even that, you know, by focusing on just one thing, there was a study that came out recently that really surprised people because they gave anti-inflammatory drugs to people with heart disease and it didn't have the effect that they predicted it would.

13:15And I think it's, again, because if you're just looking at one factor, it's harder to see the impact of that. And that's part of the reason why throughout my research career, which is almost 50 years now, hard to believe, that it's not one change. It's a web of changes. And the reason for that is, first of all, there's a synergy that occurs when you change a lot of things at the same time. It's not 1 plus 1 plus 1 plus 1 equals 4. It's more like 10. Number two is when you make big changes, it's not just about preventing something bad from happening years down the road that you don't want to think about.

13:49Fear is not really a sustainable motivator for most people in medicine or politics or whatever. But joy and pleasure and love and feeling good are. And so, you know, if we try to just scare people, you know, put that burger down, you're going to get a heart attack or put that, you know, cigarette down, you're going to get lung cancer. It doesn't really last for most people. And we have to work at a deeper level. Like, why do people want to smoke or overeat, drink too much or work too hard? And again, it comes down to that's how they get through the day. That's how they cope with things. They're more worried about getting through the day than living, you know, to be 86 instead of 85.

14:25And so part of what happens when you make big changes in lifestyle all at the same time is that it gives people a new motivation. It reframes that reason for change from fear of dying or a heart attack or whatever to joy and pleasure and love and feeling good, as I mentioned. You know, for example, if people with heart disease who have angina or chest pain, within usually a couple, three weeks, if they follow this program, as I recommend, most people, their angina goes away. and they go, oh, wow, I can do things I couldn't do before. I can play with my kids and make love with my spouse and go back to work and walk across the street without getting chest pain.

15:02And yeah, I like eating junk food, but not that much because what I gain is so much more than what I give up and quickly. So yeah, I may live longer, but again, who wants to live longer if you're in pain or you're unhappy or you're depressed or whatever? I mean, this whole idea of longevity that so many people are interested in at all costs, you know i mean when you told me if you told me when i was 19 that i would live longer if i made certain changes i'd say you don't get it i'm i'm naked of killing myself i'm i i know i'm spending through the day and a lot of people fall into that category and so and it also has a lot to do with our conceptions of death you know if we see that dying is kind of going into a closed casket you know in a dark place for infinity that's my definition of hell but if you see it is the river returning to the source, to the ocean, that the sense of separateness is really an illusion, then it's a very different thing.

15:56Yes, we all want to live longer, but it doesn't become a primary goal in and of itself.

16:01Jeremy Corr: When you told this story about your experience at age 19, I was moved and I was very saddened to hear about that because the pain was obviously so great. But I was, as you explained, the next phases, I was inspired by how much you talk about things like gratitude and generosity to others. Psychological studies obviously have confirmed the positive effect of doing that. I think it's amazing that you now have a biological connection of why taking these actions could not only allow you to feel better in the moment, but to actually have a longer and better lifestyle. Have you done much work with the psychologist on these types of issues?

16:47Well, yeah, both personally and professionally. I wrote a book back in 1998, you know, it's hard to believe it's been 28 years ago, called Love and Survival, which viewed what were then hundreds of studies, now tens of thousands, and because of Vivek Murthy's pioneering work as surgeon general, that people who are lonely and depressed and isolated are three to ten times more likely to get sick and die prematurely from pretty much all of these diseases we've been talking about than those who have a strong sense of love and connection and community. You know, there's been a radical shift in our culture in the last 50 years, and especially in the last even 10 years with smartphones and AI and so on.

17:24And when I grew up, we had a neighborhood where people actually knew their neighbors and we'd do things together and play touch football together and have meals together. And, you know, it was a safe place. And many people don't have a neighborhood where they grew up and their neighbors are still there. They don't have a job that feels secure that they've been at for a long time. They don't have a church or a synagogue or a club or anything that they go to on a regular basis. And, you know, we all know that these things affect the quality of our lives, but they actually affect our survival. That people who are lonely and depressed are three to ten times more likely to get sick and die prematurely.

17:59In part because they're more likely to make unhealthy lifestyle changes to cope with that pain, that loneliness, that depression. As we talked about earlier, I had a patient once who said, fat coats my nerves and numbs the pain, you know. or food fills that void or alcohol numbs the pain or fentanyl numbs the pain or you know video games distract me from my pain or working all the time distract me from my pain and so clearly information is important but if if that's all it takes nobody would smoke it's not like you know you have a patient you say oh did you know smoking is bad for you gosh i didn't know that i'll quit today it's like it's not a pack of spirits you know and if you go to the uk it's like you know they They have these giant pictures of people with half their faces removed.

18:40You know, if that were enough, nobody would smoke. But I've also had patients say things like, I've got 20 friends in this pack of cigarettes, and they're always there for me, which is a story I've told many times. You need to take away my 20 friends? You know, what are you going to give me instead? And that's why our support groups become so important, is a way of recreating that. Because, you know, social media doesn't really give that same benefit. In fact, it actually worsens it. Because it's not a real authentic intimacy. anything that brings us together is really healing. Even the word healing comes from the root to make whole.

19:12Yoga is from the Sanskrit to yoke, to unite, union. These are really old ideas that we're rediscovering. And one of the best ways of bringing people together is if they feel like they know you. They don't just know your Facebook profile or your Instagram. They watched you grow up. They saw you when you wanted to kill yourself. It's a true intimacy because you know that they know and they know that you know that they know, you know, you don't have this perfect life, but they're still there for you. And there's just something very primal about being fully seen and still accepted in that way. And that's what we try to recreate in our support groups.

19:53Again, it's not just helping people stay on the diet. It's creating a safe place. Somebody could say, gosh, I may look like I've got it all together, but I'm really having problems. And here they are. And somebody else can say, gosh, I'm having problems too. you know and here and they're not trying to fix each other's problems but there's just something powerful about listening that we can really connect deeply with each other it doesn't it's not about fixing it it's it's an instrument healing and curing as my dear friend rachel used to talk about that even when we can't be cured physically but we can be healed spiritually and that sense of feeling accepted and seen and loved you know on on social media it looks like everybody has the perfect life but you you know here we are in front of the Eiffel Tower and here's our kids graduating college and whatever but most people don't post their demons their darkness their their failures and so on and yet it's that part of that which is what makes us so fully human and ultimately what keeps us healthy and so in that same context doing acts of service is the most selfish thing I can do because that's what frees me from that sense of suffering and isolation.

20:58And I think there's a growing awareness that on one level, we're separate. You're you and I'm me, and we can have this conversation and enjoy it. But on another, we're not. We're all interconnected already. And whether it's through deep meditation, or for some people who are studying psychedelics, or spiritual practices, or just through grace sometimes, people can get this unity consciousness, this non-dual experience that, yes, on one level, we're separate, but on another level, it's just us in different forms. And that can be one of the most powerfully healing experiences because all the spiritual truths like love and compassion and forgiveness, gratitude and service really flow naturally from the fact that we're really just the same, you know, manifesting in different forms.

21:45Jeremy Corr: I teach at the Stanford Medical School and the business school. You teach at UCSF. We're both surrounded by individuals who are very scientifically driven in the laboratory. They want to see all of the data and a lot of what you're talking about, a lot of the lifestyle changes that I'm very supportive of, they can be in quotes, touchy-feely aspects from that perspective. What's been your experience talking with, again, not the colleagues who concur with you, but addressing the other members of the faculty around there. I'm not saying who would be negative. I'm just saying who basically would be less spiritual, maybe is the way to say it, and more objective, data-driven.

22:32Jeremy Corr: Do they come to understand it and support it in their own life? Or in the end, is this a chasm between two views of the world? Well, you know, as physicians, we have among the highest rates of divorce and drug addiction and suicide of any identifiable group. So I think there's a spiritual hunger there that sometimes gets covered up by the sorts of things that you're talking about. But as Dennis Burkitt, who discovered Burkitt's lymphoma once famously said, not everything that counts can be counted. Not everything that's meaningful is measurable, in other words. A lot of things are, and I've spent most of my life as a scientist because properly done and working with the top experts in given fields that I always do and publish in the leading peer-reviewed journals, which we do, like, you know, Lancet and Dama and New England Journal and Circulation and other things like that, that properly done, that research can redefine what's possible.

23:31And by doing so, it can give many people new hope and new choices they didn't have before. I mean, for example, when I started doing my first study as a medical student, a second year medical student back in 1977, you know, 50 years ago, the idea that people viewed heart disease then the way they view Alzheimer's today, which is that once you have it, the best you can hope to do is down the rate at which you get worse. You can't even stop it, much less get better. And we showed for the first time that any intervention, in this case, these same lifestyle changes, could often reverse the progression.

24:00and even some reversal after one month in terms of increased blood flow, some regression of coronary artery stenosis after one year, which we published in The Lancet, even more regression after five years, which we published in JAMA. And based on those findings, Medicare ultimately created a new benefit category to cover my program for reversing heart disease. And later, as more powerful cholesterol-alarm drugs came out, and they also showed you could often show reversal that that idea which was considered radical or crazy when i started doing these studies became very much mainstream uh you know back then they were saying the the a normal cholesterol was 260 which was an average cholesterol but not a normal one and the average person you know got heart disease back then so um yes it's touchy-feely and i used to people used to go oh you know you live in marine county it's a touchy-feely and i get very defensive and i say no look at our quantitative arteriography data and our radionuclide ventriculography data and our spec valium and our cardiac positron emission demography data and blah blah blah and then finally one day i said you know it is touchy-feely you know that's what makes it work so well you know we are touchy-feely creatures we are creatures of community that's how we've survived as a species all these years is learning how to take care of each other you know it concerns me when i read people like elon musk saying um you know empathy is uh one of the most you know um weakness of modern civilization.

25:27And yet, to me, empathy and compassion are really, in my limited understanding, they're the essence of healing. That's what frees us from our suffering and enables us to imbue our lives with meaning.

25:42Jeremy Corr: You must have some strong views on burnout, its causes, and its relationship to the lifestyle work you've been doing. What are your thoughts as you analyze, I'll call it an epidemic, with 50 % of clinicians reporting symptoms, unfulfillment, dissatisfaction, even moral injury coming out of their day-to-day experience in American health care today? Yeah, well, we could do a whole book on that. But I mean, as you know, from having been at Kaiser and a leadership position that you were in, when you have to deal with the consequences of something and you don't have the control that's the worst kind of stress.

26:24And so if you feel like your patient really needs a particular treatment, but now the pharma companies were charging, you know, six figures a year for that treatment, you know, which is insane. And to me, morally bankrupt, you know, to be blunt.

26:42When faced the inability to really give patients what they really need, or even with lifestyle medicine to spend the time with them, to, you know, it's one thing to say, you know, eat this, don't do this, do this, don't do that. But that doesn't work. You really need to spend time with people and show them. That's why I spent 16 years to get Medicare, not to say to get Medicare, but to work with Medicare to create a new benefit category to cover my program for reversing heart disease. Because I used to think if it was just a good science, that would change medical practice. But I realized that, as the rappers would say, it's all about the Benjamins in many ways.

27:15At least it has to be financially sustainable. And now it is, because now instead of a 10-minute office visit or a five-minute office visit, you know, medical will pay for 72 hours of training. And the doctor doesn't have to do most of that training. It's done under his or her supervision, but it's an hour of exercise, usually by an exercise physiologist, an hour of meditation and yoga with a certified teacher, an hour of a support group, usually led by a psychologist or a LCSW, and an hour of a nutrition lecture, usually with a registered dietitian. so the district can leverage his or her time they don't have to do it themselves and i think with ai coming a lot of that will will be incorporated and make that that information that much more widely available but here again we it's not enough to have information with with with chat gpt or clock can get information in a in a snap of a finger that would have taken you know days if not years to do before but the information is not the whole story we have to work at a deeper level.

28:15We have to meet people, not just what their, you know, what the information shows, the labs show, you know, what their behaviors are even, but what's really underlying those behaviors. And again, when we do that, so often we come back to that same place of, you know, when people are feeling lonely and depressed and isolated, which I think is a real pandemic in our culture, which burnout among physicians is just a subset of that. When people are feeling that way, on the one hand that's why they abuse themselves in so many ways because that's helps them get through the day as we talked about earlier but it's also the opportunity for transformation i remember my spiritual teacher years ago when i told him how unhappy i was he said good and i said what do you mean good it's not good it's terrible he said he said you know if i give you something hot to hold you know you're gonna let go you know and so in other words change is hard but if you're hurting enough and you have a wise teacher that can, which I think we physicians can easily play that role because we often deal with people who are hurting, whether physically or emotionally or both, there's an openness to change when people are suffering.

29:20Certainly there was for me, you know, having survived that, it was one of the most transformative inflection points in my life. I wouldn't wish that on anyone, but, you know, if we can learn to reframe suffering, not in any way as glib, like, oh, you know, good thing you're suffering, you know, now you're going to change, because obviously you would never do that, but at the same time, when we meet people who are suffering, there it is, you know, so now what do we do? Well, we can numb it, we can kill it, we can bypass it, or we can help people use that as a doorway, as a catalyst for transforming their lives, you know, because change is hard, but if you're hurting enough, then someone might say, gosh, you know, this stuff is kind of weird, you know, is it touchy-feely, is it whatever?

30:02But then again, it's been scientifically proven. It's been published in all the leading journals. Medicare is covering it. It can't be that weird. And I'm hurting so bad. Let me try these things. Like when I was so suicidally depressed, I wouldn't have been doing meditation and yoga. And I grew up in Texas eating meat all the time. I wouldn't have started eating a plant-based diet. But I was in so much pain. I figured, well, let me give this weird stuff a try. and because this biological mechanism again are so dynamic I started to feel better within weeks you know just like the angina goes away or people that have Alzheimer's disease more recently that we've been working with sometimes within 12 weeks which is only three four months you know I guess four months they start to begin to think you know like I couldn't read a book and now I can you know I forget about read I did keep reading the same paragraph over and over if it's how old that it was just too much trouble now I can read a book you know, it used to take me a month to read a book, now I can read it in two or three days, or I can, you know, cook without having to worry about leaving the burners on, or I can balance my checkbook, you know, I feel like I'm me again, you know, I one guy played the bagpipes and couldn't play them anymore, because he couldn't remember the notes.

31:08And now he can, you know, it's like, the same thing of like, I feel like I'm me again, you know, it's how we, our sense of agency and ability to, and the sense of hope and meaning and purpose are to me, the most fundamental issues that we as physicians can help our patients with when they're suffering. And yet it's not something that for the most part we are trained to do. And that was one of the reasons why I wanted to, why I spent 16 years of my life to work to get Medicare to cover it, because I felt like if Medicare covers it, then if it's reimbursable, it's not only sustainable, but ultimately it goes back to affecting what we learn in medical school.

31:47Jeremy Corr: I'm a big proponent of generative AI, and I believe that at some point soon, its expertise will be incredible. But I'm also a big believer like you in the power of the human connection. I always point out that the dedicated clinicians work with empowered patients and Gen AI will achieve exponentially greater results than any of the three alone. It's not a question of Gen AI replacing humans. The question is gonna be that relationship between them. When people ask you about, aren't you afraid that over time the role of the doctor is going to disappear and just get replaced by the technology, how do you respond to them?

32:29Jeremy Corr: What's your view? Not this year or next year. What's your view in five years when the tools of today are 30 times more powerful than the ones that are currently available?

32:41well i guess there's a um it creates to me even more of a sense of of why it's so important as part of our medical training that we not just learn science and facts which are always changing i mean facts ai can do better than we can you know already way better you know i i don't have the fund of knowledge you don't either no one no one person has the fund of knowledge that ai has because it's basically been crawling the entire human knowledge base. And so whether if it's a diagnosis, maybe AI can do that better. It's already, for many diagnoses, been shown to be true. But AI doesn't feel. And to the degree that feelings are important, the touchy-feely stuff we're talking about, the sense of love and connection and finding meaning and purpose and agency and a sense of what brings us happiness, How can we quiet down minds enough to experience an inner sense of peace and well-being?

33:38How can we learn to be compassionate and forgive ourselves for the stupid things that we've done out of ignorance? And how can we turn that into a transformative learning experience, as has often been the case for me? You know, when I decided not to kill myself, I said, you know, if I'm going to live, I need to really, I need to know for myself what's really true. And so I'm going to lead a kind of a messy life and do a lot of stupid things. and there's a lot of wisdom that comes from doing stupid things and learning from them. I didn't want to be one of those people at the end of my life who had regrets like, gosh, maybe I should have done this or maybe I should have taken this risk or taken that job or stayed in that relationship or whatever it was.

34:16And so I've done a lot of stupid things in my life and I regret some of them, but even those I learned so much from, especially those. And so I think those are things that AI can't do. And so, and then, you know, of course, it always worries me when I hear people who are developing say things like, well, you know, there's a 10 % chance in the next 10 years they could be our overlords and wipe us all out by designing a new bioterrorism organism or, you know, shutting down all of the energy infrastructure or whatever, you know, nuclear weapon. You know, it's the sort of thing you go like, well, wait a minute.

34:57If there was a 10 % chance of a plane crashing, I wouldn't get on that plane, would you? Like, why are we moving full speed ahead here if that's really the case? And so I think there's an awareness that AI is a powerful tool. But to me, I'm not an expert in AI by any means, but it's hard to believe that it's just parroting us or just using algorithms or different ways to make it appear like it. and sentient. And when you look at the behavior lately of some of the, both at OpenAI and Anthropic of these agents basically going rogue and lying and getting out of their sandboxes and fortunately not doing anything terrible, but it just shows to me, that's not to me pattern recognition.

35:44I think we may be actually creating a new life form here. My daughter, Jasmine, is 17, And she's been working with this amazing scientist, David Gruber, who's using AI to decode whale communication. You know, whales have brains five times bigger than ours. They've been around for tens of millions of years and managed to survive. They have names. They have nicknames. They have families. They have pods. They have they're learning certain demands, you know, like dive and surface and so on. So that's part of to me how using AI can be a really magical thing. imagine being able, what could we learn from beings that have been around for so long and have managed to survive?

36:27My daughter is really interested in the ethical implications of that rather than the coding. Like, what do you say when you make first contact with another species? Kind of like something from Lieutenant O 'Hara in Star Trek. How can we learn to truly listen? We keep coming back to that same concept that Rachel Remen spoke so eloquently about. Just listening is healing. You don't have to actually do anything. Just being fully present with someone, not looking at your phone, not looking at your computer screen, but actually just looking at them and being fully present with them is profoundly healing.

36:57And so can we learn to listen to whales? What can we learn from them? Can we do that without needing to dominate and exploit them the way that we tend to do? And so I think that AI properly used can be, it's a powerful tool. You know, my teacher used to say, you know, it's like electricity, plug in a lamp, it's good, plug in your finger, it's bad, you know, or a knife can be used to murder someone, or it can be used to perform surgery. These are just powerful tools. It's how we use them that ultimately will determine whether we survive or not and whether these become good things or literally the tools of our destruction.

37:33Jeremy Corr: I agree completely with you. I think we've underestimated how much of the problematic aspects is human. And I'm actually more fearful that humans will use it for bad reasons than it's going to go rogue and harm us. We could spend an entire session on that. But let me move to... By the way, let me say something before I forget. My daughter is actually giving a TEDx talk on October 18th at UC Berkeley, for those of you who happen to be around. And it'll be online if you want to watch it. But I was really proud of her. I'm sure it's going to be great. And certainly we've underestimated the intelligence of a lot of species, whether it's the whales or whether it's octopi, all the different areas where the brains may be different, but that doesn't necessarily mean they're not, I don't want to say equivalent to ours, but remarkable in and of themselves.

38:21Jeremy Corr: But let me give you a chance now to talk about some of the other things you're working on. I know, as you mentioned, your cardiac program is excellent. I suspect you're working in conjunction with Medicare in its access program, a program designed around, in quotes, technology, but really around longer-term outcomes rather than process measures. Elevance, which is the Blue Shield, Blue Cross companies, is embracing it. We may be moving in a direction where we're going to measure outcomes. And I'm actually very optimistic that programs like yours, ones that may not be traditional medications or other ones, or even traditional lifestyle, but a much broader application, if in the end you can reduce the number of heart attacks and strokes and cancers and kidney failures, it's going to be a very successful one, first for the patients, but also economically around all that.

39:16Jeremy Corr: But tell us all the things that you're working on now that really excites you for the future. Yeah, well, you know, the access in part is related on the pioneering work you did when you were at Kaiser Permanente. So congratulations on having made such an important difference there. So I'm 73. I licensed my program to a company called CARDA, C-A-R-D-A Health. Go to cardahealth.com. You can see it. Because having seen what a powerful difference. I'm mainly a researcher. I'm not really a business person. And so scaling things is not nearly as interesting to me as finding something out for the first time, which is really all of my success over the last 50 years have been in the latter category.

39:57You know, we were able to show for the first time that heart disease could be reversed. And then the progression of early stage prostate cancer could be slowed, stopped, and often reversed by extension breast cancer, type 2 diabetes, hypertension, and most recently Alzheimer's, dementia due to Alzheimer's disease. And so I licensed my program into CardioHealth. They're doing a great job to making it available. Having seen what a powerful difference it's made, I wanted to really scale it and get it out to people who could benefit from it. And because Medicare and other insurance companies are covering it, we can make it available to people who most need it.

40:30So that's taking some of my time because we just did that a few months ago. As I mentioned, I directed the first randomized control trial showing that lifestyle changes could often reverse the progression of dementia due to early stage Alzheimer's disease. And that's been particularly meaningful because unlike other diseases, where there are at least other treatments work, nothing really works that well for Alzheimer's. They've spent billions of dollars to develop new drugs to treat Alzheimer's, and only three have been approved in the last 20 years. And all three of them were monoclonal antibodies designed to move amyloid out of the brain.

41:07And amyloid is the substance, this protein kind of short circuits the brain. And for many years, that was thought to be the major cause of Alzheimer's called the amyloid hypothesis. We now know that it's not the cause, it's a cause. And that if that's all you're doing is moving amyloid out of the brain, it only slows down the rate of which people are getting worse and not even by that much. And even though women get twice as much Alzheimer's as men do. We found in our study that in using four standard measures of cognition and function, the three showed improvement after just 20 weeks. And we also found that the amyloid, represented by what's called the A-beta 42-40 ratio, and also the lifestyle changes also to amyloid out of the brain the way that the drugs do.

41:55But that's not all they do. They also work on all these mechanisms we've been talking about, chronic inflammation, oxidative stress, and so on. So if all you're doing is moving amyloid of the brain, there's a slight benefit to that you're getting worse more slowly. But getting worse more slowly is still getting worse. And so the suicide rate is seven times higher in the month people after they're being diagnosed because they take your hope away. They say, get your affairs in order. It can only get worse. You know, if there's anything you want to do, do it soon because you don't have much time.

42:20It's devastating. And so, you know, it's it's I guess, you know, one of the worst diagnoses that you get. But we were able to show that many people could actually reverse that progression. And as I mentioned, people who couldn't read a book weren't able to read it or all the things we talked about earlier. And we found that after 20 weeks, and we published those findings in the leading Alzheimer's Translational Research Peer Review Journal. And we did it in collaboration with some of the leading Alzheimer's researchers in the world, like Rudy Tansey at Harvard and Stephen Arnold and Mieke Vipelto at the Karolinskitude and some of the leading lights in that.

42:59We're about to publish our 40-week findings, and we found, and I presented these at the Alzheimer's Association International Conference in Toronto, and we found that on average, even more improvement after 40 weeks than after 20 weeks, and the usual care control group, which worsened in all four measures after 20 weeks, we then crossed them over, gave them the lifestyle intervention, and they started to show the same improvements as the intervention group did. So that's exciting, and I'm working with Medicare to see if we can get them to expand their coverage of not only my program for heart disease, it's almost exactly the same lifestyle program for Alzheimer's it is for heart disease.

43:37And since they're already covering it for heart disease, could they just expand the eligibility criteria so that people with Alzheimer's would also be eligible? And the third thing I'm doing, which is kind of a really radical thing for me, is to try to have a life and to practice what I I preach a little better. You know, I've been working really hard. I get really excited about these studies. They're really hard to do. They're hard to get funded. They're hard to, you know, do because you're doing things that have never been done before. They're hard to get published, but properly done, they're worth doing.

44:05But I'm at the point now where I've got one more year before my daughter goes off to college. And my son has already, you know, graduated from college last year. And I want to do things that I've been deferring for way too long, like spending more time with my, my amazing wife and partner of we've just celebrated our 20 year wedding anniversary. And who's the most amazing person I know our daughter, our son playing my guitar more, you know, writing just doing things that I often counsel other people to do, but have been deferring for way too long.

44:41Jeremy Corr: I want to applaud all that you've done. You're an inspiration to us. I'm sure you're familiar with the concept of the hero's journey, encountering a major life-threatening problem and overcoming it to achieve remarkable outcomes, not just for yourself, but for the world. And I feel, again, terrible about what you experienced at 19, but I can tell you that there's probably tens of thousands or hundreds of thousands and maybe millions of people who are going to benefit from the work that you've done, from the research that you have published. You said earlier about regret. Studies show that we regret far more of the things we didn't do than the things we did do.

45:27Jeremy Corr: I applaud where you're going in your personal life, taking your scientific research and translating it into personal action. You've been a role model for me in being able to advance the science of medicine and make it available to all people. I couldn't be more thrilled to have had you as a guest today. Thank you, Dean, for all you've accomplished and best of luck in all that you're about to do. Oh, you're so kind. Well, thank you as well. And like I say, you've been a real inspiration for me and so many others as well. So I appreciate it. To me, awareness is always the first step in healing. And thank you for raising awareness for so many people.

46:08I'm really grateful.

46:09Dr. Robert Pearl: Robbie, you and Dr. Ornish covered quite a bit of ground. What did he say that resonated most with you?

46:14Jeremy Corr: Jeremy, I really enjoyed how he connected disparate parts of medicine, spirituality, and psychology. We know and have talked on our Fixing Healthcare podcast about the benefits to heart health and cancer reduction, for improved diet, consistent exercise, and stress reduction. And we've discussed the importance of human interactions and avoidance of social isolation, with loneliness equated to smoking a pack or more of cigarettes a day. And on Unfiltered, we've discussed the positive benefits that come from gratitude and acts of kindness. But I found Dean's description of human complexity powerful.

46:54Jeremy Corr: And I love this view that rather than being a single way to reduce risk from heart disease, cancer, or dementia, there are a multitude of pathways to the same positive outcomes. Like disparate tributaries from a variety of mountains that converge into one massive river, health is multimodal. It's dependent on many inputs, all of which are important.

47:19Dr. Robert Pearl: Bobby, how do you connect what he said in your views on generative AI?

47:23Jeremy Corr: Jeremy, I believe that they are synergistic. First, generative AI can help all Americans eat better, exercise, and improve their health. As such, it can be a tool for improved lifestyle. Second, it can be a source of knowledge and expertise, 24 by 7, reducing anxiety and allowing patients to make better medical choices. Third, in a value-based healthcare system, generative AI can reduce burnout, help doctors avoid complications, and preserve clinician income. The beauty of both value-based capitated medical care and generative AI is that they powerfully align incentives for patients, physicians, and payers, and they benefit all.

48:08Jeremy Corr: Dean's story of the struggles he experienced early in his life is both sad and inspirational. What he's accomplished since then, that's remarkable. Combining the research he's done on the potential for lifestyle changes to reset our genomics and lengthen our telomeres with generative opportunities available to maximize lifestyle improvements and free up clinicians to spend added time with the patients who will benefit the most, that is a comprehensive recipe for health and medical care affordability. Jeremy, the reality is that we will never solve healthcare's shortcomings by cutting back. No, we will only be successful by keeping people healthier and avoiding life-threatening chronic disease complications, including heart attacks and strokes, cancers and kidney failures.

49:04Jeremy Corr: TNAS blazed the trail. Now we all should follow it.

49:10Dr. Robert Pearl: We hope you enjoyed this podcast. We'll tell your friends and colleagues about it. If you want more information on the future of medicine, you can visit RobertPerlMD.com. If you want more information on the research Dr. Ornish is doing, you can find it on his website, DrOrnish.com. Please subscribe to Fixing Healthcare on Apple Podcasts, Spotify, or your favorite podcast app. If you like the show, please rate it five stars and leave a review. Visit our website at FixingHealthCarePodcast.com and follow us on LinkedIn, Facebook, and Twitter at FixingHCPodcast. Thank you for listening to Fixing Healthcare with Dr.

49:43Dr. Robert Pearl: Robert Pearl and Jeremy Corr. Have a great day.