660. The Wellness Industry Is Gigantic — and Mostly Wrong

26:42Freakonomics Radio is sponsored by Range Rover Sport, a vehicle that blends power, poise, and performance. With a distinctly British design, the Range Rover Sport is built to take on roads anywhere. Free from unnecessary details, its raw power and agility shine. shine. Combining a dynamic sporting personality with elegance and agility, it delivers an instinctive drive. Its assertive stance hints at an equally refined driving performance. Defining true modern luxury, the Range Rover Sport features the latest innovations in comfort and convenience. The cabin air purification system, alongside the active noise cancellation, creates a new level of quality, comfort, and control.

27:22Terrain Response 2 offers seven terrain modes to choose from, fine-tuning the vehicle for any challenging roads ahead. A force inside and out, the Range Rover Sport is available with a choice of powerful engines, including a plug-in hybrid with an estimated range of 53 miles. Build your Range Rover Sport at RangeRover.com slash US slash sport. To kids, summer isn't just time off. It's time spent building confidence and curiosity. But when school meals pause, millions of kids lose access to the food they count on during the school year. As a neighbor-led network, Feeding America is deeply rooted in every community, ensuring summer meals continue nourishing growth and potential.

28:07Your support puts healthy food within reach, fueling the future for kids and their families. Give now at feedingamerica.org slash summer hunger. Freakonomics Radio is sponsored by Lowe's. Son's out, and so is Dad. This is Father's Day. Find what'll make his summer with Lowe's Father's Day deals. Get two free DeWalt power tools when you buy a select 5-amp hour battery kit. Plus, get a free Blackstone six-piece stainless steel griddle kit when you buy a select Blackstone griddle. Shop Lowe's Father's Day deals in-store or online, valid through June 24th, while supplies last. Selection varies by location.

28:54Last week on the show, we spoke with Marty McCary, Commissioner of the Food and Drug Administration and part of a Trump administration whose health and wellness policies have inflamed many people, including the vast majority of the political left. Zeke Emanuel has spent a lot of time in and around the political left, including the Obama and Biden administrations. But he has also worked with the Trump administration during Trump's first term. I asked Emanuel what he thinks of the current Trump administration's health policy. Everything is for s*** in Washington, but the guys running Medicare and Medicaid.

29:30As I did not predict it, he has actually done a very good job of attracting the right people and doing the right thing. Emmanuel here is talking about Mehmet Oz. He is running CMS, the Center for Medicare and Medicaid Services, way better than Biden did. Biden's person came and went and I asked everyone, I said, so what did they do? Silence. And these guys, they're actually doing good stuff. Why were you so skeptical of Mehmet? Because I thought he was willing to prostitute himself and say stupid stuff to make a lot of money on TV. And I didn't know whether that's why RFK Jr. brought him in, that he would do his bidding.

30:07And he hasn't. He really has said, how are we going to make health care better for people? And the other thing, which I greatly actually appreciate, they don't care. And I wrote this about exactly a year ago. I said, you know, these guys are coming in. The best thing that could happen is that they don't give a what the interest groups, what the AMA says, what the hospital association. And that's actually really important because you can't reform it if you, you know, constantly trying to placate everyone. And I'm impressed. I'm very impressed. These guys are actually doing good. Name a couple of things that they've done.

30:39So they've initiated some prior authorization that is going to tamp down on some abuses. They have initiated new programs aimed at getting better management of chronic illness and using apps and technology that we know work to do it. There's just a recent report about AI getting people who have diabetes on the right dose of insulin in 15 days as opposed to doctors doing it taking more than 56 days. Okay, that's really valuable. And that also means the doctors can focus on other things and the AI can handle the patient through Alexa. And I'm like, that's fabulous. Let's do more of it. And they are on that path to doing more of it.

31:19They've launched a program called Access, which is very likely to go exactly in that direction. So if you roll up, let's say, Robert F. Kennedy Jr. and Marty McCary at FDA and Mehmet Oz at CMS and roll them up into one class the first year of the second Trump administration's health and science policy, what's a letter grade? D. D. Oh, that's still pretty poor. Because you have to average an A at CMS, but an F at everything else. RFK Jr. is going to make a lot of people die through just the vaccine thing alone. He hasn't done anything really on the food system. I mean, taking dyes out is not going to save a single life.

31:59He's undercut the entire structure and scientific review process that we have. They have the focus on chronic illness. Very good. But they haven't actually done that much on it. I wonder whether you try to be apolitical or not really. In your book, you give a hard time to Casey Means, Trump's nominee for Surgeon General. You ridicule her health and wellness obsessions, which you seem to think are pretty flaky. And I get that. But a couple elections ago, one of the Democrats running for president was the self-help guru Marianne Williamson. So I wonder when you are strongly affiliated with one party the way you have been, whether it's just not possible to consider the upsides of your opponents arguments and the downsides of your allies.

32:51and whether you become too partisan a thinker, even in the health and wellness arena? That's not true for me. My goal is to fix the American health care system for the American people. That means five things, getting universal coverage, making costs reasonable for everyone, having consistent high quality, diminishing disparities like rural urban disparities, black-white disparities, and having people fully satisfied. You can't do those things without bipartisanship. That's the first thing. The second thing is, early on, I talked to President Trump in 2016, in November and December 2016, trying to talk to him about how I thought he could improve the American healthcare system.

33:36And I was pushing him to focus really on drug prices. So we had a number of meetings. I was happy to work with them. Then when COVID hit, I wrote him a memo about how to begin approaching COVID. Joe Biden called me and said, we'd like you to help. And I'm like, anyone who wants to make an improvement in the American health care and address this pandemic, I'm open to it. I told Biden I was working with Trump and he said, fine, we don't care. But Trump, that was not the same attitude. And he got upset and cut off discussions. Did you try again with Trump, too, in 2024? We are regularly working with Trump, too, about trying to address American health care problems.

34:18Who's the we, Zeke? Me, me and my team. So we're trying to work on, you know, focusing on hypertension. We're trying to work on this upcoding problem and getting Medicare to do a better job of risk adjusting. We've actually developed a better risk adjustment model than they use now and trying to get them to adopt it. I am, I don't know whether nonpartisan, bipartisan, there is a big problem and we need to solve the problem. And this problem isn't going to be solved by one ideological view. You have to work and keep working at it. There are people on the Republican side who I've learned a lot from.

34:54There are people on the Democratic side who I've learned a lot from. There are people on the Republican side who I think have wacky ideas about how to fix the system that aren't going to work, and the same thing's true on the Democratic side. I am willing to work with anyone to help solve this problem, in part because we are now at 18 % of GDP. That's one out of every$6 that we spend. It's a major cause of the unaffordability problem for every American. If we could bring our healthcare spending down to 13%, that's a five-percentage point drop. Five percent in a $30 trillion economies,$1.5 trillion.

35:30That's$5 ,000 for every American. Just imagine what would happen if we could bring our spending down to the top of Europe. A family of four would suddenly have$20 ,000 more to spend on everything else they need in life. It would radically change how Americans live. Now, I don't know that I could in my lifetime get us down five percentage points of GDP, but we should be able to get down two or three percentage points of GDP. And even that is a huge amount of money for people. Last time we spoke, Zeke, we focused on GLP-1 drugs, their efficacy, access to them, affordability, potential downsides.

36:09Can you just give me a quick update? What have you learned about the GLP-1 drugs in the last year? I do see, for instance, that Novo Nordisk, the Danish multinational pharma firm, recently won approval to sell Wagovi in pill form in the U.S. That'll be the first GLP-1 that I'm aware of in pill form. So there's obviously a lot of momentum in that area. What's the state of the union with GLP-1s in your mind? In the last year, we have learned more and more about the positive benefits, and we've cleared up suggestions that they don't have certain effects like reducing the risk of dementia. People were very hot on that, at least in the first set of studies, does not appear to be the case.

36:49But one of the biggest home runs, I think, is they have this enormous effect very quickly in terms of reducing cardiac risk factors and cardiac mortality. That's amazing. 20 % reduction in a year. That's pretty amazing results. What's the plausible biological mechanism for that? You're reducing weight. You're reducing the cardiac risk factors for causing plaque. You end up reducing blood pressure as well. And that also reduces renal disease and kidney failure risk. I think the second thing that has become quite clear is no one predicted when they began researching GLP-1s decades ago that it would cross the blood-brain barrier and it would affect the central nervous system and in fact affect the reward system.

37:39And now we know that it somehow does all that so there's less positive reward from food, but also alcohol, tobacco, drugs. That, I think, is going to turn out to be an amazing result that we're only going to learn a lot more about how you can use it to regulate these other addictions. And it gives more plausibility also to some element that food can be addictive as well. I'll just tell you, I have a very dear friend from college and I suggested he go on a GLP-1. He went on a GLP-1 and the next day he called me up and said, you know, my relationship to food is very different. I no longer have this battle with it.

38:21And then I talked to him just the other day and he said, well, you know, I've had to go off the GLP-1s because we had a change in insurance and I can't afford it. $1 ,200 a month that just can't afford it. And the problem is we have this miracle and people who need it and can benefit from it aren't able to get it because of the cost. We need to be more creative in our society when we have these really big breakthroughs for a large number of people of getting it at a reduced rate. me and my group have been advocating for thinking about subscription models of GLP-1s because, you know, we can lower the cost.

39:00The marginal cost of production is very small and increase the number of people by maybe even an order of magnitude. But the pill form I've read, and I would assume anyway, is going to be much, much cheaper, correct? I'm reading Wagovi monthly pill form will be about$150 a month for what they call the starting dose versus about$1 ,350 a month. That tenfold difference is not production costs. It's profit. And I think, you know, Novo or Nordisk has been losing market share and needs to gain market share. And this is an easy way. But I think that's the kind of, you know, if we had under$100, so we're talking maybe$1 ,000 per person per year, kind of if we got to that level, it would be a home run.

39:44I mean, it seems like we're heading in that direction. Yes. Yes, we're heading in that direction. And I think within 10 years, we're going to have a lot more options with a lot fewer side effects that are more targeted and the price will come down. And I think that'll be fantastic for American society. But let me just say, that's not the way to solve our obesity problem in America. So let's talk about that for a moment, because all these things you're saying about GLP-1s are phenomenally good and or promising. On the other hand, I hate to be the skeptic and I hate to bring the economists into the conversation where they may not be welcome.

40:21I don't know. But economists, as I'm sure you know, have this phrase moral hazard to describe a situation like this, where when you lower the risk or the cost of potentially hazardous behavior like overeating or eating a lot of unhealthy food, that you maybe, you know, encourage people to do more of the same because you're giving them a kind of safety belt. How do you feel about that? In other words, you've just written a book promoting sensible, good nutrition, diet, sleep, et cetera, et cetera, et cetera. But if there are pharmaceutical solutions that obviate the need to change behaviors, where do you fall on that?

40:57Well, I totally agree with the economists, not on the moral hazard problem, and I'll explain why, but on the idea that GLP-1s are not the solution to the obesity epidemic. Although we should acknowledge that in the last year, the percent of adults who have been obese has dropped 2%, and we've not had a drop in decades in the number of American adults who are obese. So something is happening with GLP-1s. So here's one important way in which I think actually having the GLP-1s are not going to lead to moral hazard, but actually might change the psychology of people. One of the things that happens, I think, when people gain weight is they become despondent about themselves, about life, about the future.

41:44And I think if you now recognize, well, I lost 20 % of my body weight. My body image is better. I now see the future differently. I have hope. I have hope that I can control things. I have hope that I can actually change my life. I'm going to invest in my life differently. I might adopt exactly what we want them to do. Exercise, better nutrition, better sleep. The sleep apnea will go down. All of these things suddenly become different. And the valence, my ability to see hope in the future and therefore invest in the future is going to increase. We need to figure out more about how to appropriately use GLP-1s.

42:26You might be able to get people to drop 20 % of their weight inside of a year, then go on a much smaller dose of GLP-1s for the long term. We also don't know how giving them simultaneously diet and nutrition advice, as well as exercise, coaching, how those will intersect. I suspect they're actually going to be synergistic for all the reasons I say. So what's interesting to me, Zeke, is that you write about this age we're in, this wellness industrial complex. You describe it as a tsunami of information that's coming to us, some of it too complex, some too simple. But one big point you make is that most of the behaviors that you want people to follow, which is eating sensible food, getting sensible exercise, sleeping well, et cetera, et cetera.

43:19You can't make a profit by prescribing that. And that runs up against not just the wellness industrial complex, but really the healthcare system where, as you know better than any of us, many physicians, the way their incentives are laid out is to treat illness and not to encourage wellness. So if you take a step way back, do you see any philosophical or theological adjustments that might be worth making? Oh, absolutely. A lot of people think, well, wellness is an individual thing, but that's wrong. And we all know it because the whole issue with ultra-processed foods is we've got a whole food system that is incentivizing through food subsidies to corn and soybeans and wheat and rice, as well as many other aspects that make ultra-processed foods cheaper.

44:13We don't subsidize fruits and vegetables. We don't subsidize other very nutritious elements. That's one area. The other area is we have a whole system now that is making us lonely. We've got cell phones and social media, video games. So people are no longer interacting and they're no longer talking to people. I prohibited cell phones in my classroom as well as computers. And you come into the classroom and it's a lot louder than it used to be because people are actually talking to each other. Apparently in New York, where they've bell to bell prohibited cell phones, what they've noticed is that actually the volume's gone up.

44:54And that's a positive because you've got more students talking to each other. I have noticed that the whole cohort of my students, they're sort of socially awkward because they don't know how to talk to each other. They don't know how to navigate conflict or disagreement between themselves. That is a very bad thing. We've created lots of social barriers to actually wellness, not just in the health system. And believe me, I could go on for the next two, three, four days talking about the problems of the health care system and the promotion of wellness. But we also have other social systems like social media, like the way people actually earn their living, as well as the food system, the exercise system that make it hard for people to live a healthy life.

45:40There is this age-old wisdom, and part of our issue is we have to constantly rediscover it, as you point out. And I don't think that's new. What's the Renaissance? Well, they rediscovered the verities of the ancient Greeks and Romans. Okay. Wellness is about biology, and the core elements of we're really social beings. Aristotle knew this, right? Two books of his famous Nicomachean Ethics are devoted to friendship and how important friendship is both for virtue but also for a good life. Hippocrates understood diet and exercise. It strikes me that one prescription that I'm not hearing from you or anyone is that people need to read again.

46:21When you talk to college professors, they say that even at good universities, they can't get students to really do any real reading, even 100 pages of a book. Forget about the whole book. Have we just given up on that notion, do you think? I hope not. And I was just bitching about that problem of reading yesterday. day, it's very hard to get students to read and they complain no matter how short your reading lists are. And I think it's super important. And we've lost that art. And that also means we've lost part of the art of critical thinking to read something we don't agree with or to follow a detailed argument that's a little more complex.

46:59And one of the things I bemoan over and over is how simplistic, the lack of nuance in social media posts. How can it be nuanced? And I was terribly against social media for that exact reason. You can't have a prolonged discussion. I have an avocational interest in American history. And you think about how long the debates were of the Lincoln-Douglas debates. And then you're like, oh, in American presidential debates now, There are two minutes on each side and then a 30 second rebuttal. They're not 45 minute speeches that are subtle and have a long development of argument. I mean, this is maybe Pollyannish, and I'm not even sure it's desirable, but do you see a way to get back to – I'm not talking about Lincoln-Douglas debates necessarily – but do you see a way to get back to a longer attention span, more attention to detail, more nuance, et cetera, et cetera?

47:54Obviously, there is a layer of society that still engages in all that stuff. And I would argue that probably many people who listen to this program are part of that layer. But having a thin layer at the top is not very good, I think. Do you have any thoughts for making that layer deeper? Well, I do have thoughts. And I think one of the reasons that a electronics Sabbath is a good idea, one day a week where you just shut down the computer, you shut down the phones. is good is that can be a day where you read. For the last two years, I have pledged my New Year's resolutions to have a full electronic Sabbath.

48:34I have yet to reach that. I'm about 70 % of the way there. I hope 2026 is the year I can actually fully realize it. But I think that's an important step in the right direction for us, a day when we're not distracted. And what this really is, Stephen, is it's about time allocation. And it's about prioritizing deeper thinking and deeper reflection, including time with ideas that you don't necessarily share to understand why someone might advocate that and to give them the most charitable reading you can so that you can think through, well, you know, maybe I'll change my life. Maybe this is a perspective I need to adopt.

49:14Coming up after the break, has Zika Manual figured out the meaning of life? I'm Stephen Dubner. This is Freakonomics Radio. We'll be right back.

49:30Freakonomics Radio is sponsored by Aquasana. One easy way to live healthier is to hydrate smarter. Smarter hydration starts with Aquasana. With Aquasana water filters, you get healthier odor-free water that tastes amazing. Their advanced filtration removes harmful contaminants while preserving beneficial minerals, so better hydration comes with every sip. And it's not just drinking water. Aquasana protects your home and your health with a full range of whole house, under sink, and shower filtration systems. Whether you're washing veggies, making coffee, or rinsing off after a workout, experience the difference in every drop with Aquasana.

50:03Visit Aquasana.com and use promo code FREAKONOMICS for up to 50 % off select systems. That's A-Q-U-A-S-A-N-A dot com. Promo code FREAKONOMICS. Aquasana. Healthy living starts with healthy water.

50:26Freakonomics Radio is sponsored by Advantech. No one likes a creaky floor, and builders know that the subfloor sets the tone, which is why Advantech subflooring is engineered for strength, stiffness, and moisture resistance. Advantek products are designed to stand up to the elements and give you a bond so strong it's backed by the industry's first squeak-free guarantee. No squeaks, fewer callbacks, no problem. When the schedule is tight and performance matters, head to Huberwood.com slash Advantek to lay the foundation of a solid build.

51:03Freakonomics Radio is sponsored by Dell Technologies. When you're at work, you never know when you'll be interrupted. But with the Dell Pro powered by Intel Core Ultra with vPro, no matter what distracts you, your laptop won't. It's battery optimized for the way you work with built-in intelligence that quiets distractions when you need to focus. Your laptop will help keep you locked in even when it's bring your dog to work day. Built for those who stay in the flow, the Dell Pro, built for you. Dell.com slash Dell-Pro.

51:45Let's talk about chapter four, Eat Your Ice Cream, which is also the title of the book. And I find that chapter four is kind of the meat of this book because it is about what to consume and not consume and how to behave and not behave and so on. And you describe a sort of vicious circle where people trying to do better with their nutrition and health, exercise and so on, they often get so stressed out about how to do it that it adds more stress to their lives and that can have a negative impact on their health. So can you just walk us through that vicious circle and how to get out of it? First of all, we have to remember wellness is for decades.

52:26It's not for a moment. Wellness is going to be your lifestyle, how you live, and the habits you adopt on a daily basis. They have to be things that don't require willpower because if they require willpower, you're going to exhaust them and you're not going to follow through. So that's the first thing. The second thing is there are a lot of things we're doing that are anti-wellness. And one of the interesting things about human beings that I think doesn't get enough play is we're an additive species. When we confront the problem or a puzzle or something, we tend to solve it by adding things. One of the important things I think about wellness is we have to actually take away the bad stuff we're doing.

53:05And we don't do enough of that. Look, there are a lot of negative things in our diet. The top one is sugary beverages, sodas, because they are 140 calories per 12-ounce can, 10 teaspoons of sugar with absolutely no nutritional value. Don't do them. they're not good for you. And the good news in America is, if we need good news on nutrition, is we're actually decreasing our soda consumption. The second is snacking has increased to 500 calories a day over the last 30 years. We've got to bring it way down. I'm not telling you no snacks, but bring it way down. Those two things alone will actually improve things.

53:48And then one positive, which is eat more fermented food, eat more fiber. Those are the two big things we're lacking in our diets on a regular basis. You will be a lot healthier. Just those things. Take away two items and add two items. Let's talk for a minute about the gut microbiome, which is something that for reasons I can't explain, I've been interested in for a long time. And also, it's one of those topics that I feel we've been promised a lot more good research over the past 10, 15 years than we've actually gotten. I know there are many, many, many people working on it, but it seems as though the microbiome is a much more important driver of overall health than people 100 years ago may have imagined.

54:38I don't know. For all I know, maybe they were way ahead of us then. Can you just talk for a minute about the state of gut microbiome research and what you think we'll be learning over the next 10 or 15 years that might be really useful. Oh, absolutely. I totally agree with you. For most of the 20th century, the idea is bacteria, bad, they cause illness, they kill you, and antibiotics, good. And then what we've learned over the last 30 or 40 years is way oversimplified. Those bacteria, they're really there. They're good. We've grown up with them and we've adapted to them. Just think about it from an evolutionary standpoint.

55:15We have more bacteria in our gut than we have cells in the rest of our body. They gotta be there for a reason. That's very important. And we also know that the diversity of microbiome is a very important sign. Exactly the function of each species, we're beginning to elucidate this. All of us are impatient. You know, it was 55 years ago that Richard Nixon created the war on cancer. Now we're getting all these treatments and cures, frankly. It took 55 years because cancer is complicated. The microbiome and its effect on biology, the same thing. It's going to take us probably another 20 or 30 years to really dissect out everything and the circuits and really make a lot of advances.

55:58Nonetheless, we do know just basic principles. Diversity is good. The microbiome needs a lot of bacteria, but it also needs a lot of fiber and different kinds of fiber, not just the fiber supplements you get so that the bacteria can grow. They protect the lining. It's probably related, and here I'm going a little out on thin ice, probably related to the rise in things like colon cancer and other illnesses. Especially among young people. I remember last time we spoke, you were pretty surprised and shaken by the rise in colon cancer among people in their even 20s and 30s, yeah? Yes, and I've had a lot of friends who've been diagnosed and unfortunately died from colon cancer in their 30s and young 40s.

56:41When you say that the microbiome is a site of interest there, what do you think is happening? Do you think this has to do with ultra-processed foods? Do you think it has to do with antibiotic? I don't know where to lead you, so I'll let you lead. I do think ultra-processed foods and the decrease in diversity, I also think probably pesticides that we've consumed and are on everything also decrease the diversity of our microbiome and the right kind of bacteria that protect the lining of the colon decreasing. And where do those right kind of bacteria primarily come from? Nature, all the things that we are supposed to eat.

57:18So this is fermented foods, yogurts, et cetera. And fiber so that they can grow in the gut and they can outcompete the other bacteria that we have. This is where I get nervous. About 60 % of calories among adults and children are ultra-processed foods. That is not good. We know that decreases the microbiome diversity. Diet sodas decrease the microbiome diversity. Only 7 % of the American population consumes enough fiber. That is horrible. We really need more fruits and vegetables as a regular part of our diet. I think this emphasis on protein is overdone and the emphasis on fiber is underdone, and we need to shift that.

57:58I do think, Stephen, one of the things we are going to learn is which bacteria are really important and also what the different bacteria do that impact on our cognitive function, our cardiovascular function. I think we're just at the start of it. We do now know things like fecal transplants can be effective in treating diseases like C. difficile, which are caused by over-antibiotic use, are going to be really, really important. The other flip side, and I think it's important for the listeners not to forget this, is, You know, we unfortunately have in our food system, we treat a lot of animals with antibiotics, and that's probably a bad thing because of antibiotic resistance.

58:39And also maybe some of those bacteria are not so bad for us to consume. We do know in some cases, some of the bacteria are really bad. Raw milk, not a good idea. But in many other cases, I think treating chickens and beef and other animals with antibiotics is a bad idea and not good for our food system. And this goes back to the issue we were talking about before. Being well and having wellness, it's not just what I do. It's also what the system does. And unfortunately, the American system is focused more on making profits for this part of the economy and externalizing the costs on the rest of society.

59:17What you're describing is what some people might call a wicked problem. Not just people from Boston, but researchers like to describe a wicked problem as one that's entrenched and has a lot of different players in it who have incentives to maintain their incumbency and so on. So any solution that I would think that you would like, whether it's in the health care system and the food system and so on, is inevitably a political solution, is it not? I agree with you. We have to change the food subsidy system we have in this country. Can we change it overnight? Absolutely not. We've got farmers who have grown up with this food subsidy, who've created their production, and we have to slowly shift.

59:57Can we do that? Yes. We've learned we can do that with tobacco. We've learned we can do that with coal. And we have to shift and give them alternatives. I think that is going to be in every American's interest. There are a lot of societies out there where only 20 % of the calories are from ultra-processed foods. That's where we need to be. Let's talk about Chapter 5 for a moment, Move It. this chapter I liked a lot. We did an episode once called, What's the Best Exercise? And the answer was, the best exercise is whichever one you will stick with. I thought of that because when you're writing about exercise and the benefits and so on, you're really writing about habit formation.

1:00:39You mentioned earlier in this conversation willpower and how you can't really rely on that. So just talk about that overlap between exercise and habit formation and how you would advise someone who wants to be more active, wants to be more regular in their activity, but has a hard time getting there. You have to have the attitude, I want to start this. That's the first thing. Initiation, I'm going to start. The second thing is you have to actually set a date, set a time, and make it at least three or four times a week you're going to do something. I often recommend doing it with another person because they keep you honest and they too want to do it and you're sort of playing off each other.

1:01:21The really important thing about exercise is the repetition. The best data that I have found is four times a week for six weeks really gets you to a stage where it has become a habit and you're more likely to continue it to 12 weeks. We don't have very long-term outcomes. The important thing there, I think, is by the time you've gone six weeks, you've built it into a routine. And that is the critical element, the repetition. So the thing I recommend to people is, and this is what I do, is vigorous activity. You need 75 minutes. That's 10 minutes a day. Well, I don't do 10 minutes a day. I do 20-minute chunks.

1:02:05So in the winter, I get on a stationary bicycle three times a week for 20 minutes, and I do a lot of other activity. What's your degree of difficulty on that bike? I do a Peloton exercise and I end up sweating and my heart rate has to go over about 110. That's not crazy, 110. It's not crazy. And almost everyone can find 20 minutes or, you know, with a shower and whatever else, 30, 35 minutes a day, three times a week. That's not that crazy a time period. You know, some weeks like this week, the holiday week, I am not going to exercise. I'm away from home. I will continue to do my yoga, but I'm not going to get out on the bicycle.

1:02:42All right. Then I'll go back home where I have all the setup and I'll continue it. Am I going to become suddenly unhealthy? No. You know, I'll get back onto it. Let's talk about chapter six for a minute. Sleep like a baby. So I'm already a sleep advocate. I love to sleep. I'm like Olympic level sleeper. Everyone in my family is very jealous. What's your secret, Stephen? Come on. So here's the problem. It's just natural. It comes to me. So I feel a little bit guilty about it because I have a lot of friends and family who really do have a hard time sleeping. And therefore, they reach out to what strike me as often absurd aids for sleeping.

1:03:21And you're not a fan of some of the absurd sleep aids as well or sleep advice, I guess. So why don't you give me the do's and don'ts of the Zika manual sleeping program? First of all, this is one where everyone has to be forgiving of themselves. Every other wellness behavior, you can will yourself to do. You can will yourself to exercise. You can will yourself to eat well. You cannot will yourself to sleep. You get in bed and you're willing yourself to go to sleep. It will not happen. We all know that. Second, we are all prone to quick fixes. That's the American way. We reach for the melatonin or we reach for the magnesium or whatever our pill of choice is.

1:04:02The American Academy of Sleep Medicine, no, they do not work. Do not do them. That's not the approach to take. There are two things we can do. One is we can set the bed and set the room up, make it dark, make it cool, tape over those lights or get those things out, put the phone in a different room, get in bed, read an actual book, not on a computer screen, and then go to sleep. No guarantees that way. Right. And then if you're still having problems after you've done that for a while, cognitive behavioral therapy for insomnia is the most effective treatment. You don't seem to put a lot of stock in apps that track your sleep.

1:04:43Why is that? I get up in the morning, anyone, you get up in the morning, you feel well or you don't feel well. And let's say the app tells you something different. Well, you're going to believe the app more than your body. No, your body is the ground truth. Are you feeling like you can concentrate, like you've got the energy for the day? If you don't, I don't care what the app says. If it's anxiety provoking, which I think most of the sleep apps are, it's unclear what advantage you're getting. It's not like wearing an Oura Ring or an Apple Watch that they're actually going to make you sleep. They're not solving your problem.

1:05:16They're not therapeutic. They're giving you data. And sometimes that data just makes you more anxious. And that data is not more valuable than what your body is telling you. So a lot of the advice out there around health and wellness or the wellness industrial complex, as we're calling it, has to do with things you shouldn't do. Some you should, but a lot that you shouldn't. And one thing that I just liked about your book was that you focused on some of the do's beyond just the foods that are good for you and the exercise that is good for you, but also the notion of joy and celebration and setting out to actively celebrate yourself for others and so on.

1:05:57Can you talk about how to make that more of a routine for more people? We're on this earth for 75, 85, 90 years. That's it. You can practice a lot of self-denial. You can practice a lot of anxiety over getting everything right. Or you can live a meaningful life where meaningful is mostly, I find, it's about other people. It's about doing good in the world. It's about connecting to people. When I have a dinner party and I have people over and we're having a really good conversation, that's great. My joy is up. It's also good in the long term because, you know, sociability is good. And third, it's virtuous because the other people are gaining that sociability, that good conversation.

1:06:43We're all in it together and we're all actually making wellness part of our everyday life. It's like a trifecta. It's a wellness trifecta. It's good today. It's good for tomorrow. And it's good for the other people. What could be better in life? You quote the late British chief rabbi Jonathan Sachs, who wrote, we defeat death not by living forever, which as we know is impossible, but by living by values that live forever. Your book, Zeke, is mostly about personal behavior and not values per se. But my sense is that the values are always just underneath the surface. So I'm wondering what you have to say about that.

1:07:25If I asked you to synthesize or summarize Zeke Emanuel's values to live by beyond the eating, the exercise, et cetera, et cetera, what would that be? You're 100 % right. And I don't think there's that much beneath the surface. To go back and quote Ben Franklin, his great thing is be useful. And by be useful, he meant, how are you making the world better? One of the things I think my parents instilled in me and my brothers, and now you're going to make me cry when I think about my parents, is, look, you are privileged. You came into this great world. You came into it at a great moment. And the real challenge for you is how are you going to make it better for people who aren't as privileged as you are?

1:08:09And how are you going to make it a better place going forward? I think I've dedicated my life to trying to make the world better, whether it's by improving the healthcare system, by mentoring kids and putting them on the right way. There are so many ways we can make the world better in our daily life, cheering people up, just growing things. Ben Franklin challenges us, Be useful. How are you being useful? How are you making the world better is the most important thing we can commit ourselves to. And it'll give us joy because that's part of having a meaningful life. And if there's anything that makes our life better, it's having meaning in it.

1:08:53Zeke, I enjoy every conversation with you, but I think this is my favorite. So thanks. I'm honored, Steve. And you are the best interviewer. Thank you so much.

1:09:06Let me just say, for the record, I'm pretty sure I am not the best interviewer. So if Zeke Emanuel is going to get that wrong, maybe we should just discount everything he said today. I'll let you be the judge. Again, his new book is called Eat Your Ice Cream, Six Simple Rules for a Long and Healthy Life. Let us know what you thought. Our email is radio at Freakonomics.com. So coming up next time on the final installment of the Freakonomics Radio Guide to Getting Better, are we about to take a giant leap forward in medicine? It's happening in eight emergency departments in the greater New York area.

1:09:43They're automatically being screened by the AI model for heart disease. As we all know, the health care system could use some serious disruption. There are a lot of reasons that we are pretty static and we like technology, but we like it in very, very specific ways. So how much and in what ways will AI remake medicine? That's next time on the show. Until then, take care of yourself. And if you can, someone else too. Freakonomics Radio is produced by Stitcher and Renbud Radio. You can find our entire archive on any podcast app, also at Freakonomics.com, where we publish transcripts and show notes.

1:10:24This episode was produced by Alina Kullman and edited by Ellen Frankman. It was mixed by Jasmine Klinger with help from Jeremy Johnston. For background research help, special thanks to Corby Kummer, David Wendler, Govin Prasad, Marion Nessel, Suzanne Roeder, and Zach Cooper. The Freakonomics Radio Network staff also includes Augusta Chapman, Dalvin Abawaji, Eleanor Osborne, Elsa Hernandez, Gabriel Roth, Ilaria Montenacourt, Tao Jacobs, and Zach Lipinski. Our theme song is Mr. Fortune by the Hitchhikers, and our composer is Luis Guerra.

1:11:02I drove in and I had a very nice mocha at Amherst Coffee. I normally do not drink coffee, but because it's Dr. Dubner, I have to be at the top of my game.

1:11:17The Freakonomics Radio Network. The hidden side of everything.

1:11:24Stitcher.

1:11:29All new drinks are now at McDonald's. Like the Strawberry Watermelon Refresher and the Spriteberry Blast topped with Cold Foam. Who knew ice cold drinks could be so fire? Try them all now at McDonald's. Refreshers contain caffeine. The most memorable gifts aren't found. They're made. Zazzle is a custom marketplace where you pick any product, a mug, a card, a tote, a phone case, and make it personal. A photo, a name, an inside joke. The kind of gift that actually fits the person. That's what 30 million customers have been coming back to Zazzle for over 20 years to find. Right now, save 25 % on your first order at Zazzle.com.

1:12:11That's Zazzle.com. Make it z-amazing. Everyone's talking about protein lately, but how do you actually get enough of it? Muscle milk. Muscle milk has a great tasting new formula with no artificial sweeteners, flavors, or added colors. It's high-quality, complete protein designed to support healthy muscles with fewer ingredients than the previous formula and 26 to 42 grams of protein. for when you're stuck in meetings or need a post-workout recovery. Available in chocolate, vanilla cream, cookies and cream, and strawberries and cream. Try the new great-tasting Muscle Milk today. Available in stores nationwide.

1:12:42Muscle Milk. Protein for all.