AI, Longevity, and the Health Revolution with Nayeema Raza

0:00What is your outlook on what the Trump administration has done in healthcare so far? What kind of grade would you give? RFK? I don't know if there's a grade low enough. F minus minus. We're at a crazy moment in health. We've got AI disrupting traditional medicine. Doctors don't want to rely on Chad GPT, but they're happy to rely on open evidence. RFK and the Trump administration with their Maha Make America Healthy Again movement is transforming American health for good and bad. I'm going to let him go wild on health. And then you've certainly seen people like Brian Johnson and other billionaires who are interested in figuring out how they can try to live forever.

0:37You will die. False. We brought together some of the most serious people in Silicon Valley and the startup world who are thinking about all those changes in health at newcomers brand new event, Deus Ex Medicina. I hosted the event with Naima Raza, and she's here to join me to talk about some of the major themes. We'll play some of the highlights for you and give our reactions and help you make sense of the crazy stuff and health that's going on in Silicon Valley right now. This podcast is supported by Google. Hey, folks, Stephen Johnson here, co-founder of Notebook LM. As an author, I've always been obsessed with how software could help organize ideas and make connections.

1:17So we built Notebook LM as an AI-first tool for anyone trying to make sense of complex information. Upload your documents and Notebook LM instantly becomes your personal expert, uncovering insights and helping you brainstorm. Try it at notebooklm.google.com. Naima, you're not wearing your hat. Oh my God, I have another hat. You know, I'm an Aspen, so I have like a fancy Aspen hat. You're already moving on to the next thing. You're like, we just wrapped up Day 6 Medicina. You're like, oh, I've got a new hat, new things on my mind. I love the hat. We're always going, I'm wearing the hat, you're not.

1:53That's sort of like the dynamic overall. I think you're a little too fast. Look at this hair. You want to cover this up? Baseball hats all the time. Exactly. Anyway, we have wrapped up Deus Ex Medicina, our inaugural AI Health and Longevity Summit that we hosted together. Obviously, you are the wonderful host of the Smart Girl Dumb Questions. I got my plurals and singulars, right? Smart Girl Dumb Questions host. And yeah, thrilled to be here with you. What was your reaction to the event? And what surprised you the most? What surprised me the most? You know, I thought one of the things that was electric in the room every time it came up was the Trump administration's policies surrounding health care.

2:34And what I thought was interesting was the low grades of people. What did you call it? Like a brick? Electric. I said it was electric in the room. Electric. Oh, okay. Yeah. It was electric in the room because I think people were just like really curious to know what other people thought about it. It was kind of like everybody had a thought about it, but everyone wants to know what someone else thinks before they talk about what they think. Exactly. Well, I sort of, in our predictions episode, I said, I don't know if people are going to want to talk about it, I think. Yeah. But I think people loved talking about it and loved hearing what people said about it.

3:03So there was a real, I would say, split, not within the room, but within many of the people that we heard from on stage. People would split their opinion between what they thought of vaccine policy. no good, very bad, as Vinod Khosla put it, F minus minus for RFK. Pretty much across the board, people voiced concern about it. But then a lot of optimism around the kind of kill the clipboard campaign that you're seeing out of CMS and Medicare Medicaid, a lot of hope for the administration's willingness to work with the private sector on revolutionizing some of the technology and processes around healthcare in America.

3:41And I kind of left thinking, okay, okay, is this self-interested? Is this what companies say because they need to be doing business with government here? But I really felt it was sincere. You had people on stage like Tom Hale, CEO of Aura, saying, look, I'm not a Republican, but showing some bullishness around what the Trump administration has done or could do in policy. Yeah, policy obviously loomed large. The government and Trump are affecting everything. TikTok has grown private. But health, obviously, more than anything, a highly regulated industry, Silicon Valley cares a lot about health.

4:16Vinod giving them an F - was obviously a moment. But I don't know. I'm more on the view that everybody plays their role and if I'm the CEO it's like gotta go for whatever win with the government I can get and so you have to leave some room for like, oh! It's like you're parenting a small child as I'm preparing to do. You teach them, you're aspirational, like, yo, your intentions are so good. You're trying to do this thing. You're trying to privatize the thing we all want. Whenever I hear them say they're really going to let businesses run, it's sort of like, leave us alone. Let us do our thing.

4:56But then when you actually push them on, what about the FDA? It's either what about the FDA? Like, it's bad. Or I haven't read or looked at anything on it. It's like, I don't know, anything specific. They're like pretending they sort of like have no clue what's going on. Well, I like that. I feel like one, I really like your metaphor in which Donald Trump is a baby in diapers and Tom Hale's like the big daddy being like, you're doing great. You keep crawling up here. But see, I think that if that were the case, they would be wary. I think we taped right before Trump had even, or maybe it was just around Trump kind of distancing himself from RFK's vaccine policy, but saying that the White House still stands behind him completely, whatever that means.

5:36But, you know, it was in the specifics for me. Like, when we had the conversation with Strand Therapeutics, Jake Bicraft, and Janice Chen from Mammoth Biosciences, and Janice told the story of how this administration, which so hates mRNA vaccine technology, I mean, two things that came out of that conversation. And one, Jacob Becraft clarified that what the administration had done in terms of cutting $500 million in mRNA funding, which was widely reported as such, was really around the vaccine funding. There continues to be a lot of investment dollars when it comes to cancer research, cancer-specific vaccines, et cetera.

6:14It was in the other world of vaccines, plumes, et cetera, that they had cut this research, the respiratory stuff. But then Janice made the funny point that, you know, RFK hates mRNA, loves CRISPR, which relies on mRNA technologies. And so there is clearly a disconnect. Hopefully he doesn't learn the science anymore. Like if he figures it out, it might hurt more than just like stay, just stay out informed on this connection. Yeah. So I guess I'm less skeptical of their bullishness about policy and more by it. But I'm curious, what surprised you, Eric? Yeah. I mean, the pure, the business person in me, the sort of student of the Silicon Valley startups.

6:57I'm very interested in the rivalry between a bridge and open evidence. It's not a rivalry yet, but these are two companies that are core to how do we bring foundation models to doctors. A bridge, we're going to sell to health systems. You're going to, you're a doctor talking in your note taker app. We're going to help you make sense of that. And then, very importantly, we're going to help you sell to tell your insurance company why they owe you a lot of money and owe your patients a lot of coverage. And basically, we're going to sort of be your tool in the fight with insurance companies and making sense of those messy doctor notes.

7:32On the other hand, you have open evidence, which is like, no, we're going to help doctors actually diagnose patients, figure out what's going on. And, you know, it helps the patients probably don't want to hear that their doctor is going to chat GBT to figure out what to do. So, no, we're going to open evidence. The doctor official trained on medical journals tech. And they're like basically having doctors just choose to use their free product and then, you know, getting pharmaceutical ads, the good old fashioned business model. Yeah. Anyway, so I thought there were two super interesting companies that eventually are going to compete with each other.

8:06Do you have a prediction on who is going to win, Eric? Rick, are you now going to be like, oh, you know, I think everyone's doing a good job. Keep crawling, babies. Interesting. Who do I think is going to win? I haven't actually, I mean, without the numbers, it's always hard to tell. It's a great like Silicon Valley tech question because it's like, oh, a bridge is sticky. They're selling to health systems. And so the real threat, of course, is open AI coming for them both. So I do think a bridge is building deals that might be hard for open AI to dislodge. I think open evidence is providing free advice, something that CatchBT does really well.

8:45So I guess I think open evidence faces more threat from open AI. But people love a Silicon Valley business that's so good. Everybody just wants to use it. It grows because people tell each other about it. So I guess I'm betting a little bit on Abridge if I had to pick. But they're both great companies. I thought that was a good moment in your interview with the abridged founder where she was like, oh, yeah, we are basically going to compete with them. We're going to go in that game with open evidence. I also like the moment in my conversation with the Hippocratic CEO, Manjal, as well as Daniel Kahn from Slingshot AI.

9:20And they had kind of back and forth about whether or not there'll be one foundational model that eats the rest or not. And Daniel kind of came to, when Jal was saying, oh, you know, someone unnamed, aka Sam, is pushing this idea. Sam Altman of OpenAI. Sam Altman of OpenAI is pushing one idea of one big model. And he thinks it's going to be many. And Daniel was saying, actually, Sam doesn't necessarily believe that it's going to be the case. But that is, yeah, the back end of all this, like, where is this all going to be powered? And who's going to own the models? and who on the models own the system or who attracts the doctors owns the system.

9:57We'll see. And drug discovery was very important, but I think that'll come up in the clip. So I'll hold my drug discovery takes for that. All right, let's play our first clip. And it's, I think, me in conversation with Jonathan Swirland, who's the CEO of Function. Do you see trends that are geographically distributed? When you see the data, it upsets your stomach a little bit because we see how many people are suffering needlessly with things that are actually really solvable that don't even require medical intervention, but are things you solve in your life, the level of cardiometabolic disease in this country, even amongst people you would consider healthy is so high.

10:29And the result of that is like in 20, 30 years, if they're in their thirties or forties, like there's a likelihood they're going to have a heart attack and they might leave their families behind. And these things are, I know what happens when you pull the threat on some of these issues. It's a little nauseating to see that at such a scale. And then it's also at the same time encouraging because you we flip the lights on like people are in the dark. Wow you guys just really chose the uh the least spicy moment of that whole interview. Because I thought it was a very Silicon Valley moment. I wanted to start there just because he really hit that chord you expect from Silicon Valley.

11:02It's just we want to save the world. I'm a true believer. You gave him a hard time and it was definitely amusing and people go we can we're posting the full clips on YouTube so you can go listen to it and watch them uh sort of rough them up a little bit but But I did think, what did you think of his, the sincerity of his sort of, there's so many people that need our help. And you can explain the business a little bit to people. What sincerity? Do you see what I did there? No, I know. I think that, look, he has to say that. I was curious what they're doing. Like my big question was, what are you doing with all this data, right?

11:35Because Function Health is one of the fastest growing companies. They've had, I think it's 450 % year on year growth. Like if you're on any social media platform, you have seen the ads. It's 500 bucks. Get all of these blood panels that you'll never have from your doctor. Earlier in the day, Annie Lamont, investor at Oak HCFT, had made the point that, you know, 90 % of what you see in some of these blood panels, et cetera, are actually covered by insurance. And so there's some marketing. Will every, you know, sure. Rich people will pay for functions branded. We're going to help you figure everything out, Tess.

12:06But as it reaches mass market, those people are just going to go to health insurance companies if this is possible. That's basically the trade-off with functions. And Jonathan brought up like the geographical distribution of their company. So I'm like, great. What does that data look like? Are people healthier in parts of the country or not? And I got this kind of soft answer back. So what do I think of the sincerity of that? Look, I don't think you get into the healthcare business because you're trying to kill people. Am I struggling to stay on topic? No, no, no. I'm saying you're struggling with sincerity itself, I think.

12:37No, because I think actually like – I mean I believe that most people get into their fields because they care about the thing. So, yes, I do believe that Jonathan is someone who cares about the health of Americans. I think Mark Hyman is someone who cares about that. They might have different perspectives on you about that, but they have their own stories that brought them to it. What I think is interesting about the business is you are providing services that are then executed on by Quest Labs and now with their recent acquisition of Ezra MRI scans that are done by third-party vendors. What you have value in is the data, and are you going to move into the actual labs business?

13:12And Jonathan didn't say no. He said not today, which to me as a journalist is, okay, tomorrow, you know, choose whatever length of time. Why do you choose that? The medical system is built to treat sick people. And, like, the longevity insight, you know, and I think there are a couple. But a key one is, well, we should – the medical system should be doing more for healthy people. And say you're healthy. Doctors would say, ah, don't get a bunch of tests and scare yourself. Like, just you're healthy. Be healthy. Don't worry about it. Like do these, you know, eat healthy exercise and like leave us alone.

13:45And I think like companies like function where they're like, no, get a scan. Like things could be wrong or you could be better. Like I just think businesses coming at something with a different mentality and saying, you know, we believe in medicine, but we should like look at these things differently. I think there's opportunity there just to like take a new lens to something where there's so much consensus and how medicine has thought about something. So I think they have opportunity in just that they clearly have a fresh lens for how most of, you know, medical testing is getting done. Yeah. And also, I mean, that is a shift that I think is here to stay.

14:18I mean, call it longevity, call it whatever, but preventative health and people's own kind of N of one health care, like treating yourself as your own baseline of what good health looks like and not shifting all those costs onto the system or onto the back end. Now, I think what's important is like, can everyday clinicians compete and will they upgrade and start providing a lot of these indicators and tests? And as Annie said, many of them would cover it, but you would have to ask, your insurer would have to agree, et cetera. And that bureaucratic process is really hard. So it's easier to, you know, swipe and get the blood done at home.

14:56I think we have a clip on GLP once. Maybe we go to that because I think that fits directly with this longevity conversation we're having here. And this will probably be our conversation with Noom CEO Seizu Zhang and - Yeah, yours are the best, I guess. We're doing all Naima clicks. No, no, I'm just introducing the clicks before we play them. They're not the best. I can make fun of myself. Yes. Do you think pharmaceutical companies are going to double down on GLP-1s and other kind of preventative care over the R &D that they're doing for cancer treatments? There's definitely a lot of rumors that they're going to get into explicit aging and longevity and like have an aging division, which would be the sickest thing ever.

15:35And I hope it happens like an aging drug or longevity drug sounds so radical, but it's just a preventative medicine for multiple diseases. Right. Ozempic is preventative medicine for the downstream negative consequences of obesity. Statins are preventative medicine for certain forms of age related cardiovascular disease. That's all a longevity drug is, too. And oh, by the way, statins are the most successful drug class in history. Yeah. GLP-1s are probably going to beat them. Right. And so the minute people see that, and I'm sure people there already do, they're incredibly smart. Yeah. I think it's going to happen.

16:06So this is Celine, who's the founder of Loyal, which is, you might think she's doing life extension for humans, but she's actually doing life extension for dogs, which is such an interesting play, but came up in human sciences. Why do you think of her prediction, Eric? What I love about Celine is that like she's sort of doing this like Tesla strategy, right? You start with like the roadster and then you're like from there we'll save the planet. Elon might have gotten lost on his save the planet with clean energy. But Celine is like, OK, if we can figure out how to save your dog, which is a lower regulatory burden than everybody else, then we'll be able to do it with humans and do much more.

16:42And so she's a true believer in like longevity. How can we make healthy people live higher quality lives? And I think she's right that like pharmaceutical companies are going to wake up and say, oh, there's clearly money in it. Silicon Valley is investing in it. GLP-1 has made a bazillion dollars. And we should take this more seriously. Yeah. To quote the great artiste Cuba Gooding Jr., it's like, show me the money. This is the money. GLP-1s have fundamentally shifted how we think about people's willingness to pay for health care. This is an industry that you would rather pay for. Or like you don't think twice about buying a new pair of sneakers.

17:18But when it comes to something for your health that might cost a fraction of that, you're like, no, because it should be covered by my insurance. I already paid for my insurance and the insurance should cover it. So there's this whole psychological wrap up. And what we're seeing with GLP-1s is what we've seen with, say, Botox, where people are willing to pay for a medical product out of pocket all of a sudden. And no doubt pharmaceuticals want to get in that space. And they also, I think she and Seju from Noom made this point, will want to increasingly go direct. Like, Celine has chosen to own distribution end to end from doing clinical trials and putting, you know, to putting shots in pause, I guess, is the analogy in this case.

17:58I think a subtle thing people learn with GLP-1s is, like, the story of the drug matters so much. You know, it's like they had been around, you know, has helped people with diabetes. And obviously, you know, you need it to be sort of primarily useful for obesity, which, you know, allowed for this blow up. Yeah, it's still heavily regulated. You still need a BMI of 25 to qualify for Ozempic. I think Noom has introduced this microdosing GLP-1s, which I'm very interested in. I think this will move over time. As someone who's not at that BMI, I would like to. I mean, I've thought about, oh, should I be microdosing GLP-1s?

18:35Because all of a sudden, if it's anti-inflammatory and really has longevity benefits, which are still being borne out and being tested and studied. But if that is the case, then why would we reserve it only for a portion of the population? All right, let's play the next clip. And this is you, Eric, talking to Dr. Han Pak, who's the head of digital health at Samsung. 40 % people in the U.S. do not know they have sleep apnea. There was a study that showed when you reach 60, 1 % decrement per year in deep stage sleep increased your dementia risk by 25, 27%. And so our users use our wearables a lot for tracking their sleep.

19:12One of the top reasons for sleep issue has to do with sleep apnea. So we have a software as a medical device. We'll screen for you and say, we think you have sleep apnea. 40 % people in the U.S. do not know they have sleep apnea. So the watch actually uses PPG signals, and we validated this in a sleep lab, and we got FDA clear based on the standard we met. And essentially, we're able to screen to a very good, accurate degree as to whether you have sleep apnea. I have to say, after that moment, I was like, I think I have sleep apnea. This is most people's reaction to that moment. What did you think about that?

19:50I have two very contradictory takes. I guess the one that sort of fits with what I've been saying is just, you know, it's good to help people sort of, you know, you're already wearing these devices, like get the data, figure out what's wrong with you, like find some improvement. There is another part of me that's like, man, it's what capitalism does best. It's like you don't realize you have a problem. Let us sort of plant the seed that you have a problem that we can then sort of sell you a solution to. And I do think that's where the medical establishment gets wary. It's like some of these things are only really problems if you feel like you're suffering.

20:28And if they suggest to you, you might be now all of a sudden you might have a need that you didn't have before. So I think it just depends on the seriousness of an issue. I mean, I do think sleep apnea is a real thing. But you can see how taken to an extreme, suggesting people should be worried about this new thing or that could be stressful for people. Yeah. Yeah. Sleep apnea is a very interesting use case for it because it's the kind of thing that you might not know you have it. And especially if like you're asleep and if you're not in a relationship, right? And like, if you're in a relationship, you might know someone might say to you, Hey, you're snoring or Hey, you seem to stop breathing in the middle of the night.

21:03But if it's just you having bad sleep, you have no idea what that is. And third kind of thing that triggers in me is these basic elements of health, which is like health. You know, it's like, are you hydrating? Are you eating good food? Are you moving your body? Are you having good communal relationships? Are you saying, well, kind of, those are your five real indicators of health and or like drivers of health, most people would say. And so this is one where, yeah, I think it's interesting the way they've been able to work with the FDA to get that use case out there. And certainly will be a way that we see a lot of these devices start to compete with each other is, I think, in their ability to diagnose slash prescribe or at least get proximate to that, give you readouts that are doctor friendly and or talk to you.

21:50Like the or Tom Hill. I was like, when is your ring going to talk to you? And he's like, oh, yeah, we've been talking to Manjal, the CEO of Hippocratic, about that for years. Like, could your ring just call you? I mean, to get like philosophical for a second. Yeah. I feel like there's a funny realization with health where you're like, oh, I'm in charge of it. You go to your doctor, but then at some point, like your doctors like barely see you. They're like oblivious. And you realize like, oh, it's like, it's just me. Like no one is really, your doctors definitely know less than you. They have more expertise, but they're like, they're not dialed in.

22:23And it's not that high stakes. Like if you have an issue, you sort of need to conclude you have an issue or not. And this is like a very like, I don't know, you're alone in the universe sort of revelation that I think people have at some point. And it's funny with technology that I do think there is this real potential that it's like, oh, we emit all this data and AI is getting very smart. And like someday soon there will be another force sort of like watching out for you and saying, I'm worried you have this thing. And like, will that change for good and bad? The sense that there's a protective sort of layer around us that we pre that force didn't have.

23:02Yeah. And the data around it is really interesting because all of a sudden you have that data and then it becomes what signal, what's noise in that data. And that's where you're really dependent on the device and the authorizations for people telling you. But like, you know, one of the greatest innovations of the Oura Ring in the last X years has been their ability to tell you where you are in your cycle. And people are using that for sexual health, for fertility tracking, for trying to get pregnant. And you're taking something that was a really terrible experience of like you spend your 20s trying not to get pregnant and you spend your 30s trying to get pregnant and peeing on sticks and doing all kinds of things.

23:36And Oura is making that. I think the studies show that it's much more accurate than time syncing. It's probably I don't I don't know if it's as accurate as being on a stick. But I mean, part of what you're getting at, I think, is this like it's a tool to inform you. It's like it's your data. It's giving you advice. But you still feel like the actor. It's not this sort of like other which is like, hey, like I've made this unilateral decision for you. It's like it ultimately reinforces the sense you're in control because you're getting information that allows you to be this sort of more informed decision maker.