Wellness Grifters and the Real Science Behind Longevity with Dr. Eric Topol

16:10Dr Eric Topol:Yeah, well, that's because concurrent to all this noise and grifters and whatnot, there has been a big push in the biotech world to try to reverse aging. And there are very intriguing science approaches, like, for example, the so-called cellular reprogramming or the senolytics, stem cells. And so there are some real science initiatives that are exciting. Yeah, they look good in rodents and mice and rats. We have no data in people, and there's some dangers about going forward in people. But the point is, so that has helped to take this into center stage. So you have some real science, then you have the pseudoscience marketing stuff, and then you have this other area that I'm most enthusiastic about, which let's just not try to reverse aging so much because it may not ever work.

17:03Dr Eric Topol:There's a lot we can do right now just to—

17:06Kara Swisher:have a better life that is longer. So talk about the upper limits of health span and what age, which biology wins and the human body starts to break down, no matter how good medicine gets. I mean, Scott Galloway, we always joke biology is undefeated so far on this planet. So you studied in 2008, the elderly or people who are at least 80 who have never been sick or had a chronic illness. As you noted, more than 90 % of Americans over 65 have at least one chronic disease. So talk a little bit about the upper limit of this, what you're trying to do here. Yeah.

17:39Dr Eric Topol:I mean, I think the upper limit is we can certainly get most people, we should be pushing towards everyone being a super ager as defined by 85 plus without cancer, without cardiovascular disease, and without any neurodegenerative disease. That's what we should aspire to achieve. We may not get way beyond that on average. There will be people like Lee Roussel, the patient of mine in the book, who just is about to celebrate her 100th birthday, totally intact. But even if we get to most people at 85 with intact healthspan, you can see that through now. You can see that that's a possible goal. The cost savings are enormous too.

18:22Dr Eric Topol:Oh gosh, if you don't have people with Alzheimer's and the treatment for cancer, just as you say, Kara, the economic burden is just, ginormous. And so no less the health burden. So that's what we should be pushing on. You can see that this is achievable in the years ahead. It all starts with the prevention. So today, everything is treat, treat, treat. We have to go into prevent, prevent, prevent. And we never really had the way to do that before. That's what's really new here.

18:54Kara Swisher:Talk about the key findings when we think about aging genetics. I know there was a study published earlier this year in the journal Science suggests that longevity appears to be about 50 % heritable. If genes can reveal more about aging, how does that shift the focus on longevity research and ultimately impact what research is funded? If the FDA is, you know, dicking around on peptides, which they are, what is most important to be focused in on when you're thinking about this elderly population?

19:24Dr Eric Topol:Yeah, so the genetics of healthspan is very different than the genetics of lifespan. Because, again, if you have those 15 years, that gap, and you're incapacitated one way or another, that's your genetics, maybe it has 50%. But the health span, as we've studied and others, has a lesser genomic role because a lot of that depends on your lifestyle. And so that is really one of the essential things, which we don't do enough. And hopefully, when we have individualized forecasting, we'll do much better because before we could say, well, you're at risk for something, but we could never say when. So I could risk for Alzheimer's when you're 66 or when you're 99.

20:08Dr Eric Topol:That's a big difference. Now we can say when. That's a huge difference. And when we tell a person when, who's receptive, they may actually start really getting on a lifestyle kick, of course, which is not just diet, exercise, and sleep. There's many other factors, as you all know. So that's the beginning of a prevention story is when you can forecast accurately.

20:31Kara Swisher:It's like savings for college. We'll be back in a minute.

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23:30Dr Eric Topol:For the last 10 years, everything in American politics has basically revolved around one man.

23:36Kara Swisher:And as a political journalist who came of age during Donald Trump's rise in 2016, I've had a front row seat. I am officially running for president of the United States. It's going to be only America first.

23:52Dr Eric Topol:America first.

23:55Kara Swisher:Thousands of supporters of President Trump stormed the U.S. Capitol building. But is it possible to talk about politics without talking about Donald Trump? That's the question I'm going to ask in our new show from Vox. The idea of like a post-Trump or not exactly Trump-focused show can exist because he's not really driving any agenda items. It really does feel like so reactive. You know, I think this Iran thing is also going to cause a big split in the GOP. So far, it doesn't among like people who say they're MAGA voters are still with Trump. But like for the first time, you see on a major issue, open opposition from the start

24:28Dr Eric Topol:of this war. I'm Estet Herndon and welcome to America Actually.

24:36Kara Swisher:We've known for a long time, as you said, factors like diet, exercise, sleep play a big role in long and healthy life. And actually, I say that to people, I'm like, yeah, yeah, it's not the most important. It's a combination of all of them. I mean, to an extent, don't eat fried foods and don't not sleep. Like, welcome to Donald Trump. But you've expanded the concept to what you call lifestyle plus to include other factors. You write about the often overlooked heavy influence of big food in our health, ultra processed foods, something, the only thing I think both of us agree with Robert Kennedy Jr.

25:03Kara Swisher:on, but that's kind of the duh. kind of thing. Let's start with that. Talk about the big food and ultra-processed foods first. Yeah.

25:11Dr Eric Topol:So this is a big part because bad food intake or beverages can promote inflammation and also knock down our immune system. So we have to pay a lot more attention to that. And America is the highest consumption of ultra-processed foods. And acknowledging that not all ultra-processed foods are bad, but within that group, there are some that are really noxious that really rev up inflammation in our bodies. So we want to minimize those. And there's things that we could do to change that American diet to make it healthy, and it doesn't align with what changes have been made recently. Right.

25:49Kara Swisher:So it is up to the individuals to avoid ultra-processed food, or should there be legislation and regulation to curb the abundance of ultra-processed food in our diets?

25:57Dr Eric Topol:Yeah. So big food is, of course, in command here, and it seems to be beholden to the Department of Agriculture, and our government has really not done enough to take it on, of course, has tremendous lobbying power. But what we want to get out there is that we know the diets that are anti-inflammatory, that are Mediterranean, plant-based, of low red meat content, trying to eradicate the harmful group within ultra-processed food. So getting that out without the distortion that we're seeing currently is important. So animal protein overall is not our best source of protein. And also don't want to overdose on protein because if you take too much of that in, particularly animal derived, you're going to promote inflammation too.

26:48Dr Eric Topol:So the balance of food is really important and we're way off as a country.

26:53Kara Swisher:Yeah. The reason I went to Korea is because I went to a school where they were feeding the kids. Astonishing lunch. There was rice, of course, but there was also fermented foods, miso, healthy proteins, tofu, miso. You couldn't believe what these kids were eating. And they learned from an early life. Now, they do eat junk food too, but it's a really interesting basis. And every school had a nutritionist. It was really quite something to watch. Yeah, why aren't we doing this?

27:19Dr Eric Topol:That's exactly what should be done. Yes.

27:21Kara Swisher:Right, exactly. But moving on from food, in the book you reference a quote, outspoken 47-year-old centimillionaire taking over 110 supplement pills a day. I think I know who you're talking about. New research suggests the roughly$209 billion global market for dietary supplements is projected to double by 2033. Talk about why so many people are convinced that vitamins and supplements are effective ways to increase their healthspan. Now, let me just say some are good for you, but often like, for example, someone was eating a fish oil, supplement. And they're like, Kara, what do you think of this?

27:54Kara Swisher:I'm like, it's fine, but eat a piece of fish would be a better choice. Like, I guess if you're not eating fish, and it's not a bad supplement necessarily, but, you know, and there's a couple that are probably a good idea. Talk a little bit about that, because they get mixed in with the ones that aren't.

28:11Dr Eric Topol:Yeah. So this supplement part is really where the gaps are. The vitamins, I mean, if you include something like a multivitamin, which has at least some randomized trial data, a bit. It doesn't have a big effect in older people, but it has at least a small benefit. But when you get into the supplement side, unless you have a deficiency, if you're a healthy person and you have a good diet, as you alluded to, you're better off to get those things from your diet, from your normal intake, then you'd have to take a lot of omega-3 fish oil supplements to get what you could get in your diet. If you just concentrate on the right diet, that takes out the supplement story, and you save a lot of money.

28:56Kara Swisher:Are there any supplements you think are worthwhile besides multivitamin, which I think maybe, maybe not is what I've come to the conclusion?

29:03Dr Eric Topol:Well, the one that's gotten so much play in recent times is creatine. And creatine, you know, the only data that really exists that's solid is that if you work out, you do a lot of strength resistance training, it'll reduce muscle soreness afterwards. But beyond that, does it help the brain function or other things? We don't know. The data are inconclusive. So that one has lots of attention. People are all on this creatine kicks, high-dose creatine. There's just nothing to support it.

29:32Kara Swisher:Right. No, I do a creatine after I work out. That's the exact time. That's the only thing I use it for. And people are like, oh, you're taking it. And I said, only for that. What's interesting about the supplements is they think it's going to solve 20 other problems, right? I'm like, it's good for that. Or, you know, the hyperbaric chamber stuff. I go into one. And I was like, what did you think? I was like, are you fucking kidding me? Unless you have the bends or a wound, I wouldn't recommend it. You know, oh, I get tired. I was like, you don't need more oxygen. Just breathe. Like, it was really interesting.

30:02Kara Swisher:And I did it on purpose to say, this is fucking ridiculous. Even if it's, you know, same thing, a lot of them, all of them. I did a cold punch. I'm like, it's fun, I guess, or a sound. I did a sound thing.

30:15Dr Eric Topol:That's a stress test for heart disease.

30:17Kara Swisher:That's correct.

30:18Dr Eric Topol:Your blood vessels totally constrict. And if you have atherosclerosis in your arteries, in your heart.

30:25Kara Swisher:Yes. Yeah.

30:26Dr Eric Topol:So to advocate things like that with no data, particularly where there's danger. It's great that you're on this because you'll have the anti-influencer impact.

30:37Kara Swisher:Yes, that's what I am. I'm the opposite. But some of them, like if you work out a lot, creatine, sure. Sure, why not? Yeah, I don't have a problem with that. Or a multivitamin, you're not getting enough fish, sure. Right. That sounds good.

30:49Dr Eric Topol:But the thing that gets me, Kara, is just making up doses of it. So, you know, they'll say, oh, take three times the normal creatine, and then it'll do all these other. No, because there's, show me the data.

31:01Kara Swisher:Yeah, more means better. So you include environmental toxins, which I think is important in the Lifestyle Plus, which include factors like air pollution and microplastics. You write, it was one thing to document the pervasive presence of microplastics in our air and water, but another to find it in our arteries, brains, blood clots, liver, gut, lung, placentas, testicles, and other tissues. So talk about the solution for regular people who don't have a lot of time and money, because it often can feel like we're surrounded by ultra-processed foods, plastics, and toxins.

31:26Dr Eric Topol:Yeah, well, the micro-nanoplastics worries me because as a cardiologist to see the remarkable study of these microplastics in the artery inducing vicious inflammation locally, and then a four to five-fold higher rate of heart attacks and strokes in the follow-up of a couple of years. This was studied, to me, there are others, but that really took the plastics worry to the highest level. And we're not doing enough to try to reduce that in our air and our water supply and whatnot. So what you're bringing up is central in that our inequalities, that is the people who have the worst exposure, air pollution, microplastics, forever chemicals, the ultra processed foods, they need help.

32:16Dr Eric Topol:of all the folks. They're the ones that have the highest burden of this. So we have to really work on that. And that's not been part of the longevity mainstream. It's all about catering to the affluenza, which are the people who don't need this the most. It's the people who are in the lowest socioeconomic category that are the ones who are most to benefit. Yeah.

32:42Kara Swisher:One of the things, I spent a lot of time talking about inequality, actually, which is, you know, I think I interviewed a doctor who's working on, obviously, CRISPR and sickle cell anemia. And she said, you know, if Elon Musk got sickle cell anemia, you'd be sure this would be a very inexpensive process, right? And about$2 million is very expensive, and eventually it won't be. But one of the things I kept stressing them is that really, like, everyone's like, what's the answer? I'm like, don't be poor. And they're like, that's not a good answer. I'm like, I'm sorry I can't sell you a supplement.

33:11Kara Swisher:But really, the biggest dip in longevity has been among those who are getting killed by obesity, with processed foods, in polluted areas, with enormous amount of stress. Homelessness is a health issue.

33:25Dr Eric Topol:No question about that.

33:26Kara Swisher:If you think of it that way, then it's economic to me. So every episode, we get an expert to send us a question. Let's hear yours. Hi, I'm Amy LaRocca, the author of How to Be Well. My question for Dr. Eric Topol has to do with the information that last week the American Heart Association issued new dietary guidelines that directly contradict the dietary guidelines that were issued by Robert Kennedy. And given that so many doctors have their own proprietary lines of supplements and protein powders and other nutritional products, where in the world are Americans meant to look for safe, reliable health and nutritional advice to increase and improve their health spans?

34:18Dr Eric Topol:Yeah, well, that's a great one because, firstly, the American Heart, as you might imagine, got it right. They actually had evidence-based guidelines about diet as opposed to what was done through RFK Jr. and HHS. So if you want to follow where there's the facts.

34:35Kara Swisher:Explain the difference between them. RFK said what?

34:40Dr Eric Topol:RFK has, you know, been advocating, well, fat, the wrong oils, you know, raw milk. I mean, stuff that's just, you know, Looney Tunes. Now, some of it is right. That is, we want to foster the high consumption of fruits and vegetables and plant-based. But to have meat, red meat, which is advocated by HHS, is wrong. It's okay to have red meat, but it should be infrequent rather than something that you should have at the top of a food pyramid, right? So some things are just completely unfounded in the current, hopefully short-term, U.S. HHS, whereas the American Heart went through all the data, and that guidelines piece is well done, and it sets the record straight.

35:30Dr Eric Topol:The problem, of course, in general, I mean, you brought up some of the people like Brian Johnson, and then there's Gary Brecka and all these people. And a lot of these are very close to RFK and having an effect even on him, is that they have ideas that are not substantiated by any evidence. And this is, of course, really unfortunate. But you can tell that the basis for ideas are things that they're selling, typically. And so that's where you really eliminate the lack of evidence combined with, oh, you can buy this supplement or you get this peptide or whatever. Then you already know that you stay away because it's just not going to help you to follow a person or a group that's working in a fact-free world.

36:20Dr Eric Topol:And we have a lot of really good evidence for these things.

36:24Kara Swisher:Yeah. The American Heart Association basically said to eat a Mediterranean diet heavy on legumes, fruits and vegetables, whole foods, and light on animal proteins. Not getting it out of your system. It's just lighter on it. Get your protein through fish or, you know, spinach and your fiber through whole foods, like an avocado, for example. People don't realize how full of fiber an avocado is, for example.

36:45Dr Eric Topol:Oh, yeah. Yeah. Fiber maxing, that's good. Fruits, vegetables, legumes, great. And yeah, protein, great from fish, obviously many other great sources, yogurt, tofu. So there's so many great foods out there that provide the kind of ideal intake that is anti-inflammatory. And we have randomized trials for the Mediterranean or Mediterranean-like diet. We have huge cohorts followed for 20-plus years that show the people that have the greatest health span are people that are following a very healthy diet. So pretty much this is incontrovertible, but what's happened is that we have some actors who are trying to subvert what the evidence shows.

37:36Kara Swisher:Right, right, in order to sell things. I mean, I did a long interview with Brian, and I said, you are a study of one, which means it's meaningless. He's like, I'm just sharing it. I mean, it doesn't matter. I was like, it doesn't matter what your experience is. It was somewhat sad, though, because of his obsessive measurements.

37:53Dr Eric Topol:It's sad, but you know what's really bad about this, Kara? So, for example, he and Atiyah and so many others were, they were on the rapamycin leaderboard. How much rapamycin they take. They all had different doses, you know. It's kind of like when the error is in a newspaper, you never see the error. Well, these people stopped taking the rapamycin because they were getting a lot of infections. No surprise, because it's a very potent blocker of our immune system. And so here you go, this is, oh, this is going to extend your health span, your lifespan, no data in people. And you have these influencers who got everybody onto this rapamycin kick, all the bro folks, you know.

38:35Dr Eric Topol:This is a typical thing where then they stop taking it because they have all these side effects, but all these people are already hooked.

38:42Kara Swisher:Yeah, yeah. The problem is the answers are very basic and simple and inexpensive, and so it's not a quick fix. And I think there is an element of quick fixiness that people desperately need. And it's the same thing with diet, right? It's pretty basic in terms of how you change your lifestyle.

38:59Dr Eric Topol:Yeah, I mean, there's another dimension to this that I'm sure you're on it, which is getting unnecessary tests. This is also heavily promoted, whether it's a total body MRI or hundreds and hundreds of blood tests and on and on. And this is another part of that. No evidence, but I do it and you come to my clinic and I'll do all these things. I went to one. Oh, gosh.

39:25Kara Swisher:I was like, what do you need this to know for? Why is this information helpful to me? Now, it sometimes works. My brother was a doctor, went to, speaking of cardiology, hadn't had a calcium test, Turned out he had one when he went into Medicare, and he had huge blockage, the widowmaker blockage, essentially. And it was great. That was a great test to get. And he removed it. Then he was fine. Then he just had the surgery, which was really quite less invasive than it's ever been. Really astonishing.

39:55Dr Eric Topol:With the stint. Right, right.

39:57Kara Swisher:So I think people are hoping for those ideas, that you find something drastic.

40:01Dr Eric Topol:Yeah, the problem is when you get to the real data, particularly for the total body MRI, and there are ways to assess a coronary artery noninvasively better than just getting a calcium score. But you wind up... They did a second one. Yeah, the balance about this is that more people are hurt right now. We don't have any evidence that there's a net positive. And all these rabbit holes of chasing down incidental findings that are spurious. So this is a real problem because that goes hand in hand with the supplements and the peptides. It's all part of that mix.

40:37Kara Swisher:Explain how people are hurt by these tests. Yeah. Besides having way too much fucking information that you don't need. I've had patients with total body MRI who found a pulmonary lung nodule.

40:49Dr Eric Topol:Then they had a biopsy eventually. And then they had a collapsed lung. And they had to be in the hospital with a chest tube. I've had patients who had a liver nodule, which actually turned out to be a benign cyst, but in the process of a biopsy, almost bled to death. So when this leads to getting tissue to find out what it is that you never really wanted to know in the first place, you can have pretty severe, potentially even life-threatening consequences. No less big expense and big anxiety.

41:22Kara Swisher:Yeah, it's like a bad facelift, which I've seen many on some of these guys. We'll be back in a minute.

41:57Kara Swisher:Versus 6 to 7 for placebo.

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42:42Dr Eric Topol:Hi, I'm Brene Brown.

42:44Kara Swisher:And I'm Adam Grant.

42:45Dr Eric Topol:And we're here to invite you to the Curiosity Shop.

42:47Kara Swisher:A podcast that's a place for listening, wondering, thinking, feeling, and questioning. It's going to be fun. We rarely agree. But we almost never disagree, and we're always learning.

42:59Dr Eric Topol:That's true. You can subscribe to the Curiosity Shop on YouTube or follow in your favorite podcast app to automatically receive new episodes every Thursday.

43:09Kara Swisher:Let's talk about real biotech interventions, because as you said, astonishing high-tech breakthroughs in the biomedical area, and they're transforming our approaches to diagnostics, for example. You've talked about how AI could propel the biggest transformation in the history of medicine. And talk about how important AI will be in drug discovery.

43:28Dr Eric Topol:Yeah. I mean, I wish we'd had AI when GLP-1 drugs were getting their legs. But the problem is we didn't. And it took 25 years when it started out as a diabetes drug to become an obesity drug. Had we had AI back then, we would have said, oh, hey, test this for obesity. But now we do have AI and we're seeing drugs that are truly discovered by AI. and you know we have some that are pretty advanced clinical trials now for example to get rid of scarring of tissue which we never thought would be possible i mean uh in medicine we thought if it's scarring that's it's done you know and we're seeing drugs starting to crop up in late trials that is they've already passed they're safe and they may wind up having lots of efficacy in areas that were not envisioned previously so that's led to some people like Demis Hassabis to say, you know, we're going to cure all the diseases.

44:26Dr Eric Topol:I have a different look on this. My thought is we are going to have a big jump and speed breath in drug discovery, but I call them Prev meds. They're not going to be treatment medications. They're going to be preventive medication.

44:41Kara Swisher:Right. Which you don't even know you got it in the first place. Yeah. So,

44:45Dr Eric Topol:you know, the GOP-1 story is an exemplar, but what if you had drugs that could really knock down brain inflammation, so you never got Parkinson's or Alzheimer's. And we have many candidates in the pipeline now that we didn't have before. So there's a gold rush with AI for drug discovery. And it isn't just even to discover new molecules, it's to be able to go high velocity and get the right - Right, quickly.

45:11Kara Swisher:I interviewed Reed Jobs about it, because he's a terrific guy. And one of the things he's working on is hepatitis to prevent liver issues, which leads to cancer. But you never get the hepatitis in the first place, you never get the cancer in the second place, which seems very promising to me. But explain, say, one of the things you talk about, the GLP-1s should have been studied much earlier, and they have potential, life-changing potential beyond weight loss, which is a good thing too, in some ways. Talk about a counter-argument to any of this, because once patients with GLP and stop taking Wugovir or Zempic.

45:46Kara Swisher:And now there's pills coming out, which will be more on a maintenance schedule without the shot required or the refrigeration. It is a lifetime commitment, very similar to a statin, for example. Talk about the idea of how you keep people on these kinds of things that can be life-changing and helpful for other diseases so they understand it better.

46:05Dr Eric Topol:Yeah, so I don't like forever drugs. And as you mentioned, statins, blood pressure medicines are examples of that. And so we don't need to add another forever drug if we can avoid that. Right now, we don't have a good mechanism to wean people completely. But I actually think that will be possible in the future, that we don't have to have them on high doses of GLP-1. So we have these now two pills that are like the injectables, but not quite as potent.

46:36Kara Swisher:Right. They're from Eli Lilly and Novo Nordisk.

46:40Dr Eric Topol:Right. And they're both peptides that are packed into a pill with very hard to eke out much out of that. But there are pills, low cost, small molecules, can be manually factored at scale, with the actual cost as pennies. So we're going to get the cost way down, and that will make it global for all people, not just for those who can afford it. And then the next thing is, can we get to a strategy, whether it's a lower dose small molecule pill or some other way, that we can get people so that maybe they're taking it, but much lower quantities or not at all. We know, for example, the muscle mass that you lose when you lose weight.

47:24Dr Eric Topol:A lot of these companies are vested in these muscle-building adjuncts. But actually, if you do strength training while you're taking these drugs... Right.

47:33Kara Swisher:Combination. I end up interviewing a woman who lost several hundred pounds, started off as an obesity drug, but then they gave her a whole program of nutrition, teaching how to cook correctly, combine it with exercise. And so it creates... The three things together are what's critical, I think.

47:48Dr Eric Topol:Absolutely. So, you know, I think we're going to learn about this in the future because the idea that it expanded now to many other indications that people would take it, we have to figure out a longer-term strategy. The companies, the duopoly, if you will, they don't really have a great motivation to wean people from the drug, but we do. I mean, if we can get away with keeping the weight off or having the sustained benefit of the inflammation in the body, that'd be great. I should add, though, there are many other candidates in the pipeline that have similar effects on the immune system and inflammation that we might turn to those as a longer-term maintenance strategy.

48:32Dr Eric Topol:They're just not as far along in the whole process.

48:35Kara Swisher:Right, right. Here's an article in your Ground Truth Substack explaining why all mammograms should incorporate AI. Talk about the use of AI in mammograms and how it could lead to improved accuracy and how long will it take until AI is incorporated into not just mammograms, but all diagnostics? Now, I know there's been some, like, one of the tech people are like, well, no more radiologists. I'm like, no. Again, they're always so all or nothing on everything. And I'm like, it's an aid, it's a tool. So talk about incorporating mammograms, for example.

49:05Dr Eric Topol:Yeah. So this is frustrating because we now have three ways, three different AIs that should be part of every mammogram. So every woman should have, for example, the better detection, because we know from the National Cancer Institute that 20 % of breast cancers are missed by mammograms today. And AI picks those up and then some. So it increases the yield by about almost 30%. Then the next one is that we have a normal mammogram in a woman. Well, what about the risk in the next three to five years. And we have an FDA-cleared AI to do that. Then we also have one that picks up heart disease risk from the breast artery calcification very accurately to say, oh, this woman has a very high risk for heart disease, which would often be not even in the awareness of that woman.

50:00Dr Eric Topol:So we have three AI tools, and almost no women in the United States are having the advantage of these. And the only one that they are getting exposed to in this RADNet network, they have to pay out of pocket$40 to get the AI initial interpretation, which isn't the other two AIs. So it's frustrating because we've iced this. The data are clear. The FDA approvals are out there. But we're not incorporating it in medical practice. And this is where a lot of people, there's a backlash to AI out there in the public. but they don't realize that there are a lot of good things that AI can bring to us, but we're not bringing that in.

50:38Dr Eric Topol:Right, exactly.

50:39Kara Swisher:No, exactly. But that's because they promise them as an all-solver. You know, the same thing with supplements. Like, some supplements are fine. Anyway, let's end by talking about some of the structural and institutional barriers preventing the universal expansion of healthspan. Many of the ways we alter the pace of aging carry a serious risk of cancer. Explain the connection to cancer and how you weigh the positives and negatives when you think about that.

51:03Dr Eric Topol:Well, I mean, I think we know that the risk of cancer, there's a lot of preventable aspects to it. And we reviewed now lifestyle factors. We also know that the immune system is a big driver when it starts to lose its protection as we get older. That's when the ability for cancer to develop and spread in our bodies makes us so much more vulnerable. So we have to counter that. And the way we're going to do that in the future, which we never had before, what's amazing about this, Cara, is here it is 2026. And we have no test to say your immune system is healthy or it's down, you're vulnerable. And that's something that we're on the window of having, not only through an immune clock, a piece of aging of your immune system, which will someday be routinely available, but now we also have this thymus that is the gland that everybody thought was involuted and became fatty and worthless after our teenage years.

52:06Dr Eric Topol:Well, it turns out when you do AI of the thymus, you find out that even people in their 70s and older have some of them have intact thymus. And guess what? but they also have intact health span. So the point here is that we're right on the brink of being able to say, particularly when people are 50 and older, your immune system is starting to show signs of vulnerability. So we're going to give you a vaccine to amp it up, or we're going to do this or that to amp it up, because we have so many ways to rev up the immune system that we've learned for cancer treatments, so many ways. And that's something that's in a high velocity of new dimensions of how we can rev up an immune system in people who have cancer to treat them.

52:51Dr Eric Topol:But now we have these two ways and probably more subsequently. If we start to get on top of the immune system before a person has cancer and get there, like, for example, the shingles vaccine has had an incredible impact to reduce Alzheimer's. Unexpected. I had mine.

53:10Kara Swisher:There's two of them, folks.

53:11Dr Eric Topol:Yeah, because it revs up your immune system, not because it works against the virus. Well, the same thing for cancer. And these could be generic vaccines that are not against a virus, but rather vaccine that's just trying to get your immune system amped up. So that's where I think we're going to see some big advances. And it's just because the system that lets cancer take hold in our body and allow it spread, we didn't have a way to measure it. And that's one of the aspects of the excitement in the science of aging is understanding and respecting. And also, you know, this whole idea that maybe we could keep the thymus healthy in everyone throughout our lives.

53:52Dr Eric Topol:Wow.

53:53Kara Swisher:Which would provide enormous benefit. Absolutely. And you stuck on vaccines, which we didn't get into. But I interviewed the guy who won the Nobel for the mRNA vaccines stuff. And I talked to everyone in that lab at University of Pennsylvania.

54:08Dr Eric Topol:Yeah, Drew Weissman.

54:09Kara Swisher:Yes, exactly. He was amazing. He's like, he's sort of like a very even-handed guy. He's like, well, it's really important. We could have a vaccine for cancer, for HIV. There's all these amazing things. And then all of a sudden he goes, but RFK is a murderer. I was like, oh, you know, in his most normal tone. But everyone in that lab was thinking of moving elsewhere because our country was way ahead, has been way ahead, but moving to France, moving to Canada, moving to places that they're not getting these ridiculous research cuts, because they are on the cusp of doing that, which is really kind of like shooting yourself in the foot.

54:43Dr Eric Topol:Yeah, no, the idea, it was a dream that we could have vaccines that would help us prevent cancer. We're going to get there now that we have a way to find out who are the...

54:53Kara Swisher:Maybe France is going to get there, or Canada, or China.

54:54Dr Eric Topol:We is a collective, right? Right.

54:57Kara Swisher:No, well, he was saying we're going to rely on China for this. That's what's going to end up happening, which is problematic on every issue, right?

55:03Dr Eric Topol:Absolutely.

55:04Kara Swisher:So health inequality, as you said, is a huge problem in the U.S. and globally. You note the lack of universal health care in the U.S. is holding us back. Korea has universal health care. They're so healthy in that regard. A lot of preventative stuff. Research shows that rich people not only live longer, they get more healthy years after age 50 than poor people. This should not come as a surprise to anyone. But the lack of universal health care in this country, to me, is another thing I point to. I'm like, you know how you want extreme longevity? Universal health care, basics. And then rich people can pay for more of the bells and fucking whistles if they feel like it.

55:34Kara Swisher:But what would a fair healthcare system look like in America?

55:38Dr Eric Topol:Well, it would be where insurance companies are not ruling the roost and only concerned about the one-year outcomes of big employers or the actual direct consumers that cover. So we not only have lack of universal health care, but we have such a perverse incentive that we don't have a country where we're trying to promote and prevent diseases, promote health span. Whereas other countries like the UK and just about every other high income country around the world, their incentive is reduce the health burden of chronic diseases, age related especially, and reduce the economic burden. So they go hand in hand.

56:20Dr Eric Topol:Whereas here, we have a malincentive to do that, that even transcends the lack of a universal health system, because we have no way that preventing these diseases, besides the fact that people could benefit, the financials don't click. And so we're at a disadvantage. And we could see the prevention story unfold at other high-income countries because they get it. The investment for prevention and detection and forecasting is so easy to see the benefits. Whereas here -

56:55Kara Swisher:For people who don't know, our country pays double health care,$13 ,000 a person versus six in most developed countries.

57:00Dr Eric Topol:Oh, right. Right. Exactly. It's crazy amounts of money. No, what we get for that - To be sicker. And we're sicker. Totally. And we're going to keep that up unless we start to get a new mindset of preventing diseases, which starts with prediction and finding high-risk people. But if we don't break through these barriers that are holding us back with our system of the financial coverage, that is, the last thing is for prolonging healthspan, which is a multi-year story, then we're not going to make the advances that others will certainly be able to achieve.

57:35Kara Swisher:What do you imagine has to happen? How did you get there? Because there's been multiple attempts to do it. Hillary Clinton was digging the ditch on that one many years ago.

57:44Dr Eric Topol:Yeah, I mean, I think, unfortunately, the lobbying power of these forces that are holding us back is so strong that we haven't been able to override that. It probably is only going to become achievable when we see whether it's some systems within the U.S., let's say it's a Kaiser or Veterans Health, or more likely other countries, markedly reduce their health care costs from prevention. that will maybe be the stimulus ultimately in the years ahead that we better get on this. But right now, there's no attention being paid to this potential here. But having been an advisor to the NHS and other countries, I know it's happening elsewhere because they have the great interest in keeping their whole population as healthy as long as possible.

58:35Kara Swisher:So I want to ask you the last question. And you emphasize both the power of evidence-based medicine and the risks of hype and pseudoscience. And at the same time, we're seeing a growing skepticism toward modern medicine in the U.S. and distrust of experts and institutions. Now, that may be waning down, and it's one of these things we go through. But how do you think we can distinguish between genuinely transformative advances like AI-driven medicine and GLP-1 drugs and the kinds of unproven interventions that gain traction in the wellness space? Talk about the distrust of science and what that might do.

59:06Kara Swisher:How do we regain that?

59:08Dr Eric Topol:Yeah, well, of course, you know, we had it before COVID. We started to, you know, have this fabricated data that led to vaccine questions and autism, which was completely bogus. Then it was amplified through COVID. And unfortunately, the science community didn't stand up. It led this orchestrated finance-backed minority to make serious holes. And there were missteps of public health agencies and the government. So it just all added during the pandemic to take the questioning of the medical establishment at the highest level, really a disregard, a dis that these people don't know what the hell they're talking about.

59:48Dr Eric Topol:What do you mean experts? I do my own research. So we got to this height and hopefully we're starting to -

59:53Kara Swisher:And the medical establishment has plenty to blame in terms of being high-handed, not being open to a number of things.

1:00:00Dr Eric Topol:Listening to the concerns, that is, you know, having respect for the doubting folks out there and trying to provide the evidence that their concerns are not real or they should be balanced by, for example, benefits and risks. But anyway, so we're still not that long from the COVID pandemic days where it's at height. And a lot of these people have been now empowered at the highest levels of our government agencies. So that helps perpetuate it. So in the meantime, the medical establishment has still not gotten its voice. You know, the likelihood of somebody in science and medicine to be trying to anti out, be on social media and getting good information out there, it's a tiny minority.

1:00:50Dr Eric Topol:It's so crowded out by the others. So we haven't put a den in this. And in order for us to change this, to turn the tide, we got to see a lot more people in the medical community who are credible, who are not selling something, who are going to stand up and get the facts out so that people know. And we also need compelling data. So we're not going to get AI into the mainstream until the data is incontrovertible, powerful, replicated independently. But when it is, we can't keep poking holes and questioning it because it's really going to become the standard of care. That's just one example. So we have, unfortunately, so many conflicts out there with people who are, you know, all these tests and supplements and peptides and whatnot, and they're getting the audience.

1:01:41Dr Eric Topol:They say, we have the secrets that the doctors won't tell you. You know, and don't wait for this stuff to get approved by the medical establishment because it works. You know, the rapamycin is kind of the prototype story of that. And I think hopefully people are going to learn that that's not the answer. The answer is, you know, have the evidence, restore the trust in the medical community, get more of doctors and people in life science to be activists. Talk about it.

1:02:11Kara Swisher:Talk about it. Write about it. Well, guess what? I have two billboards in Times Square, and I'm going to show off people like you. That's what I'm doing.

1:02:18Dr Eric Topol:Oh, wow.

1:02:18Kara Swisher:I'm sick of this shit.

1:02:19Dr Eric Topol:Yeah, well, me too. I'm so glad you're on it. I mean, I can't wait to watch your series because I think what you've done is -

1:02:26Kara Swisher:I talk to actual experts. Yeah. Wow. I'm sick of it. I'm sick of it. I was like, guess what? I'm going to play your game and I'm going to kick your ass just like I always did before. I was right about the tech moguls. Now I'm going to be right about this.

1:02:39Dr Eric Topol:Well, you know, the bro science is whether it's Joe Rogan, Elon Musk, Uberman, all these people, you know, this is a big part of this. You know, they're an underpinning of all of it.

1:02:55Kara Swisher:100 percent. I would agree with you. And I took ketamine just for you. I would not recommend it. I would not recommend it. But I did it, and I did it in a medical setting, and I say, do not do it. It will not help you unless you have some. But there's some promise. Even there, there's promising stuff. It's just the abuse of it, right?

1:03:13Dr Eric Topol:That's right. No, ketamine can help some people. But to have ketamine clinics all over the place, we have in California. I mean, this is crazy stuff.

1:03:21Kara Swisher:Yeah, it's crazy stuff. Anyway, Dr. Topol, I really appreciate it. We're going to be doing a lot more, and I'm going to be doing a lot more, because I think it's a huge opportunity to make people healthy, save money, have economic impact, and have everybody live longer instead of just 14 men from Silicon Valley. So I really appreciate it.

1:03:38Dr Eric Topol:Thank you.

1:03:40Kara Swisher:Thank you.

1:03:40Dr Eric Topol:I really enjoyed the talk with you.

1:03:42Kara Swisher:I enjoyed it too. Thank you.

1:03:50Kara Swisher:Hi, everyone. Want career advice from Kara Swisher? Now's your chance. Send a video to on at voxmedia.com and you might be featured. I can't wait to see what you've got. Ask any question. I'll try to answer it. Today's show was produced by Christian Castro-Russell, Michelle Eloy, Catherine Millsop, Megan Burney, and Kaylin Lynch. Nishat Kerwa is Vox Media's executive producer of podcasts. Special thanks to Madeline LaPlante-Duby and Eamon Whalen. Our engineers are Fernando Arruda and Rick Kwan, and our theme music is by Trackademics. If you're already following the show, you're on the path to a health span expansion.

1:04:30Kara Swisher:If not, enjoy the longevity lifespan circus. Actually, they're grifters. Go wherever you listen to podcasts, search for On with Kara Swisher and hit follow. Thanks for listening to On with Kara Swisher from Podium Media, New York Magazine, the Vox Media Podcast Network, and us. We'll be back on Monday with more.

1:04:56Thank you.