Brad Gerstner: The $100 Test That Could Save 50,000 Lives a Year

0:00Okay, we are here at the All In Summit at an amazing trailer that Brad Gerstner brought. You bought this how long ago? About a year ago. Okay, so Brad, tell us what we're standing in front of. Yeah, so we're standing in front of a mobile calcium CT scanner. So most of, you know, the folks who followed us on both the All In pod, the BG2 pod, etc. know that one of the moonshots I'm working on is we have 800 ,000 people die in this country every year from heart disease. It's the number one killer in the world. If we turn the calcium CT scan into the mammogram for the heart, we will save 50 ,000 lives a year.

0:36That's like ending a Ukraine war every year in the United States. It will save the government$20 billion in care for people. But most importantly, we're losing our most important friends, brothers, dads, at the prime of their life in something that's totally preventable. So this has a calcium CT scanner in it. We've had hundreds of people coming through here. We found scores over the last two days. that most definitely have saved people's lives. It costs$100 and it takes 15 minutes. So I lost my father too early and my good friend here, Rob Goldberg, I want you to hear from him. But this is the type of moonshot that we need to have.

1:13We're working with Washington. We want to get this covered by insurance so that we get 40 million people to take the scan. Mammograms, which are super important in this country, we have 40 million a year. CAT scans, which is the number one killer, we have 1 million a year. We need to have 40 million CAT scans in this country every year. But, Rob, we're going to do a tag team pod here. You are a key inspiration. Your family was a key inspiration for me in wanting to do this, along with Jason Chang and the rest of the besties. Talk a little bit about how this touched your family. Thank you. Brad, thank you, and thank you and Jason for doing this and for you showcasing it.

1:53It's my unfortunate connection to this is that my brother and I and a number of our friends were on vacation for a friend's 50th birthday, another bestie, Phil Deutsch. And in the afternoon we saw him. We were all hanging out by the pool. And then at 6 o 'clock, 6.30, couldn't find him. My sister-in-law and I started looking for him. And we unfortunately found him in the gym of the house, collapsed. and my adrenaline was going so fast I couldn't tell if it was his heartbeat or mine. So I just started doing CPR and we unfortunately brought him to the hospital and he'd been dead for hours because he had undiagnosed heart disease.

2:31And these are folks, so my sister-in-law is Sheryl Sandberg. She wrote a book called Option B about his death and about grieving and, you know, top medical, concierge doctors. He had actually passed, so this is a really important point. So my brother had passed a running EKG five months before he dropped dead from heart disease, from undiagnosed heart disease. Unfortunately, EKGs have a 4 % either false positive or false negative where he had actually done so much cardio that he taught his heart to overcome the heart disease. And so it was pumping harder and harder and harder. And then eventually, when we were in Mexico, it just stopped.

3:06He died of ventricular arrhythmia. There was reports of, because we found him near, I gave the report, we found him next to the treadmill. He did not fall off the treadmill and die. He died of heart disease. And thankfully, due to Cheryl, due to Chamath, due to some other folks, we got him back to be able to do a full autopsy and found his heart disease. But it's truly tragic, and it was completely unnecessary. He was 47. My niece and nephew were 7 and 10. They're growing up without a biological father. They have a great stepfather now. But it's just complete, as Brad just said, we are losing people in the prime of their lives who have no need to die for something that is completely preventable and screenable.

3:40And Dave was such a legend, so loved, the inspiration in many ways for All In and the Bestie group. I mean, Chamath would say he was the original, you know, who got everybody together. He might argue the points with everyone on stage, but yes. To get together for poker. And so, like, what better, more fitting way to honor Dave? But also to take this and say, like, we can do something. We can be biased to action. We don't have to sit here as though we can do nothing. We have agency. Why aren't we doing 40 million CAC scans a year? Why don't Americans know about this? Why are they all tracking their cholesterol and doing EKGs and doing stress tests and thinking they're totally fine?

4:23We've served people up some stuff that's just not accurate. And so this tells you dispositively, yes or no, do you have calcium in your arteries, which is a precursor, your predisposition to build plaque. And you don't have a heart attack if you don't have plaque. Correct. And so to me, this is, you know, we have we started the Center for Heart Attack Prevention and we have three missions with that. One is awareness. It's doing this right. It's bringing a trailer so that more people talk about it, more people know about it. And I can tell you, while the scores are anonymous, we had scores from people who took their exam yesterday that they are definitely in danger zone.

5:01Right. And so these people. Here's the great thing. Here's the great thing. A high score is not a death sentence because you can do something about it. Heart attacks are almost totally preventable, right? It's not like brain cancer that we don't have a lot of treatment for. We can do everything with statins, with ezetimibes, etc. We can lower your ApoB. We can lower your LDLs. And we can get you on a path to heart health. And so number one is just awareness. Number two is making this more accessible to people. So we need to have changes in Washington that make this standard of care in the country.

5:32Cholesterol as a standard of care is ludicrous, right? We are way passive. How did we get to that? Why is cholesterol? How did cholesterol become the key marker? And where did we go so wrong? I mean, it's so interesting. If Bill Gurley was here, and he is here somewhere, but Bill Gurley was here, he's a regulatory capture. So 50 years ago, heart health became a really national issue. I believe it was Eisenhower who had a heart attack in the Oval Office. There was a race in Silicon Valley to see who could solve heart health. one path that people went down was to invent the stent the other one was the calcium ct scanner who do you think won the lobby in washington the stent lobby one okay so he said don't worry cholesterol is good enough to track that's what we already do and if you have a heart condition we'll solve it with a stent wrong wrong answer okay so here we are many many years later my father died too early from heart disease so i hijacked a session the science corner on the All In podcast in 2022 is when I first started talking about this.

6:39And over the course of the last three to four years, we made amazing progress. Once I started talking about it, people went out and got their CACs. And I started getting hundreds and then thousands of letters from my dear friends to total strangers saying, you saved my life. I gave it for free at my Investor Day at the Rosewood Hotel on Sand Hill Road. And famous CEOs in Silicon Valley found 98 % that blockage and had three stents put in within three weeks of having the cac done. So this is only cost a hundred bucks. We got a live audience here. So I'm talking to them. This only costs a hundred bucks.

7:16It's not invasive. It can be done in 10 minutes. And the fact that people don't know about this, it's the highest ROI in healthcare, not only to the country, but to each of us and to our friends. So in our group, it's non-negotiable. Everybody has to get this. And so I appreciate your interest in this. But I would finally just say, finish up on this. I say to my kids all the time, and this really inspired the Trump accounts as well. We can sit around, you know, at the All In Summit and we can talk about the problems. But we also, what do we do in Silicon Valley so well? We start movements. We start companies.

7:54We do things. We have agency. We have a biased action. And now we have a connection to Washington, D.C. So you can bring these pillars of policy together along with pillars of action together and re-education that we do through podcasts and other things to help people help themselves. And so I'm really thrilled you were here today. I just want to thank Brad for having me. But more importantly, much more importantly, what Brad and Jason are doing, and Brad overall, whether it's Trump accounts, whether it's this, Brad is the epitome of putting words to action, thoughts to action, and passion to action.

8:27And I just I love having you out in the world doing more of what you're doing. And it's amazing. I mean, I my brother would love this, obviously, were he here. But but what you continue to do and you're doing it to help others. You really I mean, you're you're you have a day job and it's a pretty important day job. And you're doing that one pretty well, too. But but to spend the time to go out and do this is amazing. And I just want to thank you and call you out for and the Trump accounts as well. Like just helping people, helping future generations with health and with wealth. This is amazing.

8:57You're amazing. You know, if you ask, so I went to the heads of preventative cardiology at Stanford, at Harvard, at Columbia. And they would start giving me their, you know, their corporate speak. Yeah. And I said, I don't want to hear the corporate speak. What do you do for yourself, your friends, and your family? And I would just push them on this. What do you do? And every single one of them said at 30 or 35, I have them all take a CAC. If they have a non-zero score, I get them on a statin. I get their LDL is below 40 which is way below the national standards the green zone in cholesterol I think is between 80 and 120 right so we would go get our cholesterol test it would say that we're in the green zone I was in the green zone at a hundred you feel good you talk to your general practitioner They're saying you don't need a cac.

9:43You're good. You're in the green zone. You run marathons. You do whatever your Dave You're in your credit, you know incredible health wrong take control over your own heart health right it's the number one killer in this country for a reason because we're complacent about it right if we're not complacent and we turn it into the mammogram for the heart we're gonna have a transformation in heart you know in heart attack prevention in this country and we're on a mission to see that through so I have to ask because with many new health protocols or treatments and you know just testing in general people get afraid of it like people might be afraid to know the results they might be afraid to do it in general.

10:20So how do you help break down those barriers and how does this get brought into standard of care for doctors? Yeah, no, it's a terrific question. So, you know, I find that increasingly because people have aura rings on, they have Apple watches on, right? We're breaking down the barriers to health data. People now want health data. Of course, there are those people who say, I don't want to have the information. I always say to people, data is power. If you get information and you can't do anything about it, that's a real bummer. This you can totally do anything about, right? If you have 98 % blockage, you get stents.

10:53If you don't have serious blockage, then you can get on a statin to reduce your LDLs, reduce your ApoB. So because there is that power to do something about it, I find that many, many people want to do it. You know, we have our tech over here who came all the way from Florida. He's also got four kids who each got their Trump account. We hooked them all up with$100 in their Trump accounts yesterday. But this guy, you know, knows what I'm saying, that when people come here and they are empowered with that information, they can now take action. They can now do something about it. But yes, that's part of our mission.

11:25We have to explain to the country there is nothing unsafe. This is effective for mass screening. I met with Dr. Oz now several times. I've talked to many leaders on Capitol Hill. I've talked to many people in the White House about it. I think by the end of this year, knock wood somewhere, but I think by the end of this year, you know, that CAC scans for diagnostic purposes, I think it will be approved and covered by Medicaid and Medicare. If that happens, then that's how it becomes a standard of care. Because doctors ultimately treat standard of care based upon what's covered by insurance. I was just going to add that, you know, people are afraid of the results and afraid of resisting.

12:05It's like, why do you wear a seatbelt? Why do you eat anything healthy? Why do you have greens? Why do you exercise at all? If you're trying to preserve your life, this is literally one of the few tests that is literally the alternative is death. It's not just, oh, I'm going to live three months longer when I'm 90. This is literally you could drop dead if you get a negative result. And if you get a negative result, you can still fix it. So it's take the test and hopefully survive. I'm doing, so a lot of people have asked me, we could go through all the common questions. One of the number ones I get is this.

12:36Should I take the calcium CT scan or should I take the angiogram? So the calcium CT scan, you're in and out of the tube in about two minutes. It's not invasive at all. The angiogram, they put dye in your bloodstream so that they can see more specifically the level of stenosis in your arteries. They can see the soft plaques, et cetera. That costs well over$2 ,000 and it's a little bit invasive. So it's not really needed for mass screening. what I would recommend to people, and again, I'm not a doctor, and some people who are doctors think I have no business talking about this, but I'm an analyst.

13:12I can read all the information. And by the way, I think we've been misled by the medical community about not doing this. So my answer is take the CAC if you're over 35. I mean, obviously, if you have any family history or high cholesterol, then it's a must, must, must do. But I would do it as a preventative measure anyway. if you have a non-zero score so which demonstrates you have a propensity to gather plaque then I would say take the angiogram the angiogram then gives you a lot more information about soft plaques and the level of blockage if any in your arteries get a baseline now we have great AI's like clearly and other services that can sit on top of this they're radiologists AI radiologists to get really refined readings but so I did the science corner three years ago I'm going back in on Friday and I have almost no plaque almost no stenosis but I'm going back in on Friday I'm having another angiogram just so I can biohack myself and share I shared on Twitter a picture of my heart right through clearly so that everybody could see exactly my my level of stenosis I will reshare that again after my angiogram on Friday because there's nothing to be afraid of the data is power and I know because of all the messages that we've receive we've saved hundreds and hundreds of lives you save one life that's enough but the fact of the matter is if we can get this done at scale in the country the mammogram for the heart will save 50 ,000 lives a year yes thank you thank you both so much I really appreciate it and where are they where can you find the trailer next where's the next oh so that's it's a great question um so we bought this trailer because I was frustrated with all my friends in Silicon Valley say where do I get one of these yeah and so I rented a trailer for my investor day at the Rosewood and that was too much of a hassle so I said let's just buy one of these and then we had this idea that we could take it to companies around Silicon Valley and we could do a buy one give one so we could get mark many off and Salesforce to give it to all of his employees for free and then he would pay twice as much so instead of paying a hundred he would pay two hundred and then we could go give free CAC scans in East Palo Alto and other neighborhoods where they couldn't afford it or they were afraid of it or whatever.

15:27And so now we have lots of companies in Silicon Valley. I don't want to dox any of the companies that are doing it, but I would say major companies in Silicon Valley are doing this, that are doing the buy one, give one. We did it with the NFL when the Super Bowl came to San Francisco. So we're moving it all around, slowly but surely. I have tentative agreement to take it to Capitol Hill and to give it to members of Congress. They definitely need it. By the way, so I started, I probably now am responsible for 40 or 50 members of the House and the Senate having taken the CAC scan. And I can tell you that they are a target-rich population.

16:05And so, again, what happens is people are dismissive of it until they find something or their family finds something. And then they become very devoted because they know that this is a lifesaver. Amazing. Okay, well, thank you guys so much. It's great to learn more about this. Really appreciate it. All right. Great. Thank you. I'll follow you. Okay, great. All right. We're going to go inside the CAC scan. Well, maybe he will. Okay. Here, you stand over here. Okay. Nuvo scan. Yeah, it's great. So I've spent a long time. Right, right, right. By the way, by the way, so, um, so Molly, we're in here.

16:44You said you did a pre Nuvo scan as I did. Pre Nuvo's take a long time, a lot of banging, et cetera. Remind us, how long are you in the tube here for the calcium CT scan? Yeah, for the cardiac scan, you're in here for maybe around 5 to 10 minutes. Right. In the trailer or on the bed? In the trailer. So how long are you on the bed for a calcium? On the bed for 5 minutes. 5 minutes. So this is in and out, no noise. You get your results very quickly, et cetera, like I said. And we can come in here. I mean, this is pretty standard equipment. Siemens, CACs, calcium CT scanners have been around for a long time, proven technology.

17:17We're now deep into generations of this technology. There are newer ones even than this one. But the reality is, you know, you can run in and out of this. How many of these can we do a day? So yesterday, in about a nine-hour window, we did 33. Yes. So it has 33 lives. Exactly. So, and, you know, the results yesterday, would you say, we haven't shared them yet, so anonymously, but it looked like a distribution of the population writ large. Yeah, yeah, yeah. We have men, women, old, young. Yes. And some who have higher scores and some who have lower scores, like a distribution of scores. Yes, a wide distribution.

17:54Some were severe and some were none. Right. And so, you know, with the calcium CT, you know, zero means that you don't have any calcified plaque. Now, that doesn't mean you have no plaque, right? Because this does not read soft plaques. But what it does do is when you get soft plaque, it calcifies. So it's a good indicator as to whether or not you are, you know, part of the population that are gathering plaque. So like, you know, some people criticize me and they say, oh, my gosh, you're telling people they're 100 percent safe. No, in life, you are never 100 percent safe. But you get 90 plus percent of the way home, right, by doing a CAT scan.

18:28And it's something that everybody can do. And so as you heard yesterday, we had some people who took it. I'm sure they had no idea they had severe scores. And so we'll share that information through a cardiologist. So the way this works is we give them their CAC scan. He shares the scores with cardiologists who will then call the patients, and they will work through whatever they need to work through. So how often should you be doing this, and how often or how long does it take for a meaningful buildup to accrue? Yeah, I mean, listen, it just depends. Age has a huge thing to do with it. So a 30-year-old is less likely to have plaque buildup.

19:07But if they do have plaque, it's a lot more telling because that means they're gathering plaque early. A 50 or a 60 year old is much more likely to have plaque. But we can tell by the by the quantity of plaque, is it a problem or not? But the reality is a lot of Americans, we just know it's the number one killer in America. OK, so it's not like we're trying to create, you know, scare tactics, you know, for something that doesn't exist. this kills 800 ,000 people a year, right? It dwarfs the number of people who die every year from, we were just talking about, you know, breast cancer, which is devastating.

19:44But I think we have about 40 ,000 people a year die of breast cancer, 800 ,000 people die of heart health. And yet we have 40 times as many mammograms as we have calcium CTs. So I'm all, I think breast cancer set, you know, and mammograms, they invented the playbook for preventative medicine. and I would like to copy that playbook for heart health. If we do the same thing, we're going to save a lot of lives. It's very, very preventable. Dr. Mark Hyman and Dr. Sam Dixon actually brought up longitudinal data. And so to your point, one scan is great. Having some more in the future, three to five years down the road, depending on your score, depending on your genetic outlook, and depending on your lab values.

20:30for instance my the pastor at my church his father his labs looked great however he had a massive massive heart attack completely unknown and he never had one of these done so going just simply based on labs isn't enough but having that longitudinal data that's based on genetics labs is critical it's very i feel like the thing to overemphasize is you cannot rely on cholesterol data or traditional data alone because i brought this up to so many people i've told my dad about this so many times like dad because I'm like a health nut dad you have to get the calcium scan you have to get the calcium scan he's like oh my labs are fine like I'm good I just went to the doctor I did a full workup I'm like it's totally different like you've got to get this done so I guess to overemphasize that like what did we miss with cholesterol and traditional health analysis yeah I mean I have a great tweet on this that shows kind of you know the red green yellow of cholesterol.

21:23It turns out that half of the people who have heart attacks every year have cholesterol in the normal zone. Half of the people who have heart attacks every year have cholesterol in the normal zone. So the fact of the matter is it's related to. So if you have a non-zero score, that means I have a predisposition to gather plaque, then cholesterol becomes very important because that is the agent that carries the plaque to my arteries. So if I have plaque, I want to get my LDLs below 40 remember I think I told you the standard zone is 880 did 110 or 120 and so getting it below 40 is new information not a lot of cardiologists five or ten years ago we're saying this and frankly we didn't have the mechanisms to get it below 40 but if you talk to the heads of preventative cardiology today at Stanford at Harvard at Columbia that's exactly what they would tell you to do so I'm not saying that you know all doctors are involved in a grand conspiracy by, you know, by telling us to track our cholesterol.

22:24What I'm telling you is the evidence on the street, the 800 ,000 people a year are dying of this tells you that that's not enough. If it was enough, then we wouldn't have all these people dying. Okay. So do this as well. Even if you don't have insurance, this costs a hundred dollars out of pocket. Okay. Give up some Starbucks, give up, do what you need to do. You know, have a, go talk to your friends, get the a hundred bucks so that you can get this done. It's far worse, you know, to have a dad, you know, lose a dad or lose a mom. And, and, and, you know, you look back at that and see how preventable that was.

23:01You know, I've said it's a dumb way to die. Heart attacks are a dumb way to die. And, you know, I just think because they're preventable and you can do this. Now, I asked the head of preventative cardiology at Stanford, if everybody does this, are we going to eliminate all heart attacks? He said, of course not. But you'll eliminate 80 to 90 % of them, right? 80 to 90 % of the number one killer just by doing simple scans. So thank you for bringing attention to it. I really appreciate it, Molly. Happy to. Incredible work. Keep it up, honestly. Between this and the Trump accounts, we can't talk about it enough.

23:36Moonshots. Real moonshots. Thank you.