Dr. Mike on how to be alert, not anxious, about your health

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1:48It's an easy fit for a daily routine, whether that's for breakfast or a snack. In a world of overwhelm, it's a straightforward, delicious choice. Try new Kashi Gut Health Granola.

2:01This is TED Health, a podcast from TED. I'm Dr. Shoshana Ungerleiter. I'm a board-certified practicing internal medicine physician, and I'm your host for today's show. You look up a seemingly straightforward health question online. You were hoping for a little clarity. Instead, you got six tabs open and several new questions within minutes. I've been thinking about that gap between finding health information and then knowing what to do with it, knowing what to believe and what to act on. That gap can feel especially wide when there isn't a doctor or other medical provider available to talk it through with you.

2:41Today, I'm joined by Dr. Mike Varshavski. That's his full offline name, and on social media, he's better known as Dr. Mike. He's a board-certified family medicine physician who sees patients in primary care, like me, and reaches many, many millions more online, helping people make sense of medicine beyond the exam room. In this conversation, we talked about recognizing trustworthy health advice, where AI fits into preparing for your doctor's visit, and why tracking our health can sometimes leave us feeling less reassured. Mike has a guiding principle that I especially appreciate, keeping patients alert, not anxious.

3:23After our conversation, we'll hear a TED Talk from Stanford geneticist Michael Snyder, whose research explores how wearable devices might help us notice signs of illness earlier. He's enthusiastic about technology that Dr. Mike has some reservations about, and I'm interested in exploring that difference, which we're going to get into in today's episode. And a quick note before we begin, Mike and I recorded in a beautiful outdoor pop-up podcast studio at Aspen Ideas, so you may hear a gust of wind or a passing plane overhead. Here's my conversation with Dr. Mike Varshavsky.

4:05Mike, hi. Hi. So we're here at Aspen Ideas where so much of the discussion is about innovations in medicine, big ideas for the future. But for most people, I think health still comes down to very small and ordinary moments. Maybe a symptom they get in the middle of the night, a confusing search result on Google. A family member sending a video in a group chat. I just got one of those. When you look at how people are trying to make health decisions right now, what do you think they're up against in the search for accurate and really actionable medical information? I think they have to deck sacked against them in more than one way.

4:42First is it's very difficult to actually invest in primary care because there's not enough of us. There's a huge shortage in primary care physicians. If you're lucky enough to find one, the time you spend with them is usually not sufficient to get all of your questions answered. And then if you say, okay, well, I'll rely on social media for answers, odds are you're going to get inaccurate information unless you happen to be a fan of some accurate channels that are putting out good information. So it's very difficult. It's a stressful time. And honestly, there is no perfect advice on how to combat it.

5:14There's only advice that I have for the industry, for doctors, on how to improve our side of things in order to make it easier for patients. So that's the way I like to think about it. When did you realize that social media was not just a place to share health information, but a place where people were actually forming their beliefs about their bodies and their risks and their doctors? So the situation I saw play out when I was a resident, actually, was people falling victim over and over to misinformation. At that time, maybe not fully on social media, but on television. And they would be forming opinions about how the encounter should go or the medications that they would need or not need based on bad facts.

5:54And I realized that this was happening because there was a vacuum form. There wasn't enough good voices out there providing them good information outside of their interactions with their primary care doctors. The metaphor that I formed was they were basically going to this hospital on their phones, searching symptoms, searching diseases. And this hospital was not staffed by any medical professionals. It was staffed by people who were bad actors, who wanted publicity, who wanted to sell something. And as a result, they were getting bad information. So I put out a call to action. I remember in 2017 in the American Academy of Family Physicians blog of new innovation saying, this is a wake-up call.

6:34We need to be there for our patients in this hospital that is social media. And unfortunately, we did not learn our lesson at that time. It took the pandemic waking us up to the fact that folks are going to search. They're going to make decisions off of that search. And if we're not there to provide them at least some guidelines as to how they should think about certain topics, where they can get good answers, we can't expect there just to be magically good information to be surfaced. And you filled such an important gap there. I mean, I'm really such a fan of everything you're doing. And once that trust exists at scale, it seems like the responsibility becomes much bigger than simply being accurate in just one post, right?

7:11Doctors online are still doctors, even when the format is a 30-second video. So what ethical guardrails do you think should exist for medical professionals who build large audiences? And are there lines you personally try not to cross, even if crossing them would get more views? Yeah, I think about it like we do any medical treatment. Every post has pros and cons. You want to maximize the pros and minimize the cons, just like any treatment. At the same time, every treatment has absolute and relative contraindications. Absolute being you never do this in any instance. And relative is like, you probably shouldn't do this in this scenario, but it depends on the individual.

7:49So social media absolutely has absolute contraindications. You do not diagnose or treat people across social media. It's very tempting with a good intention of wanting to help someone to give them individualized advice. You never do this. At the same time, if you want to be educational, it's also tempting to share patient stories and break HIPAA. You never do this. These are absolute contraindications. Then you have some that are a bit more flexible from the relative contraindications. standpoint, where perhaps you don't share too much about your private life. Because once you give up that privacy, it's very difficult to get it back.

8:22Another relative contraindication, do not speak outside of your expertise. It's very tempting as someone who has gone through a medical education to talk about subjects that are near your field, but not exactly something you're seeing day to day. And as a family medicine doctor, I have to be very aware of this because I have to speak on a wide variety of subjects, but at the same time, remind the audience that I am not the perfect expert to present on this and point them to experts who are doing a great job on those topics. So health information online often arrives in this language of urgency, right?

8:55Don't ignore this. You're doing this wrong. This one sign could mean something serious. And sometimes that framing helps people pay attention and sometimes it turns the body into a source of constant suspicion. How do you think about that tension when you're trying to educate people without making them afraid of themselves. Yeah, this is a topic that I think about every single day, multiple times a day, because for every piece of content we post, I think about that opening hook. I think about the thumbnail, the picture that appears with the video, the title. And I always want to make sure that my medical ethics, my moral compass is at the top of that decision-making tree, that we're not scaring patients, that we're not leading them to make a negative health decision.

9:36And focusing on this tagline that I heard from one of my preceptors years ago, keeping patients alert, not anxious. So we don't want them to become passive. We want them to be alert. We want them to be engaged. We want them to click on the video where they can get an education, but we do not want to create anxiety. So every time I make content, I lead with these principles. And so far it's been great. Hasn't been perfect. We've made mistakes. We've adapted. And that's all you can really ask for from a human. Yeah. Alert, not anxious. I really like that. I'm going to use that. So for people who are trying to be thoughtful consumers of health information, the challenge is not just what to watch, but how to watch it.

10:14So for the person listening who's not in health care, the sheer amount of content can be so hard to sort through. When they see a physician, a nurse, a scientist, or a wellness creator giving advice online, what are two or three signs that say that this person probably knows what they're talking about? And what are the red flags that should make audiences think twice about what they're hearing? I'm glad you said flags because I don't think it's ever a clear cut answer. It's more so you start leaning in one direction or another and not necessarily painting with a broad brush. So if you see someone that's creating content online, you want to make sure they have credentials and not necessarily because only people with credentials can put accurate information, but for the fact that people with credentials have a liability to give you the truth that if I as a doctor put out misinformation that ends up harming you, there is a liability that I face.

11:06in making you face that harm. Whereas if it's just a wellness influencer without expertise in that field, there is no liability for them. They can say 10 inaccurate things, one accurate prediction, and therefore they seem like in the algorithm's eyes, they're doing great work. So the expertise matters. Being aware of those who present with way too much confidence. The smartest people in the room or on a viewership will always be the ones who are not afraid to say, I don't know. And the most successful wellness influencers that are snake oil salesmen that make miracle promises are the ones that are truly overconfident.

11:43That from hearing one symptom, know the exact treatment. I don't know how in medicine that would be remotely possible, but yet we have creators that are making content where they say, oh, you have headaches? It's because you're not consuming enough pink Himalayan sea salt. That's wild to me because I know that as a doctor, there has to be a differential. There has to be a hedging of that differential and the treatment plans of step one, step two, step three. And if you see overconfidence, use that as a flag. Mike, I want to bring AI into this because it's already changing the way people search for answers before they even enter into a clinic.

12:18What do you think AI can realistically help with in health care right now? And where do you think the public has maybe been sold a version of the future that's not here yet? Yeah, I think people believe AI can think and it doesn't actually think. It can create patterns from words. And that's not the same thing as actual human thought. And it doesn't actually have true creativity in it. So when patients, and I actually had podcast guests ask me, do I enjoy or hate when patients use AI before a visit with me? Jesse Eisenberg of the Facebook movie actually asked me that recently. And I said, I actually think it's great.

12:56And he said, really, I'm surprised most doctors would find it like that patients are challenging them. But I think a good patient should challenge their doctors. And I get excited when a patient wants to challenge their doctor, because that means they're empowered, they're engaged. And the best healthcare outcomes come from when a patient is invested in their care and wants to know why they're taking a medication or not taking a medication. So to me, the use of AI, when used appropriately and correctly to empower a patient, to make them feel prepared for a visit, to ask a better question, good uses of AI.

13:28Replacing a doctor's visit with AI recommendations, not a good use of AI. Can you give an example of either in your practice or where you've heard of AI becoming dangerous in this context? From a triage standpoint, there's too many times where an AI will give a recommendation as to whether or not a patient should seek care emergently, quickly, or not at all. And it does not do a good job in doing that. And even some of the more science-focused AI companies have struggled with this. So I think we need to be very careful in how we use AI and use it in partnership with an expert, with a human, as opposed to in lieu of that expert or human.

14:06We'll be back with more of my interview with Dr. Mike Varshavsky after a quick break. Today's episode is sponsored by Kashi. Say hi to new Kashi Gut Health Granola, a straightforward, delicious way to fuel your gut made with prebiotics, fiber, and cultures. My favorite flavor, blueberry almond, has perfectly crispy clusters, delicious almonds, and bursts of whole blueberries. It's an easy fit for a daily routine, whether that's for breakfast or a snack. In a world of overwhelm, it's a straightforward, delicious choice. Try new Kashi Gut Health Granola.

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15:26So I want to talk about wearables. I have an Oura ring on. I don't know if you're a fan of of the devices. You're not. Okay. So wearables have made a lot of people more aware of their sleep, their heart rate, their stress, their recovery, their glucose. They were even giving out glucose monitors here, right? For some, I think that awareness is useful and for other people, it can become another source of worry. How do you think a person can tell whether their data is helping them live better or making them more anxious about being alive? Yeah. I think the pattern that I've seen with consumer wearables and not medical wearables, because there's truly patients who need to wear insulin pumps and things that are important for their health.

16:03So I don't want to discourage that. But from an entertainment standpoint, we need to remember these are not medical devices. They're more for entertainment and potentially could be used for motivation. And I really want to underscore potentially because while getting new sneakers might encourage you to run once or twice, that is not what's going to yield sustainable lifestyle intervention changes. The new sneakers are not what's going to do that. It's a mindset shift. It's a choice that you have to make for your lifestyle, not a product that you're purchasing. So while there are examples of people who wear an Oura ring or an Apple watch and they get excited to exercise and they gamify it and it works for them great.

16:42The pattern that I found more likely what's to happen is people fade and stop using the devices or ignore the massive amount of data that comes at them because they don't know what to do with it or more worrisome. It creates a problem where there was none. We actually have a diagnosis now called orthosomnia, where people are now sleeping poorly because their sleep tracking devices are telling them there's something wrong with their sleep. So we need to use them responsibly. We need to keep in mind what their limitations are. And if we're using them for fun, for entertainment, for some motivation purposes, perfectly fine.

17:14But as long as we're honest about that. Yeah, I think that brings us to a place where culture and medicine really meet because how people interpret health advice is so shaped by things like identity and pride and fear and belonging. And you've talked about men's health in ways that feel unusually direct. Men die younger. They often avoid doctors, are underserved in a lot of health communication. What would a healthier men's health movement look like to you? Maybe one that's not built on shame or bravado or silence. Yeah, I think it's going to be very different for each individual because when we try to create this single group of men, you're going to get distortions from all sorts of signals.

17:58And we need to create not just one unifying message, but the message that all types of men need care for mental, physical support. There's new problems that are arising that are uncomfortable to talk about. Whereas body image issues that have come from social media were the last 10 years an issue for teen girls. But now with these looks maxing trends that are coming out, this is now starting to enter the world of young boys. Whereas normally they would be going through puberty and there would be a passing phase of insecurity that was a natural part of life. And now it's becoming a full identity crisis.

18:33So we need to be very careful of how we talk about both women's and men's health so that it's inclusive, but at the same time individualized enough to make sure that no one's being ignored. So, Mike, for someone who's listening, who loves a man, I'm coming back to men here, who never goes to the doctor, a father, a partner, brother, friend, what is a better first sentence than you need to get checked out? How do we invite men into care without making them feel attacked or weak? I think asking them how they feel about their health and starting a very uncomfortable at times conversation, because many times men will identify going to the doctor as a weakness, as something that is frightening.

19:15Whereas if you can begin that conversation with something that is relatable, asking them how they feel about going to see their doctor, you can get into the why before the how we're going to get there. So I think when you talk about someone's mental health and you explore it in that way, you get better outcomes because it's basically a form of motivational interviewing where they ultimately end up choosing to go as opposed to you forcing them to go. Yeah, Mike, I want to end with humility because it's something that medicine does not always model well. And you touched on this briefly before. What is a health belief that you held confidently as a doctor that later turned out to be wrong?

19:53And what did changing your mind teach you about how the rest of us should hold health advice, even when it comes from experts? Yeah, this is a strong issue that I was actually taught during my residency where if a parent would come in with a child who they did not want to get vaccines, we would dismiss them from our practice. We would give them a 30 days notice. We would say, you have to find care elsewhere. We don't want you putting our patients at risk. And that was the policy. That was what I was taught. And I believed in that policy because I said, of course, for the safety of all the other patients who can get vaccinated because they're too young or immunocompromised.

20:26And then I realized we're shunning a group of people. We're creating more distance. We're creating a bigger dilemma between these two tribes that is fully unnecessary, where now our policy has shifted, that we created a way for them to come into the office to keep our patient population safe, go into a specific quarantine room, still foster that relationship where we care about their children, perhaps not to the perfectly optimized way in which we can, but still open and create room for open where perhaps in the future, they are more likely to make the decision to get vaccinated or see where we're coming from in terms of a lifestyle modification.

21:05And since we've done that, we've seen tremendous vaccine uptake, better outcomes for those patients, more engagement from the community, from people who were once afraid to see a doctor. And I think that's the kind of humility we need to lean into. Mike, thank you for making health feel clearer, calmer, and more human. This has been a lovely conversation. Yeah, that's the goal. Thank you for that opportunity. Appreciate it. We'll be back in a moment.

21:56Try new Kashi Gut Health Granola.

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23:12My conversation with Mike made me think of how powerful it is to keep learning, to stay curious as both a healthcare professional and as a patient. And today we have more tools than ever before to learn about our bodies and our health. And this brings me back to the topic of wearables. As you heard, I wear a tracking ring myself, but Mike was pretty clear about his reservations about consumer wearables. His concern is worth considering. When does paying closer attention to our bodies become one more thing to worry about? When does curiosity tip over into anxiety? Genome researcher Michael Snyder approaches these devices with considerable enthusiasm.

23:57He wears eight of them himself. In his talk, he shares findings from his research alongside a vision of healthcare that could recognize changes earlier and respond more personally to patients. But before we listen, I want to make a distinction. A glucose monitor helping someone manage their diabetes serves a very specific medical purpose. That's a different situation from checking a daily wellness score without knowing what to do with it. There's also a difference between research that suggests promising outcomes for the future and what a device can reliably tell you today. Snyder's research has found that changes in wearable data can sometimes precede symptoms of infection.

24:44Those signals can also reflect other things, including stress. They don't by themselves tell you which illness you have or whether you have one at all. So I'm not advocating that everyone buy a wearable, track every meal, or become preoccupied with getting their numbers right. But I am curious about where this work could lead. What I'd hope for is information that helps us answer useful questions with support to understand them. And for anyone using a device as part of medical care, that's a conversation to have with your clinician. And now, Dr. Michael Snyder. Our healthcare system is broken.

25:27Our laboratory in the last 17 years has been trying to improve it, and along the way, I've even learned a lot of new things about my own health. It's broken because we practice sick care rather than health care. And even when we practice health care, if you think about it, it's a pretty archaic process. You'll travel to a physician's office. That really hasn't changed much in the last 40 years. When you're there, they'll take lots of blood. And from all that blood and the time you're there, they actually don't make very many measurements. And from those measurements, they'll treat you based on population averages rather than the individual.

26:03We're trying to change all those steps, and one area in particular is remote health monitoring. What if you can measure your health with sensors and a dashboard, much like your car dashboard? That's what we've been trying to do, and you can now do that thanks to a revolution in wearable devices, smart watches, rings, and a host of other devices. These devices will measure things like resting heart rate, heart rate variability, skin temperature and conductance, blood oxygen, even sleep, all of these things we know are very important for our health, and we can now measure them continuously 24-7, as long as you keep them charged.

26:45I'm such a big fan of these devices, I wear eight of them every single day. I'm wearing four smartwatches, two rings, even my hearing aids are sensors. They measure physiology like these other devices, but they also measure my socialization, which is important for your health as well. So you can track all of these things in real time, and we've been doing just that. When they first came out as fitness trackers, we put them on a cohort of people we were studying for health tracking. And what we discovered is that you could tell when people get ill in advance of symptoms from a simple smartwatch, in this case, smartwatch and pulse ox.

27:28The first case was when I discovered my Lyme disease, of all things, with, in fact, a pulse ox and a smartwatch, where my blood oxygen dropped, my heart rate went up, it was all pre-symptomatically. And then I did visit a physician who actually diagnosed it as Lyme disease, and in the end, we got it treated early, and I wound up not getting anything serious. I was cured right away, simply because of early detection. And so that turned out to be the first case, and then we went on to show that you can detect respiratory viral infections with a simple smartwatch because your heart rate jumped up in advance of symptoms.

28:07When the COVID pandemic came along in spring of 2020, we built a real-time detection system that follows your baseline and looks for a jump up in resting heart rate and other measures and then sends a red alert. And it turns out this alerting system works very, very well for COVID because COVID has a long pre-symphomatic period. It will detect COVID 80 % of the time with a median of three days in advance of symptoms. It's not specific for COVID, though, I should warn you. It does pick up other viral infections, which we think is a good thing. But it also picks up other stressors. And the number one trigger of red alerts is workplace stress.

28:50So it actually is both a physical stress detector with viral infections, but also mental health detector. And we're actually exploiting this further to try and tell when people get anxious and have depression from a simple smartwatch. Infections are not the only thing you detect with these devices. My colleagues at Stanford have actually shown you can pick up afibrillation, which is a heart condition that if you catch it early, you can treat it. With machine learning and AI, we actually were able to show that smartwatches are pretty sophisticated. They can actually tell your red blood cell count and other measures, things associated with anemia and hydration.

29:29But also, even your blood glucose and hemoglobin A1C, as it's called, which is important for diabetes, you can also pick up with a smartwatch thanks to the skin conductance measure on these things. So these are many, they're very sophisticated devices that can make many measurements as early signs of disease. They're not the only devices that are out there. Continuous glucose monitors are very, very powerful too. They'll measure your glucose every five minutes. And we have a diabetes endemic going on that's worse than the COVID pandemic. 11.6 % of people in this country are diabetic in the US, and 20 % of them don't know it.

30:1238 % of people are pre-diabetic and 80 % of those don't know it. And those numbers are going up, by the way. And the pre-diabetics, most of them will become diabetic. So we think it's very important to catch glucose dysregulation early so that you can prevent diabetes. And it also turns out glucose spikes are associated with cardiovascular disease, which is the number one killer in the US. So we actually put these on so-called normal people and pre-diabetics, and we did discover that some people are normal, they have good glucose control. Some people are moderate glucose spikers, so they spike somewhat.

30:53And some people are severe spikers, just as bad as diabetics, but they didn't know it. And we can pick this up with the glucose monitor. We then went on to discover that different people spike to different foods. Some will spike to bread, some to pasta. some to bananas. Here's an experiment we did recently where we had 55 people eat seven different carbohydrates, identical amounts, but the carbohydrates are in different forms. Beans, berries, grapes, bread, pasta, and white rice. It turns out most people are rice spikers. In fact, rice is worse than ice cream for most people. Some people, though, are pasta spikers, some are potato spikers, bread, grape spikers.

31:38We're all different. What's going on? We think this has to do with the heterogeneity of type 2 diabetes. It's not just type 1 and type 2, but type 2 has many subtypes. And that's because our glucose regulation is very complicated. We have our pancreas, we have our liver, our muscle, even our brain is a major glucose consumer, and we have many biochemical pathways. Insulin, the GLPs you may have heard of these days are also important regulators and there are other hormonal systems as well. And together these control your glucose. Turns out subtypes of diabetes exist that are actually very evident when you actually start looking at this.

32:23And so we took pre-diabetics and normal folks and typed them for their glucose dysregulation and we discovered, we typed them for muscle-interresistant and hepatic-interresistant, as well as beta cell defects and incretin defects, the GLPs. And it turns out, once again, everyone is different. I myself am a type 2 diabetic. You might not have guessed it. I'm a beta cell defect. We're all different. You can actually tell the subtype of glucose dysregulation you have by drinking a shot of glucose and looking at the shape of the curve and using machine learning, we can now tell your subtype just from the shape of that glucose curve, whether you're muscle-inter-resistant or have a beta cell defect.

33:08And so what used to be a thousand or several thousand dollars set of tests, you can now do for 50 bucks from a local drugstore. Not only that, you might say, well, why do I care about my subtype? Well, it turns out your subtype determines the food you'll spike to. So if you're muscle-interresistant, you'll spike to potatoes and pasta, but not if you're insulin sensitive. Likewise, if you're a beta cell defect, you'll spike to potatoes. You may know that if you actually eat your salad before your french fries, you can generally reduce your spikes, but that's not always the case. We tested this further with regards to subtypes.

33:52So we had people eat protein, fiber, or fat prior to eating white rice, which spikes them. And it turns out that if your muscle wants to resist or have a beta cell defect, nothing happens. You'll still spike when you eat your white rice. But if you're insulin sensitive or normal for beta cells, you actually can suppress those spikes with fat and fiber. So once again, your subtype actually determines not only what foods you'll spike to, but how to mitigate those spikes. We took this to extreme by actually looking at a group of people who were subtyped, and then we actually looked at their glucose by seeing these continuous glucose monitors, as well as had smartwatches on them.

34:39And the idea was to track what they do and when they do it with their effect on glucose and according to their subtypes. So just to get into this in a little more detail, we learned some things that you might already know. If you eat your biggest meal first thing in the morning, you'll have lower glucose. If you have it late at night, you'll have higher glucose. Starchy vegetables, higher glucose. Fruits and less starchy things will give you lower glucose. It turns out most people don't sleep enough. So if you sleep longer, you'll actually lower your glucose. The same logic can be applied to these subtypes.

35:25It's important to know your subtypes so you know what lifestyle things will mitigate that problem. And it turns out you take this one step further, the medications I use are also very dependent on my subtypes, so I respond to certain medications that promote insulin release from my pancreas, but not other kinds of medicines. Actually, I don't respond to metformin, which is the most common medicine. So these glucose monitors are very, very powerful, we think. What about other biochemical measures? Well, it turns out that we've been working very hard to see if we could detect molecules from a single drop of blood.

36:06And after spending seven years on this, we set up a method for taking drops of blood from your fingertip and your shoulder and being able to measure 7 ,000 different molecules from that drop of blood. Now, I know what that sounds like, but ours actually does work.

36:26Then we could do, once again, fun experiments with this. We were able to have 32 people drink this shake, a very common shake, and looked at their response. And once again, everyone was different. We had some people, their carbohydrates went down, others went way up, others stayed flat. One of the interesting results was inflammation. It turns out when some people drank this shake, their inflammation went down, others went up. Same shake, pro-inflammatory on some, anti-inflammatory on others. And we think this is important to know if you have digestive issues from the food you eat, which turns out to be about 10 % of the U.S.

37:10population. We've taken this to the extreme where we basically had one individual take a micro-sample every hour for seven straight days during waking hours. And the idea was to try and correlate, once again, what they do with its effect on their physiology and biochemistry. And what we discovered is there's lots of associations, thousands, actually. But one of the interesting ones we discovered that alpha-synuclein, which is involved in dementia and Parkinson's, shows a very interesting pattern. It correlates with certain stresses. So the idea is that if you could actually mitigate alpha-synuclein spikes, what you might do is actually be able to push off people getting dementia or Parkinson's.

37:56Where is all this going? Well, I envision a world where all of you, many of you are already, will actually be doing remote monitoring in the form of sensors and microsampling to get yourself measured more frequently and to stay healthy. The nice thing is these technologies are very inexpensive. They could go anywhere around the world. The whole world is capable of wearing these things and using microsampling. And with this, we can actually better manage their health and be able to even hit underserved populations. And then together with other technologies like genome sequencing and yet other sophisticated advances in science, we can better predict disease risk, manage people's health better in terms of early diagnosis, monitoring and treating disease, and the ultimate goal, of course, is to have everyone live long, healthy lives.

38:46Thank you.

38:53That was Michael Snyder at the 2026 TED conference. I keep coming back to what happens after a measurement. Someone still needs room to ask, what does this mean for me? And as these tools develop, I hope we can make more room for that conversation. TED Health is a podcast from TED, and I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lajas, Farah Degrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash.

39:59He'd also talk about how most Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends, it's pretty much all he talks about in a good way. What's in your wallet? Terms apply. See CapitalOne.com slash bank. Capital One N.A. member FDIC. Hey, we're Nick and Jack, hosts of The Best One Yet. Behind every episode, there's research, email, spreadsheets, and our shared Google Doc, the headline hammer. With Google Workspace with Gemini, Google's AI is built right into the premium versions of tools we already use, like Gmail, Docs, and Sheets. No new tools or extra logins, just personalized AI for the way we work.

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