back to indexJonathan Reisman: The Human Body - From Sex & Sperm to Hands & Heart | Lex Fridman Podcast #297
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We have two tubes that are right next to each other
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One is for food, drink, saliva, mucus, snot,
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whatever you're gonna swallow.
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All of that stuff must go down the esophagus,
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the food tube, and end up in the stomach.
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And right next to the esophagus, millimeters away,
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is the windpipe or the trachea,
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which goes down to the lungs.
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Throat, heart, feces, genitals.
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Every organ from moment to moment keeps us alive
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and ensures our survival.
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The genitals are, in a way, the opposite.
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How would you improve the penis and the vagina?
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The following is a conversation with Jonathan Reisman,
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a physician and writer of The Unseen Body,
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a doctor's journey through the hidden wonders
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He has practiced medicine in some of the world's
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most remote places, including the Alaskan
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and Russian Arctic, Antarctica,
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and the Himalayan mountains of Nepal.
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This is the Lex Friedman podcast.
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To support it, please check out our sponsors
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in the description.
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And now, dear friends, here's Jonathan Reisman.
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You wrote a book called Unseen Body,
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all about the human body, the messy, the weird,
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the beautiful, and the fascinating details.
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So, from an evolutionary perspective,
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are most parts of the human body a feature or a bug?
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Is it like the optimal solution
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or just a duct tape solution?
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I think that most of the time,
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the way the body works is the best solution.
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I haven't seen many alternatives, so it's hard to compare.
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But I think, you know, there's some parts of the body
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that make more sense than others.
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You know, the way our hands work, for instance.
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You know, the muscles are up in the forearm
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and then the tendons kind of come down
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like strings on a puppet.
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And just the dexterity it gives our hands
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is just really amazing.
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And it's hard to imagine a better tool
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than the human hand to do everything from, you know,
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hold things to play piano
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and do a million other daily activities that we do.
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One thing I talk about in the book,
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there's some other body parts that seem to be lacking
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that kind of brilliant design, such as the throat,
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you know, where the food, drink are swallowed
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and air is inhaled, and they kind of,
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those two paths come within millimeters of each other.
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And you slip up once, you laugh while eating,
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or you speak while trying to swallow and you die
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So it seems less than optimal,
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though I'm not sure it could be better
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from the way we're kind of formed in the womb
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as a beginning as this tiny little tube.
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I don't think it could have been done any better
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or there's any other way to do it,
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but it is an unfortunate thing that, you know,
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does lead to some problems.
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So the hand, if I could just link on that for a second,
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you talk about the wisdom of a design in the book.
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What are the important things about the hand?
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It seems like very useful for many things
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and it seems to be quite effective.
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A lot of people think the thumb is foundational
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to the human civilization.
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Is there any truth to that?
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I think that is true.
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Actually, one of the ways in which the importance
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of individual fingers comes to attention
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is when people have severe injuries to their fingers.
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For instance, I have a story in the book
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about a guy whose thumb is nearly ripped off
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by his dog's leash.
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And, you know, when plastic surgeons
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who are often the ones to repair that,
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sometimes it's orthopedic surgeons,
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they will debate, you know,
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how important is it to save this finger
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or how important is it to save, you know,
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let's say the kind of tip,
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the one third, the tip one third of one of your fingers.
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You know, it depends on the length that you'll lose.
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It depends on which finger.
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And so the thumb really is the most crucial,
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just, you know, for your occupation in most cases
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to just daily life and your ability to get around
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and take care of yourself and others.
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So, you know, there'll be more,
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they're willing to go further, do more surgeries,
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more aggressive therapy to save a thumb, let's say,
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than, you know, the tip of your pinky finger.
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So in that way, I do think the thumb, you know,
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does seem like the most important in many ways.
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It's nice that there's backups.
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I wonder if that's part of the future
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or is it just the symmetry that nature produces?
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You think the two hands is like,
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is it about the symmetry or is it about backup?
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We'd be much less formidable hunters, gatherers,
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survivors in any way if we only had one hand.
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So I think that is important to have two
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so we can, you know, even everything from kind of
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spearing an animal to firing a bow and arrow
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to butchering an animal.
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You really need two hands to do it very effectively.
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But can you do a better job with three?
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And we'll never know, perhaps.
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You tweeted, now I'm gonna analyze your tweets
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like it's Shakespeare sometimes.
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You tweeted that, quote, millions of years
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of sex and death design the human body.
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Are those two basic activities basically summarize
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everything that resulted in humans on Earth?
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So like, is that a good summary of the evolutionary process
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that led to this conscious intelligent being,
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So sex is how more of us get made, obviously.
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And death is how we get weeded out
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or the gene pool gets weeded out
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and certain genes survive and others don't.
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And, you know, the age at which we die,
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whether it's before we've, you know,
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had sex and reproduced ourselves is a big factor
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and who survives, who doesn't, who passes on their genes
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and what the future of the body looks like.
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You know, who lived and who died
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before they were able to be at reproductive age
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a million years ago was pretty important
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in what we look like now.
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And perhaps how we have sex and die now
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will determine what we're shaped like
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unless technology has an even bigger role in that,
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you know, a million years from now.
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So you think that's fundamental
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to like if there's alien civilizations out there
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that have the same order of magnitude
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of intelligence or greater,
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do you think that we will see something like sex
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and something like death?
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So the reproducing and this selection process
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plus the weeding out of the old to make room for the new,
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is that kind of foundational to life?
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I mean, it sure seems to be on earth,
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you know, perhaps in some distant future
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when medicine is nearing, you know, perfection
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and people can live a really long time.
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Maybe we won't even need to reproduce as much
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or something like that, you know,
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it's hard to even know what life will be like
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in the distant future.
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But I would guess that any alien civilization
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will have the same dependence on who has sex and who dies.
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Well, that's the problem with immortality.
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How are we going to clear out the old
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to make room for the new, which is kind of a,
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it's like a framework of adaptability
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to changing environments.
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So as long as the environment is changing,
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and it seems to always be,
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because the entirety of the earth system
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is a complex system, it seems like you have to adapt.
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And to adapt, you have to kill off the stubborn old ideas.
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And unless there's a way to like not become stubborn and old,
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but it feels like the nature of wisdom is stubborn and old.
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Like that's what wisdom is.
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It's like the lessons of life,
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the lessons of experience solidified.
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And the solidification is the thing
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that actually prevents you from reinventing yourself
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to adapt to the new changing conditions.
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But then again, why not have that both of those modes?
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Like have two minds and one person,
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one immortal person that like in the morning,
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they act like a teenager,
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in the evening they act like a old wise man.
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So you see, you can imagine within one mind both modes,
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but those are required.
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You have to have the ability
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to completely reinvent yourself,
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which is what death does in an ugly way,
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or a beautiful way, depending on your perspective,
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depending whether you take the human perspective
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or the human, the nature's perspective.
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And then you have to have the selection.
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So competition, so sexual selection.
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It's an interesting, interesting little planet we got.
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What's the weirdest part, function, concept, idea
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about the human body to you?
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We'll talk about fascinating details,
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but I should say for people that should read your book,
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they will come face to face with the fact
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that you do not shy away from the weird
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and the wonderful of the human body.
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It's like, it's fun, but it's honest.
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So given that, sorry to make you pick one of your children,
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but what's the weirdest one, would you say?
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The weirdest body part.
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Or concept or function.
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So the chapters, you divide it up kind of into parts,
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but there could be a thread that connects all of them,
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the weirdness, maybe, or maybe the texture of the substance.
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It could be the liquids, the solids, I don't know.
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Definitely every body part and bodily fluid
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has their own kind of both gross and fascinating aspects.
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That's probably why I'm a generalist as a doctor
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and couldn't just, as you said, pick one of my children,
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become a specialist, because I like them all.
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I feel like one of the strangest concepts
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about the human body is that kind of the aspects of it
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that are the most universal, that we all do,
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are the most taboo socially.
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I wouldn't have expected that if I had, you know,
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just looked from the outside, like what we do
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in the bathroom, what we do in the bedroom,
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what we do to our own genitals, what we do to our,
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you know, quote unquote, private parts, they're private,
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even though it's sort of the thing that we all have
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in common is the most we try to hide from other people
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and don't talk about in polite company.
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I mean, it makes sense as a human living in this society,
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but from the outside, it sort of might be surprising.
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How do you make sense of that if you put on
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your Sigmund Freud hat?
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The thing we all do, why do we make that a taboo thing?
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Is it because we like taboos?
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Maybe we get off, or maybe our kinks as humans
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is to have taboos, and it's kind of efficient
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to have taboos about the things that everybody does.
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Like, you can make walking taboo or something, I don't know.
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But just, maybe that's what we love,
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that's what's exciting to us, is the forbidden.
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I think, yes, society loves rules, for sure.
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They love, some societies more than others.
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You know, they love controlling how you think
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and what you do in public versus in private.
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You know, there's a lot of societies where, for instance,
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parents have sex in front of children.
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Not, you know, for instance, like in traditional
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Inupiat Eskimo societies, that was sort of normal.
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I mean, but what are you gonna do,
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go outside in the middle of the winter in the Arctic
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and do it out there?
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So, you know, there's different taboos
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in different societies.
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Some taboos make perfect sense.
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Some taboos are even public health measures,
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you know, like, as I talk in the book about in India,
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where they, you know, the hands are symmetric, as you said,
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but in Indian culture, and the left hand is taboo,
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and the right hand is what you use for shaking hands,
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for eating, for other things, and the left hand
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is the dirty hand that you use for wiping your own bottom.
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You know, that's the toilet paper is your left hand.
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So, while the body is anatomically symmetric,
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the taboo creates this pretty intense asymmetry.
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But for a good reason, you know,
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yet you probably shouldn't be shaking hands
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with other people with the same hand that you use
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to kind of clean your bottom.
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So in that sense, it makes sense.
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Yeah, maybe the roots of it makes sense,
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but the way it propagates, especially as the times change,
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might not, because you can wash your hands.
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But the taboo remains.
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Right, society is very slow to change.
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What is the most fascinating part, function,
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or concept in the human body?
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So, you know, something that fills you with awe.
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I guess the most obvious one is the brain,
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partly because it's so, you know, sort of poorly understood,
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though we understand more than we ever have in the past.
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There's still so much that we don't understand
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about how the lump of matter in our skulls
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kind of creates this subjective experience
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that we all kind of understand quite viscerally.
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That's an easy one.
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I would say the kidneys are an underappreciated organ.
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The way they tinker with the bloodstream,
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raise levels of this, lower levels of that,
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kind of our entire lives from inside the womb until we die
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is just really incredible.
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And when you look at how much energy
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different organs consume,
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the brain and the kidneys are two of the biggest ones,
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because the brain obviously in us is always active,
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and controlling parts of the body,
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but the kidneys are just consuming a ton of energy
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to do what they do.
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They're kind of the unsung hero of the body,
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relegated to the back of the abdomen,
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like some forgotten organ, but they are great.
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I did consider being a nephrologist,
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which is a kidney specialist,
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because I was so taken with the kidneys,
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but decided I like all the organs,
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so couldn't pick just one.
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So your book is ordered in a particular way.
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It's throat, heart, feces, genitals, liver, pineal gland,
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brain, skin, urine, fat, lungs, eyes, mucus,
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fingers and toes, and blood.
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First of all, great chapter titles.
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Is there a reason for this ordering, or is it all madness?
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There's a few different reasons that went into it.
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I did wanna start with the throat for the reason
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that it kind of presents the topic of death,
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which is sort of obviously very important
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in the training of a physician, in the career of physician.
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It's a big part of what I deal with.
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On the first day of medical school,
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we started the dissection of a cadaver
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in the class called anatomy lab.
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And so in a way, we were kind of thrown right in there
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in the beginning, like this is the end of the human story.
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Understand this, and then we sort of backed up
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to the beginning with embryology and reproduction and stuff.
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So it's kind of like we got, and I got thrown into that
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right away, right in the beginning,
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kind of like here's a dead body.
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Now start cutting it apart and learn the name
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and function of absolutely every bit of flesh.
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How did that change you, that first experience
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with the cold honesty of human biology?
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Right, that's exactly what it was,
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is cold honesty about kind of the story
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of each individual human body.
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It has an end, and that's it.
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I think that, well, actually before the end
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of that first day, so what we did on that first day
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was study the superficial muscles of the back,
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like the lats or latissimus dorsi and some other muscles.
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We cut through the skin of the back.
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My cadaver was laying face down on this metal gurney.
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We pulled back the kind of plastic sheets
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that would keep him moist for the next four months
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as we dissected him, cut through the skin on his back,
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and then started dissecting through the superficial muscles
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And that was really all we saw that first day.
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We didn't get any deeper, didn't enter the abdominal
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or chest cavity to see internal organs,
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but I was so fascinated with this sort of
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behind the scenes look at how things work in the body,
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how you move your arms, how you arch your back.
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You know, these are the muscles that do it
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that I decided I wanted to donate my own body
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for the same purpose.
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So I made that decision literally
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before the end of that first day of class,
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and I'm still sticking to it.
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So someday there'll be a medical student
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that can watch and listen to this podcast
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while dissecting your body.
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They might not know that that person
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they're listening to on the podcast
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will be the carcass in front of them,
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but we never learned anything.
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The universe will know.
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The universe will know.
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And they will acknowledge the irony or the humor,
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the absurdity of that.
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The universe will chuckle,
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but the medical student won't know
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because they never, as I did not,
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learn any personal information about the person,
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only what I could glean from looking inside them,
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which actually tells you quite a bit.
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I knew he was a smoker.
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I knew he had coronary artery disease.
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You know, you get a window into,
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I knew he was overweight.
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You get a window into people's lives
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just by looking in their bodies after death.
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Other cadavers in the lab, not my own,
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or I shared one with three other students,
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but other cadavers, some had metal joints,
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like a knee replacement.
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Some had a kidney missing.
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and we could tell it was surgically removed,
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not that he was born with one.
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And we could tell that he probably had a kidney tumor
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or cancer that was removed.
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So you do get an insight into people's lives
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from picking them apart after they're dead,
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but you don't know their name
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or what podcast they've been on.
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So as the book title says, Unseen Body,
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so it tells some kind of story of your life.
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So it does capture the decisions you've made in your life,
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the things you've done,
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that might be kind of secret to that person
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and maybe to a few others that knew him or her well.
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It's so fascinating.
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So what kind of things can it reveal?
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Like what kind of choices in terms of the injuries,
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the catastrophic events,
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the lifestyle choices of smoking and diet
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and all those kinds of things?
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What kind of history can you see about the human before you?
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So all those things you mentioned are things you can see.
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Take the skin, for example, right?
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Most things that happen to us leave a mark,
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as I say, kind of a story written in the language of scar
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where it tells you injuries you've had.
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And same thing with animals.
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I've seen deer hides that have marks
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that look like they're made by maybe a barbed wire fence,
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something like that.
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You can tell, sometimes it's conjecture,
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but you can sort of imagine what might've happened
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Perhaps two bucks were fighting
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and one got injured with an antler.
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And the same with humans.
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I have scars on my body,
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and when I notice them, I remember what happened.
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I got a big cut on my hand when I was 13,
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and it's still there,
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and I remember what happened every time I look at it.
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And so in that way, only I might know that story,
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but other people, when they dissect me
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and notice the same scars,
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they can kind of, it can fire their imagination
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as my cadaver, you know, did for me.
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They know that there is a story there.
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That's such an interesting way
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that the skin does tell a story,
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both tattoos and scars.
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Some of the fun you've had
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and some of the damage you've done.
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And even when I evaluate a patient,
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I can use scars to help me make medical decisions.
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So for instance, someone that comes in with abdominal pain
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into the emergency room,
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you can see scars on their abdomen
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that tell you about, you know,
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the past kind of activities of a surgeon, perhaps.
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I know, I recognize the scars that are left
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when someone has their gallbladder removed,
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the scars when someone has their appendix removed,
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maybe when someone's had a hysterectomy,
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and that can tell you what it might be or what it isn't.
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You know, if someone doesn't have an appendix,
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their abdominal pain's not appendicitis, end of story.
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So in that way, I'm sort of looking at these,
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the tracks or the footprints of past surgeries
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to tell me what might and might not be the cause
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of this patient's abdominal pain,
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which is kind of my main job in the ER
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is figuring out what's causing it and to help them.
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Is there ways to get more data about the human body
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as we look into the future of medicine biology
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that will be helpful to fill in some of the gaps
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So, you know, you have companies,
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you have research that looks at, you know,
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collection of blood over long periods of time
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to see sort of, you know, paint the picture
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of what's happening in your body,
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mostly to help with lifestyle decisions,
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but also just, you know, to anticipate things
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that can go wrong and all that kind of stuff.
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Is there, can you just speak to a greater digital world
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that we're stepping in,
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how that can help tell a richer story?
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I certainly think that we have more data
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than we know what to do with right now,
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especially with kind of direct to consumer medical devices,
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you know, smartwatches, et cetera,
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that are just collecting these reams of data.
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I have not seen them put to,
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I think the eventual use that they will.
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I think that the potential is sort of just, you know,
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unimaginable and I hope we're heading into a new age
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where, you know, you can determine, for instance,
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is a person gonna have more of the dangerous side effects
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to a drug based on their genetics
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or are they gonna tolerate one drug better than the other,
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you know, based on their genetics?
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And we are slowly moving into that age
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and especially the age of kind of
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completely synthesizing drugs in the lab,
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you know, much like, for instance,
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some of the COVID vaccines actually,
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like Moderna never had the virus in their lab.
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They made that vaccine completely
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without ever having the virus themselves
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just by having the genome, which is sort of astounding.
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And there's a lot of potential going forward, you know,
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based on that technology and some others.
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Well, I didn't know that.
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So they basically, it's all in the computer,
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it's computational.
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Right, you have the genetic code,
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you have tremendous power,
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even if you don't have the organism itself.
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What do you make of Elizabeth Holmes and efforts like that?
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First of all, I'm a curious,
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I'm drawn to the darkness in human nature
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because that somehow reveals
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the full spectrum of what humans could be.
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So there's a lot of sort of controversial thoughts
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about who she is and her efforts and so on.
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I think you may have even tweeted about it,
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but I've read a lot of your tweets, so I'm now forgetting.
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But what do you make of her and both those efforts
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and the charlatans that sort of snake oil salesmen
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that promise those efforts to do more
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than they currently can?
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I think that her, you know, that goal that she had
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that she created Theranos to try to achieve,
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to use less blood in tests is a very worthy goal
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and a huge frontier that we have not achieved
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and that I hope we will achieve.
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So I understand why, you know,
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someone describes what a huge step forward that would be
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and it would be indeed.
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I understand why people put a ton of money behind it.
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Can you describe what was the promise?
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What are we even talking about with Theranos,
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just for people who don't know?
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So Theranos is a company that was basically started
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to revolutionize the way medical blood tests are done,
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both to use a whole lot less blood in doing it.
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You know, if anyone's ever been to the doctor
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and had five to 10 tubes of blood removed from them,
link |
it can be quite surprising how much they take out.
link |
And it's, you know, that's the limitation of our technology
link |
that we need those volumes of blood
link |
to run all the tests that we want to.
link |
And so the promise of Theranos was that perhaps
link |
with a single drop of blood, we would be able to know
link |
as much about the person's, the condition of their body
link |
without drawing all that blood and thereby, you know,
link |
there would be these devices she was gonna create
link |
that would sort of do it.
link |
You put a drop of blood in and it spits out everything
link |
you ever wanted to know about what's in your bloodstream.
link |
And in a way that would make it so much easier,
link |
you know, it could be, you could have one in your home
link |
theoretically, and you, I don't know why you'd wonder
link |
what your potassium level is on any given day,
link |
but you could check if you wanted to.
link |
And so that goal is very worthy.
link |
You know, I put that goal up there with the frontier
link |
of making painkillers that are as good as opioids
link |
without the addictive quality.
link |
You know, that would be such a huge revolution
link |
if we did have that in medicine.
link |
But, and particularly for me,
link |
cause I trained in both pediatrics and internal medicine.
link |
So I learned to care for both children and adults.
link |
In children, we do draw much less blood.
link |
They have a much lower blood volume.
link |
And we use these tiny little tubes to draw their blood.
link |
And we seemingly get equivalent information
link |
out of the larger tubes we draw from adults.
link |
And I'm still unclear to be honest,
link |
why we can't draw that little amount of blood from adults.
link |
It seems technically possible.
link |
I don't know what the barriers are.
link |
I'm sure there are, or else we'd be doing it.
link |
But I do think that that is a very important goal.
link |
And if Theranos had done it,
link |
it would have really revolutionized the practice of medicine.
link |
So to return to that cadaver,
link |
that first day when you got to meet with the dead,
link |
with a human body that's no longer living.
link |
So how quickly did it take for you to get used to sort of,
link |
you said, looking at the surface muscles of the back?
link |
I mean, that can be overwhelming as a thought.
link |
And people listening to this that have never dissected
link |
anything might be overwhelmed by that thought.
link |
So like, how quickly were you able to get used
link |
to the brutal honesty of the biology before you?
link |
For me, it did not take long at all.
link |
I guess I've never been a squeamish person.
link |
So for me, it was kind of riveting and fascinating
link |
right from the first moment.
link |
But I do know some of my fellow classmates
link |
did have some trouble with it.
link |
Some of them I heard had nightmares in the first few weeks
link |
But then everyone, as far as I know, got used to it.
link |
And that was also actually a big lesson for me
link |
that it's pretty amazing what people can get used to
link |
in their daily lives.
link |
And I kind of extrapolated that to people living through war
link |
and through just terrible situations
link |
and living under oppressive regimes.
link |
And it really is amazing what people can get used to,
link |
Well, you know, in war, people often come back
link |
and they have nightmares.
link |
They suffer through it.
link |
There's a lot of complicated feelings with that.
link |
Are echoes of those same complicated feelings possible
link |
in the case of training to be and becoming a doctor?
link |
That's a good point.
link |
Yeah, I think sometimes, just as a barbed wire fence
link |
can leave a scar on your skin,
link |
emotional, psychological experiences
link |
can leave a mark on your brain or your memory.
link |
And I think that that definitely could be a problem
link |
in medical training.
link |
You do see a lot of things that are very shocking,
link |
very repulsive, things that you'd never forget.
link |
I know one of those students that had nightmares initially
link |
went on to be a surgeon.
link |
So I imagine she's not having the PTSD
link |
of kind of seeing inside her first dead body
link |
because she sees inside them all day, every day now.
link |
But I'm sure it could.
link |
You know, we go on to see so many kind of grosser
link |
or more shocking things in medical training
link |
through medical school and then by working
link |
with actual living patients,
link |
not just dead and embalmed bodies.
link |
So I do think that things can leave a mark,
link |
but I don't think that initial cadaver
link |
would be the most traumatic.
link |
Yeah, but maybe some of that trauma,
link |
the demons make you a better surgeon,
link |
just like some of your own psychological trauma
link |
might make you a better psychiatrist.
link |
Returning to the ordering, is it order or is it chaos
link |
to the ordering of the chapters from throat and heart
link |
and feces and genitals all the way
link |
to fingers and toes and blood?
link |
So I did mention that, you know,
link |
throat was the first one because I kind of wanted
link |
to throw the reader right into the brutal honesty of death.
link |
And I followed it up with feces as the third chapter
link |
and in a way, partly to also throw them right
link |
into the deep end of how I like discussing parts
link |
of the body and revealing their gross
link |
and fascinating aspects.
link |
So I didn't want to hide anything.
link |
You know, when you train to be a doctor,
link |
everything is on the table, literally in the cadaver lab,
link |
but also just, you know, you deal with blood
link |
and piss and vomit and feces.
link |
And that's kind of the medium of your craft.
link |
And yes, the medium of the craft, that's right.
link |
Like if you're a painter, this is the paint.
link |
And then you have to create a masterpiece with it.
link |
Like almost like a dance because there's multiple painters.
link |
One of the painters is the biology.
link |
So let's return to throat.
link |
You mentioned it's a weird one.
link |
So first of all, a friend of mine said,
link |
I just see humans as like a bunch of holes
link |
that just walk around.
link |
It's a funny way to look at humans.
link |
So we have ears, we have nose, we have mouth,
link |
we have the sexual holes, vagina, penis.
link |
And then, you know, what's the medical term
link |
This is a very technical discussion.
link |
The rectum's further in, don't confuse the two.
link |
Oh, that's very important.
link |
Is there a difference between throat and mouth?
link |
By the way, so when you say throat,
link |
are we talking about when that hole actually becomes tubular?
link |
The throat I would count as just sort of the very back
link |
of the back of the mouth, where the nose also comes down
link |
and meets it, where the tonsils are and the uvula.
link |
But you're right that we are a bunch of holes.
link |
But more accurately, we're a tube, right?
link |
We start in the womb as kind of this microscopic little disc,
link |
almost like a flatbread.
link |
And then we roll almost like a burrito into this tube.
link |
And we're a simple microscopic tube.
link |
And from there, we grow into this bigger and bigger tube
link |
and we become more complicated.
link |
And each end of the tube does split into various holes.
link |
So all the holes you mentioned at the front end of the tube,
link |
the front end of our body, right?
link |
It splits into the nose, the mouth, the ears, the sinuses,
link |
the tube to the lungs, which is the windpipe,
link |
the tube down to the stomach, which is the esophagus.
link |
And then the other end of the tube splits as well.
link |
Men end up with two holes and women end up with three holes.
link |
The urethra, the vagina, and the anus, and men.
link |
The urethra and kind of the reproductive system,
link |
they share a hole.
link |
So I'm learning a lot today.
link |
It really is incredible that you start from a sperm and an egg
link |
and you have some DNA information.
link |
And from that, the building project begins.
link |
And then what that leads to is like pizza dough
link |
and then you roll it into a tube.
link |
And that tube then eventually sort of becomes
link |
more and more complicated and gets eyes and a brain
link |
and then can create a Twitter account.
link |
So it's really incredible that we're just a fancy tube.
link |
And we sprout eyes and a brain and a sense of smell
link |
and taste pretty much to regulate what comes in
link |
the front of the tube.
link |
We don't wanna eat anything dangerous or poisonous.
link |
We wanna choose what we eat, even choose who we kiss.
link |
Well, we seem to be motivated by what comes out
link |
of the tube as well in part.
link |
That's not just output, it's a feedback mechanism seemingly.
link |
Like we're also monitoring the functioning of the output.
link |
We're not just obsessed about the input.
link |
We're very obsessed with the output.
link |
You're absolutely right about that.
link |
People have medical complaints about their output
link |
very often that are, I never cease to be surprised
link |
by a new kind of complaint or observation about the output.
link |
I think people have gone to wars over the output
link |
and maybe sometimes the lack of the output
link |
or the desire for output for the particular other humans
link |
that you fancy, the brain and the eyes that sprouted
link |
somehow convinced the rest of the body
link |
that this one particular other tube is fanciful.
link |
So you're going to go to major wars
link |
and lead global suffering because of the fancy
link |
and the desire for additional output with the other tube.
link |
Okay, so on the throat, that part of the tube,
link |
is it, you said the design is not,
link |
you could have thought of maybe a little bit better options
link |
because it's too multifunctional.
link |
Is that, can you sort of elaborate
link |
on the multifunctional nature of this part?
link |
Are a lot of parts of the human body multifunctional
link |
or do you find that more specialization
link |
is going to get the job done better?
link |
There is a lot of organs, for instance,
link |
do have multiple functions.
link |
The pancreas is like two organs in one.
link |
One secretes hormones like insulin into the bloodstream
link |
and the other aspect of it secretes digestive enzymes
link |
into the gut to help you digest and absorb food.
link |
The liver is like 15 organs in one.
link |
It's just amazing how many different things it does.
link |
But the throat, so basically the problem with the throat
link |
is as I said, we have two tubes
link |
that are right next to each other in the throat.
link |
One is for food, drink, saliva, mucus, snot,
link |
whatever you're gonna swallow,
link |
all of that stuff must go down the esophagus,
link |
the food tube and end up in the stomach.
link |
And right next to the esophagus millimeters away
link |
is the windpipe or the trachea,
link |
which goes down to the lungs.
link |
And your throat does these daily gymnastics
link |
to keep everything but air out of the windpipe
link |
because you slip up once and you can die.
link |
You can choke, you laugh or speak while eating
link |
and it's curtains, unfortunately.
link |
So it seems like every aspect of the body
link |
when I was learning about it in med school
link |
seemed so brilliant and so perfectly designed
link |
by evolution or whoever you might think designed it
link |
to favor survival, to enhance life,
link |
but the throat seemed the opposite.
link |
It seemed set up almost for failure.
link |
And we developed all these mechanisms as a compensation.
link |
We have the gag reflex whenever food or something
link |
is headed towards your air pipe, your windpipe
link |
or down to your lungs,
link |
your throat has this sort of like rejection of it.
link |
It pushes it away in a gag reflex.
link |
At the same time, we have a cough,
link |
which is something our body does
link |
when something inappropriate does get down the windpipe.
link |
When we get a little food down the wrong pipe,
link |
we end up coughing and the coughing does
link |
usually flush it out and get rid of it.
link |
We even have something called the mucus elevator
link |
in our lungs, which is this constant flow of mucus
link |
up the airways, up to the trachea, dragging with it
link |
all kinds of particulates that we've inhaled
link |
and perhaps some food that went down the wrong pipe
link |
and drags it up into the throat and we swallow it
link |
kind of unconsciously all day, every day is the truth.
link |
Even the mechanism of swallowing is super complicated.
link |
It uses a number of cranial nerves.
link |
It uses over 15 different muscles.
link |
It's this coordinated act to keep food out of the airway.
link |
You can see someone's Adam's apple in their neck
link |
kind of jump upward when they swallow,
link |
which helps lift the airway up against the epiglottis,
link |
which plugs it closed and allows food or swallow drink
link |
to kind of skirt just past it.
link |
But every time we swallow, those things do come
link |
within millimeters of going down the wrong pipe
link |
and it's just thanks to these kind of compensations,
link |
these adaptations we have to the danger of the throat
link |
that keeps us alive.
link |
As I actually took a sip of water,
link |
it's kind of, it makes you appreciate
link |
the wonderful machinery of it all.
link |
By the way, we have pulled up your Instagram
link |
that people should follow.
link |
You have a post about the throat
link |
and just showing so many different components
link |
from the tongue to the trachea, the esophagus,
link |
just the entire machinery of it all.
link |
The teeth for the chewing, it's so interesting.
link |
And so a lot of the structure of this,
link |
the anatomy and the physiology,
link |
does it echo other mammals?
link |
Are we just basically borrowing a lot of stuff
link |
from evolution and maybe making small adjustments
link |
maybe due to the fact that we're not using our mouth
link |
to murder things as other predators might?
link |
We use our thumbs.
link |
Exactly, we have hands, we don't need to bite them.
link |
Yeah, there's a lot of overlap between different animals
link |
which I find very comforting and fascinating.
link |
Someone asked me, is there any animal
link |
in which the throat is better designed?
link |
And my first thought was whales
link |
because the blowhole's kind of up on the top of their head.
link |
So I was thinking, oh, maybe they are more separate.
link |
But when I looked into it, actually no,
link |
the paths do come very close, just like in us.
link |
And I saw a paper about some new discovered organ
link |
that actually helps keep food and drink
link |
out of the airway in whales
link |
that they hadn't ever noticed before.
link |
So it's a different mechanism,
link |
but the same kind of basic problem is that
link |
we're tubes and the air tube and food tube
link |
are right next to each other.
link |
How well do we understand,
link |
so just even linger on this little part,
link |
is there still mysteries about the complexity
link |
You mentioned just even for swallowing
link |
all these parts in the brain that are responsible
link |
and all the different things that have to,
link |
like an orchestra play together.
link |
Do we have a good sense from both a medical perspective
link |
and a biology perspective or is there still mysteries?
link |
There's definitely still mysteries.
link |
We understand a lot about, for instance,
link |
how the swallowing mechanism is coordinated
link |
sometimes using some higher levels of the brain,
link |
but it is a very thoughtless thing
link |
as you mentioned when you drank the water.
link |
It's not something we have to think about, thankfully,
link |
or we'd be thinking about it all day.
link |
There's a lot we don't understand
link |
about the basic mechanisms,
link |
perhaps about how the nerves fire
link |
and how they kind of coordinate on the microscopic level,
link |
how ions rush into and out of nerve cells
link |
to kind of create that electrical signal,
link |
but we sure understand a heck of a lot
link |
and it's very fascinating.
link |
So, moving on to chapter two and we'll jump around.
link |
And you actually said the liver does a lot of things.
link |
I also saw you retweet something
link |
where it said, you know,
link |
showing that the liver is bigger than the heart,
link |
which is the body or the universe's way of saying
link |
you should drink more and care less,
link |
which is a good line.
link |
So, you give props, like you said, to the kidney,
link |
to the liver, to the maybe, to the organs,
link |
to the parts that don't often get as much credit
link |
as they deserve, but let us go for time to the human heart.
link |
We get chest pain.
link |
We talk about it when we talk about love for some reason.
link |
Why do we talk about the heart when we talk about love?
link |
There sometimes can actually be
link |
some chest pain involved in love.
link |
I remember when I was a med student,
link |
I was very smitten with another medical student
link |
who was totally brilliant and beautiful.
link |
And it actually does cause
link |
this kind of burning in your chest.
link |
I don't know what that is.
link |
I don't think it's from the heart itself.
link |
I don't know if it was like acid reflux
link |
because I was so nervous.
link |
I'm not really sure,
link |
but I definitely felt something in my chest
link |
whenever I saw her.
link |
I don't know what that is,
link |
but you could see why someone might think,
link |
oh, you know, maybe it is your heart.
link |
That's kind of the most prominent organ in your chest.
link |
When people come to the ER with chest pain,
link |
the big question is, is it my heart?
link |
And that's my main job is figuring out if it is or not.
link |
So I could see why.
link |
The way ancients saw the functions of different organs
link |
is fascinating, but often hard to explain.
link |
Would it be fair to say
link |
that if you look at the entirety of human history,
link |
the way most people die has to do with the heart?
link |
Well, like in America today,
link |
cardiovascular disease and coronary artery disease
link |
is one of the most common,
link |
perhaps the most common cause of death.
link |
You know, 100 years ago, 200 years ago,
link |
it was probably not.
link |
People were not living as long
link |
and people were dying of infections
link |
that we tend to die less of these days.
link |
Sure, that's true, but in terms of things to stab,
link |
so I'm trying to sort of introspect
link |
like why talk about the heart and love?
link |
My thought would be that it's because
link |
the heart was seen as the most important organism.
link |
It would be like the origin of life comes from the heart.
link |
The originator of life and the way you figure that out
link |
from sort of an ancient perspective
link |
is when you stab things,
link |
what is likely to lead to issues?
link |
It's like, it's possible to imagine
link |
that the brain is not as special as we might think
link |
from when you don't understand modern biology
link |
or physiology or neuroscience, all those kinds of things,
link |
especially because pain, you know, it's painless too,
link |
if you stab it, the brain, I mean.
link |
Yeah, anyway, so that's really interesting.
link |
I'm sure there's a kind of a poetic answer to
link |
maybe the way people wrote about it,
link |
but what to you is the wisdom in the design of the heart?
link |
I mean, the main function of the heart basically
link |
is to push blood through the cardiovascular system,
link |
through the branching blood vessels
link |
to feed every cell in the body.
link |
You know, when I believe our ancestors
link |
started off as single celled organisms
link |
floating in some ancient brew,
link |
and they were surrounded by the medium
link |
that would bring them all the nutrients they needed,
link |
so there's no issues there.
link |
And then once you start getting multicellular organisms,
link |
the kind of that are thicker and the ones on the inside
link |
aren't in contact with that sort of nutritious brew
link |
that they're growing in,
link |
you kind of need a way to distribute those nutrients
link |
to every cell, and so that's what the heart
link |
and the branching vascular tree do.
link |
So the heart, you know, it's the biggest disconnect
link |
between how the organs talked about in poetry
link |
and through history versus its actual function
link |
is probably the heart,
link |
because we ascribe all these things like love and passion
link |
and life itself sometimes to the heart,
link |
but actually it's just a simple mechanical pump,
link |
you know, that's all it is.
link |
I don't wanna downplay it, it's amazing,
link |
but you know, it just pushes.
link |
It fills with blood and then squeezes it,
link |
fills with blood and squeezes it,
link |
and just that squeezing, that pushing,
link |
creates the blood pressure that you need
link |
to get blood to every cell in your body,
link |
especially when you're standing upright
link |
to get blood to your brain,
link |
you need a certain amount of pressure to get it up there.
link |
Isn't it amazing to you how much volume of blood
link |
just gets pushed through by this pump?
link |
Absolutely, they say every red blood cell
link |
takes about five minutes to circulate
link |
and come back to the heart,
link |
and that circulation kind of starts in the womb
link |
and continues kind of until the moment that we die,
link |
but the volume is tremendous,
link |
and it can never take a break, basically.
link |
And it's sort of propagating all kinds of stuff
link |
throughout the body, it's a delivery mechanism,
link |
blood for all kinds of good stuff and bad stuff,
link |
nutrition, drugs, all that.
link |
Right, medications too.
link |
Medications, such a fascinating design.
link |
And it also takes the waste away,
link |
it kind of brings the nutritious stuff,
link |
brings the nutrients, especially oxygen,
link |
but many other things, and then it also,
link |
as it passes the cell, takes the cell's waste,
link |
so it's sort of the fresh water
link |
and the sewage system in one.
link |
So about blood, what do you use fascinating about blood?
link |
So we talk about the pump that spreads the blood,
link |
but the blood itself.
link |
Right, so the blood itself is sort of,
link |
I mean, it's the most important bodily fluid, of course.
link |
From moment to moment, every cell in the body
link |
needs a flow of blood to bring it,
link |
most importantly, oxygen, but also, again,
link |
all the other nutrients and to take away waste,
link |
and if that stops for even a few moments,
link |
you can be in big trouble.
link |
So blood is sort of the most important medium.
link |
It's also, doctors use it to kind of evaluate the body.
link |
It does have this kind of all seeing quality to it,
link |
where we can evaluate organs through the blood.
link |
I can tell you about your liver, your heart, your kidney
link |
just by taking a sample of your blood.
link |
So it's sort of like this crystal ball in a way,
link |
and we use it kind of all the time
link |
to assess someone's health, to assess their disease.
link |
Is it also the attack vector for diseases,
link |
for bacteria, for viruses and all that kind of stuff?
link |
So viruses seem to attack either the throat,
link |
maybe you can correct me,
link |
but they seem to attack different parts of the body,
link |
depending on how easy it is to access
link |
and how easy it is to get in deep,
link |
depending on what you prefer.
link |
If you want to do a little bit of hard work,
link |
but you get in deep,
link |
or you don't want to do the hard work,
link |
but you don't get in deep,
link |
those are the choices viruses have.
link |
But is blood one of the sort of attack vectors?
link |
What's like, if you were trying to break into the human body,
link |
like a parasite, a virus, a bacteria, how would you do it?
link |
Like what would be the attack vectors you would explore?
link |
Right, so you got to look for the body's weaknesses,
link |
of course, you know, we have inherent weaknesses,
link |
for instance, like our respiratory tract,
link |
we have to breathe,
link |
we have to get air in from the outside.
link |
And so that's one of the entries into the body.
link |
And so, you know, when we inhale,
link |
let's say a poisonous gas, you know,
link |
it's an easy way in, you have to breathe,
link |
can't hold your breath very long,
link |
but, you know, air in our lungs is still kind of contiguous
link |
with the external atmosphere,
link |
it's not really inside the body until it does cross
link |
across the lining of the alveoli into the blood,
link |
as you said, that's when it really gets inside.
link |
And the other besides the respiratory tract,
link |
the gastrointestinal tract is another way,
link |
kind of a chink in the armor,
link |
you know, we have to eat, we have to drink,
link |
and therefore we're taking the external world
link |
into ourselves, into our gut,
link |
in order to extract from it what we need
link |
and let the rest kind of flow out.
link |
So those two, the gastrointestinal and respiratory tract,
link |
you know, there's a reason that, you know,
link |
respiratory tract infections
link |
and gastrointestinal infections are kind of the most common
link |
that afflict us because those are the ways in to the body.
link |
So I would definitely pick one of those,
link |
not just be a lazy cold in the nose,
link |
but really a more aggressive pneumonia down deep
link |
in the lungs and get across that barrier into the blood.
link |
But also the whole sex thing that humans do.
link |
So speaking of which, let us go for time
link |
to the genitals chapter.
link |
So what are genitals?
link |
I think I've heard of those.
link |
I think I've read about a penis and a vagina.
link |
Can you explain to me how those work?
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Just asking for a friend,
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but also what do you use fascinating about it
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and maybe what's misunderstood or little known about them?
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Sure, so they're very unique organs, I would say.
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One of the things that I like to point out is that,
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you know, while every organ from moment to moment
link |
keeps us alive and ensures our survival,
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the genitals are in a way the opposite.
link |
You know, we don't need them from moment to moment.
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You don't even have to use them at all.
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And in fact, they often make us do stupid things
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that are the opposite of kind of enhancing survival.
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So, and they, you know, they've affected the brain
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and you can become sort of focused and nuts
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based on those desires that kind of stem from the genitals.
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So they can be dangerous organs too.
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But you know, I mean, sexual dimorphism
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helps with genetic variability,
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as it does in so many other organisms.
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You know, you take two people
link |
and mix them together, their genetics,
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you just get a lot more variation
link |
and more opportunities to try different genetic codes
link |
and see what'll enhance survival
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as we talked about sex and death.
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I talk about in the book, a lot of,
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for instance, the female genital tract,
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how the uterus is very unusual
link |
because, you know, it doesn't even sort of wake up
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and start doing its thing until the second decade of life.
link |
You know, it's even though babies,
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female babies are born with all of the eggs
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they'll ever have in their ovaries already.
link |
They're just sort of in this stasis
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until they start waking up kind of once a month.
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And it's this cycle, you know,
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there's so much in our bodies that are cyclical and rhythmic,
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the heartbeat, the breathing, but menstruation
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is kind of a very strange rhythm
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that takes over a decade to start.
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And only, you know, the rhythm beats once a month,
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which is very slow compared
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to every other rhythm of the body.
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The other unusual thing is, you know, in medicine,
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when rhythms of the body cease, when they stop,
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those are emergencies, right?
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When your heart stops, that's a cardiac arrest.
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You need CPR, maybe an electric shock to restart it.
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When your breathing stops, you know,
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you need a breathing machine to breathe for you
link |
or something to reverse whatever might be causing
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the suppression of your breathing.
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But when menstruation stops,
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it's the point of menstruation in the first place.
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The whole reason that the uterus grows a lining
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and sheds it each month is to one day, you know,
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get fertile, the ovum to get fertilized
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and for it to implant in the lining,
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and then the rhythm ceases.
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And that's obviously not a medical emergency,
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unlike most other rhythms, you know, cessations,
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it's the point of the whole thing in the first place.
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So these particular penis and vagina are that whole thing,
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the uterus, whatever.
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Am I not using the wrong terms?
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I'll just keep saying.
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You use those terms.
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There's more technical, there's parts, various, various parts.
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In medical school, you learn every bump
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and, you know, every little part of every little organ
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including the genitals, so.
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I never really thought of it this way, as you said,
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is that most organs are kind of full time employees.
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Like 24 seven, they're doing something.
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And then there's some organs,
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penis, vagina being representative of this,
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they're not functioning all the time.
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They're only functioning every once in a while
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and then get us to do stupid stuff or awesome stuff
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and all that kind of stuff.
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But they're not essential for human survival
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on a second by second basis.
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And that the whole cyclical nature of the human body,
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how many other cycles are on a monthly basis?
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Like that far apart.
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That's a fascinating design
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that the human body would do that
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and wouldn't start until the second decade of life.
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It's almost like, what do I want to say?
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There's some kind of meta planning going on.
link |
Like this is the optimal solution
link |
for the sexual selection mechanism
link |
among like somewhat intelligent species.
link |
Like it's useful to after the brain has developed
link |
sufficiently long to now be making
link |
sexual selection decisions.
link |
Like you need time for this computer,
link |
this really powerful computer to load in the info.
link |
You also need the body to develop.
link |
A child simply isn't big enough
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to be pregnant and deliver another baby.
link |
I wonder if there's animals in which this happens
link |
at a much more accelerated pace in different stages.
link |
Definitely, especially certain kinds of insects,
link |
like Drosophila, a lot of the fruit fly,
link |
a lot of experiments are done on
link |
because their life cycle is so rapid.
link |
A lot of kind of insects and other creatures
link |
are almost ready to mate as soon as they're born.
link |
Is there any improvements to the design?
link |
So a lot of people are very interested
link |
in these particular body parts.
link |
If you were to sort of step back
link |
as a geneticist, biological designer,
link |
or maybe a computer scientist, computer engineer
link |
trying to build human 2.0 or maybe a robot,
link |
how would you improve the penis and the vagina?
link |
Well, the penis for starters,
link |
I mean, let's also discuss the testicles.
link |
They're very important too.
link |
Okay, so they're fragile and they're important
link |
and yet they're hanging off the body in danger basically.
link |
So does that make sense?
link |
You know, they begin in the womb,
link |
they begin inside the abdomen and they slowly descend
link |
and sometimes before birth,
link |
sometimes in the first year of life, sometimes never,
link |
they pop out of the body and end up hanging in the scrotum.
link |
There's a reason because the chemical reactions
link |
that create sperm function best
link |
at a few degrees cooler than body temperature.
link |
And so that's why you might notice in the warm weather,
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they might hang further down and in the cold weather,
link |
they scrunch themselves up to get closer to the body
link |
to maintain that ideal temperature a few degrees cooler.
link |
So it's hard, you know,
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if you could create a sperm production mechanism
link |
that did not rely on that lower temperature,
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that would be great.
link |
Keep them inside the body protected like the ovaries are.
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Oh, then you wouldn't rely on the lower temperature.
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I thought you meant create some kind of weird internal
link |
cooling mechanism.
link |
No, well, I guess that would be one solution,
link |
but just maybe a different type of chemical reaction
link |
or, you know, would not be reliant
link |
on the lower temperature, let's say.
link |
You know, it'd be great to design a spermatogenesis
link |
or a sperm production process that would function best
link |
at body temperature and then we can keep
link |
those delicate organs inside the body
link |
and not have them hanging out in danger.
link |
Or maybe the argument for this design
link |
is maybe it's nice to put them in danger
link |
so you are constantly concerned about it.
link |
Could be, maybe that's beneficial for male psychology,
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I'm not really sure.
link |
There's a psychological element here
link |
about the evolution that could be.
link |
So that's the testicles.
link |
A better way to do it, you know?
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I mean, it's pretty good as it is.
link |
You know, it kind of, when it's time for it to work,
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it grows and stiffens and when it's time for it not to work,
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it kind of shrinks and hangs out.
link |
Saw this on a Seinfeld episode, so I know how it works.
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Yeah, that was a good one.
link |
But you know, that's also a bit unique,
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I suppose, that the way it has this erectile tissue.
link |
Actually, they're similar in the mouth
link |
of certain baleen whales, there's a certain similar
link |
kind of erectile tissue that helps cool them off
link |
because they have so much blubber
link |
and create so much heat in moving around and feeding
link |
that they have actually a similar,
link |
similar to the penis organ in their mouth
link |
that helps cool their bodies, because it's a big problem.
link |
They have to store all that blubber for fuel,
link |
but it makes them too hot, so as a compensation,
link |
they have this kind of erectile organ in their mouth.
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What about vagina?
link |
You know, the fact that miscarriages sometimes happen
link |
because of sexually transmitted diseases,
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because of trauma, you know, it'd be great
link |
if the uterus where the growing fetus is
link |
is sort of even more protected from those things.
link |
You know, I guess that's a side effect of the fact
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that people still have sex when they're pregnant
link |
or still, you know, exposed to injury.
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If there was a way to make it more protected,
link |
perhaps that would be even better.
link |
I did see an article recently about artificial wombs,
link |
which are rapidly becoming a reality,
link |
and in animal studies, they're able to prolong
link |
the gestation of a fetus by a month in an artificial womb.
link |
Can you explain the artificial aspect
link |
of the artificial womb?
link |
Sure, it's, I believe it acts almost
link |
like a heart lung bypass machine,
link |
so when someone's getting like bypass surgery,
link |
their heart is stopped, literally they throw ice
link |
in the chest and they give a potassium infusion
link |
through the blood, which stops the heart,
link |
but the blood is run through a machine
link |
that basically does the work of the heart
link |
and lungs together, gets oxygen into the blood
link |
and then pushes it back into the body.
link |
So I believe it's a sort of similar mechanism
link |
to keep blood and nutrition flowing to this fetus,
link |
and so it's just not inside the body of a parent,
link |
it's in some kind of other device,
link |
but I think that science is gonna rapidly improve.
link |
One benefit is, you know, babies are born premature,
link |
and while, you know, neonatology is able
link |
to continuously kind of lower the age of viability
link |
through better technology and understanding
link |
how, what you can, medicines and other things
link |
you can do to premature babies when they're born,
link |
you know, ideally, if let's say premature labor begins,
link |
you can't stop it, that baby's coming out one way
link |
or the other, if you could just then stick it
link |
into an artificial womb where it can continue
link |
its development, that would save a whole host
link |
of problems, often those babies born very early
link |
suffer from damage to various organs,
link |
including the brain, you know, for the rest of their life,
link |
so that could be a very important technology.
link |
So some aspects of the human body,
link |
we can develop technologies that outsource them,
link |
sort of offload some of the stress
link |
and the workload from the human body to do it elsewhere.
link |
Like dialysis does that for kidneys, you know,
link |
people can live decades without kidneys
link |
as long as they get dialysis, which does the work for them.
link |
Not every organ can do that, for instance,
link |
the liver, there's no dialysis version for the liver,
link |
like if your liver fails, you need a liver transplant
link |
and that's the only thing that's gonna do it for you.
link |
So that's the world's first artificial womb for humans
link |
and we're looking at a picture of what looks like
link |
gigantic balloons.
link |
Matrix, here we come.
link |
This is very matrixy.
link |
How are they floating?
link |
What are we even looking at?
link |
There's giant red spheres.
link |
This really looks like the matrix.
link |
I wonder where it's from,
link |
so there seems to be a paper on this too.
link |
I don't know too much about it, but I did see that there,
link |
it's advancing very rapidly.
link |
The world's first artificial womb for humans.
link |
Scientists in the Netherlands say they're within 10 years
link |
of developing an artificial womb
link |
that could save the lives of premature babies.
link |
Premature birth before 37 weeks is globally
link |
the biggest cause of death among newborns,
link |
but the development also raises ethical questions
link |
about the future of baby making and so on and so forth.
link |
Wow, we're going to be facing a lot of ethical questions
link |
as we start to mess with human biology.
link |
In an effort to help human biology,
link |
we might start to mess with it.
link |
That's going to be very interesting.
link |
Let's take steps towards the matrix.
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All right, what about the neighbors, poop, feces?
link |
There seems to be a lot of interesting stories
link |
in that particular output as well.
link |
What to you is fascinating?
link |
What to you maybe is misunderstood
link |
or little known about poop?
link |
Well, it's hilarious, for one thing, that we do it.
link |
The word is great as well.
link |
There's so many different words.
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I do, when I'm talking to the parents
link |
of pediatric patients, I use the word poop.
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I don't often, when I'm talking to adult patients,
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try to choose a more mature word.
link |
But poop is amazing.
link |
I mean, I guess it's sort of the dirtiest, the most vile,
link |
the most hated aspect of our bodies.
link |
It's the grossest, we don't want to think about it,
link |
talk about it, have it anywhere near our food
link |
or in social interactions with good reason.
link |
I mentioned gastrointestinal infections
link |
are one of the most common infections
link |
the human body suffers from.
link |
And the way they spread from person to person,
link |
grossly enough, is referred to as the fecal oral route,
link |
which means a bit of someone's stool
link |
is getting into your, you're swallowing it,
link |
through water supply.
link |
For instance, diarrhea is actually quite
link |
a brilliant mechanism of these microbes, right?
link |
If you, let's say you're in the intestine of one person,
link |
your goal is to get into the intestines of another person.
link |
Brilliant to just trick their intestines
link |
into secreting all this fluid into the intestines
link |
to increase the volume of stool and its runniness
link |
so that when they do poop, it gets into the water supply
link |
and then everyone else kind of ends up
link |
getting infected as well.
link |
Wow, that's brilliant.
link |
Just the same way like tuberculosis or coronavirus
link |
kind of infects your lungs and makes you cough
link |
and you send it out into the air
link |
and it ends up in other people's lungs.
link |
And that's all evolution.
link |
Yeah, it's brilliant.
link |
So diarrhea is intelligent, is a big takeaway lesson.
link |
It's one of the most intelligent things we can do
link |
as an entirety of an organism,
link |
not just the particular cognitive organism,
link |
but there's, we're made up of bacteria and viruses
link |
and there's a lot of visitors and so on.
link |
As the entirety of the system,
link |
diarrhea is one of our better accomplishments.
link |
Well, I wonder, why is poop funny?
link |
I think a lot of that is socially constructed,
link |
just how it's sort of supposed to be hidden away
link |
yet something we always do,
link |
something we chuckle about as children.
link |
But even in healthcare,
link |
it becomes this big topic of conversation
link |
because you end up talking about it constantly.
link |
Like in the ER, people come in,
link |
they're complete strangers.
link |
Sometimes like a nice old lady who resembles my grandmother
link |
and all of a sudden I have to ask her all about
link |
what's happening in the bathroom.
link |
Like, is she straining?
link |
What's the consistency?
link |
Does it float on top of the water more than it should?
link |
Is it hard to flush?
link |
I mean, there's a million different questions you learn
link |
as a medical student and you're like this poop detective
link |
when people come in with issues.
link |
And so it's funny, I guess,
link |
in the exam room with the doctor patient relationship,
link |
there's sort of no barriers.
link |
You talk about everything
link |
and you're talking about the most intimate details
link |
of a person's life,
link |
even though you just met them a second ago.
link |
It's so different than normal social interactions.
link |
Yet there is this social aspect.
link |
A lot of what I do is social.
link |
It seems like doctors, what they do is mostly scientific,
link |
but actually it's just relating to another person
link |
and you have to maintain your professional demeanor
link |
and this normal human level interaction,
link |
even though you're talking about poop.
link |
And that's a skill, that's an art and a science.
link |
Well, okay, actually I wanna linger on that
link |
because I'm a fan of just diving into conversations
link |
right away with strangers, just getting no small talk.
link |
And this is the ultimate, I don't know if it's the ultimate,
link |
but it's one version of no small talk.
link |
You get right to the point.
link |
That's really powerful from a psychology perspective.
link |
You're a kind of therapist
link |
or you have the power to be a therapist.
link |
I don't mean just about the medical condition of the body,
link |
but the psychological.
link |
There's so much fear connected to this concern.
link |
Also, self doubt, insecurities,
link |
even sort of existential thoughts about your mortality,
link |
all of those things are right there in the room.
link |
So I think one way doctors deal with that
link |
is they kind of have this cold way about them.
link |
They almost have like dual mode.
link |
One is like, I'm going to be friendly on the surface
link |
and cold about the brutal honesty of the biology.
link |
But I wonder if there's like a skillful middle ground,
link |
this dangerous place where you can help people
link |
deal with their psychological insecurities,
link |
concerns, fears, all those kinds of things.
link |
Is that just really tough to do?
link |
Yeah, it's a huge part of being a doctor
link |
is dealing with the psychological aspects
link |
of whatever's going on with the patient's body.
link |
I mean, in the ER, you deal with psychiatric emergencies
link |
kind of left and right more than ever these days.
link |
And that's a huge issue,
link |
not to mention sort of drug use, alcohol related stuff,
link |
that gets into sort of psychology
link |
and the human love of intoxicants
link |
and changing the brain's chemistry and habit, of course,
link |
we're creatures of habit and that plays in as well.
link |
I mean, a big part of, for instance, pediatrics
link |
is reassuring parents and kind of convincing them,
link |
giving them the confidence that what's going on
link |
with their child is not serious, will go away on its own,
link |
does not need any particular intervention.
link |
And, but adults too, reassurance is a huge part of the game.
link |
Yeah, in the ER, you see humanity at its most raw.
link |
I feel like you get this tremendous insight into people,
link |
how they live, what they worry about,
link |
what they think about, how their body works
link |
and also how their mind works
link |
that you almost don't see anywhere else.
link |
It's a really interesting place to work.
link |
And also the way our society is shaped,
link |
the ER is where people go for almost everything.
link |
When they're suicidal, they come to the ER.
link |
When they're too high on drugs to walk, they come to the ER.
link |
Children who have been abused, sexually abused,
link |
physically abused, come to the ER for us to investigate.
link |
It's sort of like the all purpose waste bin
link |
for the dregs of society, what people do to themselves
link |
and what they do to other people.
link |
You mentioned you're interested in the darkness of humanity
link |
and made me think of the ER where you really see
link |
what human life is like in the ER.
link |
Okay, you tweet about, you write about,
link |
you think about the emergency room ER.
link |
That's really fascinating.
link |
Just the little window you give to that world
link |
What lessons about humanity do you draw
link |
from this place where you're so near to death?
link |
There's so much chaos.
link |
There's so much variety of what's wrong.
link |
So little information or the urgent nature
link |
of the information inflows such that you can't really reason
link |
sort of thoroughly and deeply and collect all the data,
link |
all those kinds of things.
link |
You have to act fast and then everybody's freaking out.
link |
Can you just speak to the human condition
link |
that you get a glimpse at through the ER experience?
link |
Yeah, I think you do see all those things.
link |
I think on one end of the spectrum,
link |
it is this very unique place
link |
where you get all these unique insights.
link |
On the other end, it can become a ho hum workplace
link |
just like any other, which is sort of surprising.
link |
As I mentioned before, humans seem to be able to get used
link |
to almost anything and doctors can get ho hum used to,
link |
oh, dying of a heart attack, oh, actively in labor
link |
and the baby's half out.
link |
Oh, just ho hum, I know what to do, going about my job
link |
and go home and have dinner with my family
link |
and not think too much about it.
link |
I do try to maintain both my fascination.
link |
I think writers in general tend to think more
link |
about what they see, write more about what they see,
link |
maybe draw connections with what they see to other things.
link |
So I do think that writer's perspective
link |
does help me kind of maintain my fascination
link |
and my kind of more of an insightful perspective
link |
than just a ho hum, water cooler conversation.
link |
But you do see a lot.
link |
In a way, medical problems are sort of
link |
the great equalizer, right?
link |
Class, race, culture, background,
link |
the failings of the human body, the way it fails
link |
and what we can do to help in those situations
link |
is almost universal.
link |
I always like this quote from, Chekhov was a doctor
link |
and a writer and he treated a lot of peasants
link |
very low class and also treated a lot of aristocrats.
link |
And he wrote that they all have the same ugly bodies
link |
basically, which I think is really right on.
link |
And it's sort of, you can see people
link |
underneath a superficial layer of clothing,
link |
maybe it's the most expensive clothing
link |
bought from the fanciest places,
link |
but underneath their body is still failing in the same way
link |
and they still have the same anxieties, the same worry
link |
about mortality, the same concerns about why their poop
link |
turned green today, all these things
link |
that they bring to the table.
link |
So in a way, it is this great equalizer
link |
where people are kind of all the same in some ways.
link |
Yeah, I feel like people sometimes, class, money,
link |
fame, power, makes you for a time forget
link |
that you're just a meat vehicle.
link |
And just as good and just as bad
link |
as the other meat vehicles all around you.
link |
In that sense, there's this question sometimes raised,
link |
are some people better than others?
link |
And I usually answer no to that question because of that.
link |
Yeah, some people might be better at math,
link |
some people might be better at music.
link |
But in the end, we're just meat bags.
link |
Beautiful as we are.
link |
There's a poem that just, a small tangent I want to take,
link |
I just saw it, Just Acting, that you have written.
link |
I have to, would you classify it as a poem?
link |
At first, if I may read it, at first you enter the clinic,
link |
shoulders weighed down by white coat pockets,
link |
book stuffed, timid, you act out a role,
link |
your white coat, a costume, your questions, a script,
link |
your demeanor, a rehearsed act.
link |
No one is going to buy this.
link |
But then, as you play the role again and again,
link |
repeating the lines and the motions,
link |
the script slowly dissolves
link |
and the interaction becomes thoughtless.
link |
And the rehearsed act slowly fades into a profession.
link |
You suddenly find yourself unable to tell
link |
if you're still acting or if you're doing it for real.
link |
And now you're a doctor.
link |
Jonathan Reisman, MD, Harvard,
link |
Massachusetts General Hospital of Medicine
link |
and Pediatrics Department.
link |
Beautiful, so that is what it is to be a doctor.
link |
You're just acting.
link |
Fake it till you make it.
link |
Exactly, fake it till you make it.
link |
And I think, I imagine every medical student
link |
has this feeling when they first go into a room.
link |
Like I talked about asking this nice old lady
link |
about the color of her poop for the first time
link |
and you're just like, what am I doing here?
link |
Like, does she believe I'm a doctor?
link |
You know, this just feels absurd.
link |
But then it's, again, ho hum, becomes normal.
link |
Now there's not a sperm chapter in your book.
link |
You mentioned offline that this is a second and a third book
link |
that you're working on all about sperm.
link |
No, I'm just kidding.
link |
But, or maybe I'm not.
link |
Humor tends to make way for reality.
link |
So the tweet was that a human, an average human male
link |
produces 500 billion sperm, I believe,
link |
which is about four to five times more
link |
than the number of people who have ever lived.
link |
And each of those sperm is genetically unique
link |
so you can think of them, you can kind of imagine
link |
the possible humans they could have created.
link |
And they're all different.
link |
They have similarities, of course,
link |
but they have peculiarities that make them different.
link |
And you can think of all the different trajectories,
link |
all the Einsteins, the Feynmans, the Hitlers,
link |
and all the people who would have died during childbirth,
link |
would have died early in their years
link |
given the different diseases.
link |
It's fascinating to think about.
link |
An average human, yeah, we're all winners
link |
of a very competitive race.
link |
So the people who make it, we're winners, hashtag winning.
link |
Is there something that you find fascinating,
link |
interesting, beautiful, ugly, surprising about sperm?
link |
I think sperm is, yes, it is a very interesting bodily fluid.
link |
Maybe I'll write about it in a second or third book,
link |
we'll see, but I guess sperm is interesting
link |
because it's kind of the only projectile bodily fluid
link |
Vomit can be projectile.
link |
Usually that's a diseased state.
link |
That's not the expected kind of normal healthy state.
link |
Oh, sneezing, would you classify that or no?
link |
True, I guess it's, yeah, there's some particles in the air.
link |
I guess it's not a fluid, I mean, not a liquid, but true.
link |
I mean, cough, in addition to sneeze, right?
link |
Sneeze is how our nose gets rid of something
link |
that shouldn't be there.
link |
Cough is how our lungs get rid of something
link |
that shouldn't be there.
link |
Vomiting is sometimes how our stomachs
link |
get rid of something that shouldn't be there.
link |
All projectiles sometimes in their own way.
link |
Sperm is sort of interesting.
link |
It's created with the food for its journey.
link |
Sperm mostly feed off of fructose, a kind of sugar,
link |
for the few days that they live inside
link |
the female genital tract.
link |
But it's sort of, I like comparing our genitals
link |
to the genitals of the plant world, which is flowers,
link |
and in the same way that a touch me not, for instance,
link |
the kind of flower where when you brush up against it,
link |
it sort of launches seeds into the distance
link |
to try to survive in a way kind of the sperm
link |
is doing something similar,
link |
launched into the female genital tract,
link |
and then all trying to find this,
link |
competing against each other to find this egg.
link |
It's really amazing.
link |
And when you learn about it from the biological perspective,
link |
the most amazing thing is how many things can go wrong,
link |
just in the sperm not surviving long enough
link |
for it making it to the egg,
link |
and then some genetic abnormality causing a miscarriage.
link |
It's sort of astounding that it works as often as it does,
link |
and I think the lesson there is just that
link |
people have a lot of sex, and so statistics just favor
link |
it's gonna work out a good number of times.
link |
Yeah, and there might be intelligence in the design
link |
of just the sheer number of sperm.
link |
Maybe that's yet another way
link |
to inject variety into the system.
link |
And redundancy, I guess.
link |
We have two kidneys, we have two hands.
link |
If we lose one, we can still go on.
link |
We have however many millions of sperm
link |
get sort of launched in every ejaculation
link |
is if a bunch fail or don't make it inside.
link |
There's papers on this, by the way,
link |
that I read for some reason.
link |
Not read, but skimmed for some reason,
link |
which is talking about which sperm usually wins.
link |
Like what are the characteristics of sperms
link |
that are winning, and it's not the fastest.
link |
So apparently there's some kind of slaughter
link |
that happens early on, people will correct me,
link |
but it's not the fastest.
link |
There is an aspect of it's the luckiest.
link |
It really is, like the body tries
link |
to make it a random selection.
link |
It tries to make it fair in making it as random as possible.
link |
Interesting, and also interesting
link |
that they're fueled by fructose.
link |
I didn't really think about that.
link |
So they're a carb loaded athlete.
link |
Right, with food for the journey.
link |
Food for the journey, because I'm somebody
link |
that actually does a lot of running on,
link |
I guess you would call me a fat adapted athlete.
link |
So I do sort of meat heavy diet.
link |
And so you could do a lot of endurance kind of stuff
link |
when you don't need any carbs, any glucose,
link |
any of that kind of stuff.
link |
And you're very low.
link |
It's interesting to think that sperm are like,
link |
nope, they're total bros.
link |
Let's go to the gym, sprint, performance,
link |
short term performance is everything.
link |
All right, well, that sperm, returning to the liver,
link |
the place that deals with all our poor decisions.
link |
Many of our poor decisions.
link |
Is there, you said that the liver does quite a few things.
link |
What to you is fascinating, beautiful about the liver?
link |
I'd say it's primary function seems to be
link |
as the sort of gatekeeper for what we eat and absorb.
link |
You know, the entire gastrointestinal tract
link |
from the esophagus to the rectum,
link |
the blood flows from it, not back to the heart,
link |
but to the liver where it's first examined,
link |
kind of things are evaluated, packaged,
link |
you know, processed, detoxified, perhaps.
link |
It's kind of this great overseer
link |
of what we digest and absorb.
link |
And so it kind of keeps track of what's coming in,
link |
you know, the outside world that comes in
link |
and will become part of us.
link |
You know, that's why partly the liver suffers
link |
sometimes the injury from certain toxins like alcohol.
link |
But beyond that, the liver is also the place,
link |
as I said, it metabolizes things too.
link |
So it metabolizes alcohol
link |
and why it can be injured by alcohol.
link |
It metabolizes drugs like Tylenol,
link |
which is why Tylenol can be very toxic to the liver
link |
when taken as an overdose.
link |
So the liver, you know, even beyond that,
link |
the liver produces a lot of different, you know,
link |
things that float in the bloodstream.
link |
It packages cholesterol and fats
link |
and sends them to where they're needed.
link |
It deals with protein in the blood.
link |
It deals with clotting factors in the blood,
link |
helping the blood clot, you know,
link |
processes things like bilirubin and other things
link |
that really, as I mentioned,
link |
is like 15 organs wrapped into one.
link |
Maybe that's why it's sort of the biggest internal organ.
link |
The skin's bigger, but it's not an internal organ.
link |
Right, the biggest organ in the human body is the skin.
link |
Right, but the liver's the biggest internal organ
link |
and it really is a powerhouse and does a lot,
link |
which is why when people suffer from liver failure,
link |
kind of everything goes wrong in a way.
link |
And in terms of replacing organs,
link |
what are organs that are easily replaceable,
link |
Like on the list of things that are hard to replace
link |
and not, what would you put in number one?
link |
What would you put like at the bottom?
link |
Well, I'd say the kidneys are, you know, nothing's easy,
link |
but kidneys are easiest in a way.
link |
Partly, I mean, maybe a big factor there
link |
is that other people have two of them
link |
and can give one to you.
link |
So you don't have to wait for people to die,
link |
which is the case with hearts and livers.
link |
Sometimes you can take a part of a liver
link |
from someone who's alive
link |
and the liver does have this kind of mythological ability
link |
to regenerate itself.
link |
In the myth of Prometheus, he's chained to a rock
link |
and the bird eats his liver every day
link |
and it grows back every day.
link |
And that's actually biologically accurate.
link |
Not that you can completely get rid of it
link |
and it'll appear again,
link |
but when pieces of it are removed or injured,
link |
it does regenerate itself pretty amazingly.
link |
So I'd say the kidneys,
link |
the fact that there are more around,
link |
also it's, you know, the kidney is a smaller organ.
link |
It's often just, you don't have to put a transplanted kidney
link |
where the kidney should be in the back of the abdomen.
link |
You can just kind of stuff it into the pelvis there
link |
because it's a smaller organ.
link |
The liver would be hard because it's huge.
link |
And I guess we just have the most experience
link |
with kidney transplants because they are the most common.
link |
And the heart and the brain are probably quite difficult.
link |
Brain, as far as I know, hasn't been successfully done.
link |
The heart is done.
link |
And definitely I've evaluated a lot of patients
link |
with a heart transplant.
link |
It does work pretty well.
link |
The mechanical heart substitutes
link |
are also advancing quite rapidly these days.
link |
For a failing heart,
link |
there are certain kinds of devices
link |
they can surgically implant.
link |
Like when a failing heart isn't able to push hard enough,
link |
you know, that's the heart's job is pushing blood
link |
with sufficient pressure to create blood pressure.
link |
When it fails, there are actually these devices
link |
you can strap onto the heart to help it pump harder.
link |
Those are rapidly advancing.
link |
Many of those were not available even 10 years ago
link |
when I got out of med school and now they're commonly used.
link |
So maybe heart transplant won't be as necessary
link |
in the future if those mechanical things do advance.
link |
And as I said, the heart is basically a mechanical pump.
link |
So perhaps it would be the easiest organ
link |
to replace with some mechanical device.
link |
Now for something completely different,
link |
returning to testicles for a time.
link |
You posted a Instagram post of testicles as food.
link |
Perhaps eating them doesn't help libido
link |
because ingested testosterone is totally metabolized
link |
in the liver, returning to our liver,
link |
leaving none to reach the bloodstream.
link |
That is why testosterone only comes as injection
link |
or topical foam, not as pills.
link |
On the other hand, estrogen and progesterone
link |
can be absorbed orally, hence the pill.
link |
But testosterone is mostly responsible
link |
for libido in women too.
link |
I was not expecting for this biology lesson
link |
when I was looking at an Instagram picture of,
link |
are we looking at testicles?
link |
Are these like, which species?
link |
I believe all those are from cows.
link |
From cows, cow testicles.
link |
Cows are technically female, so bulls.
link |
Yeah, well, speaking of which, just we'll jump around a bit,
link |
but you've also traveled the world quite a bit.
link |
What is the craziest food you've eaten across the world?
link |
What have you learned about the extremes
link |
of the culinary arts by traveling the world?
link |
I would say, I guess I've always been extra fascinated
link |
with the diets of natives of the far north.
link |
I spent some time there in Russia and in Alaska
link |
and always loved their diet.
link |
So when I worked in Alaska in emergency room
link |
and did some other travels in Arctic Alaska,
link |
and they eat a lot of fat.
link |
Traditionally before contact,
link |
more than half of all calories in the Inupiat Eskimo diet
link |
came from blubber, marine mammal fat,
link |
or also fat from fish, fat from ducks
link |
and other birds that go up there to mate in the summer.
link |
So things like raw whale blubber
link |
was especially interesting for me and very exciting.
link |
You know, I had some beluga whale chowder, things like that.
link |
There's just all these very unusual dishes.
link |
You know, there's a dish called Mikiyak,
link |
which is whale meat fermented in whale blood,
link |
which is quite delicious actually.
link |
So is it cooked, is it eaten raw?
link |
How do they like their fat?
link |
Like in the same way up north in Russia, as you mentioned.
link |
So they often eat it raw.
link |
So the raw whale blubber is called Muktuk
link |
and it's often just sliced thin
link |
and it's sort of cold, but not frozen often when they eat it
link |
and they slice it thin.
link |
And a lot of people assume it would be very chewy,
link |
but it's not that chewy.
link |
It's quite pleasant actually
link |
and has this kind of sea smell to it as you're eating it.
link |
And what's the culinary culture like?
link |
Meaning, is it just source of energy or is it art?
link |
Well, there's, you know, traditionally,
link |
there's not a lot of cooking in the Arctic.
link |
A lot of things are eaten raw,
link |
partly because there's not a lot of fuel for making fires.
link |
So they will, you know,
link |
some of the big rivers in Russia, for instance,
link |
that flow north, they will bring trees,
link |
you know, dead trees and logs up to the north
link |
and they can get some wood that way.
link |
And same thing in some of the rivers
link |
kind of flowing northward from the Brooks Range of Alaska.
link |
You do get some trees,
link |
but just not enough to really produce a culinary art
link |
that requires cooking with heat.
link |
You know, they do have traditionally blubber lamps
link |
where the blubbers of seals and whales are used
link |
to create a little flame.
link |
Often that's for light and for a little bit of heat
link |
and less for cooking.
link |
But eating things raw is definitely a huge part
link |
of the culture there.
link |
And while I was, I went on a whale hunting trip
link |
out on the spring ice in the Arctic Ocean by Barrow, Alaska.
link |
And two of the guys, the Inupiat guys who had invited me
link |
were kind of talking about how eating things raw
link |
is sort of the most essential characteristic
link |
of Inupiat culture.
link |
And the one guy who's half white, half Inupiat,
link |
said people often doubt his ethnicity
link |
because he looks like a white guy.
link |
So he'll, you know, bite the head off of a raw bird
link |
to show them that he is truly Inupiat, is what he said.
link |
That's how you prove you're legit.
link |
We're looking at an Instagram pic.
link |
As a doctor, I was used to knowing fat
link |
as the most maligned of all body parts
link |
and the culprit in an obesity epidemic.
link |
But in Arctic Alaska, fat has always meant
link |
health and survival.
link |
In fact, the entire story of life in the Arctic,
link |
especially human life, is basically a tale of fat.
link |
And in Barrow, what's A.K.?
link |
A lawn covered with a whale blubber
link |
is still equivalent of a plush green lawn
link |
in temperature suburbia, swelling in its owner with pride.
link |
And that's what we're looking at,
link |
is a lawn full of whale blubber.
link |
A beautiful, and this, so this is,
link |
I mean, there's a lot of calories there.
link |
And this can feed a lot of people.
link |
A lot of energy, a lot of warmth.
link |
Absolutely, and it's delicious.
link |
This was like, I was a kid in a candy store, basically.
link |
I rounded a corner in Barrow.
link |
So when people do get a whale
link |
during the spring whaling season,
link |
they raise a flag or the whaling captain
link |
raises a flag over his house
link |
and everyone in town is welcome to come try some.
link |
And so before I went inside to try some,
link |
I was kinda playing around with blubber
link |
and I saw the, this is a bowhead whale.
link |
I saw its heart, which was huge,
link |
like the size of a yoga ball.
link |
And that was, for me, just like amazing.
link |
I spent probably the next 45 minutes
link |
just looking at all aspects of it.
link |
And the stump of aorta that was attached to it
link |
was the size of my thigh.
link |
That was really fascinating.
link |
It's similar Alaska and Northern Russia,
link |
like Siberia and out there.
link |
So where were you?
link |
I think you have some pics from that time.
link |
Where were you in Russia?
link |
So I spent a lot of time in kind of Western Russia as well,
link |
but I did take two trips to Kamchatka,
link |
including Northern Kamchatka.
link |
I didn't go far enough,
link |
I didn't go to Chukotka, for instance,
link |
until more recently when I was a ship doctor
link |
on a wildlife cruise that sailed from Anadyr, Russia,
link |
up to, through the Bering Strait into Wrangell Island.
link |
And we stopped in some villages in Chukotka
link |
and I got a chance to try some whale and stuff like that.
link |
Northern Kamchatka, where it's more the Koryak
link |
are the indigenous people.
link |
They do a lot of seal hunting,
link |
so I had a lot of seal blubber,
link |
but I don't believe they do any whale hunting quite there.
link |
But the Chukchi in a way are sort of, you know,
link |
similar to the Inupiat in their diet and their life ways.
link |
Of course, everyone's diet, all these people's diet
link |
has changed dramatically in the last 100 years,
link |
as it has for actually everyone
link |
living in kind of modern societies.
link |
But for them, perhaps more than anyone else
link |
since their diet was the most extreme,
link |
I think of any human culture on earth.
link |
Just to stay on the wild travel you did,
link |
and I should say, I'm using the word travel,
link |
but it really, you were a doctor there.
link |
Well, first of all, can you just comment on the decision
link |
to go to such places and to help people,
link |
to be a doctor there?
link |
What was the motivation?
link |
What was the thinking behind it?
link |
Well, I think I got the travel bug
link |
before I ever went to medical school
link |
and even wanted to be a doctor.
link |
So right after college, I kind of wasn't very into college,
link |
didn't enjoy things, kind of wanted to get out there
link |
and see the world, get out of New York City
link |
where I was a student at NYU.
link |
The first thing I did after finishing college
link |
was I was invited to be an intern at a research center
link |
in St. Petersburg, Russia.
link |
I spent six months there on my first trip
link |
and went back four more times to Russia,
link |
traveled all over, including to Kamchatka twice
link |
and other parts of the country.
link |
I'd never heard of cities like Petrozavodsk
link |
and Syktyvkar and Pskov.
link |
I didn't even know a word could start with P, S, K,
link |
like the city of Pskov, but it can.
link |
And I was sort of fascinated.
link |
I was actually studying
link |
the international environmental movement
link |
and how it came to Russia
link |
after the fall of the Soviet Union
link |
and how organizations like Greenpeace
link |
and World Wildlife Fund and the World Bank
link |
are trying to kind of push the timber industry,
link |
which is huge in Russia, toward a more sustainable path.
link |
And so I was sort of evaluating how is it working?
link |
And that seems like such a little niche,
link |
such a small detail about Russian society,
link |
but in a way, researching that in depth
link |
was almost this window into the entire country
link |
and the history in a place I knew nothing about.
link |
And I learned the language, traveled all over the country,
link |
got to know the food, the history, the literature.
link |
It was just an immersive and amazing
link |
and life changing experience
link |
that made me want to see every spot on the globe, basically,
link |
and learn about every culture.
link |
So I took that desire with me to medical school.
link |
I decided I would go to medical school.
link |
And from the very beginning,
link |
I was intent on traveling around the world.
link |
So a lot of my career has been fashioned
link |
so that I'm practicing medicine in a place
link |
with an interesting geographic context,
link |
an interesting place with an interesting cultural context.
link |
And that just makes it more interesting, I find.
link |
Not only are medical services often more needed
link |
in these remote and rural parts of the country and world,
link |
so I feel like I'm taking my knowledge
link |
and education experience to places where it's needed,
link |
it's just such an enlightening experience,
link |
the way culture, history, geography, climate
link |
affects medical disease,
link |
but just getting to know the people,
link |
getting to know their culture,
link |
being a very useful traveler
link |
by providing medical services in that place.
link |
And that's taken me to Arctic Alaska,
link |
to Pine Ridge Reservation, South Dakota.
link |
I currently work in a few different parts
link |
of Pennsylvania, Appalachia,
link |
which for me is a unique geography and culture
link |
that I didn't grow up with, wasn't familiar with.
link |
So in some ways, it's exotic for me as well.
link |
I worked in other places too, like Kolkata, India, Nepal.
link |
Just I think my love of travel has shaped my medical career
link |
and being a doctor does give you these opportunities
link |
to go to places and travel in a unique way
link |
through the medical profession.
link |
You know, there's a documentary,
link |
Happy People Here in the Taiga or something like that.
link |
I think Warner Herzog voices it.
link |
It tells a story of a simple life of survival in the taiga
link |
and I think they're trapping for food
link |
and there's an alcoholism problem too as well.
link |
There's like a very basic life of survival,
link |
of loneliness, of desperation,
link |
but also there's a, I think the underlying claim
link |
of the documentary is that that simple life
link |
that simple life actually has a kind
link |
of simple happiness to it, hence the name Happy People.
link |
Can you speak to the life that people live in those places
link |
when it may be simpler than you would
link |
in a sort of big city life?
link |
It's definitely very different for sure.
link |
You know, I guess I found like in some
link |
of the remote villages of Kamchatka,
link |
I was actually surprised how similar they were
link |
in that I saw the same family strife,
link |
the same fights, the same kind of pairing of relationships
link |
and bickering and politics.
link |
In a way, I'm from the New Jersey suburbs
link |
and being in this remote village of Northern Kamchatka,
link |
I remember writing an email to my friend
link |
about how just it seemed so similar,
link |
even though on the surface it was this exotic other world,
link |
the incredible material know how they must have
link |
to get their food from the land.
link |
You know, that the number of animal species,
link |
plant species, the behaviors of the animals,
link |
seasons, how to live that way.
link |
In a way, it's more complicated in a way
link |
that I find fascinating how people live on the land
link |
and the knowledge and experience it takes
link |
to do it well and survive.
link |
You know, obviously other aspects of modern life
link |
in a city are much more complicated
link |
than they would be there, but I guess it's,
link |
that was something that struck me too,
link |
that it's simpler in some ways,
link |
but more complicated in other ways.
link |
So some of the complexity that happens in life
link |
is originated from humans, not from the technology
link |
or all that kind of stuff around us.
link |
You can take the human out of modernity,
link |
but they're still human.
link |
They're still human, and they fill the empty space
link |
with their own human complexities.
link |
Are there people that just stand out,
link |
memorable people, memorable experiences from those places?
link |
Some people that maybe made you smile, made you cry,
link |
changed who you are as a man, changed who you are
link |
as a doctor, anything jumps to mind?
link |
I think, you know, when I was, it was interesting,
link |
when I was in Russia, I found that most of the people
link |
I hung out with were old women.
link |
I mean, actually I didn't meet a lot of old men in Russia,
link |
which might speak to kind of life expectancy there
link |
for men in particular.
link |
But I found women, older Russian women,
link |
including, you know, Russian from St. Petersburg
link |
or some of the elderly women in Kamchatka,
link |
who were, you know, some were Koriak,
link |
some were half Koriak, half Russian, some were Chukchi.
link |
I just found them to be so enlightening
link |
the way they talked about history, about people,
link |
so insightful about humanity, you know,
link |
all they've lived through in the last 50 years
link |
in some of these parts of Russia,
link |
like the upheaval, societal upheaval,
link |
the destruction, the building up.
link |
It's just something I could not even imagine.
link |
And I think their insights were just very,
link |
I'm not thinking of anything in particular,
link |
but I just remember I could listen
link |
to some of these elderly women talk about their lives
link |
for hours and hours.
link |
I remember there was this older,
link |
elderly blind Koriak woman who you would have thought
link |
was the, you know, most country bumpkin of country bumpkin,
link |
and yet she couldn't stop talking about
link |
how much she loved reading Dostoevsky and Tolstoy,
link |
which might also speak to the Soviet education system.
link |
And it was just sort of surprising and fascinating,
link |
and just those stories and perspectives on life
link |
really stayed with me.
link |
Yeah, with babushki.
link |
There's a wisdom, there's a kindness.
link |
I mean, I suppose that's true for older people in general,
link |
but there's something about, it's not just Russia,
link |
it's Eastern Europe, it's like this kind of look of wisdom,
link |
and not just like sort of middle class wisdom
link |
or something like that.
link |
It's like I have seen some shit wisdom, I've seen it all.
link |
And on the other side, I'm left here with a pragmatism
link |
and a compassion, and also an ability to cook really well.
link |
That's for sure, absolutely.
link |
There's just this balance of just deep intelligence
link |
and deep kindness, and yeah, I mean I part much of who I am
link |
is because of the relationship I had with my grandmother
link |
who was a Russian, Ukrainian born Russian grandmother.
link |
Did you learn the Russian language?
link |
I did, it's quite rusty at this point,
link |
but I did, one of these wonderful elderly Russians
link |
in St. Petersburg sort of adopted me.
link |
I think that was another thing that a lot of these
link |
elderly women on every side of the country
link |
kind of adopted me or saw me as this real curiosity.
link |
This was around 2002, 2003, it just wasn't common
link |
for this sort of strange American to suddenly show up
link |
in the middle of Kamchatka or even St. Petersburg,
link |
and just absolutely ravenously curious
link |
about everything they had to say.
link |
So I often got adopted and one of them taught me Russian
link |
and how to ride a horse, so the same babushka
link |
taught me both of those things.
link |
And like you said also, I should mention
link |
that there's something about the Soviet education system
link |
where yeah, everybody reads Tolstoy, Dostoevsky,
link |
it's exceptionally well read.
link |
No matter where life has taken you,
link |
no matter where you come from,
link |
the literature, the mathematics, the sciences,
link |
they're all like extremely well educated
link |
and that creates a fascinating populace.
link |
Like then you take that education,
link |
that excellent early education,
link |
and you throw a bunch of hardship at those people
link |
and then they kind of cook in that hardship
link |
and come out really fascinating people on the other end.
link |
It makes me surprised sort of that, for instance,
link |
like Russian medical science is not,
link |
doesn't, you don't see a lot of sort of studies,
link |
medical studies, advancing of medical science
link |
come out of Russia.
link |
It's just sort of, I'm surprised sort of,
link |
I wish that it would.
link |
I visited Akademgorodok outside Novosibirsk,
link |
which is an entire city the Soviets created
link |
just for the study of science
link |
and it's like there's the geology building
link |
and there's the biology building
link |
and there's the chemistry building
link |
and I just feel like Russia has this potential
link |
to be a science powerhouse or even in the medical sciences
link |
but I guess you just, I don't see it.
link |
I mean, you can certainly guess as to why
link |
and I see the same thing in the other,
link |
in the sciences I hold the dearest sort of,
link |
in computer science, in engineering fields.
link |
I kind of long held this desire, by long,
link |
I mean, last couple of years
link |
because a bunch of people reached out to me
link |
from Yandex and Moscow State to give lectures there
link |
to sort of connect.
link |
You know, why so little science is coming out of there?
link |
Why so little that we hear about?
link |
And it feels like we should be able
link |
to bridge the scientific community.
link |
Like science, let's even say,
link |
even in turmoil of geopolitics, even in global conflict,
link |
I feel like science should be bigger than that.
link |
But why do we not hear from the scientists
link |
is because of the limitations on human freedoms,
link |
on scientific freedoms.
link |
I feel like in China, in Russia,
link |
in any regime of its sort, you should give freedom
link |
to scientists to flourish and to interact with others
link |
and you can only grow from that.
link |
You shouldn't suppress that.
link |
The sort of Cold War ideas, we should put those aside.
link |
As somebody who spent time in Russia,
link |
as somebody who learned Russian,
link |
do you have some thoughts that you want to say
link |
about the war in Ukraine currently?
link |
It's tragic, of course.
link |
Seemingly pointless to watch the destruction
link |
of a country in real time.
link |
I guess it's, you know, when you read Russian history
link |
and Ukrainian history, I guess it just,
link |
it's sort of, you know, destruction is a big part of it.
link |
The populace being beaten down is a big part of it,
link |
you know, from the Mongolian hordes
link |
through the Tsar and the Soviets and Putin.
link |
I guess, you know, it's just,
link |
in science in particular, medical science,
link |
it feels like this sort of unrealized potential.
link |
You know, the culture is so beautiful,
link |
the people are so smart and well educated.
link |
I think the word unrealized potential
link |
is kind of how I feel.
link |
That's why I wanted to celebrate that part of the world
link |
is there's so many beautiful people,
link |
so many brilliant people.
link |
And I just happen to know the language
link |
so I'm able to appreciate the beauty of those people.
link |
I'm sure the same is true in China.
link |
I'm sure, that's one of the things that makes me sad
link |
is there's all these cultures that I don't know about.
link |
I can't fully appreciate their brilliance.
link |
Even Japan and places like that
link |
that are sort of, there's channels of communication
link |
wide open and there's a lot of interaction.
link |
It's still, not knowing the language,
link |
I feel like I miss some of the culture.
link |
Or Portuguese and, you know, looking at South America
link |
and all that kind of stuff.
link |
But anyway, in Russia there certainly is
link |
that unrealized potential.
link |
In Ukraine, so many brilliant scientists,
link |
engineers came from Ukraine, from Russia.
link |
And I hope they get to flourish soon.
link |
And I hope we put this,
link |
I hope we stop this war, because all war is hell.
link |
Is there something to comment about the biology
link |
of war, is there echoes of the emergency room experience?
link |
Have you dealt with patients
link |
that have been touched by war time?
link |
Definitely, war and medicine has a very intricate
link |
and complex relationship.
link |
I don't know if it was Walt Whitman who said it,
link |
though he was a nurse during the Civil War,
link |
that war is the best medical school.
link |
But some people have said that.
link |
And even advancements in medicine come from war.
link |
The wars in Iraq and Afghanistan have, in some ways,
link |
really revolutionized certain aspects
link |
of the way we treat trauma patients
link |
in the civilian world as well.
link |
The importance of tourniquets,
link |
the importance of transfusing whole blood
link |
instead of red blood cells isolated from serum
link |
and platelets, et cetera.
link |
The importance of pain control in the battlefield,
link |
that's changed dramatically.
link |
Everything from ketamine injections
link |
to fentanyl lollipops in the battlefield.
link |
So war has really improved medicine in many ways.
link |
In another way, the Department of Defense
link |
spends a lot of money on medical research
link |
and really pushes the envelope.
link |
DARPA is one aspect of the military budget
link |
that really funds these moonshot experiments
link |
that are really fascinating and really push the frontiers
link |
more than seemingly most kind of universities
link |
doing doctors and researchers doing their research.
link |
So in a way, the space program,
link |
which sort of was military initially
link |
then became civilian under NASA,
link |
also has led to a lot of advances and understandings
link |
of health on Earth and in space.
link |
So the military or war in general is a huge way
link |
that medicine advances,
link |
not to mention the epidemics that come.
link |
My grandmother was from what's today Moldova,
link |
what was then Romania.
link |
She got typhus during World War II.
link |
So there's typhus outbreaks, there's cholera outbreaks,
link |
you know, all these, even infectious disease things
link |
can advance in war, which you wouldn't expect.
link |
You expect sort of trauma to be the sort of main problem,
link |
but actually infection is a huge problem
link |
throughout history and war.
link |
So we can learn a lot.
link |
It's this kind of horrific natural experiment
link |
Yeah, and I've recently been reading about
link |
some of the horrific medical experiments
link |
performed by Nazi scientists, Nazi Germany.
link |
I'll talk about it another time perhaps,
link |
but nothing reveals the honesty of human biology like war.
link |
Just to stay on your wild journeys for a little bit longer,
link |
you have a tweet about Shackleton saying,
link |
here's a photo of Shackleton's medical kit
link |
from his storied expedition to Antarctica in the 1910s.
link |
Some perigoric for pain, some laxative.
link |
Only the essentials.
link |
Would you put laxative under the essentials?
link |
Anyway, sorry to interrupt.
link |
When I worked as a ship doctor in Antarctica in 2018,
link |
I had a huge cabinet full of meds and even EKG machine.
link |
So if you can comment sort of on that contrast.
link |
First of all, your own journey, how harsh was it?
link |
How difficult was it?
link |
And given that context, can you think about
link |
how hard Shackleton's journey was?
link |
I think the difference is unimaginably stark.
link |
One thing I do wanna point out is that
link |
the use of laxatives early in the 20th century
link |
and before that, they were used for a surprising
link |
number of ailments where they probably did not help at all.
link |
But I think that was a holdover from sort of
link |
the old theory of medicine, the humoral theory
link |
where you have to balance the fluids in the body.
link |
And so causing people to vomit,
link |
causing them to have diarrhea or purposely taking blood
link |
out of them in bloodletting was a big part.
link |
And I think that crazy use of laxatives
link |
was maybe a holdover from that time.
link |
But that being said, they were probably not eating
link |
very high fiber food on that expedition.
link |
So perhaps laxatives could have been helpful.
link |
There's a lot of seal, penguin and seal meat being eaten,
link |
which is not super high in fiber.
link |
So I don't wanna discount the importance
link |
of laxatives in that setting.
link |
But that wouldn't be the essential thing.
link |
If you're thinking of a tiny kit
link |
that has only the essentials, I mean pain, yes.
link |
Laxatives, I don't know, maybe not.
link |
I think the medical kit possibilities
link |
were much narrower back then.
link |
This was before antibiotics,
link |
before I think germ theory might've been,
link |
it was known, but there wasn't much to do about it.
link |
So the availability of medicines,
link |
I mean, that's something that exploded
link |
over the course of the 20th century.
link |
So what I can put in a backpack today
link |
filled with modern medications, whether injectable
link |
or to be taken orally is just many orders of magnitude
link |
greater than what they had back then.
link |
So when I went, my expedition was nothing like Shackleton's.
link |
I was on a huge cruise ship with 160 Japanese passengers
link |
who came with their own translators.
link |
And as I said, I had cabinets, not just one cabinet,
link |
many cabinets full of medications,
link |
both injectable, some patches, some pills.
link |
I was very impressed actually with what was available there.
link |
And I didn't have to use a lot of it, thankfully,
link |
though I did use some of it for people.
link |
And I slept and I got free room and board on the ship.
link |
So every Southern summer cruise ships
link |
go take people to Antarctica,
link |
the Southern Atlantic islands like the Falklands
link |
and other parts of the South Pacific.
link |
And then in the Northern summer,
link |
the same kind of cruise ship explosion happens
link |
going to Greenland and Iceland and Svalbard
link |
and Franz Josef Land and other parts of the North Alaska.
link |
So, and every ship needs a doctor.
link |
So it's a great opportunity.
link |
They want specifically ER doctors to deal with emergencies,
link |
but you're really working in the middle of nowhere.
link |
And all you have is the medications there on the ship
link |
and supplies and your knowledge and experience.
link |
And so it's a very different experience
link |
than working in a high tech modern hospital
link |
with every bit of technology
link |
and every sub specialist consultant available.
link |
But I sort of liked that challenge.
link |
I mean, I like going to the ends of the earth.
link |
It's beautiful, it's exciting, it's fascinating.
link |
Practicing medicine in those settings is extra challenging
link |
and really makes you hone some of your skills,
link |
which is part of the reason that I sought them out.
link |
Do you see echoes of some of that same effort?
link |
I've gotten a chance to interact with astronauts
link |
and those kinds of folks working on space missions.
link |
Do you see some of those same echoes of challenging efforts
link |
going out into space and maybe landing on Mars
link |
and maybe beginning to build a small colony on Mars?
link |
Yeah, I think the healthcare that is needed
link |
will be a big part of that.
link |
Obviously, we're probably gonna send
link |
overall quite healthy people,
link |
but there's a lot of medical decisions to make
link |
about what should be brought, what should be expected.
link |
To some extent, I've had a lot of doctors say,
link |
oh my goodness, I can't believe you work
link |
in the middle of nowhere.
link |
What do you do if someone gets a brain bleed,
link |
like falls, hits their head, needs a neurosurgeon?
link |
I mean, the obvious answer is they die.
link |
You know, when you're in the middle of Antarctica,
link |
things kill you that wouldn't
link |
if you're inside a university hospital
link |
that's fully equipped to help with every problem that arises.
link |
Mars takes that to a crazy extreme, obviously.
link |
I know that even going to Antarctica,
link |
different countries have had different strategies.
link |
I believe it was Australia used to kind of just,
link |
in anticipation, remove people's gallbladders
link |
just so that it wouldn't get inflamed
link |
because that is a very common medical emergency.
link |
So they would just remove it beforehand,
link |
even though it was not diseased at all,
link |
just so that while they're stuck in Antarctica
link |
over the winter, for instance, that wouldn't be a problem.
link |
You know, there's many other issues that can arise.
link |
But so those are some decisions to make.
link |
Maybe the people who go into Mars
link |
should have their appendix removed,
link |
their gallbladder removed.
link |
Maybe they should have a cardiac cath
link |
to see if they have coronary artery disease
link |
just to know their chances of getting a heart attack there.
link |
Though it's not always predictive.
link |
You know, it's hard to predict
link |
who's gonna get a heart attack,
link |
but maybe with all the data around today,
link |
we'll get better at predicting.
link |
But that will be a huge part.
link |
You know, we can't have people,
link |
the few pioneers in a Mars colony
link |
dying of heart attacks and things like that.
link |
Don't anticipate stuff.
link |
You've gone to some harsh conditions to be a doctor.
link |
Would you go to Mars to be a doctor?
link |
It would definitely be amazing, I think,
link |
because I have a wife and two small children,
link |
probably not in the cards for me at this point, but.
link |
You humans with your human attachments.
link |
If you just put more priority on the death than the sex,
link |
I think we would be better off.
link |
I would love to go to Mars.
link |
And actually, you know,
link |
I practice high altitude medicine in Nepal.
link |
Space medicine is sort of an extension of that.
link |
You know, the air is just much thinner, like nonexistent.
link |
You know, as you go higher in the mountains,
link |
the things that happen to human physiology
link |
are very bizarre and strange
link |
and still not well explained by science.
link |
And in space, it's just like a crazy extension
link |
If I could just return to the, we didn't really,
link |
I think we mentioned a little bit about the food you had.
link |
Just if we can high level say,
link |
what is the greatest meal you've ever had?
link |
So your last meal, let's go.
link |
If one more meal, I get to murder you after this.
link |
This is your last day.
link |
We get to spend it together.
link |
Where in the world would you go?
link |
What would you eat?
link |
I would say the most delicious thing is bone marrow.
link |
And I would love a full meal of bone marrow
link |
for my last, last dish.
link |
I did on my birthday in 2002,
link |
ate a kilogram and a half of crab meat in Kamchatka.
link |
And that was also amazingly delicious.
link |
The king crab they have there is incredible.
link |
But I would go with bone marrow,
link |
which is I think just one of the most delicious foods.
link |
And it's sort of this weird body part.
link |
You know, it's basically all your stem cells,
link |
not all of them, but the stem cells
link |
that produce all your blood cells.
link |
So they are spitting out billions of white blood cells,
link |
red blood cells and platelets every day.
link |
And there's a bunch of fat in there as well.
link |
Just one of the places the body stores fat.
link |
And so you basically add heat and that's all you need.
link |
It's like the perfect food.
link |
The fat for frying the stem cells is already there.
link |
There's naturally a bone vessel to contain it all.
link |
Probably add some flavor too.
link |
It's like the perfect food.
link |
Does it matter which animal?
link |
I prefer a larger animal just so there's more of it.
link |
I actually like, well that's true.
link |
I actually really like sort of bone marrow
link |
from like chicken bones.
link |
Right, just sucking it out of the bone.
link |
Yes, I'm known for leaving absolutely nothing edible
link |
on the plate except bone itself.
link |
There's one other human I know that loves bone marrow
link |
as much as you do and that's Joe Rogan.
link |
So go, it's unnatural how much that man loves bone marrow.
link |
I love the steak part.
link |
The bone marrow, you know what, let me argue with you
link |
because I don't know, it could be an acquired taste
link |
but there's just too much, it's like too much
link |
with too little work for it.
link |
Like it's as if you gave me lobster meat
link |
without the lobster having to clean the lobster.
link |
I just feel like I'm spoiling myself.
link |
So it's very fatty, it's, I don't know,
link |
maybe I wanna work for something that tastes like that.
link |
Well if you start from the whole animal,
link |
you do have to work to get at it, right?
link |
A lot of animals have the teeth and the jaw muscles
link |
to chomp through bone, we do not.
link |
So when you buy it from the store, it's already sawed up
link |
but I've definitely gotten marrow out of deer bones
link |
with a hatchet, just chop off the fat end
link |
and start spooning it out.
link |
Or maybe I'll revisit it, that's fascinating.
link |
And where, where would you eat it?
link |
Where and which place of the world?
link |
Is there something about who cooks it, who you eat it with?
link |
You're not allowed to pick your family.
link |
So like which place in the world, rural or in the city,
link |
those kinds of things, you've been
link |
to so many fascinating places.
link |
I would say I'm, Antarctica I would say
link |
is one of the most picturesque places I've ever been.
link |
I really did not, I didn't know how mountainous it was
link |
and I guess I knew there'd be ice
link |
but just I didn't know how much ice it was.
link |
You know, it's ice and mountains just overwhelming.
link |
I just, you know, as kind of overwhelming bone marrow
link |
might seem to you, sort of that feast for your eyes.
link |
And just ice in general is amazing,
link |
like the icebergs floating around Antarctica
link |
is just astounding, like the different shapes,
link |
the sizes are incredible.
link |
There's actually a, I believe it's a US Navy website
link |
that tracks the largest icebergs
link |
and you can read about each of them and how big they are
link |
and just the formations you see, similar up near Greenland,
link |
though I have not been to Greenland.
link |
Just ice in general is just amazing.
link |
So I could just look at its different forms
link |
while eating bone marrow forever, until you kill me,
link |
Yeah, and afterwards we go.
link |
There's back to the death, the death and sex.
link |
What is it about the ice?
link |
Is it sort of the enormity of nature
link |
that just reminds you that it's going to be there
link |
before you and after?
link |
And then you get to partake in the eating
link |
of the thing you need for maintaining of your biological,
link |
temporary biological organism?
link |
Yeah, I think it's a few things.
link |
One is just the shapes that you see,
link |
the wave action, just eating away at these pieces of ice.
link |
You get these arches and just these shapes.
link |
I mean, it's just like.
link |
The geometry alone is amazing.
link |
I studied math as an undergrad
link |
and I've always appreciated geometry
link |
and just the shapes alone are just look like brilliant works
link |
of modernist art and just obviously no two
link |
are ever the same.
link |
Not to mention a lot of them are this unearthly blue color
link |
that is just really startling and fascinating.
link |
The same color of glaciers in various parts of the world,
link |
that blue color is just really amazing.
link |
And I also just love how it's sort of this constant shedding
link |
from our Antarctic continent, from Greenland.
link |
It's this constant process of snow falling inland
link |
and pushing the glaciers further out to sea
link |
and them breaking loose.
link |
I mean, obviously it seems to be happening faster these days,
link |
but it's sort of this constant shedding
link |
and sort of, I always like thinking about
link |
how the body has something similar.
link |
We're constantly shedding and renewing
link |
and rebuilding everything.
link |
And so ice is sort of this constant similar process.
link |
Yeah, I did not know you were a math undergrad.
link |
So that, I mean, you just keep getting more fascinating.
link |
Can you maybe take a small step into that direction?
link |
What do you find beautiful about mathematics?
link |
Why did you journey into that part of the world for a time?
link |
I especially liked, so college math,
link |
I did some calculus in high school.
link |
When I got to college math,
link |
I was amazed that there were no more numbers.
link |
The digits disappeared.
link |
It was just variables, concepts.
link |
There was almost no more numbers at all.
link |
It was like this totally abstract kind of way of thinking.
link |
But that sort of reflects the natural world
link |
and teaches you about the natural world,
link |
though it's sort of this perfect platonic ideal,
link |
perhaps, of the natural world
link |
that can still sort of help explain
link |
what happens in the natural world.
link |
But just these concepts are so abstract from life
link |
and from the natural world.
link |
I was actually getting interested in the natural world
link |
at the same time when I was at NYU studying math.
link |
I took a tour of Central Park that was pointing,
link |
the guy, Steve Brill, was pointing out
link |
these wild edible plants.
link |
And I was learning to identify the first plants
link |
and knowing what's edible, what's not.
link |
That was totally fascinating.
link |
And sort of this kind of thing
link |
that I felt like was connecting me to nature.
link |
And it was balanced with this utterly abstract science,
link |
or utterly abstract lessons I was getting in math class
link |
where I was thinking through series.
link |
As we approach infinity, what happens to these equations?
link |
And concepts of like rings and abstract algebra,
link |
I don't know, it was just this dichotomy
link |
that I enjoyed both aspects of.
link |
Yeah, the concepts.
link |
But so different, this kind of logical,
link |
rigorous view of the world and the world of biology.
link |
Why the big, how did that feel to take the leap
link |
into the biological, the mushy mess of the human body
link |
from the mathematical, which is all very clean?
link |
Right, it does feel like a big step.
link |
I think there's more connection than you think.
link |
We talked about symmetry of the body earlier.
link |
That is a real thing.
link |
Fluid dynamics of how our various bodily fluids flow
link |
and what makes them not flow as well
link |
and what makes them flow better.
link |
All these different aspects of science go into the body.
link |
Everything from hard bone to softer kind of flesh
link |
to liquids of various consistencies.
link |
A lot of science and math does teach you
link |
about kind of how the body works, how it can work better,
link |
what happens in sort of disease states.
link |
Yeah, I suppose there's a connection.
link |
There's also kind of a sort of computational biology
link |
of this computational equivalence of each of the disciplines
link |
which are becoming more and more fascinating
link |
with all the work that DeepMind is doing
link |
and the work of genetics, all that kind of stuff,
link |
simulating different parts of the body
link |
to try to gain an intuition understanding of it.
link |
That to me is super fascinating,
link |
but sometimes it does feel like an oversimplification
link |
of the way the body really does it
link |
because the body is an incredibly weird complex system
link |
and it finds a way.
link |
The adaptability, the resilience,
link |
the redundancy that's built in, it's weird.
link |
It's incredibly powerful and so unlike
link |
the kind of computer based systems that we build,
link |
at least we engineer in the software engineering world,
link |
which kind of starts to make you think
link |
how can we engineer computer systems in a different way
link |
that make them more resilient in the real world?
link |
That's sort of the robotics question.
link |
What do you think about that?
link |
What does it take to build a humanoid robot
link |
or robots that are as resilient as the human body?
link |
How difficult do you think is that problem?
link |
Having studied the human body,
link |
how hard is the engineering problem of building systems
link |
like that guy over there, the legged guy
link |
that is as resilient as the human body
link |
to the harsh conditions of the real world?
link |
I think it's very hard
link |
and we definitely haven't gotten there yet.
link |
I think we could probably learn lessons
link |
from people who are trying to grow artificial organs
link |
in the lab to eventually transplant into people,
link |
which would solve a huge problem
link |
of needing to get those organs from others
link |
and the rejection of putting a foreign material
link |
Your immune system tends not to like that.
link |
That has advanced a lot recently.
link |
I think some advances actually have been
link |
where we pay a lot of attention to stem cells,
link |
stem cells, stem cells.
link |
We can grow whatever we want out of stem cells,
link |
but now there's sort of a recognition
link |
that what we call the extracellular matrix,
link |
which is sort of the foundation of the body,
link |
the thing that holds all the cells into their proper shape
link |
and keeps them where they should be,
link |
that is actually crucial.
link |
And there's probably a lot of signaling that goes on.
link |
Like you stick a stem cell
link |
on the right extracellular matrix,
link |
it will turn into the kind of cell that you want
link |
and take the right shape and position
link |
and start functioning.
link |
I think that's been a huge, huge advance
link |
knowing that it's not just these celebrity stem cells
link |
that are the answer.
link |
It's this kind of part in the background,
link |
this sort of just like laying the foundation,
link |
the system that you put these cells onto.
link |
And we're not there yet,
link |
but there's definitely a lot happening,
link |
a lot of research happening.
link |
And I think there'll be some advances probably soon.
link |
So now on the topic of interaction
link |
of computational systems with biology.
link |
So if you look at a company like Neuralink
link |
or the whole effort of brain computer interfaces,
link |
now there's a neurosurgery component there.
link |
We have to connect electrical systems
link |
with biological systems.
link |
So just even the implanting is difficult.
link |
Then the communication is difficult.
link |
But what would you say from what you know about the brain,
link |
what you know about the human body
link |
and all the beautiful mess that's there,
link |
how difficult is the effort of Neuralink?
link |
Do you think it's feasible?
link |
I think it's definitely feasible.
link |
I think we need to probably know more than we do
link |
and know how to connect it in all these ways.
link |
I think some advances, for instance,
link |
much less sexy, but really already impacting medical care
link |
is something called deep brain stimulation,
link |
which is done for Parkinson's disease and others
link |
where neurosurgeons implant this device
link |
that's electrically stimulates the part of the brain
link |
that is not functioning in Parkinson's disease.
link |
And it's quite dramatic how effective it works.
link |
And I remember as a med student,
link |
watching a neurologist literally like turn the electricity
link |
up on this handheld thing,
link |
and you could see the person's Parkinson tremor go away
link |
and you could see them start to walk
link |
in a more steady fashion.
link |
And I know there's studies, there's actually studies
link |
or there may be studies in the future
link |
studying the same deep brain stimulation
link |
for everything from eating disorders to severe,
link |
like severe OCD, like paralyzing OCD,
link |
not just like I wanna wash my hands three times,
link |
but and so I think the potential is there,
link |
but I guess connecting the brain in a microscopic way
link |
in sort of a multifaceted way,
link |
there needs to be sort of a million connections
link |
or some very high number of connections
link |
for them to work fluidly.
link |
As far as I know, I'm not an expert in the area.
link |
First of all, I believe and I trust
link |
in the adaptability of the biological system
link |
to whatever crazy stuff you try to shove in there.
link |
So it's going to potentially reject things,
link |
but it's also going to, if it doesn't reject things, adapt.
link |
And if we can create computational systems that also adapt,
link |
AI systems that adapt and can kinda,
link |
both of them reach towards each other
link |
and figure stuff out.
link |
But actually our current AI systems are not very adaptable
link |
to the what, like in the wild way
link |
that biology is adaptable, like adaptable to anything.
link |
And if we can build AI systems like that,
link |
I feel like there's some interesting things you could do,
link |
but of course there's ethics
link |
and there's real human lives at stake.
link |
And there you can't quite experiment.
link |
You have to have things that work
link |
and maybe simulation can help, but reality is,
link |
it's a dangerous playground to play on.
link |
You tweeted that quote,
link |
"'If you look back from far enough into the future,
link |
"'every doctor today will look like a total quack.'"
link |
First of all, that's humbling to think about.
link |
Like we don't know what we're doing in the great,
link |
like there's been so much progress
link |
that we kinda have this confidence
link |
that we figured it all out.
link |
If you look at history and you read how people thought,
link |
I mean, there's so many moments in history
link |
where people really thought that they figured it all out.
link |
It's almost like there's nothing else left to do
link |
at every stage in history.
link |
And then you realize no,
link |
progress often happens like exponentially.
link |
And every moment you continue to think
link |
you figured it all out.
link |
But if you're being honest, if you're being humble,
link |
then you realize we're just shrouded in mystery.
link |
So what do we make of this?
link |
Like how should we feel that?
link |
How should you feel as a doctor?
link |
How should we feel as scientific explorers
link |
of the human body?
link |
The fact that we're probably going to be wrong
link |
about everything we currently know.
link |
Right, there's a saying actually,
link |
by the time you finish med school,
link |
half of what you learned is wrong,
link |
which is quite illustrative.
link |
And becoming more true as time goes on,
link |
so much medical research going on,
link |
so much learning going on, it's really wonderful in a way.
link |
But in some ways we still learn these concepts
link |
And I know when you take a test as a medical student,
link |
sometimes you know they want you to give the old answer,
link |
but you know there's a new answer
link |
because of recent science,
link |
but you know to give the old answer,
link |
that's now incorrect to get the question right on the test.
link |
That happens actually quite a bit
link |
because things change so quickly.
link |
Yet, you know, when I look back at doctors
link |
from centuries past, I mean, it's absurd
link |
what they were doing to their patients.
link |
I mean, for probably for most of human history,
link |
they were doing more harm than good.
link |
You know, they're draining people of their blood.
link |
That was, you know, bloodletting was a huge part
link |
You know, George Washington died of a paratonsular abscess,
link |
an abscess right next to the tonsil,
link |
which has the great name of Quincy,
link |
and they bled him to death.
link |
You know, I mean, kind of adding insult to injury.
link |
Doctors are a menace and do a lot of harm.
link |
I mean, hopefully not intentionally.
link |
You know, even medical errors are still a huge problem,
link |
cause of death and morbidity.
link |
So we do a lot of things that are not great,
link |
but you know, our knowledge, yeah,
link |
it's very imperfect at this point.
link |
I do have some confidence.
link |
You know, I guess perfect scientific studies
link |
that try to get at the reality of the universe are essential
link |
because when I think of why a certain medication works
link |
for a certain condition,
link |
it might make perfect sense in my head,
link |
knowing the biology, the biochemistry, the anatomy,
link |
it makes perfect sense, it must work.
link |
I gave it to the patient, they got better,
link |
and that's happened 20 times in the last year,
link |
but it's, you know, I'm wrong.
link |
Like when you actually do a study,
link |
it actually doesn't help, maybe it hurts.
link |
And that's really, I think the way we explain medications
link |
working in our minds is often wrong
link |
when you end up finally doing the study.
link |
And some of the most interesting experiments
link |
involve what we call sham surgery.
link |
So for instance, people who injure their knee,
link |
you know, arthroscopy where an orthopedic surgeon
link |
goes in there with a scope, gets bits of bone out,
link |
shaves down the cartilage, you know, cleans things up,
link |
and it helps some people,
link |
but they actually did some studies where one group of people
link |
got the true arthroscopy and others just got sham surgery
link |
where they put them to sleep,
link |
made little cuts in the skin so they woke up with scars.
link |
And then it turned out that it's not clear
link |
arthroscopy is actually helping.
link |
And the same, there was a recent huge study
link |
of putting a stent in someone's coronary arteries
link |
if they have stable chest pain,
link |
not like I'm having a heart attack,
link |
you need a stent like right then,
link |
but, you know, kind of chronic coronary artery disease
link |
where every time I run up the stairs, I get chest pain,
link |
and then when I rest, it goes away.
link |
Like obviously you put a stent,
link |
you increase blood flow to the heart,
link |
like how could that not work?
link |
But then when they did the sham catheterization,
link |
it actually looks like it might not actually help
link |
better than the sham.
link |
So I think those placebo controlled studies are essential.
link |
I mean, it is shocking,
link |
and this has been driven home during the last two years,
link |
how hard it is to figure out
link |
what the hell's going on in the universe,
link |
especially with our bodies.
link |
Like it is really hard to get at the truth
link |
and what you think makes sense, like often turns out,
link |
I mean, the history of modern medicine
link |
is littered with examples where it made perfect sense
link |
and it seemed to help some patients,
link |
and it turns out it's not doing anything or it's harmful.
link |
Yeah, there's all kinds of narratives swimming around.
link |
We convince ourselves as a human civilization
link |
that something is true.
link |
There's a propaganda machines, there's just self delusion.
link |
There's a centralized communities,
link |
like there's a scientific community
link |
that believes a certain thing.
link |
There's the conspiracy theories
link |
that believe a certain thing.
link |
Sometimes the scientific community, right?
link |
Sometimes the conspiracy theorists are right
link |
throughout human history, I mean.
link |
And we now think the scientific community,
link |
well, now the science has really figured it out.
link |
We're way smarter than we were in the past.
link |
And then there's these like interesting studies
link |
that I've seen, I think Robin Hansen mentioned it to me,
link |
that if you look at the entirety of medication,
link |
like the effect of medication on human health,
link |
if you do those kinds of broad studies,
link |
does it actually help?
link |
Like does quality of life,
link |
lifespan, certain measures of the wellbeing,
link |
does if you, and you look at human society as a whole,
link |
does taking medication or not actually help?
link |
And those studies find there's no positive
link |
or negative effect with medication.
link |
And that's a very kind of interesting perspective.
link |
That mean you could probably argue a lot of ways,
link |
but the point is, because you can bring up
link |
literally a billion cases where medication
link |
has significant positive impact on a particular patient,
link |
but you have to kind of zoom out
link |
and honestly look at the positive effects of medicine,
link |
of lifestyle choices, diet choices, of exercise or not.
link |
Maybe we'll find eventually
link |
that exercise is actually bad for you.
link |
Maybe like there's all kinds of things
link |
that we're going to, I feel like we're going to figure out.
link |
One of the things I think we're going to figure out,
link |
everything I've learned about my body,
link |
is that aside from it being adaptable,
link |
there's a lot of very unique parameters
link |
that are opaque to me that I'm measuring
link |
through this feedback mechanism
link |
by trying stuff and learning about it.
link |
And one of the things we might learn
link |
is that medicine cannot be done without collecting
link |
a huge amount of data about each individual human.
link |
So it's absurd to be, like if I show up and see a doctor,
link |
it's absurd for that doctor
link |
to have just a couple of minutes with me.
link |
Like just looking at basic symptoms,
link |
looking at such crappy data.
link |
Like first of all, no long term data,
link |
no longitudinal data, no historical data,
link |
no detailed analysis of all the possible things.
link |
Not just the related to your symptoms,
link |
but related to other things that you're not complaining about.
link |
Just giving you a full picture of the data
link |
and then using AI to help the human doctor
link |
highlight the things that you should perhaps
link |
pay extra attention to.
link |
I think we'll look back at this time as ridiculous
link |
that doctors were expected to help anybody whatsoever
link |
without having the data,
link |
without having a huge amount of data about the human body.
link |
Like you have to do so much with so little data.
link |
It's very 19th century.
link |
It's very 19th century.
link |
So it relies on the brilliance of doctors
link |
and of course the intuition,
link |
the instinct you build up over time.
link |
And that's quite powerful.
link |
The human brain is pretty damn good
link |
for using experience to teach you
link |
how to make a good decision.
link |
But still it's, you might as well be bloodletting.
link |
Like it's humbling to think about that.
link |
It is humbling and it's important.
link |
I think doctors sometimes lose that humble perspective
link |
And I think it's very important
link |
because as I said, medical history is just,
link |
medical dogma has been tossed into the trash bin
link |
Something doctors were sure of was the case is not.
link |
And it's important to be cognizant of that.
link |
You tweeted about somebody that had a big impact
link |
just by reading about him on my life as well.
link |
Still think about him.
link |
Rest in peace, Dr. Paul Farmer.
link |
A big inspiration to me.
link |
His medical career was a testament
link |
to what one person can do to improve the world.
link |
So who was Paul Farmer?
link |
And what made him a great doctor and a great man
link |
and somebody who was an inspiration to you?
link |
So Paul Farmer was a kind of pioneer of global health.
link |
He started Partners in Health,
link |
which is kind of an international health organization
link |
that operates originally in Haiti,
link |
also Rwanda and elsewhere.
link |
And I think he was just so a zealot
link |
for getting healthcare to some of the poorest people
link |
And I remember reading some of his books
link |
and a book about him by Tracy Kidder
link |
that's really great, Mountains Beyond Mountains,
link |
about how even when he was a medical student,
link |
he was flying back and forth to Haiti in between exams
link |
and just with this really intense focus and interest
link |
in getting healthcare to where it's not.
link |
And I think traveling around the world,
link |
especially to poor places like India, Calcutta, Nepal,
link |
you really see how unevenly the benefits
link |
of modern medicine are spread
link |
over the surface of the earth.
link |
Not only if you're,
link |
cause if you're in Antarctica and have a heart attack,
link |
you're in serious trouble,
link |
but just medications that cost pennies a day
link |
A lot of children in India under five die of diarrhea
link |
and all they need is oral rehydration solutions
link |
Most of them can't afford IV fluids, for instance,
link |
to get admitted to the hospital.
link |
And really dehydration just kills hundreds of thousands
link |
of kids throughout the world.
link |
Not to mention bacterial pneumonia also is a major cause
link |
of death in children under five.
link |
And many of them, not all, would be saved by amoxicillin,
link |
which is just pennies.
link |
And I, for me, I took a, had a path
link |
and I wanted to have a career in global health.
link |
And I started traveling abroad to India and elsewhere
link |
when I was a medical student and continued doing that.
link |
Paul Farmer was sort of one of the first
link |
to kind of open everyone's eyes, I think,
link |
about the good you can do with just money
link |
that we would, you know, change that we would throw away,
link |
just, you know, put in a person, forget it,
link |
or wherever we accumulate change these days.
link |
So that's very eye opening.
link |
And while medical science advances and that's good,
link |
you know, we shouldn't forget
link |
that 100 year old treatments could save lives
link |
in parts of the world where they're just not available.
link |
People should definitely read Mountains Beyond Mountains.
link |
Just, for me at least, sort of a person from outside
link |
all of it, it was the first person to make me realize
link |
how difficult and the amount of humanity
link |
that's involved in being a doctor.
link |
So it's not some kind of cold economics based argument
link |
about where to send treatments and so on.
link |
That is there too, like you said,
link |
basic treatments can help hundreds of thousands,
link |
millions of people in many parts of the world.
link |
But it's also when you have a patient in front of you,
link |
there's some aspect of you that's willing to give
link |
a lot of your time, a lot of your money,
link |
a lot of your effort to saving them,
link |
even though it doesn't make any sense.
link |
It's irrational in some sense, but it's also human.
link |
And that's the struggle of every doctor.
link |
Like when you have to choose how to allocate your time,
link |
how to allocate your mental energy.
link |
It's a tough choice that a doctor has to make
link |
and it's a human choice.
link |
It's not some kind of cold game theoretic choice.
link |
It's also a human choice and it can be irrational
link |
People are asking you for help.
link |
That's basically what every patient interaction is.
link |
Someone's asking you for help.
link |
So your inclination is to help them.
link |
And even if it means going above and beyond,
link |
I mean, a lot of factors affect how compassionate
link |
a doctor might be on any given day or point in their career,
link |
their own stress and burnout, et cetera.
link |
But it's someone asking you for help
link |
and so you do what you can to help them.
link |
You've done quite a lot of things in your life.
link |
It's been an interesting journey.
link |
Of course, there's a lot of story yet to be written.
link |
But what advice would you give to young people today?
link |
In high school, maybe undergrad, college,
link |
starting out on that journey.
link |
Maybe trying to pick majors, trying to pick jobs,
link |
careers, dreams and goals they can pursue.
link |
What advice would you give them to have a career
link |
they can be proud of or to even have a life
link |
they can be proud of?
link |
Well, I think having passion,
link |
which isn't always a voluntary thing.
link |
You just have it or you don't perhaps.
link |
But becoming passionate about something
link |
and following it wherever it takes you,
link |
I think is really important.
link |
You know, when I finished college
link |
and sort of went to Russia for the first time,
link |
that was in some ways the beginning of my whole career
link |
and passions in my life.
link |
And I didn't know what I was going for,
link |
what was gonna happen,
link |
what kind of career it would turn into,
link |
what kind of job would it help me get when I got back.
link |
I wasn't thinking about any of that.
link |
I mean, I'm very fortunate I got that opportunity.
link |
I'm very fortunate to be able to go and see those places
link |
and have my mind opened.
link |
And I think that really just the fuel from that passion
link |
that was created during that time
link |
is still 20 years later going strong.
link |
I'm partial to healthcare.
link |
I love being a doctor.
link |
I think it's the perfect combination
link |
of kind of intellectual problem solving,
link |
being a detective while also working with your hands.
link |
You know, when you do procedures,
link |
especially in the ER, it's sort of the perfect combination.
link |
I'm not a surgeon, but I do use my hands quite a bit
link |
for a variety of reasons.
link |
And so I always loved working with my hands.
link |
I loved crafts, especially prehistoric crafts
link |
before medical school.
link |
And I just love kind of problem solving,
link |
getting clues, figuring out what's going on,
link |
following your nose, using your instincts, your knowledge,
link |
and also just keen observation of the patient.
link |
After seeing patient after patient, hundreds of patients,
link |
maybe thousands over years, you do get this sort of
link |
innate kind of sense, this gestalt
link |
about what might be going on.
link |
And, you know, it's not always a numbers thing.
link |
There's always, gestalt is actually a big part of medicine.
link |
You know, you often in ERs or in hospitals,
link |
hear a nurse or a doctor say something like,
link |
this patient just doesn't look good.
link |
And it's sort of, you can't point to a number, a value,
link |
a level in their blood, you know, a test,
link |
but something about them.
link |
And a lot of that I think has to do
link |
with the color of their skin, believe it or not,
link |
which can change in certain disease states.
link |
But I think that it's just,
link |
medicine combines this observation, the skills,
link |
the knowledge, it's art and science, it's human,
link |
and it's robotic, you know, algorithmic at the same time.
link |
And I think it just, yeah, combines kind of
link |
all my passions all in one.
link |
And I would, you know, if anyone's going into healthcare,
link |
I'd strongly encourage them to do so, but I'm very biased.
link |
So with that early passion, whatever that little flame was
link |
that brought you to Russia, were you able to vocalize it
link |
or was it just something like a gut
link |
that's pulled you towards some exploration
link |
of the unknown or something like this?
link |
I think it was a combination of things.
link |
One was just going to a different place
link |
that was different from where I grew up, you know.
link |
The suburbs, you know, when you're in high school,
link |
you hate them, later on they don't seem so bad.
link |
But, you know, I just wanted to get,
link |
I mean, I'm very fortunate how I was raised
link |
and never wanted for anything that wasn't rich,
link |
but just to get out and see a different place,
link |
a different people with a different culture
link |
and history and language and literature
link |
and to see different climates and geographies
link |
and ecosystems, I just wanted to see something different.
link |
And that, I guess that's what I've sought after ever since.
link |
So just that was just so fascinating.
link |
Like my trip to Kamchatka in 2003,
link |
where I was there for four months
link |
and I didn't speak English for, I think,
link |
two months out of it.
link |
And just, I remember lying on the floor,
link |
some wooden floor in a hunter's cabin
link |
in the middle of Northern Kamchatka,
link |
just being like, what am I doing here?
link |
This is, I'm just so grateful for like the experiences
link |
I was having, what I was seeing and realizing and learning.
link |
It was just, I was so grateful,
link |
even though I was lying on this hard, uncomfortable floor,
link |
it's just like, this is so amazing.
link |
And that, I don't think I'll ever have another travel
link |
as meaningful and life changing
link |
as that particular trip to Kamchatka was.
link |
Though I'm still striving after it.
link |
You never replicate that first high, but you always try.
link |
So I just think that seeing something different
link |
is kind of the game.
link |
And there wasn't really a plan.
link |
Cause I got a chance to talk to the CEO of Qualcomm recently
link |
and his advice is, always have a plan.
link |
And it sounds like you're saying don't have a plan.
link |
Don't need to have a plan.
link |
Just listen to your gut, your passion and follow that
link |
and see where that takes you.
link |
Cause it's telling you something.
link |
Yeah, I think, I guess the plan could be specific
link |
or it could be as general as I just wanna go far away
link |
and see something very different, that's my plan.
link |
And I did just one line.
link |
Yeah, just followed my nose from one thing to the next,
link |
just being interested, following my passion.
link |
And again, very fortunate I could do that.
link |
Are there places in the world you're kind of thinking
link |
about that your life might take you at some point
link |
to be a doctor there for a time,
link |
to explore for a time that you haven't yet?
link |
I have some colleagues who do kind of global health work
link |
in various countries in Africa and Central and South America.
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I would really love to go to some of those places,
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not just for a short trip,
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but hopefully for an extended period of time
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with sort of the healthcare being the ticket in,
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but then maybe even bringing my children or just,
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I guess at this point, some of the travel I dream about
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is sort of replicating what I did
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and showing it to my kids in a way.
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But there's still a lot I haven't seen
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and would love to see as well.
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But I think those opportunities sort of lend themselves well
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as a doctor with kind of the ability to go there
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and sort of help patients,
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but also teach medical students and residents.
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Teaching is actually a huge part of being a doctor
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that's underappreciated,
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but that's actually part of the fun of being a doctor
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is that you're also a teacher.
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Of course, the word doctor means teacher,
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but it's come to mean something else.
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But in some of my jobs,
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I'm working alongside medical students and residents
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and I'm giving them my knowledge, my wisdom,
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sharing with them stories.
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And so that's a very satisfying part of the job.
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If we could take a brief step
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into a dark place together for a time,
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is there, what is a dark place you've gone in your mind
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What would be the darkest place you ever gone
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for a time, for a moment?
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And how did you survive?
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How did you overcome it?
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That's a very good question.
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I would say I haven't had as dark moments
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as many of the people who I care for in the emergency room.
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I'm fortunate in that way.
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I've had a pretty enjoyable, satisfying life.
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I think everybody has dark moments though, including me.
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One of the most shocking things I feel like
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becoming an adult, my two big realizations have been,
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one, no one knows what they're doing.
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And two, suicide is incredibly common,
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like in all humans and all societies.
link |
That I just find shocking.
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I mean, I've never seriously contemplated myself,
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but I wouldn't say it hasn't crossed my mind
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during some more stressful times of life.
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I think it crosses everyone's mind.
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And sort of as a kid, I found that I never would have guessed
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how common suicide is.
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It's an important question to sort of the Camus question,
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Because like life, especially when you're struggling,
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especially when life is shit,
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like why am I doing any of this?
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And then on top of that, chemistry of your brain,
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it could be as simple as diet and nutrition
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and aforementioned exercise and things like this
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that affect the chemistry such that you're more predisposed
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to go to the places of asking the question why,
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and maybe struggling to find a good answer.
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Because it's actually a question with no good answer,
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except something in your chemistry says,
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well, I kind of like it.
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But there's no good intellectual answer.
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And especially if day to day, it's pain.
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You get to see these stories of Robin Williams,
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these people that are on top of the world
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from an external perspective,
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but from an internal perspective, it's struggle.
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Every day is pain, feels hopeless,
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and yeah, that's a question we all have to struggle with
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or learn how to ignore.
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Maybe because if you ask the question too much,
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you're not going to find a good answer.
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That's a choice you make.
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I personally think you should ask that question a lot.
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But maybe because I have the luxury of the chemistry I have
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where I'm not in danger of seriously contemplating suicide.
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But why live is an important question to answer constantly
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and struggle to answer that constantly.
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But people, I've been extremely fortunate
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to meet people over the past couple of years
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that are really struggling.
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And you have probably met people
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who are really struggling, like orders of magnitude
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more people who are really struggling.
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Some of it is psychological, a lot of it is biological.
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And man, life is a motherfucker.
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It's pretty tough.
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I do think also past trauma plays a big role there
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like we talked about, war wounds and PTSD.
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A lot of people grew up with just horrific childhoods.
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They were abused in one way or another.
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And I think a lot of people who have not,
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I'm not saying a majority, but a lot of people,
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for instance, who I see in the ER coming in
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for threatening suicide or actually trying and failing
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and being brought to the ER,
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a lot of them just have really traumatic experiences,
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saw their parent commit suicide, were abused.
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These leave scars in the human brain and mind.
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And a lot of their subsequent lives
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of whether it's substance abuse, alcoholism, et cetera,
link |
is almost trying to escape from their own memories.
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And it's sort of such this overwhelming battle sometimes.
link |
Like sometimes people get ruined, it seems,
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and just can't be fixed, you know what I mean?
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Yes, you can improve diet and health and your life choices
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and seek out your passion and exercise.
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And those definitely will help.
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But sometimes just like, you know,
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you bear the scars of the past
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and there's no getting rid of them.
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Yeah, I think it's possible to live with them.
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I think so too. To the struggle.
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I would never say give up, you know.
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It is a constant, it can be a constant battle
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I know it can be, and I've talked to many of those folks,
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I know it can feel hopeless, but keep up the good fight.
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Hopelessness. Keep up the good fight.
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Hopelessness is kind of one of the big suicide risk factors
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that you sort of ask about as a doctor, you know,
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do you feel hopeless? And that sort of can be a harbinger.
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I have quite a few dark moments.
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So if you're listening and you're struggling,
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we're in this together, brother and sister,
link |
keep up the good fight.
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Life is a motherfucker, as you said.
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It's really harder.
link |
I think as a kid, you know, in a joy free childhood,
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you don't realize, like, obviously there's a ton
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you don't realize about life,
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but then when you get to be an adult,
link |
you realize just how complex and hard it is.
link |
Is it this hard for adult animals?
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I don't know. I don't think it is.
link |
So I haven't seen the honesty of biology before you.
link |
Do you think about your own death?
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Do you contemplate death?
link |
Are you afraid of your own death?
link |
How do you make sense of it?
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I've definitely thought about it,
link |
especially maybe while doing certain risky things,
link |
ice climbing and others where every time I looked down,
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I thought about my own death.
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But I think, you know,
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I think having kids changes the equation for sure,
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should change the equation perhaps.
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So I think a lot of,
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now when I think about what will happen when I die,
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you know, there's a lot of worrying about
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what will happen to the people I care for.
link |
You know, you think about things like insurance policy,
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life insurance and, you know, disability insurance,
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that's not related to death, but more just injuries.
link |
And that's part of the weight, I guess,
link |
that you feel as an adult,
link |
that I think grows rapidly when you have kids.
link |
Though not only, you know,
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there's other people you can care for,
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your own parents and loved ones.
link |
Like a lot of people depend on individuals.
link |
And so you think about what will happen
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to the other people when you die.
link |
But also, to push back, that weight
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might be something you've convinced yourself to think about.
link |
It's an important weight to think about.
link |
But you focus on that weight to escape the other weight,
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which is, at one point,
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this consciousness just comes to an end.
link |
And it's hard to make sense of that.
link |
We kind of delude ourselves in thinking,
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okay, it just, yeah, it ends.
link |
That's the natural way of things and so on.
link |
That makes sense, so we're good.
link |
Okay, that's the way of life.
link |
But I don't think it's cognitively easy
link |
to just realize how terrifying that is.
link |
We love life so much that the end of it,
link |
it just, it's something that makes no sense.
link |
And if you linger on that thought,
link |
I think it's a painful, I would say even terrifying thought.
link |
Not scared of like, in a way that's
link |
almost like philosophically terrifying.
link |
Like, it just reminds you, maybe humbles you
link |
that you don't know anything about anything.
link |
But one of the things we do as humans really well
link |
is we, especially with kids, you realize,
link |
okay, we start caring for others in the community,
link |
in the family, and so on, and that distracts us.
link |
So then we can at least focus on other people's problems
link |
and not deal with our own.
link |
When I was a medical student, I was particularly
link |
fascinated with kind of what actually happens
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as people die, like in the last minute, seconds of life.
link |
It's sort of surprising sometimes,
link |
like what actually kills people.
link |
You know, like you can get, let's say, a bad head injury
link |
and you know, what kills you.
link |
Sometimes it's just your consciousness decreases
link |
and you become kind of comatose, you aspirate,
link |
your oxygen plummets, and you get cardiac arrest.
link |
You know, that kind of sequence of events.
link |
Or, you know, a heroin overdose,
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let's say you stop breathing.
link |
Similarly, your oxygen goes down,
link |
then you get a cardiac arrest.
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So I was really fascinated with what actually happens,
link |
what makes people die.
link |
And it was sort of a morbid fascination, obviously,
link |
like most of med school is.
link |
And I had many instances where I've had patients pass
link |
and as a medical student, I was sort of learning
link |
what's actually happening, watching it happen
link |
and not always being able to prevent it.
link |
It was sort of a scientific exploration.
link |
Then the patient's family comes in and are just devastated.
link |
And then it's like, rips you out
link |
of this scientific perspective
link |
and you just realize how horrible death is,
link |
but the person's fine.
link |
You know, it's the family, I guess.
link |
And that's why it's always, I guess that pointed out
link |
just how what people leave behind
link |
is often kind of the horribleness of death.
link |
Like just becoming unconscious and staying that way
link |
doesn't seem, I guess to me personally, so bad.
link |
Sort of like going to sleep, not waking up,
link |
not counting the pain and stuff that precedes it.
link |
So the actual pain, the actual suffering
link |
is often felt by the people who love the person who died.
link |
So both financial pain, psychological pain,
link |
for years missing them, all those kinds of things.
link |
Right, never forgetting the anniversary of their death.
link |
You know, just having flashbacks or something reminding you.
link |
That sort of brought home to me sort of what death means.
link |
And it was more about what people leave behind
link |
than what happens to them specifically.
link |
See, I like those concerns
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because I feel like I can do a lot about those.
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Those make sense to me.
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Then just be, if you're a father, just be a good father.
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If you're sort of, you mentioned sort of insurance.
link |
Yeah, there's like financial stuff to take care of.
link |
What I don't know what to do with
link |
is the philosophical existential crisis
link |
of the fact that this fricking thing ends.
link |
It doesn't, I don't know how to deal
link |
with the mystery that's beyond death.
link |
Why are we born at all?
link |
What is consciousness?
link |
And you just look at yourself.
link |
Why do I have the capacity to suffer?
link |
Why, why, all these kinds of why questions
link |
that don't have answers.
link |
Speaking of which, let me ask you a why question.
link |
The biggest ridiculous one.
link |
What do you think is the meaning of life?
link |
Having, with this book, studied the incredible,
link |
beautiful biology of life, the components,
link |
the engineering components that make up this human body.
link |
But when you look at the entirety of it,
link |
Sometimes, probably more often than not,
link |
feel like the question of why is a trick
link |
of the human brain.
link |
And outside of our thoughts, there is no why.
link |
Why is not something that's in the universe.
link |
It's just this trick happening inside our brain.
link |
So why is a game that the human brain plays on itself?
link |
And then the reality of life doesn't have why's.
link |
I do wonder if asking why
link |
is sort of an evolutionary adaptation.
link |
Like why, you know, maybe hunting, gathering.
link |
Why does this plant grow there and not there?
link |
Why do I see the same deer tracks
link |
and by the same tree every three days?
link |
Why, you know, why is this, why is that?
link |
Why does this plant make me vomit and that plant doesn't?
link |
I guess those why's are very practical
link |
and oriented towards survival.
link |
But then obviously, you know, we not only use why,
link |
you know, we use it to maybe hunt better,
link |
gather better, survive better,
link |
but then we sort of extrapolate it
link |
into these unanswerable questions, you know,
link |
about why, like why does life exist?
link |
And it's possible that they're not unanswerable
link |
in the long arc of science and history.
link |
It's we're just striving for the really difficult questions.
link |
Right now, we just don't know much about anything
link |
and so we're striving.
link |
But there's a long, so most of human history,
link |
you were asking why questions
link |
for which we now have very precise answers,
link |
including with biology and physics
link |
and all those kinds of things.
link |
And maybe the why's, this cutting edge of science,
link |
of the explorer of the curiosity of the human mind.
link |
Like man's search for meaning
link |
is the sort of the ultimate driver of the why.
link |
And it's almost like it could be an evolutionary adaptation
link |
of asking exceptionally hard why questions
link |
that will never get answered.
link |
Like, so you should always have,
link |
like it's like a queue, it's a stack of questions,
link |
why questions, and that thing should never come
link |
to the bottom, should always be striving.
link |
And that's useful for humans to come up
link |
with better and better ways of survival.
link |
And maybe from in a bigger perspective
link |
for the universe to figure out something about itself.
link |
And it's just humans, just a useful tool for that.
link |
Or life on Earth is a useful tool for that.
link |
Well, John, this, you're,
link |
for people who should know, you're from Philadelphia.
link |
I'm from Philadelphia, so it's an honor
link |
that you would travel all this way
link |
from a place I love to the new place I love
link |
and that you'll write this really incredible book
link |
that celebrates the human body in the most honest of ways.
link |
And thank you for everything you do,
link |
for being a great educator, for being a great doctor,
link |
for being a great person, and for spending
link |
your really valuable time with me today.
link |
Thanks for having me, Lex.
link |
Thanks for listening to this conversation
link |
with Jonathan Reisman.
link |
To support this podcast, please check out our sponsors
link |
in the description.
link |
And now, let me leave you with some words from Paul Farmer,
link |
a doctor who has inspired both Jonathan and me
link |
with the way he practiced medicine
link |
and the way he lived his life.
link |
The idea that some lives matter less
link |
is the root of all that is wrong with the world.
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Thank you for listening, and hope to see you next time.