EP. 155: THE POWER OF DATA DRIVEN NARRATIVE IN PUBLIC HEALTH

WITH DAVID AGUS

Sep 22

WITH DAVID AGUS, MD

An international leader in longevity and New York Times best-selling author shares his experience using data-driven narrative as a tool in the fraught field of public health — and offers a new vision for the patient-physician interaction.

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Elephants rarely get cancer, ants quarantine when sick, and altruistic pigs have a higher pain tolerance. In this episode, we discuss insights from the animal world that shed light on human health and wellness, as well as the power of data driven narratives in effective public health education.

Our guest is David Agus, MD, founding CEO of the Ellison Medical Institute and professor of medicine and engineering at the University of Southern California. As a CBS news contributor and author of three New York Times bestselling books on health, Dr. Agus emphasizes the need for experts who are willing to explain rather than tell.

Having experienced the politicization of public health during the pandemic, he highlights the importance of data transparency and the urgency for more physician leaders. With technological advances making data collection and analysis ever more accessible, Dr. Agus shares a vision for the future of medicine, where patients bring their own health data to the clinic and physicians act as educators guided by the values of their patients.

Editorial Note:

This episode was recorded in December 2024, after the nomination of Robert F Kennedy Jr as Secretary of Health and Human Services had been announced but prior to his confirmation. Some comments by the podcast hosts and our guest will reflect this timing.

Dr. David B. Agus is the Founding CEO of the Ellison Medical Institute and a professor of medicine and engineering at the University of Southern California. A medical oncologist, Dr. Agus leads a multidisciplinary team of researchers dedicated to the development and use of technologies to guide doctors in making health-care decisions tailored to individual needs.
An international leader in global health and approaches for personalized healthcare, Dr. Agus serves in leadership roles at the World Economic Forum and is co-chair of the Global Health Security Consortium. He is also a CBS News contributor.
Dr. Agus’ three books The End of Illness, A Short Guide to a Long Life, and The Lucky Years: How to Thrive in the Brave New World of Health, are all New York Times and international bestsellers. His latest book, The Book of Animal Secrets: Nature’s Lessons for a Long and Happy Life, was released in December 2023. He is a 2017 recipient of the Ellis Island Medal of Honor.
He lives in California with his wife, two children, and their dog, Georgie.
In this episode, you’ll hear about:
2:30 - Dr. Agus’ journey to medicine and how he found his way to focusing on preventative health and public education
6:50 - Navigating the politicized nature of public health as a public health educator
14:17 - Dr. Agus’ viewpoint on the controversial nominations of RFK Jr. and Dr. Oz as public health officials
19:51 - How medical education needs to change to adapt to our data-driven world
24:20 - The current state of nutrition science and how people can make the best choices with the latest data available
32:12 - The potential benefits of making big data in electronic medical records available to physicians
32:48 - The inspiration behind Dr. Agus’ new book, The Book of Animal Secrets, and what the animal kingdom can teach us about living a more fulfilling life
52:11 - A vision for empowering patients with their personal health data in the age of AI
54:31 - Dr. Agus’ advice to clinicians on supporting patients with their preventative health
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions. A quick note to listeners.
Tyler Johnson: [00:01:04] This episode was recorded in December 2024, after the nomination of Robert F Kennedy Jr as Secretary of Health and Human Services had been announced. But prior to his confirmation, some comments by the podcast hosts and our guest will reflect this timing.
Tyler Johnson: [00:01:23] Elephants rarely get cancer. Ants quarantine when sick and altruistic pigs have a higher pain tolerance. In this episode, we discuss insights from the animal world that shed light on human health and wellness, as well as the power of data driven narratives in effective public health education. Our guest is Doctor David Agus, founding CEO of the Ellison Medical Institute and professor of medicine and engineering at the University of Southern California. As a CBS news contributor and author of three New York Times best selling books on health. Doctor Agus emphasizes the need for experts who are willing to explain rather than tell. Having experienced the politicization of public health during the pandemic, he highlights the importance of data transparency and the urgency for more physician leaders with technological advances, making data collection and analysis ever more accessible. Doctor agus shares a vision for the future of medicine, where patients bring their own health data to the clinic, and physicians act as educators guided by the values of their patients.
Tyler Johnson: [00:02:23] David, thank you so much for taking the time to join us and welcome to the show.
Dr. David Agus: [00:02:27] Well, thank you. It's a privilege to be here.
Henry Bair: [00:02:29] So we're going to explore so many of the ideas, the rich ideas that you've presented in your books. But can you take us all the way to the start of your career and share with us a little bit about what initially drew you to medicine and to oncology specifically?
Dr. David Agus: [00:02:47] Thank you. Henry. You know, when I was younger, I was a geek where other kids were playing baseball, I was in the lab, so I literally was in the lab from kind of a young age, and I wanted to go into a field where I could take something from the lab to the clinic, and that clearly to me, meant oncology. So I was at Hopkins, I was doing my residency, and I went and met with my chairman of medicine, and I said, hey, I'm going to go into oncology. And he looked at me and goes, you know, you're smart. Why would you do that? It's just giving poisons to people. He goes, go into pulmonary or cardiology where you can make a difference. He goes oncology. And still today oncology is not part of medicine. It's separate at Hopkins. He goes it's literally just giving methotrexate and five fluorouracil do something more intellectual. And it kind of doubled my resolve to go to where people weren't up to where they needed me.
Henry Bair: [00:03:37] I have to interrupt you there. And I actually I'm unfamiliar with that stereotype. To me, when I think of oncologists, every oncologist I've worked with, they they spend so much time digging into the data. They're all about the clinical trials and the data.
Dr. David Agus: [00:03:51] Yeah. But you're you're young, you're young. Back then, we didn't have molecular targeted therapy. We didn't have immunotherapy. We didn't have DNA sequencing. All we literally had were a couple of forms of chemotherapy. I'm old. I was the first person in history to go from Hopkins to Sloan-Kettering. And so I went from Hopkins to Sloan-Kettering and started to work in the lab. My mentor had been there, a guy named David Goldie. And it was very exciting for me to be able to work on something that I could potentially take to the clinic. And, you know, the idea that the lab could actually help people was something that excited me more than anything, I love science. But more than that, I wanted science that actually helped the patients. Because the problem with oncology is you see a lot of suffering and you realize that why basic science is tremendously important. It's not going to help someone today. It may help them tomorrow. And I wanted to work on things that I could help people today. And then, you know, my career changed also where, you know, while I'm in the lab there, there's a knock at the door. I look up and it's that years time. Man of the year, a guy named Andy Grove. Andy was the CEO of Intel. He was a Holocaust survivor. I go, Doctor Grove, what are you doing here? He goes, David, he goes, I like your science, but you're a horrible public speaker. I go. So he goes, part of your job is to educate people. Part of the job of a doctor and a scientist is to be able to talk about it and educate that next generation, educate patients, educate people in general who are paying the bills because their taxes are what funds? Nih and National Cancer Institute. But he sent me a fax every day of where to show up at 6:00 and give a speech in New York. And I gave 200 talks in a year, whether it be a bank or an office or a school. And force me to become a better public speaker.
Henry Bair: [00:05:41] Wow. So tell us a little bit about your journey from on clinical oncology to now. Of course, now most of your writings are more focused on wellness and preventative health. How did that transition happen? Or was there even a. Do you conceptualize it as a transition?
Dr. David Agus: [00:05:56] You know, I mean, I think it's the notion that, you know, to understand peace, you have to go to war. And the war on cancer gave me a profound understanding of what peace was, and that is preventive health. And I realized very, very simply, is that, you know, treating cancer well, we can ease some of the suffering. We can't cure most cancers once it metastasizes unfortunately, we can't do that much, but we can focus on the prevention side. And so it really was starting to write about that and scale those ideas that, you know, got me excited to get information out there. And so I wrote my first book, which was about modeling disease in the body as a complex emergent system called The End of Illness. And it did very well and kind of spawned, you know, a subsection of what I do, which is educating the public about health and medicine, writing more books, going on TV. And it really was a privilege to educate people in that regard.
Tyler Johnson: [00:06:50] So, Doctor Agus, one of the things that I was hoping that you could talk about, you know, you have made this interesting career where in addition to being a doctor, you know, you were telling this story about the mentor who sort of dragged you around to all of these different public speaking events and forced you to become a public speaker in addition to a medical doctor. And one of the things that really strikes me about that is that that entire idea of being a medical doctor who is also, in effect, a professional public speaker, at least it seems to me, though I you know, I will grant that my historical memory on this subject is is not, you know, as long as some people's. But it seems to me that that has become significantly more fraught right before the pandemic. I feel like most public health officials could go on television and say whatever they were going to say. And if anything, the most remarkable thing about the response is that there was a lot of yearning, like it was very rare, at least as far as I can remember, for anything any public health official said to be considered controversial, let alone to stir up a bunch of, you know, outrage or whatever online. But of course, then during the pandemic, and especially with the advent of the vaccines, you would think, perhaps intuitively, that a pandemic would be the time when everyone would want to listen to public health officials and where public health officials would be lionized.
Tyler Johnson: [00:08:15] Right. That you would become heroes. And of course, there were episodes of that. But then by the end of the pandemic, it seemed like it had become at least very controversial and almost in some cases dangerous to be a public health official. Right. You had Doctor Fauci being pilloried widely, especially on the political right, and you had a number of people who had tried to, you know, basically make factual statements about the vaccines and other things, who became very controversial, who became lightning rods for these Partizan divisions in a way that I think was not intuitive to many people who were working in the medical field or even in public health before the pandemic. So I guess all of that is to say, I'm hoping you can just talk to us a little bit about how do you think that looks on the ground from your place, and what do you make of the way that there has been that transition over the past few years, in terms of what it looks like to publicly practice public health?
Dr. David Agus: [00:09:13] But you're right. Prior to the pandemic, the role I had predominantly was CBS news and some others, which is going on talking about science, you know, amazing nature paper showing how fish got mercury, a remarkable way to educate people. Talking about the study. Well, the study is interesting, but it really wasn't power. Don't make a decision on it or this this, it makes no sense or this is brilliant. We have to change what we do. And so being able to get out there and talk about things. Remember, in order to get normative behavior change, you need leadership. Health and food are about 30% of the US economy, and there's almost no leadership. And so most people you ask, who is the surgeon general? Who's the secretary of HHS? Nobody knows. And so we're in a field where there hasn't been real leadership. And so the idea of doing this through the media channels was powerful. During Covid. It became politicized. And, you know, listen, what I did was tried to rise above politics as try to not take a side, try to explain things. You know, if I get up and I tell you, I want you to do this, this and this, you roll your eyes. If I explain and show the data, you can actually get behavior changes. One of the biggest Silicon Valley companies had me come in once and say, hey, we want to really do something good for our employees. What do we do? I go, listen, if you want him to get him to eat the right thing, why don't we take the burger and we'll double the charge and make the salad half? So the burgers subsidize the salads and they go, great idea.

Dr. David Agus: [00:10:38] And they did it. And people got pissed off and nothing changed. Two weeks later I changed it next to. Each food I wrote, the good and the bad. Because there's no perfect food and there's no horrible, horrible food. There's probably everything has some benefit of moderation. And we just wrote next to each food, the good, the bad, the ugly and behavior changed overnight. And so it was an amazing message that when you tell a story and you educate, you can get people to do the right thing. And you're right. One of the biggest problems with the pandemic is you had some of our government leaders who would make declarations without explaining. If you explain and you say, hey, listen, we know the role of a vaccine in someone over the age of 65. We know the role in an infant, but in somebody who's 20, we don't have a lot of data of what it's going to do. We don't think it'll cause harm. We're not sure it won't spread. But creating immunity there, we think is worth it, even though we don't know the outcome. That's very different than just saying everybody needs to be vaccinated. And so I do think what we have to do better is being transparent with why we're doing things, what is the data, and then trust the American people to trust us. And we didn't do that.
Dr. David Agus: [00:11:46] And I think that's what people are upset about. And you're right, it got very political. You know, when you had leaders saying, this is my way. And then there's his way and her way, and that really made no sense. One of the things that really is informative to me was about 12 years ago, I wrote a letter to one of the leaders in Italy, and I said, one of your national treasures is this amazing sculpture that I want to make a copy of and put it here at my institute. This is eight foot tall sculpture. He wrote me back a letter basically saying F-you. During Covid, we helped with the vaccine rollout in Israel and the EU, and the then head sent me a letter and saying, hey, as part of our diligence on you, we found your original letter and we'd love to have our national sculpture make a copy. And the national sculptor, his wife had died of Covid at the beginning of the outbreak in Italy. He was very emotional and it was a sculpture of this country doctor in the UK named Edward Jenner, who noticed that when women milk cow, they would get pox on their arm and not die of smallpox that was killing 11% of the world population at the time. And they were the only ones with this crazy infectious disease that could take care of somebody with smallpox and not die. And so we went to the king and he said, listen, I want to draw pus out of their arm and inject other people.
Dr. David Agus: [00:12:56] And King said, you're crazy. Get the hell out of here. That night, the king had the dream of King Solomon, where there were two women who said, this is my child. And King Solomon thought for a moment, I'm going to rip the child in half. And the real mother said, you take the baby. And he called Jenner back and said, you know, listen, your wife died of smallpox and you had one child together as five years old. If you inject your child, I know you believe. And why this sculpture, the first vaccine equivalent is important to me, is not that it was that. It's the fact that the King and the royal family were number two through 11 to get the vaccine. So science without leadership dies on the vine. And in today's world, we need that leadership to step up. What happens on social media is we scare people out of stepping up. Right? When I got out there and would talk about Covid or talk about the vaccine, I would get death threats. And it is scary as a cancer doctor in Los Angeles to get people threatening you and your family. But we have to stand up and just put a blind eye to what's going on with people challenging us. Obviously, naysayers have a very loud voice. Most people have no voice on social media, and those small number of voices can drown out the others and push people out of going into leadership roles, especially in our field. And we can't let that happen.
Tyler Johnson: [00:14:17] So I recognize that even asking about this is going to be potentially controversial. But at the same time, I feel like we we sort of can't not ask, right. As we are recording this, we are in the middle of the new president or. Well, once and new president has made nominations for various cabinet positions, and some of the nominations related to health in particular have become very controversial, specifically the nominations of RFK and of Doctor Oz. And so it's interesting because anybody who has a cabinet level position, in effect, they really have two jobs. You can make the argument even the president has two jobs, right? So on the one hand, there is the substantive part of what they do, where they make internal decisions and they hire and fire people, and they put together panels and they, you know, whatever, all of those things. And then there is the public facing part of what they do, which is largely a way of talking about things. Right. It is communicating to the public what the government thinks is and isn't important. And which, again, is something that, you know, that specific enterprise is something that you have effectively dedicated a large part of your life to. And you know, clearly these pics have been controversial because a lot of people point out that both of those people have held, at least in the past, significant positions on significant issues of public health that do not align with what most people consider to be the preponderance of evidence that we have on those subjects. And so, while I recognize it's a fraught question, I'm hoping that you could talk a little bit about your thoughts about those nominations and the potential confirmation process.
Dr. David Agus: [00:16:05] You know, it's funny. Um, if tomorrow the Senate said, hey, listen, RFK Jr. You're no longer going to be HHS. We're not going to vote for you. It probably would create a backlash such that would hurt science more than if he goes into the position. And I think it's interesting in that regard. You know, the problem is or the good is, is both of those people. Mehmet Oz and RFK Jr are very, very smart people. Some of the things they say make sense. Many of the things they say are conspiracy theorists and make zero sense scientifically and create harm, potentially to significant numbers of people. And so the challenge is that they think very quickly, you know, very much before they speak, and they do the right thing. Listen, you know, I was on a call where RFK Jr was explaining what was going on. He goes, listen, I'm not against vaccines. I said, good, but I do think that we need to start to look and keep longer data on people who are vaccinated as children. Makes all the sense in the world. Nothing wrong with collecting real world evidence. We have a wild system that the day you submit data to the FDA for any drug or vaccine or therapy, we stop collecting data.
Dr. David Agus: [00:17:13] It's the stupidest system in the world, if you think about it. You treat 1000 people in a clinical trial and submit it to the FDA, and then we no longer collect data anymore. We should be collecting data, and especially now with what's going on with structured data, the ability to use real world evidence, AI and other things all the time and then be able to go back and fine tune our recommendations, he said. You know, maybe we can, you know, try different ways of schedules, of vaccinating kids and see which is best. And again, in a clinical trial, that makes total sense. As long as we don't scare people from these life saving interventions, which truly do, and the data are very there, they don't cause harm and they have dramatic benefit on a global population. And so, you know, I don't want to throw out the baby with the bathwater. You know, whoever becomes secretary of HHS, I will and have to support and help push them to do the right thing. And the same is true with who is president and who is a surgeon general. And so I'm not going to go out there and say something negative about them till I see what they do.
Dr. David Agus: [00:18:11] But my job, and I think every doctor's job is to help push them with the right data to make the right decisions. I've known Mehmet Oz for decades and he is a good human. When I knew him, you know, some of the things that he said when running for Senate, I don't really agree with, and it scares me a little bit, but I hope and pray that he becomes data driven. That being said, our system has a lot of checks and balances. The Secretary of HHS, HHS cannot eliminate vaccines. He cannot eliminate eliminate pasteurized milk. He cannot take fluorine out of the water. There are a lot of systems in place. So that doesn't happen. And so the answer is I honestly don't know. Our current Secretary of Health and Human Services, I mean, what do you think of his positions? And the answer is I don't know because he doesn't have many positions. You know, the first Trump administration, Scott Gottlieb, was the FDA commissioner in those two years he was FDA commissioner. The FDA probably got more done than anybody in the last several decades. And I look back and then I'd say, you know, that's amazing. And I hope that happens here.
Henry Bair: [00:19:14] Thank you very much for the candid response. I mean, it's a lot to think. It's definitely a it's really interesting to think about.
Dr. David Agus: [00:19:21] But I love that there's public debate about it. You know, uh, the mayor of New York said you can't have large sodas. And everybody argued nanny state is good, bad, etc. nobody argued soda was good for you and it gave a new understanding. And actually buying patterns changed in New York City. So I love the fact their discourse over these positions, over vaccines and doctors are stepping up talking about data. With discourse comes understanding. So that part of it in the end, may be this kind of positive we never thought about.
Henry Bair: [00:19:51] That's really great. Um, you know, we sort of, um, just there alluded, uh, we kind of touched upon the idea of misinformation a little bit. I want to use that to circle back to exploring a little bit about how you've spent a lot of your, your time, uh, in terms of what you've been thinking and writing and teaching over the past couple of decades. So preventative health, lots of misinformation. To be honest, I don't I in medical school, maybe we had I don't even know, a few hours of preventative health. I realized after I got to medical school, when I started intern year as a residency, and I would have patients come in and ask me about questions about preventive health because, you know, they're in the hospital, they've had a heart attack, and they're asking me for advice. And I realized I had very little to go off of. I was basically googling all their questions. Or in today's day and age, I was ChatGPT like what their questions were. Point is, I don't know that much, and I don't think most fresh grads from medical school or residency really know all that much. How did you learn about the current body of knowledge that you now educate people on, and what has shaped your approach to preventative health and wellness?
Dr. David Agus: [00:20:58] You know, I mean, listen, medical school is screwed up, no offense. I mean, we all went through it. It is basically selects kids who are good at taking tests and it encourages them to memorize. In today's world, we all have these little devices. It makes no sense. You want people who can think, can look through data, can have compassion, can speak. Those are all skills that we don't train for in medical school yet. We need. And so the medical boards are, in my mind, one of the stupidest things that exists out there. They are irrelevant to the care of patients, which is astonishing if you think about it. So, you know, when you look at preventive medicine, it's very easy to say, hey, you know, how do you know so much? And how do you write these books? First of all, there's not that much data out there. There aren't many large, well done studies showing things that work. And so everybody says, well, you write that, you know, you're against vaccines. I go I mean, against vitamins and supplements. I'm for vaccines. I go, no, I'm not against anything, but there's no data showing they work. And I'm not going to support taking something when there's no data. They work and there's potentially data. They can cause harm. And so I think it's very important that we start to tell these stories and to get information out there about where there is data.
Dr. David Agus: [00:22:15] You know, there are countries out there. You know, our country is amazing. They say when you turn 65, do whatever you want. Smoke all you want, be obese, sit on a couch all day, and then we'll pay for the healthcare ramifications of your behavior. That's the current state of affairs. And when you look, health is 1,718% of GDP and it's a runaway train. In Singapore, if you get colon cancer and you skip your colonoscopy, you pay a significant fine. And then they'll give you colon cancer care. If you're a smoker, you're allowed to smoke and you get lung cancer. You pay a fine and then they will treat your lung cancer. And so they say, listen, you're allowed to do what you want. But we're not going to have the nonsmokers subsidizing the smokers. We're not going to have the people who took health seriously, subsidizing the people who didn't. And it's a staggering approach. And obviously the answer is somewhere in the middle. We're not going to do that in the United States. But Obamacare did allow for differential charging and behavior based on health care based on behavior. So now in the United States, there are companies Dell Computers said, hey, you smoke? I charge you three times the health insurance cost.
Dr. David Agus: [00:23:19] The day you go into a nonsmoking program, I lower it to the average. If you're obese, I charge you 2.6 because that's what it costs me the cost. As soon as you go into a weight loss program, I will lower your premium. And so, again, incentivizing people to do the right thing, there's a big backlash. And then he just changed it and said, I'll give you a discount if you don't smoke. It's the same numbers. But Carrot and Stick had dramatically different outcomes, which is kind of wild when you think about it. But there was a void, right? Almost everything written in health or selling something or pushing something or pushing an agenda, talking about a diet, you know that if you ate, you know, three cucumbers one day and two carrots the next day, then everything would magically get better. And I just said, hey, listen, I want to put data out there and just do the right thing. And that's where the books came from. I mean, my first book I wrote is about modeling disease in the body as a complex emergent system. Not a sexy topic, if you will. But we were able to talk about it and do it with stories. So it did very well globally. People had an appetite for data driven health information.
Tyler Johnson: [00:24:20] One of the things that I think you are that I would say that you are trying to do through your engagement with the public in all of these various media platforms, is to make public health legible or audible, I guess, to the people that are exposed to it. In other words, you want to take really, really complicated information and make it simpler, make it digestible, make it so that a person can hear it and say, okay, now I know what I'm going to do. And I feel like one of the places where the country and the world is most in need of that is in terms of how to think about what we eat, right? So first off, I don't know if you've seen this, but there's this very funny video that purports to show a person being kind of like hopscotched through time periods, and they're getting like dietary advice according to whatever is kind of, you know, in the cultural water at the time about our eggs, good or bad. And how do you think about cholesterol and how do you think about fat? And is there good fat or bad fat? Anyway, all of these things and the sort of the joke of the thing, right, is that you start in this one place and then you go 20 years down the road and end up in almost the opposite place, and then go 20 years further down the road, and you're back in the place where you started, right? And so it almost leads to this sense of sort of like nihilism, like, well, how am I even going to know? How can I possibly know what is good or bad for my diet? If the advice from quote unquote science is changing all the time? So, you know, one of my favorite sources to look at in terms of this question is Michael Pollan's book In Defense of Food, which I think gives a very intelligible and accessible sort of summary of the data and a way to think about what we ought to do and not do in terms of our approach to food.
Tyler Johnson: [00:26:01] But I would love for you to just talk a little bit about, as someone who has thought both about the facts on the ground, but also about the way to talk about those facts, how would you summarize what we know about food and sort of the state of the evolution of the science of nutrition and sort of how the public should be thinking about that.
Dr. David Agus: [00:26:19] So let's look at the simplicity, right? The simplicity, which is all I write about, very simple things, which is it's not just what you eat, it's when you eat people who graze and snack. What happens is you have a snack at 2:00 today. Tomorrow at 2:00, your insulin cortisol go up expecting you to have a snack. The body is good at predicting things. That lowers productivity, that lowers athletic performance and lowers cognitive function and its stress on the body. So eating whether you're a two meal a day guy or three meal a day girl, it doesn't matter. Just stick to it. Around the same time every day, baseball players who change a time zone and eat their meals at the new time zone lose 6 to 7% on their 6 to 7 points on their batting average. It's pretty amazing the data and the statistics behind it. So just regularity will enable you to actually lose weight and perform better. The second is, in almost every study done, the Mediterranean diet has trumped everything else. And so we were made and designed as humans and evolved over long periods of time to basically eat whole foods, processed foods, things in a blender we weren't designed to eat. And they have very different impacts on our insulin and our physiology than real foods. Right. You're made to chew something, swallow it, absorb some here, some here, some here, some here.
Dr. David Agus: [00:27:31] And that's very different than in today's world where we put things in a blender and try to drink it, or we put it into a bar or other things in processing them. And it's very simple. Eat real food same time every day. And that's where the data are. And there's no more. Yes. Does cancer love sugar? Of course. But at the same time, your glucose serum glucose is 100 no matter what, right? If you eat an insulin bar, your serum glucose is 100. If you starve, it's still 100. So there's always sugar for the cancer. So yes, eating concentrated sweets can raise insulin. And most cancers have insulin receptors and it can actually impede or induce their growth. And so you want just moderation. And that's the key with everything is moderation. And it's as simple as that. There's no magic food. There's no secret food. I mean, you look at vitamins in a $245 million study trying to show that vitamin E would prevent prostate cancer. What do you know? It increased prostate cancer by 17%, and they had to halt the study. The study on vitamin A and beta carotene in lung and smokers and former smokers showed an almost 27% increase in lung cancer and a 16% higher death rate in the supplements.
Dr. David Agus: [00:28:39] And by the way, death is a bad outcome to a supplement. And you start to look at that and you say, hey, listen, people are spending a lot of money. Remember, vitamins buying in stores didn't exist until the rise of the fast food movement. With the rise of McDonald's came the rise of multivitamins. And who makes most of the vitamins J and J? Novartis. It's all the pharmaceutical companies make them, and we buy them because we think that we're the antidote to fast food. And it's kind of a wild if you look at the history of that. But going back to real data, hell, there were studies done in the UK with over a quarter million people in each arm showing that a baby aspirin a day reduced not the incidence, but the death rate of cancer by 30%. Heart disease by 22% and stroke by 16%. Yet we in our country don't practice that. One study comes out showing that in the elderly, if they had never been on aspirin and go on it for four years, there's increase in bleeding and we stop doing it in the country without looking at all the data starting at a young age. Effect on cancer and all of those. We're very good at these reductionist concepts. We never look at the big picture.
Henry Bair: [00:29:45] One of one of the tricky things about, um, data when it comes to food or lifestyle. This is one of the reasons why I actually, I, I really don't like going to the data about food and lifestyle and exercise is because you can find pretty robust clinical evidence published in peer reviewed journals that support almost anything you want. You can you can find data that says that you know egg yolks are good for you. You can say egg yolks are bad for you. You can find data that shows that red meats cause cancer, or that red meats don't cause cancer. You find data that says statins are great for you. And then there's like, you know, post-hoc analyzes that say, actually, no, statins don't actually benefit you that much. Usually I just start at this point, I kind of just give up and then I just forget about it and then I'll come back to it, I don't know, like a few a few weeks later and then get frustrated over again.
Dr. David Agus: [00:30:33] But that speaks to lack of leadership, right? I mean, if there were leaders that you trust, right? Then you would listen to what she or he said. And I think that's the problem, right? It's very hard for the average person to say, hey, if it's a New England Journal, is it the same as if it was in, you know, Journal of Heart or whatever it was? And they're not all the same. And it's very hard to deduce the quality of a study. But to get normative behavior change you need leadership. And so I think there are certain things that we should be doing in medicine that have very little downside that can have tremendous upside when we start to look at the data. And that makes sense. Other things don't. In our country, we spend 75% of our health care preventive dollars on one test. What test is that? To prevent colon cancer. Colonoscopy. Because it's so expensive. Right. We spend an inordinate amount of our preventive dollars on one thing, and we do that. I mean, certainly colonoscopy works. If you're the NIH director, wouldn't you think? Let's spend a couple of billion dollars and make a blood test for colonic polyps, because most people don't need a colonoscopy. And then all the money we save from colonoscopy, we put to heart disease, cancers and other things because we're not going to get more money into the health care system, but we got to use it better. We need leaders who start to think like that and can really approach the global set of things and do it. You know, in the UK they did a study where they took two towns and they took everybody and everybody over the 50. They put on an Ace inhibitor, a low dose, low dose aspirin and low dose statin. They never measured bloods, so it didn't measure cholesterol or anything. And they showed that the people on this three pill, they called it a one pill. Three things in it. They lived longer than the people on the placebo. Pretty amazing.
Tyler Johnson: [00:32:12] So if we can switch gears a little bit, again, you know, a lot of what we have talked about so far is basically discussing how do we think about communicating what is most important about whatever public health initiative to the public. Right. How do we help people to think better so that they can live better in effect? Let's broaden the scope a little bit, and let's pretend for a moment that you woke up tomorrow morning and you were tapped on the head and designated as the public health czar for the United States of America. And let's say that whatever presidential administration was in power at the time that this happened in our imaginary scenario basically said, you've got carte blanche, permission and power to do whatever you need to do to change, whatever you need to change wherever you think the best bang for the buck lies. Just go there, do whatever whatever you think will be the most meaningful. Where would you turn your attention? Like, what do you think is the not necessarily the lowest hanging fruit, but the but the stuff that is potentially actually doable. And that would make a really big difference. What would that look like if you were in charge?
Dr. David Agus: [00:33:27] So, you know, listen, I've been on the board of the Biden Cancer Initiative with President Biden. I've worked with him closely. You know, we helped on the vaccine rollout, and the Trump will work with any administration. And so, I think, you know, first and foremost, what you want to do in this country. I mean, you're an oncologist. Lung cancer is 60% of people with lung cancer when they're diagnosed have no molecular testing at all. And, you know, you can give them an ALK inhibitor, which is a pill, an EGFR inhibitor. You can buy them potentially a year or 2 or 3 of quality life time with your kids, their grandkids, Kids just by doing a simple test. So if we could equate care in this country and in today's computing world with electronic health records, we should be able to. That would be the first thing to start with. You know, right now, electronic health records are bags of words. That's all they are. So what we want to do is start to do a data overhaul in this country so that they could be structured data. So we could start to learn, you know, I alluded to that. You know, the day something is submitted to the FDA, we start collecting data. Well, that makes no sense. As an oncologist you can prescribe a drug off label for whatever you want, right? Use Chop to treat a lymphoma. It's not FDA approved yet. We use it and it's standard of care. And so I do think we need to start to collect real world data and that it was a feature, not a bug of electronic health records, that you couldn't get data out of them. The two companies involved, Cerner and Epic, viewed it as their long term future to be able to monetize data.
Dr. David Agus: [00:34:53] So don't let anybody get any data out of him? Well, that makes no sense. The good is Larry Ellison, who's my big backer, bought Cerner, and he's changing it open to get data out of it. And the same has to happen to epic. Is that we can start to do it. When I moved to my first hospital, I moved to California. I led a prostate cancer center, and so all the locals would come and submit biopsies for our. We had a dedicated prostate pathologist, the only one in LA, and at the bottom of the form, I had them put the docs percent positive biopsy rate in the community, percent positive rate. So if a Doc biopsy in 80% of his or her biopsies were positive and the community was 30%, the doc probably isn't biopsying enough or vice versa. So when we started three and a half standard deviations, within three months we're down to 0.8 standard deviations. I didn't tell a doctor what to do, but I just gave data to give them the context of what was happening in the world. Because when you're a doctor in the world, you're basically on an island, right? You don't know what everybody else is doing? But all of a sudden now with technology, we should be able to enable that. And I think that's the first thing I would do, is build an information highway to connect. Doctors, put every decision in the context of similar patient decisions, and show doctors the outcome. No doctor wants to be told what to do, but they want data so they can make the right decisions for their patients.
Tyler Johnson: [00:36:15] Let me tell a brief story and then just ask a sort of a follow up question. So, you know, back during the discussion about Obamacare, there was a lot of talk about increasing transparency, about what was happening with doctors and with hospitals and trying to do a better job of sort of recording and measuring the performance of healthcare systems and whatever. And of course, that makes perfect sense, right? Because, you know, obviously, if I'm not that most people really choose what doctor or I mean, what hospital they go to, but nonetheless, if, you know, just as a thought experiment, If I think, well, I could go to hospital A, B, or C, and I know that hospital A does a much better job of taking care of their patients than hospital B, then of course I'm going to want to go to hospital A right? That makes sense. And and certainly there is a deep irony in the fact that if I want to go buy a new car or a new or if I want to go out to eat at a restaurant, or if I want to buy some clothing, or if I want to get virtually anything right, I can get on Yelp or any of a number of other similar reviewing websites, and I can look up in three seconds how well reviewed the restaurant is, or the car is or whatever.
Tyler Johnson: [00:37:20] Look at Consumer Reports on and on and on. And it is very strange that you really can't do that with healthcare. I mean, yes, you can log on to Yelp or whatever and look at what do people say about a given doctor, but you really can't know about hard markers of quality, let alone about cost, because oftentimes that information is not really available. Having said that, though, I have also become convinced over the last few years that the execution of what seems like an intuitively Unassailable idea is a lot more complicated than it might seem. So for example, I was involved in a hospital committee some time back that the point of the committee was to try to figure out how to improve what is called the observed to expected inpatient mortality ratio at the hospital. So basically what that means is that you do a bunch of very calculated calculations to try to figure out how sick overall, on average, are the patients coming into this hospital. Then, based on how sick they are when they come in, there is an algorithm that makes an estimate of what the overall mortality rate should be, given that patient mix and and disease load mix. And then you measure that against what the overall mortality actually is.
Tyler Johnson: [00:38:30] And of course, what you hope if you're running the hospital is that your actual mortality is significantly lower than your expected mortality, because that says that you are delivering care that is superior to the other institutions around. What was striking to me, though, is that while it may of course be possible that there were other initiatives in other parts of the hospital with other people on them that were dedicated to doing something to really raise the quality of the care in the hospital. The committee that I was on was largely dedicated to fixing documentation, meaning that we were trying to figure out how to more accurately record the complexity and overall sickness of the patients who were coming into the hospital. That is to say, if you're thinking of an O and an E ratio, we were not even really trying to do anything about the O. That is the actual delivery of good care to the people in the hospital. Rather, we were trying to adjust the E. We were trying to accurately reflect how sick the patients were when they came in. Now, to be clear, of course it is the case that transparency only makes sense if you have accurate record keeping in the first place, right? So it doesn't make any sense to report, for example, an Ode mortality ratio, which is something that goes into a lot of hospital, you know, safety ratings and all that kind of thing.
Tyler Johnson: [00:39:46] It doesn't make any sense to report that in the first place if the E is not accurate, because if the E isn't accurate, then the statistic doesn't mean anything. Nonetheless, what was really striking to me is that after many months, actually, I think years of working on this committee, when we found that when we eventually were able to demonstrate that the patients who were coming in were significantly sicker than we had previously been, assuming that was looked at from the outside as this sort of quantum leap in the quality of care that we were delivering, when in fact, all that had happened was that we had changed things so that there was a more accurate depiction of how sick the patients were when they came in. So all of this is just to say, I'm not trying to argue that that doesn't matter. I'm not trying to argue that accuracy is not important. Of course, accuracy is important, but it's just to say that this idea that by reporting out data and increased transparency and everything else, that that is going to lead to better care. Strikes me as much more complicated in the execution than it might seem in the theory.
Dr. David Agus: [00:40:52] Now you're right. I mean, the US newsroom report, every college, you know, changes their thing so they can be highly ranked. There's no question about it. That being said, that shouldn't turn you off from the whole field of trying to improve medicine. And I think, you know, you can have an experience, say, screw it, it's not going to work. But if you think of it this way, 60% of people with lung cancer never molecularly characterized in today's world. With AI, I can look at an h.a slide. So h.a is how we color slides their color purple and pink. When we look at a pathology site. Do you know why that is? Because the human eye, it comes from the 1800s in Germany. The human eye can discriminate remarkably well with purple and pink. So that's why they literally arbitrarily chose. And when you look with AI, cells are arranged on a slide based on their morphology and based on what gene is turned on. So if I turn on Gene X, they're going to look differently than if I turn on Gene Y. So just with AI with 93 genes, I could be almost as accurate with an image as I can with sequencing DNA.
Dr. David Agus: [00:41:53] So if I built that into the electronic health record that the image of every patient was looked at and you could just do a Q to a doctor. Hey, listen, this tumor looks like it may be EGFR mutated. You may want to send it to sequencing because patient could get drug X or drug Y. That would be game changing. And the number of lives that would improve in this country is staggering. So again what you're talking about are things that are recording quality that are public. I'm talking about just putting data in front of the doc so she or he can make their own decisions. I'm not grading them. I'm not putting in a public, you know that. They followed it 90% of the time. Docs in general want to do the right thing. Docs in general want to help their patient. You know, we see suffering on a daily basis and we want to alleviate most of the time we have to make a quick decision. And if I don't have all the data and I make the wrong decision, I did the best I could. I'm just trying to use technology so we can improve that.
Henry Bair: [00:42:48] That clarification makes makes all the sense. I do want to spend some time talking about your new book. You know, The Book of Animal Secrets, which is, you know, revolves around the same themes as some of the your other recent books. Tell us a little bit about what motivated you to draw inspiration from the animal world to to help us live better?
Dr. David Agus: [00:43:08] Yeah, I went on a coolest trip ever with my family. I took my kids to Africa to go to safari, and it's wild. You saw the way the world was and were there with the guide. And this elephant walks by that's, you know, an elephant's 40 to 100 times bigger than you or I. And I, with my cockiness, say to the guy, listen, he has 40 to 100 times more cells than we do. He's in the sun all day. They must get lots of cancer. He looked at me like I was stupid. He goes, elephants never get cancer. And I was like, what? And we looked into it. And you and I have a gene called the guardian of the genome called p53, that we each have a copy of one. Every elephant and every continent has 20 copies of this gene. So here's a creature that evolved away not to get cancer. You know, elephant females give birth into the late 60s. The dominant male protects the herd until the day he dies. So they couldn't afford to get cancer through evolution. By the time you and I classically hit 30 or so, we've had our children. So we have are of no use. If they knock us off, we can actually provide more food and housing to the next generation. And so if we can recapitulate what an elephant does, oh my gosh, we could prevent all cancer. And then I started to call experts in giraffes, in big apes, in ants. And I say here are the hallmarks of Alzheimer's, heart disease, cancer and longevity. What can I learn from your system? And the answers back were amazing. We've all been on this earth a million years, and we all evolved every creature to have certain things to help them live longer and better, and we can learn from other species. And so it was a tremendous excitement for me as talking to these experts and writing their stories.
Henry Bair: [00:44:42] So, I mean, what are some examples, some concrete examples for those who haven't read your book yet? Like what did you learn from these experts?
Dr. David Agus: [00:44:50] So, I mean, there are things like ants, you know, talking to the ant expert. Believe it or not, there's an ant expert. He lives in Germany. And, you know, the first thing I said to him is, you know, tell me the worst experience you had, you know, living in the field with ants in Africa. He goes, well, I'm driving to this colony I studied and I studied this colony for years. You know, you first identify the queen ant, and once you look at all the behaviors and you study for several months, once you get the queen ant, you do something very scientific. You put white out on her back. And that's how you identify who she is, because they have a white spot by putting that on them. By the way, the queen ant lives 40.5 years and the worker ant, same genetics. She gives birth to all of them. They live six months. So what can we learn between that difference? That's a whole nother story. But he said I was driving there and then my son called. He was 13. And you know, I felt so guilty because I kept leaving him for long periods. And he had broken his leg playing soccer, what he called football. And he goes, I felt so bad I was crying that I ran over my colony.
Dr. David Agus: [00:45:49] I go, that's horrible. He goes, no, it actually gave my biggest discovery. He goes, when an ant has three or more legs injured, they leave him to die in the battlefield. They triage when it's two or less. They bring it back. They lick the wound for 24 hours because they have anti-infectives in their saliva, and they have a 93% survival rate. They triage when an ant gets a virus, they're sick. He or she leaves the colony and they stay out for four days. If they survive, they come back and join the colony again. If they don't, they die. But they don't get anybody else sick. And so it's a remarkable thing that, you know, look what we did during the pandemic. These ants have been doing that on their own in nature, which is kind of wild. But the worker ants take risks, right? They go out, they leave, they get exposed to infectious diseases and other things, and they die at a very young age. The queen ant doesn't take risks. She does. No risky behavior. She's in the colony. Nobody who's sick is allowed near her. And she lives almost four decades. It's an amazing observation, if you think about it. I talked to Jane Goodall about big apes, and she said there are three kind of ape parents.
Dr. David Agus: [00:46:54] And she goes, I know for decades I just observe them. There's the one kind of parent who has a child and just lets him do whatever they want. They fall out of a tree, they break their arm. And those kids, when they grow up, take so many risks that they never live a long life. And they are never leaders. There's the kind of a parent who hovers, who doesn't let the kid climb a tree at all, doesn't, you know, as soon as he's with the rough kids, takes their kid away. Those kids grow up and become followers. They're never leaders. Then there's the parent who lets the kid climb up the tree and is out of the corner of their eye, looking at the kid. Once they get a certain height, they take them down, but they let them skin their knee. They let them get in little fights with the other kids. Those are the kids that become leaders. They know there's someone looking over their shoulder, but they're allowed to take risks. And it's such an amazing lesson for kind of human parenting that we can get from these big apes, which is wild.
Henry Bair: [00:47:48] So it's fascinating. And, you know, obviously there are so many more examples, concrete examples you share in the book. But I'm wondering and this sounds like maybe a counterintuitively simple question, but it's part of the whole purpose that you're writing this book. So I think it's really important to explore what that actually means, which is what insights do you have after having done all these, all this, all this interviewing, all this research? What insights do you have on what it actually means to be happy and to live well? Are there common themes you've discerned that help us lead down a path of happiness?
Dr. David Agus: [00:48:29] You know, it's interesting. I mean, Dan Buettner wrote a book called Blue Zones, where he went to parts of the world and showed certain areas people live much longer than others. And what are their habits? And there's some profound lessons there. But what you're talking about is happiness. You know, we have a hormone called oxytocin, which is the love hormone. And so the more human interactions we have, the higher oxytocin. Oxytocin makes us happy, relaxes our blood pressure. It actually makes us feel good. You know, I have a dog, Georgie. When I look at her in the eye, her oxytocin goes up and so does mine. And so I think it's very important that we especially we learn during the pandemic that we have human interactions. As I say to you over zoom, you know, we need to do more of them. We can make ourselves feel good. There was an amazing study done in pigs, believe it or not, where they showed that when a pig was altruistic, when they shared their food with others and then they induced a pain. Sounds kind of barbaric, but the pain threshold was they had much less pain. So if you feel good and you have pain, you experience much less of it, so all aspects of your life will be better if you're happier. So whether that means just more human interactions, whether that means sharing things with people, doing good. When you do something good, it probably has more benefit to you than the person you're doing it for. And I think that's one of the most important messages we can give people. And I think it's exciting. You know, listen, having a pet correlates to living longer and better because it gives you interactions on a daily basis and their feedback interactions. Right. You interact with your pet, you feel good.
Henry Bair: [00:50:06] What are some concrete things that you want readers to implement in their lives?
Dr. David Agus: [00:50:12] You know, I write books and I tell stories because I want people to understand, you know, when I tell people what to do, they roll their eyes when I explain to them and tell them all of the data, they end up doing the right thing. And I think that's what's really important and something we forget all too often. You know, as doctors, many times a patient comes in, I say, do this, do this, do this. And the patient leaves their eyes and says, oh, you know, I came out with the first consumer genetics test, right? You spit into a tube and you sequence 40 genes, and we said your likelihood of a disease. That day, Steve Jobs called me up and goes, agus, you screwed up. He used more strong language than I can say. And I go, what do you mean? He goes, you can't tell someone 40 things at once. The human brain turns off. What you should have done was just launched the tests for cardiovascular risk six months later. Did colon cancer. Six months later, did X, did Y and Z one thing at a time? So tell one lesson at a time, one story at a time. And then people can understand and comprehend. And that's where we try to do.
Dr. David Agus: [00:51:13] I don't think there's any secret to living to 100. I think it's just understanding and then choosing the behaviors that make sense for you. You know, listen, we all have a right based on our value system to do what we want. Hell, if I gave you growth hormone tomorrow or a month from now, your friends are gonna say, oh my gosh, you look healthier, you look more muscular, you look great, and it works. The problem is, on average, it takes a decade plus off your life. But you look good today. And it's a value system based decision. What you want to do. But the key is to have all the information to make those. And I think all too often as doctors we tell people what to do. We spoon feed things. We don't explain and tell the stories. It takes too much time. I've got to see ten patients today. 20 patients. I don't have the time to explain things. I just tell them what to do. My field cancer. There's very few times there's the right decision. Most of the time is the right decision for the value system of the patient. And so it takes a lot of time to explain that.
Henry Bair: [00:52:11] Yeah, I mean that was going to be my question is like as clinicians, how how do we incorporate that. Right. Because we do get these questions all the time from patients. Sometimes it's in the inpatient setting when we actually have a little bit more time, but a lot of times it's in the outpatient setting when you have three three minutes per patient and you're running two hours over, you know, two hours late. And it's again, it's not necessarily counterintuitive things. I mean, like, okay, get enough sleep, eat well, exercise. They're not hard to articulate. And, you know, when patients hear that they'll say, you know, well, yeah, I knew about that. Um, but just it's so hard to feel like you have the bandwidth or the training or the mental energy to go much deeper beyond that.
Dr. David Agus: [00:52:56] Remember, our clinics now are made to collect data, right? You come in, I check your blood pressure, I draw your labs, I examine. That's collecting data. We spend the majority of our time collecting data and a tiny fraction transmitting information back. In fact, most of the time I have to call you a couple days later with the results. So the transition will happen when people collect the data outside and come to us for an explanation. That's where medicine should be. You should be able to go to a local place, prick your finger. They draw all of your labs. You collect three weeks of blood pressure data. We have your sleep data, your deep sleep data, your REM sleep data, your exercise data, all of that information. And I could put it together. And some machine learning algorithm can very quickly, just like ChatGPT can summarize a chapter of a book in three sentences. It should be able to summarize that, and then I can give a cogent explanation to the patient and have supporting materials to give them even a deeper explanation. That's where medicine needs to be. You know, I started to write books because many more people wanted to see me than could. And so here's a way to scale what I do in a way that's data driven that I believe in. But I think AI now is going to transform all that technology revolution to collect data. You know, if you want to buy a Cat scan for your office, it's $1 million. But as we transition everything to edge computing is all you need is the detector there and all the compute power is in the cloud. It's down to $100,000. So you democratize the technology that's happening with every technology in our field. And it's very exciting.
Henry Bair: [00:54:31] Yeah, a lot of what we talked about actually are more and a lot of what you're so passionate about involve more systemic changes right there, like sort of what you're talking about democratizing the technology, having a more robust, interoperable data structure in healthcare. With the last few minutes here, I'm wondering if you have any advice for the day to day clinician like on the ground, just, you know, I'm me, I'm done with medical education. I'm done with medical school. I'm unfortunately, I'm not part of the you know, I'm I'm not in some high powered like I'm not a public health official. I don't run this healthcare startup trying to implement new technologies. I'm just seeing patients day to day. What are some concrete steps I can take now to better connect with my patients and push them towards the right direction.
Dr. David Agus: [00:55:20] You know, it's interesting. Steve Jobs gave me a couple of lessons. One, he says, if you walk into a patient's room and you sit down versus stand, they perceive twice the amount of time as if you were standing. He said, don't wear a white coat. It's from a hundred years ago where they, you know, they didn't have clean clothing, etc. nowadays, don't separate your patient. In fact, try to choose a chair that's lower than your patient because you're looking up at them. It shows a sign of respect. You know, my office is a table, not a desk, because I don't want someone to sit across from me like I'm the professor and they're the student. I want it to be more equal conversation. Try to go into the room with all of the data, so you can go in and actually have a real conversation. And when you take your notes, all too often our notes are blood pressure. This you know high exam this prescribe this. Try to put some notes about some of the cues that matter to the patient. You know, patient broke their arm. Couldn't go to son's events. Ask about it Next time you bond with a patient and show you care. You're going to get twice as good at compliance. Every time I send a patient out for a test, whether it be a colonoscopy, an x ray or blood draw, I put a queue to have someone, myself or someone in my office send an email to the patient. I know it's illegal to send emails, but to send an email to a patient to say, did everything go okay with your colonoscopy? All of a sudden the patient goes, oh my gosh, they care. They trust me more. Now there's compliance and I get better outcomes. So I got better outcomes by getting the patient to trust that I cared about them that many times. Can Trump doing the most sophisticated molecular test in the world. Just having your patients listen to what you say and do the right thing.
Henry Bair: [00:56:59] Yeah. One of the one of the most powerful things I remember doing, no one really taught me to do this. But in intern year, during my first year of residency, one thing that I started doing was calling patients after they left the hospital just to check in on like, how are you feeling now that you know it's a week been it's a week past since you were last in the hospital. Did you pick up that medication? All right. How is it treating you? Anything that you've noticed, any side effects? They're always surprised in the best of ways. And they you can feel the gratitude and you can feel the respect that sort of builds and the trust that builds. So I love that advice.
Dr. David Agus: [00:57:38] Not HIPAA, but it's the interpretations of HIPAA really have created a wall between physicians and healthcare providers and patients. We're afraid to communicate things and we have to get over that. I mean, if you look really what HIPAA says, it doesn't say you can't do it, but interpretations of HIPAA by hospitals, you know, if we let lawyers guide what we do, we're in trouble.
Henry Bair: [00:58:01] Well, you know, with with that, we want to thank you so much for your time, David, for taking the time to join us, for sharing your stories, for sharing your your big ideas. But you know, your your writings, but also, you know, for for the very useful, insightful, concrete day to day advice you have for both patients and clinicians alike.
Dr. David Agus: [00:58:19] Well, thank you, Henry. I truly appreciate it.
Henry Bair: [00:58:24] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:58:43] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:58:57] I'm Henry Bair.
Tyler Johnson: [00:58:58] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.