Part One: Peter Attia and the Cult of Longevity

Welcome back to Behind the Bastards, a podcast that tells you everything you don't know about the very worst people in all of history. And this week, I'm one of the laziest people in all of history because I'm getting a week off of researching and writing a script thanks to my good friend, Dr. Kaveh Hoda, who has come in and wrote, written, wrote, wrote, written a script for us. Kaveh, welcome back to the show. Thank you so much. How are you doing? It is so nice to see you both. I miss your faces when I don't get to see them. That's right. And now I get to see your faces and that makes me happy. And then I get to talk to you. This is now it's my turn. You've done so much. Yes. You've done so much to bother people with terrible stories. Really made them unhappy a lot. Yeah. It's my turn to give back to you. And I want to. Wait, I'm going to I'm going to give you a present first. Have you had. Fiber today, my friends. You should eat more fiber. Yeah. Kaveh does always say that. Fiber zaddy here. You're welcome. Fiber zaddy. That's what they call me online, Robert. Fiber zaddy. Yeah. And I looked it up and it's a good thing, apparently, to be a zaddy. So that's me. No, that's that's good. You know, Robert, let me ask you a question. When you envision a doctor, someone trustworthy, someone you feel like you should be listening to, someone with advice you would follow. What would that be? What do they look like in your mind? What do you what do you envision? Are they are they handsome? Are they fit? Are they charismatic? And don't don't lie to me, Robert. I can tell when you're lying. Honestly, I picture my old pediatrician, Dr. Sherrod, who was the doctor I had growing up as soon as we moved to the Dallas area. He was a really good. I had a bunch of like weird health issues around my allergies as a kid. And every other doctor we went to was or every other pediatrician we went to. I had trouble figuring out what to do. And Dr. Sherrod did not. He was a really good doctor, like helped me with my allergy problems as a kid was just always like my mom worshiped the guy. He was great. That's probably why I have such a positive opinion about doctors, because I grew up with a really, really good one. Must be nice. Yeah, I think about him. And Sophie, what about you? You know, you know, the details of my medical history. Yeah. A little sour on doctors these days. You know, but I love you and I love my brother and you're both doctors. So there you go. I'm one of the good ones, Robert. I'm one of the good ones. Well, you know, here's the thing. I you are both doing, I think, the reasonable thing, which is you are using your own memories, your own relationships with people you know and have met and you know to be good doctors. But I would think. Unfortunately, that's not always the case in this country. I think when a lot of people in this country are thinking of a doctor, first of all, they're probably thinking of a male doctor, although most evidence most evidence we have would actually suggest you're better off with a female doctor. They've actually looked at that just in general. Well, if for particular, the study showed it was like in patient hospitalizations, but it's certainly not worse. So that was like actually kind of. It's funny that this had to be done. But at one point there had to be a study that said having a female doctor can women be doctors. Right. And actually, it's probably better. So. Yeah. Yeah. We'll probably get more of that. We'll probably get more of that in the future, too. But I usually prefer like most of my doctors and an adult have been women. And I usually I just feel like they pay have paid more attention to me, I guess. Yeah, I think that's probably it. You know, the study didn't really specify why. I mean, I suggest. I'm guessing that's probably it. But I think the truth is for a lot of people there, they're going to think of this doctor that's like tall and handsome and stately and well put together. Someone they could imagine wearing like a tailored suit on general hospital or like fitted scrubs on Grey's Anatomy. Of course, of course, you got to tailor your scrubs that you're going to throw out. It is crazy to me, the tailored scrub thing. I wear the biggest, baggiest, goofiest looking. Hell yeah, brother. I mean, here's the thing. I, I, I like my favorite part about my job is that I essentially get to wear pajamas to work. That's fantastic. Us too. Yeah. I mean, I am wearing pajamas right now. That's a good point. I could have skipped a lot of medical training and just gone straight to podcasting. But hey, live and learn. We all could. Well, I told my brother. So, so people, people are thinking like these Dr. Oz's and the Dr. Drew's and these kinds of guys. But I'll tell you something right now. I'm going to tell you right now. I'm going to take a stance here. I think doctors, should be schlubby and silly looking. Basically, I should be like the max handsomest doctor that you should envision. Like it shouldn't get better looking than me. Convenient rule to suggest. Yeah. Anything better looking than me, you're going to run into problems. We've seen it time and time again. And I have another question for you. Have you ever heard of a Dr. Dennis Lowe or Dr. Faith Fitzgerald? No, but Dr. Faith, I'm already getting like, oh, that could be a problem. I mean, I know it's a normal name. For a lot of people, but just the name Dr. Faith really concerns me. Well, I'll tell you this. The reason you don't know of them is because they were amazing doctors and they dedicated their lives to service and education. And I'm assuming they never had a Q score greater than 20. I'm sorry, Dr. Faith. I apologize for judging you. And Dr. Dennis Lowe, Dr. Faith Fitzgerald passed, but Dr. Dennis Lowe still kicking. And I was lucky enough to be mentored by both of these terrific and caring doctors. And that's why we're not talking about them today. But we'll be talking about someone you have heard of, one of the most famous, most influential, and most widely followed doctors in popular culture, Dr. Peter Atiyah. Oh, boy. I know that name. Have you heard? Yeah, I'm curious. What is the thing you've heard? I guess I know what it is. Not much. He just shows up. I mean, he's involved in the administration, right? Like he's been one of those guys. Very peripherally. Very peripherally. He is someone that the wackier people in the administration sometimes cite to show that they're not so wacky. He kind of does a little bit of science washing. We'll get into that. But he's the doc who, more than any other modern doctor, has worked to popularize and legitimize the field of longevity medicine. Are you guys familiar with that? Yeah, like the Brian Johnson, try to live forever. I mean, like the quack end of it is Brian Johnson. Measuring his sleep erections. Obviously, there's a good reason to care about longevity. You know, like that's that's there's also definitely a non-quack side of it. Oh, yeah. We're going to get into that. We're going to get into the good and the bad of it. So like what I know about him is he exchanged quite a lot of emails with a not so friend of the pod, Jeffrey Epstein. Yeah, I have a question about you are correct. And we're going to get to that. But my question for you is Jeffrey Epstein, like you've probably made this reference already, but is he like the Forrest Gump of terrible people? Because the fact that he showed up in the story, that wasn't even the reason I wanted to talk about Peter Attia. And then when I was learning more about him and I discovered that I was like, is he involved with every questionable person? Well, I mean, kind of. Yeah. But like Forrest Gump, it was just sort of like coincidental that he kept winding up in all of these historical situations. And I think that's kind of the reason why he was involved in all of these historical situations. Jeffrey Epstein like knows and was involved with a lot of powerful people because he was providing them with services, so to speak, or he wanted the cloud associated with them because it because there were people who didn't do anything awful that Epstein either funded or invited to a lot of things because he liked to camouflage himself being surrounded by great scientists. And after his arrest, the people who were legitimately like just caught up and like didn't know anything about him, they were like, you know, we're not going to do anything and we're legitimately just caught up and shit. They stopped hanging out with him once he was charged and convicted of, you know, child molestation. But yeah, anyway, so yeah, well, he shows up here and we're going to get into that before we do. There's a lot of other things I want to talk about. That actually wasn't the main reason I wanted to discuss him. We're going to get inside the bad of it. We're going to have a little bit of a nuanced, I'm sorry, an advanced discussion. We're going to do the risks and benefits talk, just like you're supposed to. In medicine. We're going to talk about the potential harms of over testing and over medicating. We'll talk about whether it's important to have the VO2 max of a Tour de France cyclist, how important it is to track your blood sugars by the minute if you're not diabetic. And if it's normal for your doctor to be on an email thread with Jeffrey Epstein discussing the nutritional benefits of cunnilingus. Yeah, no, that doesn't, that seems questionable. Yeah. I don't know if you want to use that as a cold open, but, you know, welcome to Behind the Bastards. Yeah. Behind the Bastards, the only podcast that just said cunnilingus. Probably not the only one. One of them though. This is an iHeart Podcast. Guaranteed human. Wait, this is a soda? Yeah. And it has protein? 10 grams. No sugar? Zero. And it actually tastes good? It's Skypop. Skypop protein soda delivers the refreshing taste you want from a real soda. Crisp and delicious with 10 grams of complete protein. Zero sugar. And just 45 calories. So you're not choosing between great taste and real benefits. you're getting both in every sip sky pop protein soda reach for the sky get your sky pop protein soda now at target lisa tell them about our new show we have a new podcast it's called don't lie to me i'm lexi you want to we're two best friends 22 years apart but so close at heart and i'm lisa di giulio the old one which means we have wildly different references occasionally different opinions and at this point in my 50s i've lived it all now in my 30s being the founder of new shoes good taste is my business listen on the iheart radio app apple podcasts or wherever you get your podcasts there are thousands of podcasts that can tell you how to better yourself get worse with kyle prue is not one of those podcasts so if you're interested in getting thinner going to therapy starting peptides setting boundaries taking supplements making your better getting closure then i would humbly recommend other podcasts if you're interested in blackmail love revenge then we've got a little something something for a dastardly individual like you listen to get worse with kyle prue on the iheart radio app apple podcasts or wherever you get your podcasts i'm lacy mosley author actor stand-up comedian creator and host of scam goddess podcast the true crime comedy podcast all about robbery fraud and those who practice it each week i bring on an amazing guest oh i scammed him what i could talk to you for an hour you're a generational yapper like me that's why i had to make yapping a job and now i'm going to talk to you for an hour now you can catch full episodes of my show on youtube start listening to scam goddess on the iheart radio app apple podcast or wherever you get your podcast i'm melissa jeltsin host of the what happened to her podcast we're kicking off the season with the sandra birchmore story a case the police wrote off as a suicide in a snowstorm her family never bought it and the man they suspected wore a badge you never know who that devil is because he's wearing a disguise sometimes it's a police uniform and you can get access to all episodes 100 ad free with an iheart true crime plus subscription exclusively on apple podcasts available only to iheart true crime plus subscribers so don't wait head to apple podcasts search for iheart true crime plus and subscribe today okay so before we get into this episode i have to clarify a couple things he's not going to be the worst person you've ever seen he's not going to be the worst person you've ever seen you've discussed on the show he's not even the worst doctor of course you've discussed he's not even the worst doctor you've discussed with me on the show he's obviously not a bastard on the level of a stalin or saddam hussein or mark zuckerberg but in my mind he represents a new kind of danger in medicine one that doesn't come from direct harm to patients but from credibility and from charisma and from privilege from someone whose influence is outsized and ideas are actively reshaping medicine and whose model of care in my mind is deepening inequality in this country it's this his whole approach is this sweeping reimagining of health care that claims to prevent heart disease neurodegeneration and all this stuff and it sounds great but it's not all supported by randomized trials it relies a lot on speculative pharmacology and under-tested and aggressive biomarker manipulation and testing we'll talk all about that i obviously take issue with some important aspects of his practice uh this whole model of manosphere wellness influencer or maha adjacent doctor is something i find very troubling history has shown us that if we don't nip these dr oz's in the bud early they can become real problems for everyone down the road they wind up in charge of everybody's health care yeah that's right like the people who are now in charge are the people i i were all internet trolls 10 years ago and it and it blows my mind it's bleak um so about the manosphere because i think it's kind of important that we discuss it uh actually you know i have to say one of the first times i was really exposed to it it was a couple years back you probably don't remember because you see this stuff all the time but somebody tweeted that robert prop and i were part of the quote unquote leftist manosphere and i didn't know what that meant and i still don't know what that means yeah it's not great i don't think i don't think it was a compliment and i doubt it what manosphere are we up to okay as as the girly pop on the podcast oh fuck no yeah i don't know i don't i don't know what that's supposed to mean but okay okay i think dr attia might maybe take issue with being labeled part of the manosphere but a large part of his strongest support comes from there and his appeal really right comes from that same milieu that creates our joe rogan's or andrew andrew hughes rogan but sure joe's yeah right right yeah it's like attorneys general yeah like johns hopkins yeah right exactly attia's rise whether he likes it or not is inseparable from this podcast industrial complex they all exist in the same ecosystem now i'm not an expert in this in fact most of what i know about the weirder parts of the online world i've learned from you people here on cool zone media yes that is kind of our milieu and i've been there's an you don't know there's been a number uh of times that i've like uh texted uh garrison to be like hey can you explain what this means or this means and like like i'm like the the old boomer like who needs help with their vcr um but here's what that's good that's good that's good that garrison's being a resource we we love that really good it's like hi i know things it's like the modern equivalent of uh walking an old person across the street yeah yeah that's and i appreciate that so it's the internet yeah it's the internet and so but i think if you think of this online male self-improvement world as a venn diagram i think you'd see four circles and please correct me if i'm wrong and weigh in on this but one you have the red pillars the looks maxing people online forum dudes and another you have the bro science fitness sphere the testosterone growth hormone guys bodybuilders or in the third is the tech sphere biohackers that's again where andrew huberman comes in yeah silicon valley longevity enthusiasts like brian johnson um who will want to talk about some point in this and and also then there's also the mainstream wellness sphere people there are less offensive in general more standard fitness stuff like your crims chris hemsworth and hugh jackman's proponents of the health jackman yeah huge jackman um and peter lives somewhere in between all these but probably more three and four not that far from the manosphere though the manosphere definitely borrows from him particularly his language on testosterone metabolic health right two max protein his audience definitely shared with rogan too and i will say this actually here in san francisco so silicon valley tech folk love him and i've met some very reasonable people who listen to him and follow him closely i've had people with no history of diabetes ask me about getting continuous glucose monitors because of what they've heard on his podcast that was really eye-opening for me yeah so what sets him apart from these people is that he doesn't talk about gender politics too much he has or had a lot of female followers especially after guess who exposed him oprah uh and he also had a 60 minutes profile piece uh and more like and more than most of the people in this world he does actually seem to look for evidence-based medicine he cherry picks it a bit when he does but he's i think he's actually a smart guy i know a lot of doctors like dr oz and dr ben carson all these guys they're very successful and i think people consider them smart but in truth i don't actually find them that intelligent they're great at surgery and they're very hard working but you know they're they're surgeons i'm sorry surgeons sorry um we could talk about difference between neutral medicine surgery at some point if you guys like but i never found a song about that people are aware yeah did he really yeah like a surgeon yeah oh yeah to the tune of madonna's like a virgin yeah yeah yeah yeah well as with most things it was explained early in the 80s by weird al yankovic yeah but i never found them that smart it's actually kind of wild how far you can go in medicine with some charm and some hard work and i think those two are are examples of that but i think atia he's really smart and and i have to tell you as i prepared for this episode there were multiple points where i was like oh my god i was like i actually i like a lot of what he says more than i expected i agree with some of his recommendations and there's even some stuff in his history that i empathize with but there is definitely this pipeline of men who start with guys like atia and huberman and end up with peterson and tate he's like the evidence-based gateway to the manosphere and that's one of the reasons why i think i want to discuss him here with you folks right before we get into him though let's talk a little bit about longevity medicine in general and what it actually is um its proponents would say that for the past century medicine has been reactive you've probably seen people talking about this quote-unquote sick care right right you you get yeah shocking that doctors focus most on like saving people's lives when they're ill i mean like obviously preventative medicine is important but it's not weird that that's the way it you know yeah goes yeah that's kind of what we have to do because if we don't right what what's going to happen you do you have no one else to take care of you um but there's some there's some truth to that like it's always important to think about preventive care. And in longevity medicine, it's meant to be sort of a way to flip the dynamic that it's preventive, personalized medicine that aims at expanding not just your lifespan, but what they call your health span, those years that you're in good health. It's driven by something called the geroscience hypothesis, which is basically aging itself is the shared root of most chronic disease. So instead of playing whack-a-mole with one disease at a time, you could, in theory, delay all of them. And like every system that is totally on the up and up, you can consider it like a pyramid. The base is the lifestyle components. The middle is measurement, tons of testing, wearable, biologic age clocks that claim they can tell you how old you are. And at the top level of this pyramid, of this particular field of medicine, is the experimental frontier with drugs and supplements, aimed at aging pathways, like metformin, rapamycin, NAD+. You might have seen that one already. One pattern about all these meds, including the ones that we'll discuss later, there's some impressive effects that are in mice or lab animals, but limited or really non-existent proven effects in humans. The evidence of longevity medicine working in people and humans is actually pretty thin. And we're not even sure if we're measuring the right things with these biologic clocks and that sort of thing. And of course, there's a question of safety of taking some of these medications long-term. We'll get to that. I think some parts of this field are generally very interesting, and I'm hopeful that some good science will grow out of it. But the more I learn about longevity medicine in general, the less I like it. The thought of these uber-wealthy technocrats learning to expand their lifespans, even more than they already have, I find to be kind of terrifying. And as we're going to get into this, I'm going to talk about some of the things that I'm going to talk about. In the second episode, longevity medicine is particularly bad because it disproportionately affects the wealthy, if it works at all, allowing them potentially to extend their influence, consolidate their power, and delay the generational progress of science and cultural, political progress and all that stuff. I don't know, maybe I'm being nihilistic, but my question for you and you both, I'd love to hear what you have to say, is would you even want to live forever? I'm assuming the answer is no, but how would you say that? Be honest, how long would you want, what's the longest you would want to live for? I don't know. I can't imagine. It depends. I think the big thing for me, and there's some reasonable people in the longevity space who talk about this, is health span. I would like to stay healthy and mobile and independent the entirety of my life. That said, I don't know that I'd want to live longer than 90 years at the outside. I don't think the kind of human lifespan, more or less, like 90 to 100 or so, I don't feel like that seems great if I could not be miserable and decrepit and dealing with Parkinson's or Alzheimer's or whatever at the end of it. That's kind of the big thing for me, as opposed to objective lifespan. There's already things that I know are good changes to society that I'm never going to be okay with. At some point, we'll figure out. You know, some degree of self-driving or we'll finally get our shit together and replace all the cars with good public transit and whatnot. I like driving. I know that's bad. I support society reforming and getting out of its addiction to cars. That'll just never be something I'm personally ever able to enjoy as much as other people. I don't want to go on too long to the point where, hopefully. If things go well, the world will be a lot better, you know, in 70 years or however, 50 years, 40 years. But I don't know that I'll be comfortable in it, right? You kind of hope that the world evolves beyond you, if you're not a shitty person, I think. You know what I love? After everything you've seen and studied, you're still kind of an optimist on the inside. I mean. I don't know if I think that's likely. I know you can't really say that because you have to be cool and like, you know. You have to be aloof and whatever podcasts are, but you're kind of an optimist, and I love it. The darker thing would be to say, I don't want to live through the complete collapse of the biosphere's ability to support life, which certainly seems likelier than us getting rid of cars and developing good public transit. Yeah, but you could have said that. You could have said that first, but you didn't. Yeah, because it's. Because you're an optimist. I would be nice on the internet to people. I don't want to depress people anymore. I do that too often. Sophie, how long? How long would you go for? Well, if I could be healthy and Anderson could be healthy, you know, probably the same answer as Robert. I don't want to be. I don't want to be uncom. I don't want to be, like, miserably uncomfortable and a burden to the people around me, one. And, like, you know, if they could, like, health max my dog to live longer and live great and be strong and live long, I mean, that would be sick. I don't know if we need to do that for people, but for dogs, dogs don't live long enough as is. I agree with both of you. About the health span. I think that is very important. I think we should be focused more on living our best lives for as long as we can. Eventually, it will catch up to us all, but, I mean, yeah, I think that's a realistic thing to do. I hear you. There's chia seeds in this shit. For you. Look at you. For you, Kaveh. Health nut. You know, for me, a big part of this is not just the longevity medicine aspect of it. It's that I dislike concierge medicine in general. Yeah. It feels bad. It shrinks access. It feels bad for everyone. It feels bad. Well, there's a reason. It shrinks access for everyone that's not wealthy and turns healthcare into this subscription-based privilege rather than a social responsibility to take care of people. And a typical doctor who moves into a concierge practice, and by the way, I understand very well why you would want to do that. And there's like a non-zero percent chance that I will eventually sell out and have my own concierge practice. So, I get it. But a typical doctor who moves into a concierge practice, I get it. But a typical doctor who moves into a concierge practice will reduce their panel from something like 2,000 to 3,000 patients closer to 300. And this is only accelerating the collapse of our healthcare system. And it's also leading to ethical drift in the medical profession. And concierge medicine is, right now, really the only delivery system for longevity medicine for these people. We'll get into that. But let's get into the atia of it all. But first. Yeah. But first. But first. You know what will make you live forever? The sponsors of this podcast. I guarantee it. And if you don't live forever, you can sue iHeartMedia. You know? No, no, no, no, no. Sophie, Sophie, it's perfect. They can't. Look, if they don't live forever, how are they going to sue us? If they die, what are they going to do? No, no, no, no, no, no. What are they going to do? It's the perfect. It's the perfect scam. We'll be way out of the podcast game by the time they figure it out. Yeah, we'll be in El Salvador by then. Oh, man. Don't tell them where we're going. It's okay. Honduras is what we meant. It's okay. We're really going to North Korea, Sophie, but we're not going to tell them that. Robert, no. This ad is brought to you by Veve Healthcare. They're makers of Devato, Dolutigravir, Lamivudine. If you're living with HIV, do learn about Devato. 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Tell your doctor about your medicines or supplements, medical conditions, liver or kidney problems, pregnancy, breastfeeding, or planned pregnancy. Do ask your doctor about fewer medicines. Visit devato.com or call 1-877-844-8872. Yeah. And it has protein? 10 grams. No sugar? Zero. It's Skypop! Skypop Protein Soda! Delivers the refreshing taste you want from a real soda. Crisp and delicious with 10 grams of complete protein, zero sugar, and just 45 calories. You're getting both in every sip. Skypop Protein Soda. Reach for the sky. Get your Skypop Protein Soda now at Target. This episode is sponsored by BetterHelp. If you've thought about trying therapy with our long-term sponsor, BetterHelp, insurance options may now be available nationwide with an average co-pay for eligible members of just $23. $23 per session. Your mental health doesn't know it's World Mental Health Day. Stress does not politely wait until October 10th. Burnout does not RSVP. And your brain definitely doesn't check the calendar before deciding to spiral at 11.47 p.m. Mental health is just a part of regular health. Therapy isn't only useful for big life choices. It could be a place to talk through smaller things. That work situation, taking up too much of your mental real estate, or a relationship dynamic you can't quite name, or simply the sense that something feels off. If you've been waiting for this episode, please subscribe to our channel. We'll see you next time. $23 per session with insurance. Don't have insurance or live outside the U.S.? You can still get 10% off your first month. Visit betterhelp.com slash behind to explore your payment options. That's betterhelp.com slash behind. Lisa, we should tell them about our new show. Oh my God, Lexi. We have a new podcast. It's called Don't Lie to Me. I'm Lexi Iwano. We're two best friends, 22 years apart, but so close at heart. And I'm Lisa DiGiulio, the old one, which means we have wildly different references, occasionally different opinions. And at this point in my fifties, I've lived it all. I'm not going to get anywhere fighting. That is wild. I learned that about you today. Now in my thirties, being the founder of new shoes, good taste is my business. And I've always got something to say. If men were just honest about this, there would be so much more peace in the world. We're going to talk about dating, relationships, beauty, getting older, I'm a little wiser. We're best friends, but we don't always agree because you told us how accommodating you are. Obviously I would do what I think I could do to fight the fight, but there's only so much fight I can fight. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Don't lie to me. Liar. Listen on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. I don't really care. There are thousands of podcasts that can tell you how to better yourself. Get Worse with Kyle Pru is not one of those podcasts. So if you're interested in getting thinner, going to therapy, starting peptides, setting boundaries, taking supplements, making your better, getting closure, then I would humbly recommend other podcasts. But if you're interested in blackmail, love bombing, cloning yourself, or getting revenge, then we've got a little something something for a dastardly individual like you. Take a listen to some of the incredible advice we've given so far. Fake a back injury. Get the spray tan. Up your alcohol consumption. Should be allowed to have guns. Kill him. Kill him. Kill him with a gun. Listen, it's already over. I'm all about lying if it's something that really happened. The next time a bear is running at you, you just calmly stop what you're doing. You look the bear in the eye and you say, this isn't you. Do not preserve relationships. You don't need them. You only need one thing, and that's the Get Worse podcast. Listen to Get Worse with Kyle Pru on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. And we're back. Sophie and I aren't moving to North Korea to avoid extradition laws. We didn't spend years working out a plan with Kim Jong-un or whichever Kim we've got in there right now. I think it's Jong-un, right? I forget. Anyway, let's continue. Should probably learn that before, you know. Kim Jong-un. Yeah, his dad was Kim Jong-il. Look, whoever I've been emailing is in charge of North Korea according to the guy I've been emailing and sending. Yeah. If you just call him Kim. It's fine. Exactly. I get it. Yeah. Let's talk about Peter Attia. Let's start with the early years. He's talked a lot about his childhood, but it's usually in these controlled, self-narrated ways through podcast monologues or interviews. Or his book, Outlive, The Science and Art of Longevity. There's been a couple of very useful pieces written about him, but not any real investigative biography. So we have to reconstruct his early life with what's. Revealed in his podcast. I listen to a lot of podcasts, both his and others, that he's been on and what I can gather from online sources. So he was born in Toronto in 1973 to Egyptian parents who had immigrated to Canada. I don't think a lot of people know that he's Egyptian. I didn't actually until we started this. And it's a little bit of a personal bummer for me whenever you see a famous Middle Eastern type doctor that's not rad. He described his parents as highly educated, intellectual, not sure what they did for work. From some interviews, I got the sense it was white-collar work. But in his book, Outlive, he actually refers at one point to his father working in a limestone quarry. So I'm not sure. I'm assuming there's not a lot of white-collar jobs in a limestone quarry, but I could be wrong. No, no, no. I mean, I guess the limestone could turn your collar white because it's limestone. So maybe, like, literally, yeah. Yeah, that's right. That's what I was thinking. And I'm sure this is not surprising to anyone, but his family was very achievement-oriented. Yeah. He described them as emotionally restrained and demanding in subtle, culturally specific ways. And then that last aspect is probably pretty similar to Dr. Oz and his backstory. And it's something I actually know a little bit about myself. I could probably dedicate four whole episodes to this particular topic, but I'll just keep it short here. And that being a physician of Middle Eastern descent myself, my family, and my father in particular, were also very clearly achievement-oriented. But it's also a large part of how and why I became a doctor and why I've had any success. That being said, one major difference between me and him, as I was reading about him and thinking about him, I don't think anyone would ever mistake my family for being emotionally restrained. Like a lot of Persian households, we felt things out loud, you know, very loud. And his family situation felt like a more high-pressure immigrant household with love being expressed only through words. Only through achievements and not as much through affection. And I think that is fertile soil from which an optimization-obsessed man can grow. I'm assuming this is a recurrent theme you've seen in some of the people you've covered. You did Dr. Oz, right? Yeah. Yeah, we've talked about Dr. Oz. We've talked about most of the Oprah industrial complex bastards. Yeah. That's great. So he described himself as a very anxious child who was obsessed with being perfect and was terrified of disappointing people. Sure. And a lot of doctors can understand that and relate to that. Doctors are people-pleasers. And sometimes this is helpful, sometimes it's not. Well, not always, but yeah. Dr. House, of course. Yeah, right. He was not a people-pleaser. Being an exception. No. Actually, interestingly enough, this is a small aside. Remember I mentioned Dr. Faith Fitzgerald? She was this brilliant internal medicine doctor at UC Davis. And the rumor is that she was the basis for that character. Not because she was crotchety or mean. She was actually super-smart. Super sweet and nice. But just because she was one of these brilliant, like, diagnosticians who would come up with, like. She was so good at her job, yeah. Yeah, right. So he excelled at school, academically, from a young age. Top of his class. I have no doubt about that. He also said that being smart was the only thing I had. And, quote, If I was not exceptional, I was nothing. Which I think is like the Middle Eastern equivalent of Ricky Bobby's, if you're not first, you're last. Yeah, yeah. Being normal is the greatest shame. Yeah. There is. Sure. If that makes sense. Yeah. A lot of pretty textbook gifted kid identity formation stuff happening here. And there's also some overlaps with Andrew Huberman and Dr. Oz in that they all have this sort of early athleticism and these signs of obsession with being physical and physical fitness. He reports that he was always pushing himself physically and was drawn to endurance sports that tested his limits. And this is a seed for things that come up later for him. Ironman races, swimming the Catalina Channel, the VO2 max focus he's big on. He was also a boxer, which is, you know, actually surprises can surprise people. But it's one of my favorite things to watch in terms of sports is boxing. My dad was not only a doctor, but he was a boxer when he was younger. So I kind of grew up watching it. And although the doctor in me does not love what boxing does to your brain, I do enjoy watching the boxing. And that is a dirty little secret that I've never shared on air before. So there you go. A little. A little behind the bastards exclusive there. Who doesn't? I mean, especially just from a medical standpoint, I love watching CTE as it happens, you know? I mean, just in real time. Yeah. I mean, I will watch it and just be like, God, I don't feel good about this, but I'll watch it nonetheless. I love it. Something that is not a very bastard like trait about him is that he has been open about dealing with anxiety, perfectionism and fear of failure and even anger issues. It's usually in the context of how, how he overcame it. But that's just stuff we have to be talking about. We have to be talking about moral injury and doctors. We have to be talking about how doctors have psychological and psychiatric issues just like anyone else and how to get past that. So kudos for him for discussing it. He's actually even talked on air about going to a recovery center in Kentucky called Bridge to Recovery, not for alcohol, but for what sounds like anger management. So actually, I feel like if you focus all his work on just like that, how his background created issues for him and how to address that, I think he'd be a pretty cool dude. But, you know, regardless, it seems like he didn't get unconditional love growing up. And whether that left an emotional wound that shaped his relationships or need for mastery or later why he felt prey to the gravitational pool of powerful people like Jeffrey Epstein, I think is something to discuss. And I'll be upfront. I am not a psychologist. I'm not a psychiatrist. I am a simple gastroenterologist, which is, essentially an ass dentist. But I think it's important to touch on these psychological components of his drive. And actually, I think from listening to him talk, I think he would agree that that's an important thing to discuss as well in his credit. Yeah. In his book, he briefly mentions kind of obliquely experiencing trauma, but it doesn't really, he never really explains it. I didn't see what that meant, what he was referring to. Did he just mean the upbringing that we've already discussed or was there something else? I, I couldn't find that, but he does great. He gets, into Stanford Medical School after completing a Bachelor of Science in Mechanical Engineering and Applied Mathematics at Queens University. Not the typical humanities, biologic science-leaning approach a lot of medical students do. Nothing wrong with that. I mean, I studied biology and music in college, and it was always cool to me when someone came from a different mindset, like engineering or some systems-minded thinker. I think there should absolutely be room for that. I think it's cool. He loves math. It actually makes me wonder if being a doctor didn't come with this sense of accomplishment or achievement that he could show his family. I wonder what he would have done. Probably could have been very useful to the world in that sense as well. And I'll say this. I know Stanford pretty well. I did rotations there. Did research there as well. And they do great research. A lot of very important bench-to-bedside translational science happens there. And this is going to be a hot take and one that I will certainly regret, but since I do have some familiarity with what I speak, I will say this. It's not the best place to go for clinical training if you really want to take care of patients. Strong stance, anti-Stanford, coming out here. I know. And I'm going to absolutely going to regret that and probably ask you to cut it. But no, we're going to do it. We're going with it. The best rotations you get when you're there are when their students and their residents get to do time at the Santa Clara Valley Medical Center. Which is this terrific county hospital that Stanford works with and that I spent most of my training in a fantastic place. And, you know, I'll give an excuse. I mean, I don't need an excuse to give them a shout out, but I'll take any time I can. Santa Clara Valley Medical Center is rad. Yeah. If you get, go hurt yourself now and go there. You know what? Ideally, I'd shoot a nail gun into your hand and head right over. You know? Yeah. No, great people, great doctors. Really great mission there for the doctors there. So, and I know people that went to Stanford around this time, and it's clear that even then he was standing out. People knew he was going to be kind of something at an early age. He was athletic. He already had this shaved head look that we kind of see now. What was that? Okay. Shaved head, sure. Right. Yeah, yeah. I mean, there's some guys that lean into that early. Easier. He's got the Mr. Clean. And it looks, I mean, it looks good on him. It's a good look for some people. He has the right head shape. It won't work for me. I hate to say it. I won't tell you that. I hate to say it. But right now, it's going to be bad news. I'm going to Turkey when things get real bad here. I am, I can't, it's not going to be good for me if I don't. I'm going to need to do something when I get bald because I, my head's not this well shaped as his. So he graduates and he matches at general surgery residency at Johns Hopkins. It sounds like he was going to go into a surgical oncology field after that. But as we'll discuss, he didn't actually finish his surgical residency. It's a, a general surgery residency. And stop me any time if I'm going into the weeds here about this. But I think it's kind of important to note. They're usually about five years long. It can be longer based on if you do research and if you do a fellowship or extra training on top of that, like surgical oncology, it can be even longer. He did some time at the NIH as well, which, you know, Johns Hopkins was great for getting funded research, at least then. I mean, who knows now with the country being the way it is, but it's still a very prestigious place. Johns Hopkins, great place to go in your five. What ostensibly could have been his last year, he quits residency. It's not clear if he was counting the extra year of surgical oncology and that, but he's towards the end of his training and he quits. Now, I think this is something to discuss. I have no evidence that he was forced out, but I do have to say, it's always a little unusual for residency programs when someone leaves. In the rare cases I've seen it, there's usually a reason. There's usually someone's being forced to leave. In this case, I don't see that, but it is always something good to note. Um, even people who doubt whether or not they want to be practicing physicians and they hate residency still finish it to at least give them the option of being a doctor afterwards if they want. I actually loved residency, but I would never, ever do it again. It is by far the most challenging time of a young doctor's life, particularly in the beginning. I mean, you don't sleep. Him and I were both around the same time, him before me, but we both experienced what life was like before the 80 hour work restriction. There is a restriction now, so you don't work more than 80 hours. And that was considered soft. Just a nice, mild 80 hours. Yeah. And we were, well, I was like the first class to really experience, um, how, to see how different that was. Um, so I was, I was a lucky one, but, uh, anyways, uh, so generally the last year of residency isn't, isn't necessarily easy, but it tends to be easier. You have more specialty rotations. You're usually not on call as much, but it is interesting because we've seen this now a couple of times in people that are related to the manosphere or related to the current administration. For example, Casey means, I don't know if you're familiar with her. She was president Trump's Donald Trump's earlier surgeon, right? Yes. Sophie talked about this. Yeah. Yeah. Yes. She, she was like very like wellness guru-y type content and had very questionable opinions on scientifically proven things. You're exactly right. She's really a co-architect of that Maha messaging that, that was pushed and still being pushed. And she dropped out of her OHSU head and neck surgery residency six months before completing her five-year program. Now, as opposed to with Peter, there are some different accounts. No one's ever, I haven't heard anything from anyone, even people who knew him, that there was a reason he left other than what he says. But with her, her account is, you know, basically she got sick of the stick care and et cetera, but her colleagues have a slightly different account of why she left. But I have no reason to doubt him. You know, to be honest, people should be able to quit, leave what's not right for them. Actually more doctors probably should, should do it. I know too many doctors. That are unhappy and stuck in that sunken cost fallacy where they feel like they can't quit or leave. You could actually even question why, you know, Abdul Saeed wouldn't, didn't even go to residency in the first place. I think in his case, it makes sense. He never bills himself as a clinical doctor. He doesn't seem to have any interest in providing direct patient care. He's more interested in the, the broader strokes of public health. Now for, for Peter, when he was asked about why he left residency without finishing or, becoming a board certified MD, he reports that he left on his own accord because he became disillusioned with the medical system, what he calls medicine 2.0, which the fact that he's already referring. Yeah. You're getting a vibe already that it's being referred to. Excited for medicine too. Medicine one did too much like, you know, vaccines, stopping the spread of horrible plagues, making it so that you don't stub your toe and then die of an infection. I'm excited to see what medicine 2.0 brings us. Yeah. And it just really 70 hour erections. The sky's the limit. Well, he calls what we're experiencing now medicine 2.0. What he wants to offer you is medicine 3.0. Was medicine 1.0 like arsenic and telling you to go to the sea when you're sick? Yeah, I don't know. Um, but he, he calls it medicine 2.0 and it really just strikes me as odd. Cause it has this real sort of like Silicon Valley. Bro vibe to it just off the bat, you know, um, doing that. And he explains that he did this because he had essentially a crisis of faith. Again, he's, he sells this frustration as the symptom saying that it's built to react to disease instead of preventing it. And whenever I hear that it has a real like pick me energy. I'm, I'm a different kind of doctor, you know, I'm not like the other doctors. I'm, you know, I'm, I'm a cool doctor. Yeah, yeah, yeah. That's, that's, that's a bit of a red flag. Keep that in mind. Um, and when this topic comes up, he explains why he left by telling a story about his last year in residency when he was treating a patient in the ICU with an antibiotic called gentamicin. Now, gentamicin is a type of antibiotic called an immunoglycoside. This is going to be on the test and it's used for bad infections sometimes. And it gives you really powerful activity against gram negative bacteria. But here's the issue with it. There is a narrow therapeutic window that you kind of have to go through. You kind of have to hit when you use it. The effective dose is actually pretty close to the toxic dose. And, ah, okay. Yeah, I can see how that could be a problem. You can see why this is a problem. And small, small errors can cause real harm, permanent harm to either your kidneys or giving you what's called ototoxicity. You can lose your hearing from it. Um, it's terrible. It's like, uh, it's a boards question when you're young. And it's one thing you always keep in mind. You rarely see a, I don't think I've ever seen it. But. There's systems in place to help prevent this from ever happening. It is something that has to be monitored carefully. Because if you give too much, you can cause permanent damage. But if you give too little, well, then you're not stopping this bacteria that may be trying actively to kill you. So it's, it is an interesting antibiotic in that sense. And it's tightly controlled with weight-based dosing and checking kidney functions to make sure you're getting rid of it. And checking peak and trough levels. So you check the blood when it's at its highest point. you check the blood when it's at lowest points, of where you need to give the dosing it's not the kind of drug that a resident should be casually fucking around with and there's right there's generally protocols for its use and at least really it's a measure twice cut once kind of drug exactly yeah it's actually twice or they die and this is why pharmacists are so amazing because the pharmacists have the amount of you know deaths pharmacists have you know prevented by double checking doctor's orders mine included um you know cannot be uh underplayed it is it is huge and there that's why at most hospitals and john hopkins john's it's not by the way it's john's hopkins it's not john it's like ruth ruth chris's steakhouse it's a never understood that but at john's hopkins it's attending approved and pharmacy driven it's like the pharmacists are really the most important thing about the pharmacy it's like the pharmacists are really the most the ones that you rely on for these sorts of things so okay while he's caring for this patient receiving the antibiotics he starts considering there has to be a better way to optimize the timing of this drug he wanted to disrupt the waste delivered he didn't say those words disrupt i don't think but that is how i feel i feel like he said it in that silicon valley sense of the word to disrupt yeah yeah he's a disruptor um so he stays up he stays up late while he's on call he presumably steadies up on the drug's half-life and other factors and he creates an excel spreadsheet that would change the timing to more accurately predict when the drug would hit trough levels and that's the best time to give it it's not entirely clear to me if this was a problem that was in need of solving i mean the current method may not be that efficient there's a lot of moving parts to it um it's hard to know whenever he brings this up on podcast it's usually with like some you know uh dude bro who doesn't like have follow-up medical questions for him but yeah yeah yeah so it's hard it's hard to know i mean i would actually if i had a chance to talk to him that's actually probably the first thing we'd start with is talking about the story and uh he's he apparently ran it by an infectious disease fellow and they recommended against doing it but he does it anyways right he enacts this new dosing protocol without his attendance approval or without any communication with the pharmacy and when he tells his attending this the next morning when everyone's like doing rounding and they're all standing around you stand around a group do you guys know what rounding is you know what attending is do i have to stop me if i'm like using medical yeah like doing your rounds you mean like like that's that's right yeah like in house with the yes or scrubs actually shows that a lot more yeah in house yeah yeah yeah but for for the audience if you haven't seen house you haven't seen gray's anatomy it's when a bunch of doctors discuss the case and go around and discuss all the cases you lead the doctors who are like doing their residency around and a more experienced doctor is like talking through as they look at different patients and stuff to learn yeah that's exactly right every time though just to be clear listener robert knows what he's doing every time he says yeah it's like house he knows that a little part of my soul dies and that's why he does it no i mean my last experience my my last direct experience with rounds was when my dad was dying his oncologist took like two rounds and he was like oh my god i'm gonna die i'm gonna die i'm gonna die i'm gonna die a bunch of students around and they were doing like their rounds and i overheard them talking about my dad's case where he was just like yeah this one really like uh you know it's a very surprising case we didn't expect it to go that like it was it was not a great thing to hear after his you know uh because it didn't like the case did not proceed the way he had expected it was not into like expected to be a very serious uh situation he wound up dying uh so i got to overhear him like talking to students about that but yeah i know what rounds are yeah you know it is a it's never fun to be the interesting case no family no you really don't want to be interesting no yeah god now i feel like an asshole for making no i mean i didn't blame him like he's an oncologist right yeah that's the job okay so he enacts this this new dosing protocol and he's telling the team about it and the attending is the the head of the team the person that's out of training they kind of run the team they're at the top of the ladder they spend the least time you know the interns residents they're the ones that are there all the time and the attendant kind of comes in for a period of time but not as long and he thinks he's going to get lauded for for being a very special boy here instead he gets chewed out his attending considers it a serious breach of safety and hierarchy and i have to tell you um things i think have overall gotten better but there are a few things worse than having the attending totally dress you down around around other people and in some places particularly i think johns hopkins that's the kind of place where that sort of thing is going to happen less so here on the west coast where we are people tend to be like more chill but man there are attendings with like that i need to get a little kick out of seeing their intern their medical student their resident cry like it is it is terrible so i i actually even though i i agree with the attending i do feel i do feel for him in this case i don't know what happened to the patient there's no there's never any discussion of that if it hurt the patient or if it didn't i'm assuming it didn't i'm hoping but i don't know i assume the attending was worried that changing the testing and dosing could have either invalidated the levels or caused the next level to be uninterpretable or maybe even wind up delaying the patient's care even more so i'm not sure why the attending was so i never found anything from their perspective but at the end of the day it's their it's totally their responsibility it comes down to them so if anything happens to that patient i i can understand why they'd be so pissed right now that response pisses off atia who feels his brilliance is being stifled and he feels that this is an example of medicine punishing out-of-the-box thinkers but before i tell you more about what happens next i want to tell you uh that coming up soon you're going to hear some uh in the box thinkers that's right that's right maybe the box of money that you need to give to them or i was thinking blue apron if they're still sponsors if not blue apron does send boxes i think they may have gone out of business because of all of the all the deaths but i'm not sure uh you know no no we don't joke about the island anymore we just joke about the deaths ah that's a little break i'm taking over the podcast now folks i'm calling the ad breaks we'll be right back yeah this ad is brought to you by vive health care the makers of devato dolutigravir lamivudine if you're living with hiv do learn about devato devato is a complete hiv treatment by prescription only for some people 12 and older your doctor will determine if devato was right for you most hiv pills contain three or four medicines devato is as effective with just two no other complete hiv pill contains fewer medicines than devato it is unknown if devato is safe and effective if you have hiv and hepatitis b if you have happy don't stop devato without talking to your doctor as it may get worse or harder to treat don't take devato if you're allergic to its ingredients or taking dofetilide due to serious or life-threatening side effects if you have a rash or allergic reaction symptoms stop devato and get medical help right away other serious or life-threatening side 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today now in my 30s being the founder of new shoes good taste is my business and i've always got something to say if men were just honest about this there would be so much more peace in the world we're gonna talk about dating relationships beauty getting older and a little wiser we're best friends but we don't always agree because you told us how accommodating you are obviously i would do what i think i could do to to fight the fight but there's only so much fight i can fight don't lie to me don't lie to me don't lie to me don't lie to me don't lie to me don't lie to me liar listen on the iheart radio app apple podcasts or wherever you get your podcasts i don't really care there are thousands of podcasts that can tell you how to better yourself get worse with kyle prue is not one of those podcasts so if you're interested in getting thinner going to therapy starting peptides setting boundaries taking supplements making your better getting closure then i would humbly recommend other podcasts but if you're interested interested in blackmail, love bombing, cloning yourself, or getting revenge, then we've out a little something something for a dastardly individual like you take a listen to some of the incredible advice we've given so far fake a back injury get the spray tan up your alcohol consumption only women should be allowed to have guns kill them kill them kill them with a gun listen it's already over i'm all about lying if it's something that really happened the next time a bear is running at you you just calmly stop what you're doing you look the bear in the eye and you say this isn't you do not preserve relationships you don't need them you only need one thing and that's the get worse podcast listen to get worse with kyle prue on the iheart radio app apple podcasts or wherever you get your podcasts i'm lacey mosley author actor stand-up comedian creator and host of scam goddess podcast the true crime comedy podcast all about robbery fraud and those who practice it each week i bring on incredible guests like conan o'brien iowa debory lamorne morris and nicole byer oh i scammed them what i could talk to you for an hour you're a generational yapper like me that's why i had to make yapping a job and the scams run the gamut i'm talking about scams from the 1800s all the way up to today i also warn you and keep you safe against scammers call your grandparents tell your parents to stop clicking on links please and now you can catch full episodes of my show on youtube if there's a scam i'm here to protect you and i'm also here to laugh with you so if you like fun if you like comedy and you like learning and protecting yourself from criminals start listening to scam goddess on the iheart radio app apple podcast or wherever you get your podcast and we're back kava you really should explore at some point accidentally creating a conspiracy theory about a company that people really do believe and then you have to backtrack it because you didn't realize that it was going to actually be taken seriously it's always a good time that is um is that is that real that happened people actually believe you're very clear obvious jokes for sure for sure that's why we stopped making the blue apron jokes yeah people someone was like is there really an island yeah more than one person took it seriously i will say this after my first or second appearance on this podcast many years ago um you you did do an ad break and you bleeped out the name of the the the company and i got a number of messages from people begging for me to tell them who it was who yeah of course and and i was like no i signed an nda i can't uh say that yeah um but uh yeah i guess i'm not surprised that people took it seriously but speaking of taking things seriously uh last we left off peter attia felt his brilliance was being stifled and he took that seriously and he was very upset i listened to a couple of podcast interviews he did about this and this is something he said it struck me as anti-intellectual maybe my model wasn't perfect we'll never know but the fact that nobody even cared to see if there was a better way to do this drove me batshit crazy now here's the thing let me say something here let me say something here let's take a little quick aside here i think this is very emblematic of my broader thoughts on peter attia maybe he had a good idea and we should always be trying to push science forward and deliver things better deliver better care but you know when he says we'll never know because nobody cared to see if there's a better way to do it there is a better way to do it you can make a study out of it why not do that he's right we'll never know if it works because he didn't study it he had the idea and he didn't study it this could have very easily been done at a place like johns hopkins and you could do this and prove that it works if it's not unethical an irb will review it as such and you can prove it yeah i just want to add that please do the work i'm really enjoying the way that you pronounce johns hopkins every time johns hopkins i really have to really stress the plurality of johns there's more than one john involved in the hopkins of this situation and it i don't understand it so this was this will probably bum out the doctors on my little group chat you know my little doctor group chat that i run some of the stuff by but as i'm researching this guy for this episode and i use the term research lightly i actually there's a lot of things i like about him if he was more inherently a physician and less a businessy sort of like accountant engineer guy i think he could have been a great doctor and like peter right pete i don't know if you're listening yeah my middle eastern brother i don't think it's too late for you to have an amazing redemption arc i think it's still possible but this that mentality has to change i mean be just a doctor do the doctor thing says the medical podcaster the doctor yeah i mean it like yeah you don't have to you don't have to make bedfellows with the worst people in the world to do medicine we'll get we'll get to that in the next episode so basically what he was doing here is an unauthorized experiment and i know this sure sounds like a sort of small potatoes issue to a lot of the behind the bastards it it's not mass murder um and again he's not as bad as rfk jr who i really really really don't like you probably know that i don't enjoy him very much i don't like the man um but this laissez-faire approach to medicine and science is just not how science works science is supposed to be a little boring yep honestly 10 years ago i probably wouldn't be bothered by this at all but what has happened over that time is that a lot of the little stuff in medicine that we just let slide has added up and it's led us to where we are now in this country 20 years ago if i heard about gwyneth paltrow putting a jade egg you know a per hoo-ha or somebody using essential oils to cure their diabetes it's the medical term we would we would laugh and move on that would be it but all these things add up over time the more nonsense we let go by without saying anything because it's easier to ignore it the more coffee enemas we let slide now because we don't want to have to explain to you that you don't need to detox outside of your liver and kidneys and that it's bad for you the the the more of this we let go the easier it is to eventually have confusion around important public health care issues like vaccines for example it creates this murkiness around science where people can be like yeah there's lots of different ways to interpret science like it's religion and like you should that's not how that's not how you're reading tea leaves as opposed to just trying to figure out like what works and doesn't empirically yeah yeah because now we have like this thing where people are like hey you have your interpretation of science i have mine and and sure to some degree that is true people can have different interpretations of the study but um there are basic tenets of science that need to be met before you can do that anyways in listening to a tia talk about this particular experience in his podcast sometimes he acknowledges yeah it was kind of a bit reckless what i did in his book he kind of comes across as much more like uh contrite and he he seems to understand that maybe he was just trying to prove himself but i actually feel like in the more truthful moments when he's talking about this on like the manosphere podcast he interprets this as less of being a misguided intern to being more of a misunderstood iconoclast he okay yeah he uses the story to justify leaving surgery and setting him up as this maverick thinker ready to tell you the one trick your doctors don't want you to know and there's a telling quote that i heard him uh talk about in an interview about why he really left okay he didn't feel residency was a meritocracy so on an interview with a guy named jocko are you familiar with jocko jocko willick yes yes the former seal team guy who was uh the officer in charge of uh the american snipers unit we talked about them in our seal episodes because their unit killed all of them and he was like oh my god a lot of civilians yeah or was alleged by another navy seal i've haven't killed a lot of civilians that checks out that checks out i have to tell you in preparation for this episode i exposed myself to some real manosfery stuff yeah and that that felt real manosfery up in there um yes i felt like discipline self-improvement type stuff yeah so so he's having this discussion with jocko and in regards to residency he said quote we all get paid the same we all take the same number of years to get to the hospital and we all get paid the same number of years to get to the hospital through first of all i if i said that exact quote i would mean it in the 100 different way he does but he said okay we all get paid the same we all take the same number of years to get through it seems crazy to me like there's no other system where that would be the case like i couldn't think of another system where they just have this complete total lack of meritocracy and i'm like bro what are you talking about that is the point of residency we all get paid the same number of you all have to do the work you all have to do it we're all in the ship together that's the whole thing right is that like everybody has this like same basic kind of like the same but like yeah you there's a standardized procedure for getting prepared to go be an independent doctor right that's and that's why like even if you're on a flight and there's nobody around to help you if there's a psychiatrist there you're still better off with the psychiatrist helping you through an emergency than somebody who has no experience because they've been through a lot of this shit you get a lot of training during this time and and it's not about the prestige or the paycheck that can come later and and i'm trying to think of an analogy here it's a bit hard to do but it'd be like say somebody uh somebody shows up to boot camp and they're already able to do like 50 pull-ups and right they're expecting because of that they can like skip rifle training uh right because the pull-ups will be enough yeah yeah because they're ahead of the curve it's like great congratulations on the pull-up but you still don't know how to be like a marine dude like yeah being smart and hard working doesn't mean you know how to practice medicine no no being able to answer all of the questions on a test doesn't mean that you know how to practice medicine because there's like a lot more it's just like you could have someone who knows intellectually and can explain how to deal with like a gunshot wound or like a fucking horrible broken leg with the bones protruding from the skin but then if they actually sit down in front of a person they have like a panic attack because they can't handle blood that person may have all of the still can't be a doctor because you can't be scared of blood and be a doctor that's it's exactly it's exactly right it takes actually i think years of being an actual attending to get past to where to get to where you need to be and you know even after years i think you still should have some imposter syndrome like i don't think the imposter syndrome should go away anytime soon i think like i think that's that's just a uh something that we always need to be humble about but something i mean speaking of humble there is a little bit of a prestige of a sort right if you really wanted to if you're really good you do get asked to be a chief residence like i was that is a little bit of prestige i was i was chief resident that is correct so oh my god honey i did not know you were that good no no no no no if i'm being honest it's like they're like hey we need some schmuck to stick around one year and not take a paying job and just do some teaching so it's you know they were much smarter people you were like i volunteer as tribute yeah they they had a sucker in me i was uh i've always thought of you as the jennifer lawrence of medicine yeah that's always been what i've called myself cave from the block yeah absolutely so anyways after this you think of a different jennifer but okay yeah i don't know i didn't catch the reference but i just think of jennifer lopez i explained the whole thing yes yes yes that's all good that's all good yeah yeah um yeah i didn't understand the jennifer lopez of it at all but i thought it was uh still good so he makes this decision he's gonna leave residency and after a chance encounter with a radiologist who worked previously at a consultant firm named mckinsey and company in palo alto you that name might be familiar to some of you he leaves medical training to try his hand at consulting and i think i'll probably pick up there for the second part in the conclusion of this episode this topic i guess when we get into some more of the the real bastardy parts of of this okay um but let's maybe end there for now does that sound like a good plan it's your podcast i don't want to i don't want to be running your podcast you tell me what i i appreciate it thank you for for again doing the episodes this week that's going to be part one we'll be back on thursday for part two until then comment you want to tell the uh the people that you're going to be doing the episodes this where they can find former chief resident dr kava hoda that is how i think i should be referred to at all times okay so thank you again very much for letting me come on and and do this it's it's fun it's a lot of this uh conversation i think is is really important i'm really glad that we get to have it there's a lot that's going to go into this conversation particularly the second part that says a lot about our state of medicine where we're heading why i find it troubling and uh i appreciate you guys having me so thank you so much okay so some of your listeners may already know that they can find me on my podcast the house of pod it's a relatively fun informal look at medicine and science and we take a look at wellness and health grifters and talk about rfk jr all the terrible things he's doing to usher in this golden uh age of diarrhea that we are in uh and you can find that anywhere you you look for podcasts and uh both of these fine people i'm talking to today have been on that podcast in the past so you'll hear from them and i'll see you in the next podcast you'll hear people you you'll know and love but starting later this month uh there's also something very exciting for me that i'm very excited about and i want to tell you all about it is my new podcast about persian history it's going to be a fun look at persian contributions to the world of art medicine science philosophy uh taking a look at a lot of things that we've sort of been either written out of or at least minimized in in terms of telling the history of it uh it's going to be with my co-host my friend shaheen devar if you guys watch survivor season 48 he was on that i'm really enjoying preparing this and uh recording these episodes i think it's going to be a ton of fun for you all as well even if you're not persian it's just if you like anything about history and fun storytelling we're going to be doing that it is called persian of interest so keep your eye out for that please awesome thank you thank you i feel pretty proud about that one check it out everybody check out persian of thursday bye everybody behind the bastards is a production of cool zone media for more from cool zone media visit our website coolzonemedia.com or check us out on the iheart radio app apple podcasts or wherever you get your podcasts full video episodes of behind the bastards are now streaming on netflix dropping every tuesday and thursday hit remind me on netflix so you don't miss an episode for clips and our older episode 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