Today we're going to talk about the fascinating world of prescription drugs and their intersection with culture and society. And for that we're going to be joined by science journalist Thomas Getz. Medications are some of the most consequential advancements of modern life, but their stories are often quite nuanced and complicated. What if some of our most common diseases
are design flaws of modern life? In other words, we always need to be asking when we're treating biological illnesses and when we're medicating our way around the world that we've built. Also, does it matter if we are fixing a root cause versus just circumventing it. If a pill can quiet hunger or pain or anxiety, is that cheating? Do cures ever create the next crisis? So today we're going to talk about the larger stories of social ills
and public health. Welcome to enter cosmos with me David Eagleman. I'm a neuroscientist and author at Stanford and in these episodes we sail deeply into our three pound universe to better understand the world around us. Generally, when we think about medicine, we picture a simple story, which is a disease appears science identifies the cause and a drug fixes
the problem. But biology is sufficiently complicated that it rarely cooperates with stories that are that your body is trying to regulate hunger and mood and pain and sleep and anxiety.
It balances internal signals against the outside world. But the fact is that world has changed faster than our biology ever could, and we now live in environments saturated with calories and stimulation and stress and chemical shortcuts, and much of the world that we've built is designed explicitly to capture our attention and to override satiety and to make
us feel better fast. So it's no surprise that many of the most common conditions of modern life, obesity, anxiety, insomnia, chronic pain, heart disease, are what scientists sometimes call mismatched diseases. In other words, we are ancient biological systems operating in a world that we weren't really designed for, and when those systems strain, we reach for medications. Now, prescription drugs are fascinating from a biology perspective because they are in
a sense controlled perturbations. You stick some molecules into the bloodstream, and those cross barriers and binder receptors and nudge the activity in some circuits, and then we watch what happens. Sometimes the effects are kind of miraculous, other times they're subtle, And sometimes only decades later do we realize that a drug meant to solve one problem created some new problem. So we end up with medications for anxiety that camp down fear, but they create dependence. We get painkillers that
blunt suffering, but they cause addiction. We have sleep aids that knock us out but damage our normal sleep architecture. Even the most elegant drugs can rip through the system in ways that we never anticipated. Now. Part of the challenge is scale. A lot of side effects don't reveal themselves until thousands or millions of doses have been taken, and part of it is just an issue of humility.
Our biology is staggeringly complex even today, prescribing a drug as something like sending out a sonar ping and hoping the echo tells us something useful about what's happening beneath the surface. So this raises deeper questions. Are drugs treating diseases or sometimes treating symptoms of the world we've built. If a pill can quiet hunger signals or reduce cravings or lift mood or dull pain. Does that mean the problem is solved or merely postponed? And what about responsibility?
When nearly half the population struggles with obesity, or when anxinxiety and depression are among the leading causes of disability worldwide, is it meaningful to frame these as individual moral failures? Or are we forced to confront the interaction between biology and behavior and environment and forced to rethink what choice really means. So these questions sit right at the intersection
of medicine and society. So to dig in on these topics, there's no one better to sit down with than science journalist Thomas Getz, who has just come out with a new podcast series called Drug Story. Every episode of Drug Story takes a single prescription drug like ozembic or xanax, or ambient or opioids, and uses that drug as a lens to tell a much larger story, a story about disease and biology, but also about markets and incentives and
unintended consequences. Thomas gets is an award win journalist. He's the former executive editor at Wired and the author of The Decision Tree and The Remedy. He spent years reporting on medicine and science, and he has a special eye for connecting molecular mechanisms to human behavior and individual patients to systemic forces. So here's my conversation with Thomas Getz. So, Thomas, you've just come out with a podcast series called drug Story.
Tell us about that.
I spent the last ten twelve years on an unexpected journey deep into pharmacy. So my background is in journalism and I have a background in public health. But I kept on thinking about the way we use drugs in our society to really treat problems which are manifestations of much larger problems. So when you think about the major kind of maladies of the modern life, like the heart disease, ibetes, obesity, even things like depression or anxiety, a lot of these
things are manifest because of the world we've built. But then the thing that we have, one of the things that we have to treat them are drugs. And so we have medications and we have prescriptions, and it works pretty well for some people, but it doesn't actually solve
the root problems of what's going on. And so I thought, I thought the idea of the podcast is to use individual drugs to tell these larger stories about disease and society and economics and business, but really to focus on the drug as a as a kind of proxy or mcguffin to tell this larger story.
So let's take an example of some of the drugs.
You looked at the EpiPen for allergies, you look to ambient for insomnia, xanax for anxiety, at opiates for pain. What kind of through lines do you see when you when you examine these different stories.
Right, Well, with that group you just did, all of those drugs, oddly have had pretty massive unintended consequences.
So like EpiPen.
You know, EpiPen treats anaphylaxis, which is an allergic reaction, a severe allergic reaction. But the reason that that kind of we had this upsurge in food allergies over the last twenty thirty years was actually because the official guidance on food and possible allergic foods was exactly backwards. For twenty years, the American Academy of Pediatrics was recommending that parents avoid exposing their kids to peanuts and milk and
eggs early in life. Well, then that was under the precautionary principle, the idea that they should you know, people should do no harm and if something seems risky, then avoid it until the kids are a little older.
Cow's milk, I assume, yeah, yeah, yeah, cow's milk.
Yes. Well, turns out that was exactly wrong. So it turns out that early exposure is really useful and actually helps actate their body in the immune system to these possible allergens. And in fact, in countries where kids are exposed to things like peanuts from a very early age, there are basically no peanut allergies. So that was just this massive unintended consequences of well well minded, well intended
guidance that that was just backwards. And so along comes the EpiPen and and it was perfectly timed to take
advantage of this upsurge in food allergies. And along the way they raised the prices click click click, and made a lot of money and then had congressional hearings and it was it was there was a lot of outrage about the cost of drugs, which was really the EpiPen was case a. But when you look at these other drugs like xanax and ambient for instance, these were drugs that at the time when they first came out, they
thought they were perfect pills. They thought they were magic, almost magic pills, and because they worked, because they worked really well, like ambient works pretty well to put people to sleep, and and xanax worked really well to eliminate somebody's anxiety really quickly.
But it turns out that.
These these same medications, because they work so well, they create different human behaviors, and so people take them too much. They tend to abuse them, they tend to get tolerant to them, and it's really hard to stop using them oftentimes.
So those are great examples of kind.
Of the the unintended results of using these medications in great amounts millions of people without enough kind of attention paid to what are the possible consequences.
Yeah, our society is like a giant and amical system, and so when you push down over here, you get something else happening over here, and so on. Would we have been better off without these drugs, though presumably not, because if somebody has insomnia, or somebody has high anxiety or an allergic reaction, we still want to be able to help them.
What's your take on that.
Yeah, Yeah, totally. So, yes, these are useful medications. The trick is how to use them. So again, thinking about xanax or ambient, they're really at this point intended to be used for very short periods of time when something
is acutely wrong. Right, so somebody is having a lot of trouble sleeping, then maybe an ambient is appropriate to use for a very short duration and then to remove it and come up with much more durable, sustainable solutions like not using your screen in bed and things like that, more behavioral solutions. The trouble is that patients get prescribe these drugs and they work, and so the patient reasonably it says, why can't I keep on taking these drugs?
Where they're not necessarily cognizant of the dependencies or the talents that their body are acclimating to the drugs. So we have to think about these drugs not as the solution, but as part of a much order kind of program or treatment program. And one of the problems that we have in medicine is that a lot of doctors are just not trained or don't have the time to manage individual therapies closely enough. And it's just a matter of time and man hours and billing, and it's the complexity
of our healthcare system. But what happens in reality is people get prescribed to drug, they leave the doctor's office, it works, and they just keep refilling it. And so for those drugs, those drugs that have potential abuse or dependency issues, those are really the ones that we need to work out or watch out for. And obviously opiates
are a prime example of this. You know, they really should have only been prescribed for acute pain temporary short durations, but they were widely prescribed for even moderate chronic pain, and people took them for months, years, and we had an epidemic of addiction.
And speaking of pain medications like opiates, where are we now with that now, How that opiates are considered persona non grata, what's the future of pain control?
One of the things about opiates that was that was again kind of an undertended consequence, was that they were really widely prescribed. When pain experts started to recognize that and argue that pain should be acknowledged, should be a was worthy of treatment, because pain was really not considered and doctors were not treating patients for their pain, so they there was a program around the late nineties early two thousands called pain as the fifth vital sign, where
they instructed doctors. They were recommended doctors ask people just like they took their blood pressure or their their breathing rate. They said, okay, a fifth vital sign would be ask your patients whether they're experiencing pain. So it was a zero to ten scale. Zero is no pain, ten is excruciating unbearable pain, and doctors started asking their patients about their pain level. That was one dull in terms of flushing out a problem that people a lot of people have.
Twenty twenty five percent of Americans deal with chronic pain, so it's a massive issue. The problem, the unattended consequence was that once that was on the table, it became something that the physician was then obliged to treat. And different people had very different ways of rating their pain. So for me, what would be a two, could for you be a ten. The doctor was really in no
way of understanding what the relative concern was. But the treatment at hand at the time was opioids, and specifically oxy content, which had just been approved as a supposedly safe version of an opioid. So it seemed like a great opportunity to use a so called safe drug to treat a newly cognizant condition. Well, it didn't work out that way. It turns out oxy content was highly addictive.
People would abuse it rampantly. So opioids solved the problem, but they, as we've been saying, they created other problems. So now or pain therapy are they're trying to find new ways of dealing with again that very real problem for twenty twenty five percent of Americans. So there are new drugs, There are non opioid drugs. There's a new one called gernaviks, which was just approved last year twenty
twenty five, by Vertex Pharmaceuticals. It's a non opioid peripheral nerve agent, so it doesn't work on the brain, doesn't work on the opioid receptors. They're very insistent and glad that it works on the peripheral nerve systems. The trick though, is that has only been approved for acute pain, not chronic pain. So people can use it for two weeks four weeks, but insurance will only cover it, will only
pay for the drug for that amount of treatment. Now, I spoke for my podcast, I spoke to some patients who actually have found it very useful for their chronic pain, but their pain out of pocket, and that's one of the problems. And it's about a thousand dollars a month to pay out a pocket, which which is a lot of money. So the drug company is trying to get evidence that it works for chronic pain on a population level. They're trying to bring that to the FDA. That's a
whole process that is ongoing. But we're still trying to find solutions to pain. One of the things that actually works. And again you know more about this than I, but cognitive behavioral therapy for a lot of these issues turns out to be a very effective long term solution. But the issues there are access to therapists, access treatment, so there are consequences or concerns onto a self.
I mean, the good news is with apps and AI and so on, things like cognitive behavioral therapy can be addressed at scale now in new ways totally. Yet people still like in a sense taking pills. What's the attraction to saying, hey, here's a solution, I swallow this, I'm going to be fixed.
Well, it seems like an easy fix, and one of the things I learned was it's only really in the last fifty seventy five years that we've had this kind of medicine cabinet of drugs like behind in most pharmacies there are about two or three thousand drugs behind the counter. A lot of those drugs have been only developed in recent decades.
The big boom in the pharma.
Industry was in the fifties, sixties, seventies, eighties, where we had these whole classes of drugs emerge. So they provided real answers or apparently provided real answers to all these problems heart disease, diabetes, you know, the ps, psychiatric concerns.
So that's awesome, but on the other.
Hand, we've only had a few years to understand what works best. And one of the things that has always surprised me is that the odds of any drug working for any individual are roughly a coin flip. It's roughly about fifty percent chance. So you go to something like an antidepressant and there's kind of a thirty percent chance than any given antidepressant is going to work for any given patient.
So what that means is trial and error.
So patients are kind of start a drug, they take it for a few weeks, they see if it works. If it doesn't, they go to a different drug. If that doesn't work, they go to a different drug. Well, on average, it can take a person seeking treatment for depression. It can take them six months or more to find something that works. We talk about that as a process, but it's not exactly a process for the patient's experience, right, it's a it's a kind of a trudging through darkness.
It's a real struggle to get to something that works. And that's true not just for psychiatric conditions or chronic pain. It's also true for something like heart disease because you have other variables like side effects like diarrhea is probably the most common side effect to drugs. When you're taking chemicals, putting them into the body, your body reacts in some ways that are intended, some ways that are not intended.
Sometimes you can tolerate those unintended consequences, sometimes you can't. So that all adds up into the recipe of does it work. It's not just a clinical sense, it's like does it work for you as a patient, And for most conditions, that is a process, and it's a messy one. And it's a muddy one, and it has a lot of frustration and anxiety and frustration to it.
It seems to me the central issue is that biology is insanely complicated, right. I mean, we often talk about the brain is the most complex thing we've discovered in the known universe. And so what we're trying to do is say, look, here's a here's a molecule of a particular shape, and if you take a bunch of those in, they'll bind some receptor. And what we're going to hope is that that that fixes this whole system, whether that's depression, anxiety, insomnia,
whatever it is. And it seems almost impossible that that will ever work. But sometimes not just things in the right direction, or let's say, for fifty percent of patients, as you mentioned. So, what is your take on how you see the drug industry nowadays? Having been doing this drug story for a while now, how.
Are you seeing this?
Do you see drugs as miracles of biology that they work sometimes or problems for society?
You're exactly right, these are complicated systems. You've got biology and the brain, like the brain is even in these biological illnesses, the brain is still at play. Like just with allergies, there's this constant fear and concern about that
people have before they take an EpiPen shot. People who have an EpiPen in their purse, they describe to me this whole thing about like is a reaction EpiPen worthy because they just aren't sure if they should waste that shot or take that shot which costs three hundred dollars or so. So there are all these psychological concerns that get wrapped up into the biological So that's the first thing. Now back to your question, like what about the drug industry.
I think drugs are an amazing accomplishment of our society and of medicine and of clinical medicine and of public health. Right like, they save and treat thousands of people, millions of people every day in this country around the world. They save lives, full stop. Drugs are a benefit to society. The trouble comes when we expect drugs as you as we just were talking about, like you take the pill and it's going to fix the problem. That that isn't
the way it works. On the one hand, biology isn't that simple, and two it isn't fixing the larger problems of these these deeper social conditions that oftentimes are creating the disease or the illness. So there's this great evolutionary biologist in at Harvard called Daniel Lieberman, you might know them. So he talks about these as mismatched diseases that we've put our body like we've designed a world that is very comfortable and accommodating, but it's not necessarily the world
that our bodies evolve to inhabit. And so we a lot of these diseases, like heart disease or obesity, are the results of the context in which we live. And so the diseases we're getting, like like heart disease or obesity, are not the inevitable result of human life. They are the exact consequence of the world we've built, the food systems we've created.
So this is a good segue into GLP one. Yeah, yeah, so let's talk about that, right.
So glp ones are so I should say when I started the episode on GLP one, so ozempic.
I was, by the way, for anyone who doesn't know, GLP one's glucagon like peptide one.
And these are the drugs that people are taking for weight loss.
Yes, and they they basically you'll describe it better than I will, but I'll describe it in simple terms. They basically interfere with the signal between your gut and your brain, and so they turn off your cravings.
That's exactly right.
These are normal hormones that you have in your gut that tell the brain, Okay, now you're full, go on, do the next thing. And the GLP one drugs are what are called agonists to these receptors. They mimic the action of these hormones so that they tell the brain, hey, no problem, you're full.
A lot like you're a neuroscientists, you explain it better than I would. So the GLB ones what they do is they they because they interfere with that signal, they turn off what is called food noise in the brain. So they stop people from craving these foods that you know, eat more and more and more.
And they have other benefits as well.
But so what people feel like is just not hungry. I'm just not thinking about.
Food, right, And so sometimes they so people who oftentimes had spent decades trying to just not eat one or find it easy to not eat one more or not at all, and so it's been extremely helpful for individuals for whom who have been struggling for years, for decades with being overweight, being obese, and the consequent health consequences of that like diabetes, joint pain, you know.
Obstructive sleep, app now, all the things that come with obesity, that's right.
Just being able to move, just being able to live a active life.
And how many millions of people are on these GLP one drugs now?
Well, so there are there are about forty percent of Americans ro obese, so that's that's more than one hundred million people. And so far about ten percent of Americans have taken a GLP one so that's that's thirty million people.
And when you say have taken, once you start, you really have to continue, right, so you are taking people for.
Most people, but there is there is a it is possible or for some I should say this, some people do have success in tight trading, in backing off where they reach their target weight and they're able to then kind of maintain behavioral fixes that that don't make them depend on the drugs. But yeah, for most people, they're going to be taking the GLP one for the rest of their life now, that there's nothing bad about that.
There's no shame in that.
If you are prescribed as statin, you will take your statin for the rest of your life. If you have a high bloodressure medication, you're you'll be taking that for the rest of your life.
Blood thinners rest of your life. Yeah, exactly.
So it's not that that is that is one of the things that we wait one of the ways we use medicine. But the thing about golp ones is it's very much an individual treatment, right it is. It is one person changing the way they eat and it solves
the problem for them. When you're talking about a population wide problem like obesity, again forty percent of Americans being obese, soon to be fifty percent, you're looking at really huge social issues that when you are prescribing things like glp ones, which at present are very expensive drugs, it just becomes a really difficult proposition to think about, Okay, well, how are we as a society going to afford that, and are there other changes that we could be making that
would be given the amount of money that we would be spending, which is something like one point five trillion dollars. If you put everyone everyone in America who's obese on a GLP one at full price, it would be one and a half trillion dollars.
So that's a lot of money.
We could do a lot of things with one and a half trillion dollars, including change some of the food systems that we have. So you just have to think about the kind of trade offs and costs.
So specifically, what you're thinking about is you feel like food manufacturers have done things to optimize food for consumption, to make them salty and sugary and fatty and small and tasty and so on, So you can keep going with it.
This is what you're addressing. Yeah, well there's I mean, they have been doing that.
Right and so and so the point you're addressing here is that not only could we be addressing this with drugs with JLP ones, but also doing something about the food industry. I do have a question, though, what would you How would you actually legislate that, because what they're doing is making food so that people will buy that food and enjoy that food, and you can't exactly legislate to say, hey, don't make it as tasty as you have.
Right, So I'm not saying that you have to legislate it. I'm not saying that it requires government intervention. It could, but it doesn't require that. I think one of the things that's interesting that we're seeing is that when people take these GLP ones and the food noise turns off,
they independently change what they decide to eat. They eat more vegetables, right, They don't eat the stuff that is full of sugar, fat and salt that is on the shelvesult processed foods, and so what you end up seeing is that the food companies themselves are trying to anticipate new products and develop new products that are in fact more healthy, more appealing to the millions of people who
are taking glp ones. So that is a market based solution, right, People's people are changing their behavior and the industry is trying to change in turn. That would be wonderful if food companies develop healthier, less quote unquote less addictive foods that that people would want to buy and and that don't don't end up, you know, manifesting in in excess body fat and obesity.
So so some of that is.
Market based, but there is possibly a role for you know, the FDA, the f and FDA stands for food. Food labeling is something that they governed. They can control kind of claims of being healthy, they can control claims of good for you, things like that. So there are ways that that regulatory arms can be brought to bear.
Yeah, and it makes sense because when people are on GLP ones and they start eating more healthy foods, more salubrious foods, it's because they know that they should be doing it, and they no longer have the pull of this tempting sugar, salt fat thing over there, so they're able to just think through the problem and make the
right choice. And so making sure the labeling is correct so that something doesn't erroneously say falsely say hey this is healthy for you allows people to make good decisions use the rationality there.
But I have a question for you, and I'm actually curious, what do you make of the idea that foods are addictive or might be addictive, that some foods could be addictive.
Do you think that's true that other I do think it's true.
What's interesting is people sometimes use the word designed there as in the companies designed the food. But there's also a sense in which it's just evolved. It's a natural evolution that you know, people gravitate towards things with more salt and fat and sugar and so on, and they like these things. So we've always had, you know, junkie food like this, and we just have more and more of it. So this leads to this interesting question that you post in your podcast, which is does it seem
like it's cheating to take GLP ones? So, first of all, what have you seen in your interviews in your research do people feel like, hey, this is cheating to take this drug and lose weight that way as opposed to doing the hard work of going to the gym and resisting and using willpower.
So that is the debate that is that has been the debate in part around GLP ones. That has also been the debate around obesity itself for decades, that this was something that individuals should just you know, take control of their own free will, live better, exercise more, lose the weight. It's not that easy, and it hasn't worked that way because that argument has been made for decades and the obesity rate has been climbing every year, so
there's larger systems at play. Part of the problem I think with that debate is that one the foods actually are manipulating our brains in ways that are maybe outside of our personal control, that they are addictive in some sense, some of these foods. The other concern is that this debate around cheating is one where we are blaming people. There's still this kind of this notion of blame and responsibility for obesity in particular, which we don't necessarily have.
There's a lot of stigma to obesity that we don't have with other diseases, even something like high cholesterol. It's just often behavioral based. It doesn't appear you don't look when you have high cholesterol. It doesn't really look like you do. So there's not as it's not as easy to attribute stigma. But it's also a particularly American problem
or American argument about individual responsibility. Other countries, other cultures do not have as strong a history of individualism and individual responsibility, where there's two edges to the sword that you are both have the freedom to pursue your own interests, but also you have to be in control and suffer the consequences of your decisions and choices. That is a very American way of looking at individual choices, and again Europe other societies do not have as strong a strain
of individualism. They have much more of a commonality or communal notion of health and responsibility, and so they don't kind of have this culture of blame, which is problem again uniquely American one.
So this is interesting because it all comes down to this question of whether obesity is a choice. Right, you're saying with the double edged sword, you know, you have all those freedom to do things, but also you're responsible for your choices. But this is really the heart of the issue is biologically there's a huge amount of variation on any axis that you measure, and some of these axes have to do with, for example, how much food noise one has, how saated one can be when one eats,
and so on. There are genetic differences, there are you know, childhood differences and so on. All these things add up to people being quite different from one another. So the question here is about choice, because this doesn't take weigh somebody's choice, but it does bound it. And this is I think the important part to recognize with all this is that we all make choices and we're all bound.
We're fenced in by our biology, and sometimes we're fenced in differently so the answer is both, we're you know, we're making decisions, but we don't come to the table equally.
But I totally agree with that.
I would also say we're fenced in by our society and culture and by industry. So in the nineteen eighties, Nabisco and Craft, that two of the largest food companies in the world, were bought by big tobacco companies, and big tobacco brought all the science and engineering and marketing that they had learned in cigarettes to food, and so they started to create snack foods that were even better,
even more irresistible. Now you might say, like that's just good business, that was just smart, you know, of their markets, but there was a recent study that actually showed that the food products that were sold by those companies when they were owned by big tobacco were actually eighty percent higher in salt, sugar, and fat than products that were owned by non tobacco companies. So they were actually engineered to be very high in those ingredients because people like them.
As you say, because that's what people are choosing. But at what point does that notion of choice and choosing certain products just because they taste better, just because we crave them. At what point does that stop being an individual decision and start being something that you know. There are larger structures and forces at work. There's marketing in terms of the grocery stores, and we're what's being put
at light level, that's paid for, that's placement. There's the commercials that were being told these foods are irresistible and that's a good thing. So those are all the contexts that I think also surround these ideas of individual choice that have a great deal of influence and have had a great deal of invisible influence on our diets and on our behavior in the past decades.
Absolutely right, And I think the way we can put this together is to think about the fence lines around your own behavior, given your biology, in the context of the world that you're in. Some people will just have the capacity to watch it Rito's commercial and resist and not pick them up. And other people will watch it and they have so much food noise from that, and they have so much craving, and they're influenced by the
marketing and so on, and they go for it. The question is, given your genetics and your experience, what is your capacity to resist and make good choices in the context that you're in.
Yeah, and it does have I mean there are socioeconomic variables here too. Wealthier people have more opportunity and more agency. One of your former colleagues, Albert Bendora, talks about self efficacy, the ability to form our own make our own choices, the confidence that we have to guide our own paths. That is something that that wealthy people have much more of than people who are not wealthy.
They they you know, more.
Stresses in life. So those are all those are all issues as well.
Just before we go off GLP ones.
And my question is there are all these other consequences that they're having that are extraordinary, like people are giving up smoking and gambling and other sorts of things.
What's your take on this?
Well, it makes sense right again, you're the neuroscientist. I'm not, but they seem to this. They seem to be things that are also affected by these pathways. So substance abuse, drinking, drinking alcohol to access. Uh, these are all behaviors that where we're hitting our pleasure centers, we're hitting our dopamine receptors whatever it is they work on our brain and GOLP ones somehow turn it off, and it's I think where they're just starting to do clinical trials in these areas.
It's extremely promising. It's extremely hopeful for human health much more broadly. And remember, we're getting much stronger, better, more effective GLP ones in the pipeline. We're going to start having oral GLP one's pills. Right now it's injections. So once we get to pills and that are going to be more efficacious at fixing or addressing some of those behaviors, some of those issues. I think the doors are wide open to how these drugs are going to help us in the years ahead.
Now, by the way, you made a very interesting calculation in your podcast, which is that it would cost, as you mentioned earlier, one point five trillion to get let's just say we're talking about ABCD to get everyone with ob city in America on these trucks. But what you calculated is why this might actually make sense to spend that money.
Yeah, well that's with the caveat that's full list price. So you know they're talks about doing deals with the drug companies to lower those prices. But roughly that had one point five trillion dollars.
If it were that ye, why would it be worth it.
Yeah, So the reason it's worth it, I think is because we spend hundreds of billions of dollars. We spend five trillion dollars on healthcare in this country every year, right, more than any other nation on Earth. And out of that five trillion, we spend hundreds of billions of dollars on obesity. We spend hundreds of hundreds of billions of dollars on diabetes, hundreds of billions of dollars on heart disease.
So if we're.
Addressing obesity, which is upstream from all of these other conditions, well, we would be chipping away at the amount we're expending on those issues, right, So there it wouldn't be kind of erasing them altogether, but we would spend far less on diabetes if we had far fewer people go from
obesity into diabetes. That's one point, But the other issue is really I think goes to kind of quality of life and quality of health span, Like how do we help people have the best possible life that they can, the best possible health they can before they get sick.
And that's one of the things that's so promising about these GLP ones is they're really good at prevention, and so if we can if we can help people pay that one point five trillion dollars to give people better lives instead of waiting for them to get sick and go in the hospital and you know, surgery and all these other things that we spend that five trillion dollars on. That's that's probably a good argument to spend that money.
That was my interview with Thomas Getz. Thomas's podcast Drug Story dives into many topics that we didn't touch on here, like lipiitour and heart does ease, or zoloft and depression, or xanax and anxiety, or ambient and insomnia and so on. So I just want to summarize by hitting three issues first. From the point of view of biology, every drug is a hypothesis.
It is a guess.
It's a carefully engineered intervention into a system that we only partially understand. We identify a receptor or a pathway or a circuit, and we nudget. Sometimes the result is great, you get meaningful relief. Other times the effects are delayed, or they're indirect, or they're only visible years later, when
millions of bodies have already been changed. The fact is that even with all the massive progress in biology, we still don't have predictable outcomes, and we're not going to for as far as we can squint into the future, We're always working to scratch out insight to a vast dynamical system that is shaped by evolution and development and experience. So when we intervene chemically, we always want to act
on a single system, but we essentially never can. Instead, all we can do is perturb a system that's going to adapt and compensate, and that often surprises us. For the most part, medicine just can't tackle the complexity of everything happening under the hood, at least not yet. Medicine can't simulate the entirety of your biology, at least not yet, and certainly can't simulate your biology decades into the future to see what the long term effects of drugs are
or aren't. When you're dealing with exceedingly complex systems like the human body, it's just impossible to have certainty. And that's exactly why so many of the drugs on the market come with complicated stories that stretch beyond the biology.
Into societal issues.
The second thing I want to point out is the question that is always there about the distinction between normal human experiences and medical conditions. If you have grief after you lose a parent, or sadness after some hardship, or anxiety in stressful moments, those shouldn't be thought of as diseases.
Those are just appropriate human responses to life. They become medical diagnoses when they persist without a clear cause, when they become chronic, when they start to impair your daily functioning, like we see with clinical depression or anxiety disorders or chronic pain. In those cases we can say, okay, the issue is not just a specific event or injury, but an ongoing physiological state, and treating it medically can both
be appropriate and life changing. And modern medicine has made unbelievably great progress in addressing these conditions with drugs as part of broader treatment approaches. But the boundary between normal human suffering and diagnosable disease, that boundary is subjective sometimes and it's always blurry, and that raises really difficult questions about when treatment is warranted and how society decides which conditions justify large scale medical intervention. And these are questions
for which there are no simple or definitive answers. Finally, I want to highlight Thomas's view that many of the conditions we now medicate, things like obesity and anxiety and pain and insomnia, these are signals, their messages from nervous systems doing their best to regulate themselves in a world that often pushes them out of equilibrium. Drugs can help, sometimes they help enormously, but they also reveal the limits
of a purely pharmacological solution. They remind us that biology and culture are never cleanly separable, and that treating downstream symptoms without addressing upstream causes is only going to take us so far. So we're probably never going to find
the perfect molecules that finally fix everything. But perhaps we'll get better at integration drugs alongside changes that we're able to make in our environment and our behavior, in our policy and our technology, we'll get better at pairing molecules with psychology and neuroscience and social design. So to my mind, one of the most important things about understanding prescription drugs is resisting simple stories, and Thomas does a good job
with that. Prescription drugs have changed the world for the better, and also their stories can be complicated. So what we can do is keep researching. We can build bigger and bigger simulations with the help of massive computational models.
We can leverage AI to understand those models.
We can measure carefully, we can watch for unintended consequences.
And that's what science does.
It just keeps getting better, such that in one hundred years from now, when some future broadcaster makes Drug Story two, the interplay between our drugs, our bodies, and the world we've built will hopefully be much more straightforward. Go to eagleman dot com slash podcast for more information and to find further readings. Join the weekly discussions on my substack, and check out and subscribe to Inner Cosmos on YouTube for videos of each episode and to leave comments Until
next time. I'm David Eagleman, and this is Inner Cosmos.