Dr. Nick Bernthal Returns | REAL ONES

is there anything else like do you want me to do your job and tell you what questions or just like social you want to have a comment yeah i mean you just walked in i mean you were late You know, you were very late. I was late. I'm sure I'm going to hear about that. It's my God complex. Go ahead. Like I was late. I've been waiting for you for 40 years and I'm late now. Okay. I'm sorry. I'm sorry to everybody, you know, anyone else. Huh?

How are you? What's up, buddy? Good to see you. Good to see you too, Nike. Thanks for coming back and doing this. repeat repeat guest thanks for inviting me the last time you came on like how how was that for you i mean besides catching up with me and like whatever i mean was there any was there anything i mean you don't you don't really do like i mean you do do public facing things as far as you

go around, you do conferences and like that. But as far as, I mean, a lot of people saw that was, was there any sort of reaction from it? Like what were your feelings from doing it? yeah i mean i i actually was surprised i i was surprised kind of the of the who came and said hey i saw that it was not you know i think everyone's got their kind of vision of

who someone's audience is or not. And I think at that point, you know, you guys were just getting started with this project and didn't know if anyone was going to watch these things. But really, I did get, you know, a fair number of... patients from kind of different walks of life came and just said it was really cool to hear your thoughts on different stuff and you realize um that you know as a as a doctor you see people for

very small actual segments of time and you relate to them on literally the most important issue of their life, right? Like, Everything else went out the window that day that they or their loved one got diagnosed with cancer. Literally nothing else matters. Right. you try to get to know them outside that. And in some ways you do, but you don't do a lot of talking yourself. It's more listening, right? And so it's like, it's getting to know them.

And so I think it was cool. I mean, I do think a lot of patients sort of came and said, I was interested in this, what you talked about. And it gave a...

connected a connection point i guess um with some with some people who i i wouldn't have otherwise there's probably a desire on your part to make them feel as comfortable as possible but how do you even go about that i imagine i mean that's such a sort of sacred time for them and i mean is it is it uniform sort of across the the bat like are those rooms you know everybody's different one of the things i've always thought is super interesting in medicine yeah is um especially in today's world

with with information flow being so readily accessible is that I think there's sort of this concept to people that there's like you come in and meet with someone they're coming in to talk about cancer right they walk in the room And there's sort of this, you know, if you talk about something else, it's almost like, okay, I'm going to do the human part of the interview here in the meeting and then I'm going to get into the scientific part. And it's so, it's so wrong.

Like it's so wrong. And I think it's going to be more and more wrong as we go forward. What do you mean? Because that connection point actually ends up guiding all of your treatment decisions. I mean, it's so interesting how that works. But if you talk to them and connect. So the first question I ask every kid who walks in the room. Kid walks in the room, family's sitting there with them.

They walk into the room usually being told by someone they probably have cancer, but you got to go, you know. Meet this doctor. He's going to talk to you about it. Because they don't want to have that tough conversation. But they have to kind of say why you're going to an oncologist, right? The parents of the kid. The other physician who saw first x-ray that showed something funny. Like they walk in the room and they've got...

their list of questions in their head, right? They've been prepping whether that meeting is a day away or a week away. They have not slept. They're sitting there saying, here's what I want to get out of this as a patient, as a dad, as a mom, whatever, as a brother. You walk into that interview saying, am I going to survive? Am I going to keep my limb if the cancer is in a limb? Am I going to walk again? With kids, it's often, am I going to have to take time off of school?

Am I going to ever play my sport again? They're going through their questions. They are all cancer related. What is this going to do? How upended is my life, right? Am I going to survive or not? The reality is... is that when you open up that conversation with what do you like to do in your spare time they're like wait a minute like what you know I came here to

talk about cancer and so some really engage that some are kind of like can we get to the topics at hand yeah but I think the reality is is that like just yesterday I had a kid who I know We're here talking about surgery for their leg and how to fix things when we take out the cancer next month. And it's like, but I know she loves basketball, right? I know that because when we walked in, the first thing she said to me is basketball is my thing.

Right? She's 13. Do you immediately tell her you play basketball? No, it's not. But I know it's hard for you to get that you don't jump to like your own accomplishment. Don't be a f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f***ing f

So, but no, you know, she says, I love basketball. So for me, when I'm thinking, okay, I've got different ways I can reconstruct the skeleton when we take out this tumor, right? There's different metals you can use, different implants, some.

are good at this. Some are good at that. Some are more durable. If you've got a kid who's going to bang on this thing and try and play basketball, which if that kid looks you in the eye and like basketball is my thing, I don't care what you tell me, I'm playing basketball. It changes the whole narrative, right? We're not going to use an implant.

that when we reconstruct things that might be really great in some ways it may be the longest lasting implant but i don't trust it if she has a fall right if kid comes in and says painting is my thing right you go a different way right And so I think what's so cool about getting to know them a little bit up front and what their interests are.

Is that in the future, that's the whole difference, right? That's where like the machine learning AI algorithms break down. Yeah. Right. They're going to be better than me at taking. a million data points and saying what's the diagnosis and what's the treatment plan optimized for a patient population right they're not going to be better than me than saying this kid wants to play basketball and that's

existentially important to this kid and I'm going to offer them the reconstruction. Even if it's not the best reconstruction in the world at this, it is the one that gives her the chance to do basketball. Right. wow that that's and like and and is that sort of like moment of connect i mean because i know how you move and i know how you operate

And I know that you're not just sort of like lobbying that sort of attempt to make some human contact because that's part of a script to make you feel easy. Do you ever feel like they feel like you're just trying to like- People don't know what they're getting. They walk in and they hear a question that feels off. Different people react differently to it. And you adjust?

You try and adjust. You try and give them, I mean, the big thing, and no one's perfect at this, but the big thing is if you have important news that you know someone is waiting for when they walk in that room, put it up front. Right? So people who come in and they're here for their scans, is my cancer back or not? I'm not going to start out saying,

What did you do this summer? Did you see the Super Bowl? Yeah. Right. So for that person who's coming for a singular data point, they're coming to say, like, they want to have the relationship, but they're holding their breath. You know, they're getting scans every three months. And how hard is it to give that back?

just you walk in and you say hey let me just move the elephant to the side here like your scans look great they look totally great everything's clean what did you do last summer like what'd you do this summer how was it what's going on with your kids your brother whatever

You have to do that for them because they're not, you know, not able to open themselves up in any meaningful way to a conversation until they get that data point. They're not interested in talking about the summer until they know they're good. And if they're not good, you're not going to get to the summer. Right. You know, if they're not good, it's here's the bad news. We do see tumors back. We have to do X, Y, and Z. And in those meetings, you have to go in with a plan.

or an acknowledgement of here's how I'm going to get to a plan. Sometimes I don't have the plan. Like they get the scans that morning and I look and it's a problem. I say, you know, this is really not the news we wanted to see. We do see the cancers back. But, you know, I've got Dr. X and Dr. Y and Dr. Z. I've already sent them a note. We're going to meet later tonight and talk about which thing goes first. Surgery, radiation, chemo, whatever.

And I'm going to get back to you later. I imagine for you, it's very, very difficult. Just knowing you, it's very difficult to deliver that bad news. I mean, you're a grown man and you have a job to do and you do it. But I imagine that also takes like an emotional toll on you. Yeah. I mean, there's no question that there's no question that there is a weight.

of these conversations and they're sort of an you feel like an aging process in yourself of this stuff where you just feel like i don't know how long i could do this stuff of being in this type of conversation all day every day The flip side is, like anything else in life that we all deal with, the concern about the conversation is much harder than the conversation.

Every person out there dreads stuff that they have to deal with in their life. For sure. It's what dad always talked about. It's like, you know, sooner begun, sooner done. And like you start these conversations. But in this case. I think what you find is you're buoyed by just enormous strength of other people. No one walking in and saying, you know, I went and got a scan this morning and it might have tumor, it might not.

Like, no one had it outside the realm of possibility that they were going to be having this conversation. Everyone knew going into that scanner there might be bad news attached to this. And so... does it suck it sucks it sucks for everybody and and like you you just you can't ever no matter how many times you have it you can't ever

kind of truly empathize and say like, what would it feel like on the other side? You don't know till you're on that side of that coin. But I think the flip side is people, when they're told straight bad news and they're told that you're walking the path with them and that you're.

in it and that you got the best team possible and if there's any part of your team you don't think is the best team you're going to go find the best team you're going to talk to every colleague everywhere if it's a problem that you think is outside of your grasp and You know, you're going to bring the best that we have in modern medicine to bear. People turn to that. I mean, people feel like it is bad news that you are giving them. but that they are totally aligned with you in battling that.

I would imagine to a certain extent, like how much you care about the person isn't necessarily what's important. It's how dedicated you are to fighting this thing. And like, how do you manage that? And is that just something, I mean, is that something you do? consciously or yeah i think i i think people get that um you know a physician is a really good doctor is someone who can help but it's not someone who dictates the outcome in the end

A lot of this stuff, health is, there's a lot out of our control in medicine and there is some in our control. And so I think the more... What I would strive for, what I would tell our residents and fellows to strive for in these conversations is that if the person walks out of that room saying that... person is capable and is totally dedicated to bringing the best of everything they've got to be on my team that's what I can ask for out of that visit not more not a good outcome

They can't guarantee a good outcome, right? There's a humility to it, but I think there is also a divorcing yourself from... the outcome of the disease being the only thing you can offer somebody. It's not. And I think in medicine, we really go in saying like, cancer is going to be cured or not cured. It's binary. Success, failure.

Right. And of course, as surgeons, we really kind of pathologically look at the world that way sometimes. I mean, it's, it's, it either goes well or it doesn't. It's totally not right. You know, they're some of the closest relationships I've got. are with folks who either passed away or with the loved ones of people who passed away. And like, do I sit and stare at the ceiling and say like, what could we have done differently? Is there anything, anywhere we miss something? Of course.

But I think I also get more kind of inner fulfillment from sitting down and talking to parents years after their kid passed away and staying connected to them. And knowing that we celebrate that kid and that person and that life together and that we both saw magic in that kid and that we tried to provide things. During that process, even losing a battle to cancer, we provided support in many other ways. We provided kids a chance to do things. We provided them...

someone in their corner. So emotionally, it was less scary to go through that. I mean, we're all going to die, right? And so that process, as unthinkable as it is... When you sit and talk to parents who say, you know, I lost my kid, but like I, the humanity that, that your team. that people on your team, that Dr. Smith, Dr. Jones, whoever it was, showed us through that, always gave, you know, this kid our kid. He never dreaded these visits.

Even though he knew he was getting perpetually bad news at these visits, he never dreaded them. He connected with people. He looked forward to being here. He felt better walking out knowing facts, even if they were bad outcome. because he felt his team was tirelessly working for him. And so I think in medicine, that's part of the deal, right? You just can't control the outcome always. Right. And man, I, you know, with that, we talked a little bit last time also just about, I mean.

You know, look, I mean, beyond anything else, like you're a dad, right? Like I'm a dad like that. Trying to even like begin to imagine that process and you deal with it all the time. I mean, it's... You know, and we, you know, like we've known people in our lives, you know, people that we're really close with who have lost kids. Like, you know, we've lost friends when we were young. And you talked about last time something that really stuck with me.

You know people who sort of can can kind of like handle that kind of process the best for lack of a better word you know and and you talked about people who like really have a close relationship with god or with religion they normally can sort of like deal with that process better can you just speak a little bit more to like sort of um

You know, folks who have suffered losses like that and things that may be an example of something that you've just been really in awe of or you really admired the way that somebody handled it. And can you also. I don't know, for folks that might be facing it or folks that are going through it, something that you know, sort of things you got to be aware or things that go the other way? I'm not sure I have any.

kind of brilliant wisdom for coping mechanisms. A lot of folks have a hard time connecting to something bigger, bigger purposes, whatever it may be, right? It's... You know, our sort of faith in institutions is less. Our faith in religion a lot of times is less. And I do find that families and people who... kind of can see the world with a bit of perspective in terms of purpose, tend to find a little bit more peace after this.

after losing somebody. I think there is an unimaginable loss for all these folks. And you can't make the loss less. It's not that the loss becomes less. But I do think folks who are able to see whether it's, you know, religion is an easy one. But there are others. And I find that people, you know, there's a kid who was sort of a diehard baseball player who passed away. And it's like...

You know, is baseball for most people walking in and talking about baseball when they just lost their kid is like connecting to baseball would be silly. I mean, we have to remember, we always forget that like. The thing that a kid loves, they love as much as the thing you love now most. So you think about how you think about your kids, how much you love your kids, what you would do to protect your kids.

Like a 12 year old who loves baseball would do that much for baseball. And that's like, I mean, that, that. It sounds so silly, but it is like that is their connection to baseball. It is their life or whatever their passion is. And so, you know, when a kid who passes away... when the focus can be a connection to something bigger. And the family, the kid's brother, they found enormous peace in connecting with their baseball community.

Right? They got involved as coaches and volunteers and raised money to name the field after the kid. And that doesn't kind of lessen the loss. Of course. But his life... to them, goes on through that. And so I think there's a connectivity to purpose. kind of finding that passion that, that works better. And, and sorry, it's a long answer to a short question, but I think like the, the caution side is, is maybe about missing that is, is maybe about.

the family focusing on the things that didn't happen. The kid didn't get to do this. They didn't get to graduate high school. They didn't get to go to a prom. And there are granular things. We all spend so much time thinking for our kids. It's an endless cycle.

And look, it's inevitable, right? Because you're going to stay close with your kids' friends. You're going to watch them get driver's license. You're going to watch them graduate. You're going to watch them go to college, find spouses, have kids at each phase. There's no question there's a part of you that's like, why didn't my kid get that? Why didn't my kid get that? That just is endless. But...

When it gets flipped into, hey, I'm supporting the local church and getting other kids these opportunities that my kid is responsible for. That's my kid who's doing that. i think there's they live on they live on and and you through per i mean that's a really beautiful way of saying like through purpose i mean i've told you a little bit about like you know that family that we've gotten real close with on on on on bill's team you know and

You know, they lost their little girl. And I'm like, you know, and she got sick the same way Addy got sick and, you know, didn't make it through. And I see like in the way that they move and they celebrate her and they continue to like. really go and help other families. They're very outward about it. She remains enormously present in all their lives in the way that they love each other, in the way that they celebrate their other kids, in the way they reach out to other people that are doing it.

I really see that, you know? And you know, it's interesting because when you talk about purpose, if you talk about like so much of like the violence and so much of the stuff that goes on in the world. um where people are like motivated towards whether it's you know what's going on in the middle east now whether you talk about you know gang violence you know a lot of that is it's you find purpose you lost somebody you're hurt you put it into purpose it's towards a you know it's towards a cycle of

of destruction and negativity, but it's enormously powerful. It's enormously powerful. Sometimes loss happens and you need to shake something. You need to hit something. You need to shoot something. Like that fills people. And that can be very powerful for good too. I mean, I think that anger that comes in with loss. Um, I've seen a lot of families kind of take that and, you know, cancer is nice in that respect. There's a target. They're getting t-shirts made that say.

cancer right they're gonna go raise money to go to go beat cancer but you you take that rage this like go put it into something go put it against something and and it's just what you pick as that target that's right right so smart and so um i think that that side of it man i i've seen some families do some amazing stuff yeah with with kind of weaponizing yeah um all of that all of that rage yeah

And then that gets it out. Yeah. Right? Like that is their way of getting it out. It's obviously, you know, different for different type of trauma. Sure. But for this one, you know, there is a common enemy.

right right right oh you know we didn't even like really introduce you this is my little brother and dr nick burnt all but dude i hit up silva and i was like hey can i get this guy's resume So I can talk about him, you know, so I can say like, hey, here's who Nick is. Dude, you're.

in resume is 46 pages long dude listen to this listen come on dude let's move on let's have a conversation no one is interested no one needs because it's it's important if when i have a soul on here if i have like it's important to know what they but dude listen to this bro i just because this is important get the editor ready here to cut this just the education part listen

Princeton, New Jersey, graduated magna cum laude, right? Graduated with five beta kappa honors, right? Right, and then there's some other. He went to University of Cape Town in Africa, Medal of Outstanding Achievement. This is when you still. Kid, right? Cornell University, right? Graduate with Alpha Omega Alpha Honors, whatever that is. You know, postgraduate talks about all the, you know, fellow in musculoskeletal oncology, Huntsman Center.

Like getting, getting someone who can't read to read a resume is just like, this is torture for everyone. Hold on, hold on, hold on. But dude, like it just never. stops about all the fellowships and all the awards and then honors and special awards. USA Today High School All-American. Thomas Sidwell Award for overall contributions to the community.

Medal of Outstanding Achievement, Princeton University. What is Phi Beta Kappa, by the way? Don't worry about it. And magna cum laude. Don't worry about it. PH Keen Award for Public Health, Cornell Medical. This is all when you were still even a... Kid, Jane Marshall Award for contributions in orthopedic research. I think we got it. But so, okay, okay. Now, I'm just saying, dude, you were like that from like a very young.

age but nobody really pushed you nobody really like when you were i mean i pushed you to like be a better athlete and that's true he was a great football player played d1 basketball you know i think you were all league in basketball and baseball too which is a bunch of crud and uh because i was so underrated as an athlete but no listen i'm actually not trying to be funny i'm actually really wondering like

No one was like telling you you had to get like great grades or anything. Like no one, no one, no one put any pressure on you. Right. I mean, this is, I think that is true. I think that's true. So what does that, like, what does that teach you about? I mean, like. Because I guess it's not result oriented. It was never like, hey, nobody said you got to go to an Ivy League school. There was never on the, you know, nobody told you to do any of that.

You weren't like one of these kids who were in like 30 different things. You had to play basketball. You had to play with integrity and work ethic. Like that's all you knew. Like I told you don't be on the football field, play hard, like win games, right? Like what, what pressure was on you? No, I don't think there was pressure. I think, you know, I think mom and dad, you know, had some, had just some amazing.

tactics approach to raising kids. And I think they had three kids who all followed things that felt good and felt like passion and felt like they were constant getting positive feedback. And every kid needs something different. right yeah you certainly needed some different things um but every kid needs something different and and i think mom and dad never said go for this goal

Never. They never said, you want to make a varsity team as a freshman. They never said, you need to get an A. They never said, get to this college. We never thought about that part of it. What they did say is, you know... do something, put yourself into it. I mean, you know, dad always talked about how it's a lifetime to build a reputation and it's a minute to lose it. Right. And it's like, you go out there.

And if you're going to play football, if you're going to play basketball, if you're going to go take that math test, if you're going to like, you work hard at it and you do well at it. And, and then, you know, you don't. take an easy road in something you're going to say you care about. You don't have to care about everything, but in the things you say you care about.

you have to put work in. And you think that that was instituted in you? I do. I mean, it's definitely in all three of us. I think it's in all three of us. And I think it was a thing that they did not tell us. We had to be everything. Never. You know, they never said, do this, do that. I mean, they let us walk away from a lot of things. If you look back, you know, you took one piano lesson and we're like, I'm out.

As a parent, as you find yourself, again, kind of having this approach, am I going to be the parent who pushes things or am I going to be the parent who lets the kid find things? And finding the middle ground. of saying, you know, you kid are going to give to me what matters to you. Right. Can't be nothing. Right. Can't be everything. Right. But the things that you say matter to you, you're going to give effort. Right. And, and that.

For me, I liked school. School was important to me. I liked that positive feedback of getting good grades, of learning something, of feeling that. You know, there were a bunch of things I didn't like and I walked from. So anyway, I mean, I don't know. And I think trying to figure that out with my kids is what we're all I mean, what you're doing, what I'm doing is.

Some kids, it's easier than others. Some kids will walk in and say, this is the thing I love. But yeah, I always liked it. I liked being good at school.

I mean, for me, like I always felt good about it. And sports the same? Sports the same. Yeah. We're just at this thing that like honored you in your new position, right? Can you explain? what that was and can you just sort of explain, just explain like what you do and like, you know, who you are and all that. Like, I'm sorry, Nick. We can edit it, dude. Don't worry. But can you just shut up? So the event, which was very cool. Yes, it was very cool. Surprisingly, like it.

It was really cool. There have been many times in my life where I've seen stuff from you, like the movie Rudy, where I've had tears in my eyes. I had tears in my eyes that night. Seeing you play against Penn. Seeing you play against Penn.

You know, walking out there, I felt that way. Some comebacks in football, in high school, a quarterback, I felt that way. You know, you're wet. I was just like, damn, dude. Because there was all these incredibly... incredibly impressive people, doctors who I don't, you know, and they are clearly impressive, clearly, you know, older. Unbelievably successful. There was a lot of people there. It clearly was a big deal. And they all clearly feel like you are enormously special.

and different as a surgeon, as running this hospital, and as a researcher, and the way that they were talking about you before. The ceremony started, which is sort of like, this really doesn't happen. And that's something that I've, like I said, you've always been this little special type kid.

But I think that this transcends into not just like your accomplishments or your, but it also just like the kind of person you are. So anyway, what was the event? With that succinct background. Yeah, I mean. The event was celebrating. I recently got...

named to lead our orthopedic surgery department at UCLA. It's an enormous responsibility. We've got a really large department, and that means that while I do orthopedic oncology as my practice, I'm also kind of entrusted with, you know, all the spine care, the sports medicine care, the care for cerebral palsy, hand care, foot and ankle care, all of this stuff that all of these other...

physicians, nurses, teams, researchers all work on. And it's a big department. It's a super impressive department. And I think traditionally that was sort of a role for people at the very tail end of their careers. Right. That's what they're saying. Like the closest person to you is like 15 years old or whatever. These sort of chair roles are kind of when you're ready to be done with your clinical practice or your own research and you're ready to be a manager.

And for me, it's very much not. I mean, for me, it's very much, I think, one of the things, you know, it's an interesting world right now in terms of... of how companies run and businesses run and i'm certainly no expert in this stuff but it seems like this sort of traditional thing where you have owners and then managers and then workers

is sort of being disrupted across a lot of fields right now where kind of everybody's sort of recognizing, like, should I really sit and pay these managers this much money to sort of... sit and manage right is does that make sense like what is managing people right now and like technology is pretty quick we can communicate with them directly and so there's kind of this whole class of

people who were sort of mid-level leaders. And I think, you know, what we're seeing in medicine is to be able to connect. to the next generation of physicians, but respect the past generation and the present generation of kind of senior leadership. You got to be able to like all of the. connections have to go up and down a little bit. You got to be able to communicate. You got to not be seen as a manager.

but you still have to manage. I mean, that's the interesting, you have to work though. You got to produce. So anyway, long story short is now I run the department, but I also run my practice and I run my lab. So it's like taking on another hat rather than having a separate hat. And I think communication is just a hugely powerful tool and respect and communication. So we make decisions as a group now. It used to be very hierarchical. It's just the chair just says, this is what's happening.

We vote on stuff. And that like phenomenon that you're talking about, it's like sort of going in so many different industries. Does it really come from like... there's just a thing like you're either one of the people that do it or you're the one of the people that sort of like allocates and talks about it and there's a real strength and wisdom

And shared experience in sort of promoting somebody who's actually doing it because they are much more closely aligned and associated and in relationship with the real issues that are affecting how well you do the job. And that's totally true. Right. And it makes perfect sense, except that you are also promoting people to run big organizations.

who may not have managerial skills, right? And like, that's the scary part of doing it this way. And so, you know, who knows? But so far, so good. The department's done exceedingly well. Everybody's sort of... seeing the excitement of it and a new energy and kind of, you know, we really are trying to build around this idea that we're going to create

the new standard of care yeah and that innovation yeah just sorry when you when you were making when you were talking at that event you talked about uh access and and excellence yeah and that really hit me can you just sort of explain what you meant by that i mean i i think so many places

in healthcare decide if they're going to be aimed at access or they're going to be aimed at excellence. Like if you think of your, the hospital you go to, the hospitals that others, the doctors they go to, you're either someone who's saying like, I take all comers. I'm going to always be there.

Or you have someone who says, well, only the elite get in here and we're going to show that we do the best at the top and we're going to advertise the celebrity, the pro athletes that we take care of. And so... Health systems, doctors, departments, they're all aimed at that. And I firmly believe that the future of medicine is to not see those as competing interests.

I think everything is, you can provide access and excellence and you can actually make one kind of play into the other and support the other. How so? You know, a lot of medicine historically is a lot of science. When you look at what's studied, super interesting. Like you look at a study that dictates, you know, new medication comes out.

right? They ran a clinical trial and historically they would run that clinical trial and they would run it usually only through what's called an excellence hospital, right? A high-end hospital that caters generally to affluent white men. And they ran a clinical trial that showed that a drug worked for affluent white men. And they didn't run a clinical trial.

that was gender equal, that was diverse, that showed, and we know that genetically some of these medications work better in some than others. You need to have access points for all type of people, old, young, every different kind of. Look, nationality, gender, everything. To say that your care works, it needs to transcend the differences in people. It's just a fundamental principle.

And so one of the things I love about what we do is, you know, I took care of about two years ago on the same day into my clinic, a kid who's... father was one of the royals in the Middle East, flew their kid out with a cancer on a private plane. came out and saw me. And then in the next room, I took care of a kid who's the exact same age, who's a kid from South Central LA with no resources, same diagnosis, same thing. They get the same chemo, the same surgery, right?

And if you can do that, if you can really provide that type of thing, then you start to see if what you're doing really is, if what you're doing is really right. The champ is here. Tommy just walked in. Are you coming on, Tom? What do you mean no? Why? Dude, Tom, Tom, you said that you were going to be with your wife, bro. You said when I talked to you two days ago.

Come say hi. Shut up. You say hi to Nick, dude. Tom, come sit in here. Why? What, you didn't get your nails done or some shit? Huh? Right now? what are you all talking about well right now we're uh we're talking about uh health care and we're talking about um we're talking about

No, dude. Shut up, man. That was my real disappointment the last time I had Nick. I made fun of him too much. I didn't actually like, you know. No, no. I know you're making fun of me. I know. Tom, you really don't want to come in on this. When are you leaving?

Tom, if you have anything, just hang out, Tom. I think the thing that you said before about people losing faith in institutions... it's very clear that like right now probably more than you know whether it's politics whether it's people you know believing in our country whatever it is i mean there's no question right now there's like

you know there's such like a lack of faith in in health care and it's one of the things that like sort of like in the zeitgeist people are kind of like preaching and i think probably like a lot of that

A lot of that came from COVID and a lot of that came from sort of like everybody kind of like all of a sudden having healthcare be kind of like something that everybody was talking about. There's no such thing as like an atheist in a foxhole, right? It's like when people are dealing with cancer, they're not like, well, I heard on...

Rogan that like you do this or that. They're not like... Yes and no. Is that true? I mean, you'd be surprised. Really? You'd be surprised. You know, people's convictions are pretty firmly held right now. We are at the early stage still of this kind of information overload. And no one has figured out exactly how to train people to process what comes in and how to develop thoughtful kind of internal algorithms for sorting out what is real and what's not.

I think as we go through, I mean, it's just an interesting idea. I also teach, right? Like I got to teach at the medical school and I teach residents and teach students and fellows. And you're actually in labs actually figuring out what the scientific method. Right. I think it's one of these things where historically our entire how we teach people was all about retention.

How did you get tested your whole life? It's like someone tells you something and then it's how much of that did you retain and can hand back to somebody. And now... All of education has to shift to developing a way in which retention becomes far less valuable, but sort of analysis, prioritization. some sort of kind of methodology for taking what is, you know, infinite data that's available to you and sorting out what should come to the top. And unfortunately...

Right now, it's about what feels good, right? It's like the data you want to come to the top comes to the top. Super easy to find. And that's if you can find unlimited data and you can always just sort of. Take the one you like best. It fits with your worldview. And so with cancer, it's a big problem, right? Because you can go look up any of the cancers that I take care of and, you know, you'll find...

Somebody who's written something that says, you know, walking four circles around a wood post in the desert of Nevada is going to cure cancer. Right. And we have people who. who say like, I got to go try that first. Yeah. Like I did this really, but how you navigate that as a doctor is tough, right? Because there's some stuff that's just batshit crazy. Right. Right. And like, you can't.

If time is of the essence and they're going to go and they say, like, I read somewhere I've got to spend three months walking around that wood post in Nevada, like, that's dangerous. They're going to be dead before they get back. Right. Right? If something is not dangerous, you got to let them do it. Because it might make them feel better? No, because they have to come to terms. It goes back to that original point, which is I can't guarantee the outcome.

If I had something that was an 100% I do this and you are 100% good, I would say, you're crazy. Let me do this. There's no risk. I can solve this immediately. Nothing in medicine is that. So if it's not that... I got to let them not, if they need to do something that's important to them. So there's that kind of, those categories, which is, you know, take data.

take something that they've found that they just want to do because it's important to them. As long as it doesn't hurt them, you got to let them do that. The second category, which is big, is the stuff we in medicine, Western medicine, don't understand. So it may or may not be real. We don't think it's real. We can mock it. There's no data saying it's real. But it's also possible that it has some benefit.

Right. And so we see this a lot with like Eastern medicine, traditional medicines, turmeric. I see a lot of, you know, we get a lot of patients who, who come in, you know, especially ones with, from Indian descent. And there's a lot of interesting use of turmeric and kind of some of these spices and stuff that, you know, traditionally they used against tumors. Do I think it's going to help? I don't.

Is it possible it helps? Sure. I mean, there's a lot of things out there we don't know. And so those things you try to figure out, can I convince this patient to do that in parallel with what I'm doing? Can I convince them that I agree with them that this might help? I've got no data saying it will help. And I know what we're doing has a positive benefit. Can we negotiate that?

to fit in line with their kind of personal beliefs. And sometimes you get people who say, I got to go try the turmeric thing first. You know? And every once in a while, we see it work. You do see it work. Every once in a while, you see one of these crazy things and you just don't know. And I think one of the things we're learning in all of this stuff around healthcare is that, you know, the old model of...

Cancer gets hit with surgery, chemotherapy, and radiation. Like we know that works some of the time, most of the time, depending on the tumor, but a lot of times it doesn't. We now have this, you know, the field in cancer is immunotherapy is trying to get the immune system to tackle these cancers. And we know that people's immune systems are different. And we know that everything you do, what you had in your coffee.

does impact the immune system. And so is it enough that it's going to get your immune system stronger to be able to battle this cancer? I don't think so, because if coffee boosted the immune system to beat cancer... No one who drinks coffee would have cancer and we wouldn't see that. But, but, you know, certainly might be beneficial and we don't know. And acting like we do have all of those answers, you know.

it is not right. So then it's more about me looking at the safety of stuff. If you want to go try turmeric, you want to go try going to the desert, you want to try doing whatever it is that you believe. right or wrong, if it doesn't get in the way of me giving you the best care, I'm all supportive of it. If it does, then we got to talk about it and kind of negotiate the kind of rank order of what we're going to do so that we don't hurt you. What role did COVID play?

And in terms of like the overall distrust in medicine or the overall belief in medicine, what's your take on that now looking back at it? And what has it done sort of for society as a whole and their trust in medicine?

So I guess there's a couple of things to that. I mean, one, I certainly have a biased view of this. I have a skewed view. It's from the doctor's point of view. It's from the scientist's point of view. It's certainly a skewed view. But number one, I don't think that COVID... led to a distrust of doctors I actually don't I don't see that in my practice I don't hear that talking to people I think that whole thing has shifted to there's a distrust of government there's a distrust of

medical experts. There's a distrust of pharma. But really, what is interesting is... Even data that's out there about do you trust your doctor? Most people love their doctors. Most people really trust their doctors. When they're one-on-one, we as a society still trust. When it's... an institution, when it's amorphous, when it's ambiguous, that is where trust broke down around COVID. Is the distrust in politics, Big Pharma, just leave? Literally just came to go to the bathroom.

Unbelievable. Bye, Tom. Great to see you. Unbelievable, bro. Get together soon. Okay. Is the distrust in big pharma, is the distrust in political sort of health administering, is that warranted? Is any of it warranted? Skepticism is warranted, I think. Specifically from how COVID? Scientifically, a scientific approach to something. The scientific method that we base everything in Western medicine on having a hypothesis gathering data analyzing the data Is built on skepticism

You trust nothing. You test everything, right? And so I think skepticism is totally warranted. But recognition that the situation we were in... there is a huge risk of inaction. And so, you know, everything in your own personal healthcare and in society. can't be weighed in a vacuum. Everyone wants to say, we want to talk about what happened and what a bad decision it was. The Biden stimulus plan, it was a bad decision because of X, Y, and Z.

but we weigh it against a sort of theoretical where we were before that. Well, where we were before that plan... was not where we would have been after had that plan not happened. So I don't know if it's a good thing or a bad thing. I can't say that the decisions made by government officials were good or bad, but I guess I do feel... pretty clearly that the people who were trying to come up with these plans in that situation, I believe deeply that they were trying to do the right thing.

That they were working with limited data sets in an unprecedented situation. And they were trying to do the right thing. Were there people who tried to take advantage of it? 100%. Yes, there's huge examples of corporate greed. Were there... companies that tried to take advantage of it? Is there lobbying that may have influenced someone that subconsciously made them approve? Sure. And were there missteps?

Absolutely. Across the board, there were missteps. I think, though, that, you know, it's really easy to scrutinize people's decision making. from, you know, the comfort of your own home. Sure. And to post what you want to post and to say what you want to say. And looking back on it. Looking back on it. And retrospect. Yeah, retrospect. You know, dude, the pressure on...

the folks who were actually decision makers in this thing, with thousands of people dying, with morgues filling up. Like, I just... You know, you've got to remember that these are human beings making decisions with imperfect data sets, and we don't know what happens. You will never be able to live through.

if the other decision was made to know if it was truly right or wrong. So, you know, certainly bad actors, people, but you know, it's like me saying, well, a bunch of those, uh, little pop-up shops that were testing for COVID. on the street a bunch of them kind of turned out to have shoddy testing and like they they they were just doing this for money right right does it mean that everybody who

did COVID testing? Does it mean that every pharmacy out there is, is malintented? Does it mean that? No, it means that there were some people yeah and there were some some really kind of people who took shortcuts to make a profit yeah um and were bad intention and so i i don't know i mean i tend to be a um

I I'm not a conspiracy theorist. I don't think, you know, somebody at the top was designing something to enrich themselves or something. Some of that goes on. No question. Yeah. But, um, I, I just. You know, I look at like what Tony Fauci, who's become, you know, this kind of very polarizing figure from how he handled all this, man. Show me someone who could navigate that situation through that period of time in different administrations. I just look at it and it's like that's a tough spot.

to being yeah and I think he was you know for everything I know he was doing absolutely the best he could do given that circumstance and he made some mistakes and he did some things great and and do you think that I mean, because like right now, since there is such a, you know, abundance and an overflow of information and there's all these, you know, podcasts and people are like, hey, I'm not a doctor, but and there's all these sort of like theories that get pushed.

Or I am a doctor. Or I am a doctor. It's like, I'm not a COVID doctor. Right. I'm not an expert in COVID. Yeah. Right. But like, what do you, what, what is, what is the real time danger of, of that? You know, of like the magnification of everybody's voice.

think there's certainly a lot of ramifications of, you know, self-proclaimed expertise right now that that's across all fields, right? I mean, look at your industry, right? Like anyone is a director of a movie because they, you know, my. My five-year-old is a director of a movie because she took my iPhone and filmed her little brother. There is a real benefit in everyone's opinions being able to be heard.

I mean, it's foundational in our country, this idea of federalism, this idea that having 50 states do things a little bit differently is going to teach us 50 ways of doing something. And then we get to pick out the best, right? That's not as efficient as a country that has a more centralized government. It's not as efficient as a dictator. I mean, a dictatorship is hugely, hugely efficient, right? And if you have a great dictator...

You know, hey, that's a pretty good way for a country to succeed. There's just enormous risk in it and there's not a lot of innovation in it. And so I think this idea that everybody can get their thoughts out and it starts. Having a danger when it's presented as fact, when it's magnified as fact, and when really the impact of an opinion is weighed on how many people listen to it. Yeah.

Right? Because that's where it breaks down from sort of the scientific method. It's no longer an idea to put into the discussion to be tested. And all these things become weaponized. I mean, I remember... I remember when I was living in South Africa, the early on when Nelson Mandela had just handed over power. to Thabo Mbeki. He was the second president of South Africa. So five years into their independence, Thabo Mbeki didn't want to touch the HIV crisis.

He just saw it as a political hot button issue. At that point, 30% of the population had HIV. One in three people had HIV walking down the street. No treatments available. He was just like, I don't want to touch it. And so what they did was even before the age of like, you know, tech firms amplifying this stuff, they basically found a couple of rogue scientists.

who were American rogue scientists. They were kind of pushed to the side in the American medical community, but they obviously had enough people listening to them that they had written books and they had kind of gone out there. And these guys had said, HIV, we don't believe HIV causes AIDS. We actually believe that AIDS is an immunodeficiency.

And they kind of used a little bit of circular logic to say, you know, there's other things that cause immunodeficiencies. All that means is your immune system isn't working. And so they broke this fundamental scientific chain from Really a key chain from unprotected sex to HIV to AIDS to death. Because if you have no medications, the only thing you have is that chain. Right.

is to tell people the only place you can intervene is by either not having sex or by wearing a condom. Like that is your opportunity. Once you get here, you are going to die from this. Yeah, yeah, yeah. So the South African government... didn't want to take on this issue. And so what they said is they hid behind this idea of like freedom of ideas.

And they said, hey, there's these great scientists in the U.S. We need to invite them into our leadership council. We need to have a discussion where their voice is heard too. Because doesn't everyone like more voices? Right? But what happened is, is that became their HIV policy was we're going to have debates about whether HIV causes AIDS rather than we're going to. And so, you know, a few countries north in Uganda, like they got a dictatorship at the top.

And he's like, hey, unprotected sex to HIV to AIDS to death. This is a clear line. I'm going to put billboards on every corner. I'm going to tell every trucker because the truckers were the roots that really were disseminating HIV at that time in Africa.

Their HIV rate went like this. And so you have this dictatorship that's sitting there that like, you know, the West is saying like, oh gosh, you know, it's a dictator. He's horrible. He's a military leader. But... they got right on top of things and South Africa kind of this democracy, this open idea forum really set them back a generation, you know, and it, it, it really, so.

I think, I know it's a little bit of a long-winded answer, but I think when we get into these ideas, they are valuable. Like that guy's idea that HIV may not lead to AIDS is valuable. But everyone's got to know their role. And everybody's got to know, right? Like the scientists are there to study scientifically these hypotheses. That is their role. The government is there to set policies that keep people as safe as possible.

with the science we currently have, and to make those decisions based on recommendations from those scientists. And people who... are not trained in any of this, but who have hypotheses or they are trained, but they have contrarian ideas, just have to be willing to put the time in to test their hypotheses. Go find some scientists who want to run this.

Run it in a lab. Do a mouse model of HIV and see if you can block the transition to AIDS in an animal model. I don't know. I mean, whatever it is, there's scientific ways of asking those questions and disproving it. But instead, someone has an idea and they spend all their time on going out and propagating the idea, getting celebrity and fame around the idea, being congratulated for having this contrarian idea. And they're really just celebrating their own contrarianism.

They're just saying, I'm different, so you should listen. And then the desire in all of us to sort of say like, oh, he might have an answer or the system or. That's right. But like, what do you say to all these- Super interesting dinner conversation, right? For sure. But that's not like, have the courage to go test your hypothesis. So when I would send you like-

you know rogan episodes of doctors you know like that that you know that that were contrarian that were getting amplified and they say like well they have tested it and they found you like how do you explain that because like what is scientific method like how do you know whether something's like proven or whether it's like yeah because it seems that you can kind of it seems like in science you get a guy who you listen to on a podcast and he's like

35 board certified. So how does that work? And is there really a way to be contrarian without overwhelmingly... I mean, isn't the whole idea... About these tests that it's like overwhelmingly one way or the other. Yeah. So, so that that's, if you think about media right now, as opposed to media when we were kids.

It's the same thing in the scientific world. So in media previously, like... the newspapers you kind of had three or four big options the tv stations there were three or four big options and they were seen as truth like what got what got presented on the nightly news was truth what was in the washington post or new york times was truth Now you can find an article in a journal, paper, newspaper, something that says literally anything you want.

If you hunted hard enough, someone has said something that is in print somewhere. Science is the same way. So it used to be we had a couple of big journals. right? Every field had their, every field had their big journal. There was a big cardiology journal, the big, you know, New England Journal of Medicine for kind of all of medicine. You had these big journals that were at their best.

like the media organizations, at their best, they did an enormous job of scrutinizing bad science before they put it out there to the world. At their worst, we're a good old boys network of... people who controlled the science that got out in the world, right? And so you have to... And that's pharmaceutical companies? It's a little bit of everybody.

right? It's a little bit of everybody. It's who they know, what institution did they train at? You'll hear doctors all the time say, well, you know, I trained here, not at... the mayo clinic and and that journal only takes articles from the mayo clinic right and they only like them this is why i'm not being valued maybe they're right maybe they're wrong i don't know but the reality is you had an environment

that there was so-called scientific truth because you had these journals that everybody would agree that only really high-quality, peer-reviewed science was published in. Now there's... thousands and thousands and thousands and thousands of journals, right? It is a for-profit industry. People do journals. They publish them. They're e-publishing them. So there's not really cost. It's not like they're printing books and selling them.

And the whole thing is just content. It's no different than Netflix. It's no different than, right? I mean, they just need. content because the more content the more eyes on it the more they can charge for advertising the more they can charge for whatever it is

That's what the scientific journal world is. So all these links that you send me, when I listen to a few minutes of them, I try and be respectful. Some of their ideas aren't bad. But when they say things like, I've got articles to support this. You could, if you sat here right now and told me you wanted me to find an article that shows scientific support that's published in a peer review journal.

i could find an article that supports anything you you could come up with okay it doesn't mean that it's quality science right because someone is deciding that it is better for them to have more content and so with that You get into this situation where if I want to say HIV doesn't cause AIDS, I can find 200 articles that say HIV doesn't cause AIDS.

And the truth is, is there's probably, and these numbers are completely made up, but you know, there's probably only a hundred that say HIV does cause AIDS because that was taken as a scientific truth. Once this was published with high quality stuff, we as a community of scientists, we move on. We start talking about this drug can break that cycle. This intervention can break that cycle.

You wouldn't get published. You only are supposed to get published if you have a new idea. And what happens is contrarians want to just generate volume. of for the echo chamber of their idea so they just publish to publish they want numbers of articles but that's probably there's probably some

people who have contrarian views who don't want that, who actually want to help. And I'm using the word contrarian wrong. The truth is, is contrarian science is good science most of the time. And there's a huge variation in quality.

And so you can have great quality stuff that is taking a, in fact, every great scientific discovery of history came from a contrarian. Right. Because when you go into your cancer labs, I'm sure you're looking, if you found something that we like, everybody's like, dude, they're going to think I'm.

crazy but this works you're going for it right because your motivation is helping people and so then you get to a place where you say you know and look then it gets messy right then it gets messy you're a contrarian who may Totally believe what you are saying is the future. And then you got to go out and get money to do the next study. Where do you get that money? Right? If you feel like, well, pharma only wants this narrative. I can't get money from pharma.

The government, the NIH only funds things that establish scientists, lead the review process. They're not going to believe my contrarian view. So I can't go to the NIH. Where do I go other than... To, you know, get out there and to try and find other people who like what I'm doing through media and try and raise money that way. And that's a fair, like for me, if I hear somebody take that opinion.

who says, here is my contrarian view. It differs from all the other scientists out there. What I want to do is this really well done study and what I'm lacking. is institutional support from anybody to do it. Love that person. Right. Immediately say, that's the kind of person who's going to make a breakthrough. Right. When I have somebody who says, there is data showing that I'm right. Right. I've already proven this. I've already proven it. Nobody else reads it.

nobody else sees it because the whole world they're either evil or they're trying to keep profit like that for me whether it's right or wrong that that that's too easy a road that's not doing where you're at in which you know you know there's some there's to that like there's just like to be able to say it's proven in peer-reviewed journals you know what you know what's what's real and what's not in that

That's a good distinction. And so I think a lot of medical people, scientists and medical people use the term articles, scientifically proven studies that show, right? That to me is no different than, you know, us saying

Yeah, I read it on the internet. It literally is, that's not a qualification right now. Right, right. Because you have this just kind of explosion of places that are willing to put anything into their journal. You could go all day and like... go on the internet and read about like aviation flying an airplane, but you sure as would not go into the cockpit and be like, I got this.

Right. But like, you know, with like somehow in medicine like that. And I imagine. So let me tell you a story. Yeah. Okay. I have to be careful how I say this because I really can't like. I took care of someone who had a massive, massive following.

around contrarian theories for cancer and then they got cancer and then they came to me to get taken care of and this person who is sitting there with Again, not to say all contrarians are this, but this person explicitly stated to me multiple times how essential it is. That nobody sees them coming in or out of the hospital. That nobody sees them being affiliated with a hospital. Because their entire enterprise. was based on saying Western hospitals are evil, are doing all things for profit.

You know, so there's your, you know, atheist in a foxhole, right? I mean, it's not saying some people don't live by this stuff and some people don't do it. I'm sure there are. But there are a lot of people out there on both sides of this coin. who may have secondary gain from what they're doing. It's not just the pharma side. It's not just the contrarian side.

There's secondary gain and secondary gain can be conscious or subconscious. Not everybody is evil, but they start to believe things because they start to get traction when they say them. Sure. And...

That either feels good. That feels good. There's a snowball effect. Yeah, for sure. That feels good. And what do you think like, you know, I mean, you know, as far as like, you know, staying on the sort of lack of faith in medicine, you know, pops always. would say that, you know, as you get older and as you kind of get further in your life and especially if you, you know, you advance in your career, the longer you're in your career, you start to realize.

that so many people who do what you do in any field are really like live in the level of like mediocre to like really bad. You know, I know that. True in my business, right? And he would use an example. I guess he was doing all that stuff with scatter plans and dealing so much with aviation.

you know tra um air traffic control and stuff and there was like this whole thing he he talked about called the big sky theory where when you when you really get to know air traffic controllers and you start to talk about them there's this one guy who did this this interview with him and they talked and he said there's something called the big

theory. And that is you think, you know, we're responsible for all these planes up in the air at once, right? And like, we've got to live every day that if we make the littlest mistake and say to go off course in one way or the other, it's like...

You can kill people. And the things that save us from that pressure is a big sky theory. Airplane's a teeny little speck in a giant sky. And the truth is they make... mistakes all the time just like people make mistakes in every field that they do and not even talking about good apples and bad apples and good teachers and bad teachers and good cops and bad cops just people

And to what degree would you say you see that in medicine? Are there doctors that truly suck? So there's two questions in that question. And I think they're both kind of interesting topics. I guess the first one is do hospitals, doctors, medical personnel make mistakes that kill people? 100%. 100%. That data is out there. I mean, we know and it's not a small number of people that get hurt in hospitals. There is a certain chance of something bad happening in a hospital.

If you just think of it is people outside of their normal conditions. Right? People are disoriented. They're sleeping in a hospital bed. They're not getting good sleep. They trip and fall. The nurse gives the wrong medication. The doctor orders the wrong medication. That stuff. has to happen at some frequency. And the goal for us is to keep that number as low as humanly possible. Some hospitals are better than others. No question.

The question about are there just bad doctors? The history of medicine is a little bit interesting with this because medicine is a different type of field than other fields based purely on its history. So around, it's actually kind of an interesting history. And basically prior to kind of the early 1900s, anybody could open a medical school. You could have the John Bernthal School of Medicine. You could teach people how to, you know, swing a baseball bat.

And say, that's what you do when someone comes in, you hit them with a baseball bat and that will totally get their problems solved. Right. But that's when you get into ideas of like releasing the evil humor. You could start a medical school based on anything you want.

and what happened is is the government actually for all the people who say the government never does anything good but the government got together and got this guy abraham flexner who was a physician they said go around the country and figure out some criteria you got to have to have a medical school. Because we can't have these people out there hurting people. This field matters too much. So...

There's this kind of forever changing medicine in the United States document that came out in the early 1900s called the Flexner Report. And basically he went all around and he found that Johns Hopkins was the model program. He said, this place is really teaching medicine in a way that people should teach it. They have the right balance of science and anatomy and these other things, and they have criteria and things you need to know.

if you're going to be a medical school. So he created these things and he said medical schools have to hit most of these if they should be stayed as credential medical schools. And overnight, most of the medical schools in the United States closed. They shut down shop. So there were only about 100 medical schools for the entire 1900s.

I mean, to 2000 and even more recently, if you look, look at the number of law schools that are out there and look at the number of medical schools. So because medical schools kept this kind of philosophy of the Flexner report, you have to meet these criteria. Law schools, almost any college can open a law school, right? And the assumption is, is like the market will sort it out. If you're a really bad lawyer, you probably won't get that many clients over time.

right? Medicine, they've always said, here's the criteria. So the end result of that was two things. One, we have a country with way too few doctors. The end product of this was... We don't train enough physicians to take care of our population. So when you look and you say, hey, in Los Angeles, in New York, we have access to great medical care.

Well, that's true, but only in parts of Los Angeles and New York. And if you look at half of our country, more than half of our country geographically, they have a really hard time getting into good medical care. They travel huge distances, right? And so we have too few doctors because of that Flexner report. They said this is the criteria. The flip side is to your original question, are there really bad doctors? Well, the answer is yes, there are really bad doctors. However...

I think it is different than a lot of other fields because the funnel was so narrowed at the entry point to medical school. Yeah. That you didn't have just sort of a free market sorting that out. You had some quality filters. So it's like, I mean, in a way it's like special forces. Like you have to at least gone through an intense. level of training to even be able to wear that coat. I think that's right. So what happens is that bad doctors in general, I don't know many physicians.

who are not smart enough to be good doctors. I don't think that's ever the criteria. I do think that life pressures like... every other field in the world. You want to be a good, you know, good at what you do, a good cameraman, a good writer, a good, right? I mean, you get to a place where you've got to make decisions about putting in extra effort.

or you're lazy or you're trying to make as much money as you are. There's no question medicine is no different than any other field with that. So once you get into sort of the human aspect of it, there are bad doctors. There are doctors who... There are bad people who are doctors. There are people, and bad is a judge. There are people who I would say allow their... We all do. I do. Let my competing interests get in the way of being a perfect doctor.

I have a voice in my head from Eckhart always who says, always do the harder thing. That's what he just believed that in life, if you sit there, you will have a point every single day of your life where it's go check on that patient. or go home, right? You're going to have that decision 100% of your days in the hospital. If it crosses your mind, what's the harder thing is to go up and check on the patient, right?

But that's a competing priority, right? That means I sometimes don't get home to my kids. That means I'm a bad dad. Doesn't mean I'm a bad person, right? And so every day you weigh that and you can always justify all of those decisions to yourself.

You can always justify running out of the hospital because you're being a better dad. Or you're running out of that hospital to go make money as a consultant on the side because you need to make more money to support. You can always justify it, but it does lead to bad medicine. I think there are bad doctors in that sense. They've lost that prioritization that being a good doctor doing the extra thing.

should be either the top priority or damn near close to the top priority of their daily rubric. The grants you get from the military and the grants, what's a grant that you're most proud of? Or just explain that process. Like, cause they were saying that when they were honoring you that, that night and you could go back into the access and excellence, you know, topic if you'd like, but, but, but I mean, I'd like, you know, I'm not saying you do this for, but anyway.

You know, they were also talking about all Just like there's kind of a staggering amount of money that you've received in like grants and what the process of that is. And I imagine like in terms of like the sort of pseudoscience, for lack of a better word, or people say, hey, study show or appear. In order to get a grant for something, you need to have real scientific proof. Those are hard to get, correct? Yeah. So, yes.

It depends. There's a hierarchy of grant funding like anything else. And there are grants that you're convincing somebody to just hand you money because you convince them it's a good idea. A lot of our... national granting agencies. The NIH is the biggest grantor, and that's our government's granting agency. And the Department of Defense gives a ton of medical grants for advances. Those are tough to get.

And you really have to have good science and good rationale and a good approach. What are some of those that you did? Grants are... Research in medicine is awesome. It is that aspect where you really get to bring your big ideas and your creativity to bear. And I think what is the most fun thing in it... is you really can connect with people and their needs in a different way when you write these grants. So what I mean by that is I started my lab 15 years ago.

that was really interested in looking at how we can make patients, I mean, conceptually, it was how we could improve the outcomes of surgery globally. not orthopedics, not trauma, not oncology. How can we do better? What can we push? And Dr. Eckhart always said like, you got it. If you're not tackling a big problem, like what are you doing science for? And so...

I said, you know, what is the biggest cause of failures of surgery? And without question, it's infection. Just without question, a surgical infection across fields. Whether you're putting a hernia mesh in or doing a cancer surgery or doing a knee replacement, infection is the thing all surgeons fear more than anything else. We know how to deal with the cancer and how to get it out. What we don't know how to mitigate is once that infection takes hold.

It's a disaster. And so we got into this space of infection work and trying to figure out kind of how we could make patients more ready for surgery. And that opened all these incredible doors. It just like one thing after another is more interesting than the next. It's so cool. Things from super, super easy, straightforward things. We found out that... really proved in a mechanistic mouse model that somebody's vitamin D level going into surgery absolutely predicts their risk of having infection.

And that if you give someone who is vitamin D deficient, if they have a low vitamin D level going in, I mean, this is like basic, no risk stuff. They have a massively higher risk of infection. And that if you give them vitamin D prior to surgery, just prior to surgery, forget vitamin D their whole life, you can bring that risk back down to what the normal baseline population is. So you're sitting there saying like, this is vitamin D. I mean, this is literally like taking a Flintstones vitamin.

prior to surgery is going to make a meaningful difference in this thing that is just life-changing for people. You know, if you get, just as an aside, if you get a joint replacement and you get an infection with that joint replacement, Your likelihood of survival is worse than being diagnosed with breast cancer, multiple myeloma, or HIV. Damn. Right? You have a higher chance of dying in the next five years with that.

than any of those I mean this is serious life-changing stuff and so it's a different comment but it's like when you when somebody goes in for these surgeries like what is this idea of informed consent did you discuss with them Do you really, you know, this surgery, if you get an infection, we go down this pathway. It's scary stuff. So anyway, we got into this science, some easy things like vitamin D. We've developed a few drugs in the lab that are really cool that are new drugs that...

can treat these infections if they do take hold. And we've opened some clinical trials and we're starting to get that good kind of rigorous data to show that it works. But I think one of the cool examples you say like, what's a cool grant? So we have this world in our lab that works on infection research. And we found over time that other than my patients, oncology patients, who are big surgeries, on chemotherapy, really at risk for infection, who cares about infection?

as much as that. Those people are the highest risk, but the only people we found who care about infection as much as that is the military. These are people who are going out getting blast wounds. open wounds, contaminated, they're getting a bunch of bacteria in the wound, and tons of soldiers end up losing life or limb because of these infections in their bone. Wow. Right? And what happens is they get, historically, they got airvacked out. They'd go somewhere. They'd get...

They get orthopedic surgery. They get a nail put in or plates and screws fixing fractures, but they didn't clean out that bacteria well enough or that fungus. They get an infection on it and they lose their limb. They can't go back to their work. They can't go back to their life, whatever it is. So the DOD got really interested in infection and we partnered up with them and they gave us a lot of support to try to, they thought some of our ideas were good ideas.

But what's super cool about it is you actually, when you do this stuff, you get to really, I imagine it's not that dissimilar than acting and like meeting someone in a part. You have to, to do it well, you have to go into their life. For sure. You have to really say, like, if I'm going to make a discovery that matters to the Department of Defense that's paying for this, there are certain realities.

that exist in their world, that if I do this the way it works in a lab at UCLA, like it doesn't help them. And so what are some examples? Like we, they said, we said, we're going to make, what we're going to make for you guys is a... a coating basically that you can pour onto a blast wound out in the field that's going to prevent that wound from getting infection.

Okay, fairly simple idea. What are the things we needed to know from them? And I learned all this stuff from these military guys and it's super interesting, right? They said, number one. Air superiority of the U.S. military cannot be guaranteed going forward. And I said, what does that mean? I don't know anything about air superiority. So what does that mean? It means that since Vietnam...

We always assumed that we could go in with a helicopter, pull out a soldier, and take them to a regional hospital. We've assumed that our helicopters would be safe doing that. The assumption at this point from these military guys is... that military leadership says that no longer is the case.

We have to assume our adversaries are going to have at least as good air capabilities as us and certainly will make it so evacuating people is no longer... Rockets to... They got something that makes this idea. So the entire... higher military infrastructure.

was set up with this tiers of care. And you can, you know, you've had people on here who can speak about this more intelligently, but it's like, you know, get them to the regional hospital. If they need to go to the, you know, to launch stool in Germany, then they get kind of escalated up.

So now they need to make things that are in far forward environments. You've got to assume you can't pull that person out. How do they get medical care to them rather than medical care out to this facility? Right. So that's number one. Number two is military battles now are fought by small groups of people in remote environments. Like it's not, you can't rely on having a medic.

in each group, right? If this are small special forces guys going and fighting fights, there's going to be five, six guys, one guy, two guys out in the woods somewhere, in the jungle, whatever it is, they're alone. They're not going to take one of those key two or three or five spots for a medic. Right. Right. So it's got to be simple enough. Any solution has to not require a medic. Number three, you can't have anything that adds weight that they have to carry.

Zero. You have to get something that is not in pounds, but is in grams of weight because anything they carry there is some weapon they can't bring with them or protective gear they can't bring with them. So we went to work with kind of those criteria. What can we do out in the field? And so you try and replicate all these scenarios and we thought we had something great.

We like, we really like, you know, we sat, we got the best minds together to work on this thing. We thought we really had something great. And we started writing it up. It was working. We were kind of positive about the early results. And then we went and showed it to them. And it's interesting. It's like how science and reality interplay. But we went and showed it to them. And what we did was.

we had something that used canteen water. So the water they got to carry anyway, that's going to be the water that makes the liquid that covers the wound. So we just have a powder that weighs nothing that we can combine with canteen water. Then they don't have to carry a liquid around with them. So that was good. But then we ran into this problem that...

We had the chemists in our group were saying, what we're going to do, you have to make something that rapidly congeals. It can't be a liquid that pours off. It has to hit here and solidify on that wound. And so they said, well... We've got this brilliant solution. We're going to use UV light, a little like pen light almost that weighs nothing that you can just pour and run over this thing and it'll cure it on the wound.

And so we thought we had solved it. No weight in this UV light. Like we thought we had this thing not. Yeah. And then like we go and show it to the special forces guys and they were like, yeah, UV light doesn't work. Can't have anything. I mean, they're like, our adversaries might be able to see UV light. We're hiding somewhere. We're not doing something that's like, hey, we're here putting our wound care on.

So we had to go back. We got, you know, the chemists went back to the drawing board and, but it's cool. It's like they, you go and that's, what's fun about working at a place like UCLA, because you have world experts in everything like on our campus around. You just have someone who specializes in everything. And so I found someone who's, you know, one of the fathers of click chemistry and this like way of...

Making things rapidly solidify quicker with chemistry rather than with an external light beam. And like all these people I talked to were like, impossible. You need something to synthesize this. It's just not going to work. You got to quit on this thing. walk into a guy like that who's literally used to staring at a chalkboard and students like that's all he does he's never had a translational process

And like you walk in and tell him the problem. He's like, well, why don't you just substitute these groups on this and move these carbons to here? And then he's like, yeah, it'll be click chemistry. It'll just go immediately without any synthesizer. We were like, how immediately? Yeah. Immediately. Shouldn't be an issue. so we try it we do it in small animals we do it in large animals it works immediately you just take the uv light out of the thing which all these other like experts in the field

have told us you're not going to be able you can't achieve your goals without that so it's that kind of thing you wouldn't even know it's an issue if you didn't spend the time with this guys on the ground you don't know like being able to connect that's like going into your patient in the first place that's right and that's like that's the best part of being an md who does research is like you get

to see the patient side you get to engage with the real life problem you're not hiding in a lab all day right but then you get to go back and some of the ideas are yours most of them aren't most of them are getting a team together that has a chemistry expert a drug delivery expert you know just putting that crew together so i think that the the stuff i'm from a grant standpoint i'd say the thing that's been most gratifying is feeling like

We've really partnered with the DOD and we can start to make meaningful contributions that are going to make the soldiers safer. I mean, I think that feeling is great. Is there some sort of failure or some sort of event or something that you think you...

you learned from or grew from immensely or changed a life outlook for you that has ended up really shaping you or serving you or serving your profession? I'm not sure it's the answer. What jumps to mind immediately when you say that is Rob Grandadine. It's just like, it's not, I guess, a failure of anybody's. But, you know, for me... Rob was one of my college roommates, as you know, one of my closest friends.

We had planned, I was living in South Africa at the time, and we had planned to go climb Kilimanjaro together. It was the trip of a lifetime. We were going to meet and do this hike up Kilimanjaro with our group of friends from college. And that was now almost 25 years ago. But there was a terrorist attack a month or two before we were supposed to meet in East Africa on the embassies.

And the U.S. issued a travel warning and said, you can't go, you know, or we advise against going to Tanzania or Kenya. And so we canceled the trip. And, you know, we said, we'll do it next year. And the day we were supposed to be summiting Kilimanjaro, I got a phone call that Rob... Had a party outside his house and had, you know, dozens and dozens of kids at the house and that the deck collapsed in Chicago and that he died. And for me.

Like that. I've seen, you know, professionally a lot of death. Personally some. But, you know, that like horrible irony. Of we made a decision in the name of safety to not do a once in a lifetime thing. And yet the worst possible outcome happened. I think for me, that moment, that experience, I think about it all the time. And I think about how...

what I do in work about making the most of my time, what I do in the lab about taking risks and studying things that matter, not things that don't. I think about it raising kids. about how much we really can and should be protecting kids from any sort of risk and discomfort they may have. And, you know, I think it kind of guides a lot of... my belief that the worst thing in life you can do is not do the things you want to do.

You know, and obviously we got to be prudent about it and you don't want to take stupid risks and you don't want to do things haphazardly. Right. And by the percentages, I'm sure Chicago was a hell of a lot safer than being in Tanzania that day. But it wasn't for him. And I think in the end, that lesson gets amplified by watching kids who are sick with cancer.

you know, our, our time is the only resource that matters and like what you do with it and how you jump on it and how you attack the day with, with enthusiasm, you know? Sure. with this idea that there is going to be a time in all of our lives that our health is gone. that our ability to go do stuff, you know, and you just, we don't sit there and think it. We don't appreciate it when we wake up, when you, when you, when your back doesn't hurt when you wake up. Right.

You don't sit there and say my back's not hurting today. I'm going to go get them. Yeah. You know? And like, I, I, I just, um, so I think that event. And trying to really appreciate, you know, what cancer does is in the cancer side is it shortens that clock for a lot of people. And we're all on a clock. And so seeing... people who would give anything for that day of not...

facing this of not being on chemo, of being nauseous, of being sick. I mean, they would give anything and they're keeping good spirit. I mean, they're, they're saying today's a good day, even though I'm doing this, but if you offered them a day without that reality. Yeah.

they wouldn't care about anything else. Yeah. They wouldn't care about how much money they made. They wouldn't care about who said what to who they wouldn't care about. Like they would take that day and trade anything for it. That's right. And so... I don't know. None of us do it perfectly, but I certainly try and, you know, when the day-to-day stuff is sort of weighing heavily, I think that event and subsequent.

events really kind of sit with me how do you how does that translate into into the kids and how you raise them um i i think i think i'm really conscious of of saying no to things. I'm really conscious of, you know, saying we're not gonna. go check out that museum or that event or make that drive to come up, you know, we're not going to go see you guys or go to those so-and-so's game. Like when the trade-off is sitting at home and being comfortable. Yeah.

And I, and I, I just, you know, I kind of pray that that if anything sticks with my kids, it's the idea to, to kind of attack life. Yeah. And, and. And really get after it and appreciate it and all the stuff that is working. And, you know, that kind of old statement of sort of being the thermostat, not the thermometer.

You know, it's just like, it's, you know, it's this idea where you set the temperature of the room. You set the temperature. Don't be someone who measures the temperature of a room. Set the temperature of a room. Where'd you learn that? I didn't teach you that. And I think this idea that you can be that thermostat to your day, you can set it and it's going to go that way. Yeah.

rather than just kind of being someone who, hey, they're complaining, I'm going to complain. You're not going to buy into it's a bad day because of. Sure. I like that. So I don't know. I mean, we'll see.

We'll see if the kids pick it up and we'll see if we can live it every day. That's not like a you are or you aren't. You had so much success athletically. Again, I do really believe that's probably because of me. I mean, it really is probably because of me. I mean, it really is. But how do you feel? We've talked about a lot. Raising an athlete now is a totally different deal. The whole thing is just so.

insane and you know we talked about with a bunch of different guests you know eric was on here and like like that you know i'm seeing it with bill who's a little bit you know older and further down down the road and it's been really interesting to me to look at like bill and henry and the different paths that they've taken athletically and like how that's kind of manifesting itself and then and then

too like with her and you know it's like it seems like you're constantly in this you know there's so much pressure to to to um to push yeah and and so much pressure to sort of like let kids follow their passions but also it's like you can't just do that in a simple way anymore and as like you know a college athlete and you know multi-sport athlete like how do you look at that now

I think it's back into that kind of read and respond thing is just trying to figure out where their passions are and what they want to do and try and support it. It's a little bit of a cliche answer, but my kids are young, so I'm figuring this out.

you know i'm at the beginning stages of trying to figure this stuff out i think um there's a lot of ways to teach sports now and to engage with sports that are different and so i think all of us kind of you know nostalgically think about like can't they just go out and like play amazingly and have fun like we did and and i think like look it's a different time yeah um as long as they're getting enjoyment i think i tell you the story you know my

Jack's baseball team, like he, you know, these two coaches that he joined a team were so into, I mean, he was, he was like, six almost seven when he started with these guys and they had like this coaching clinic that his their practice was like with 13 year olds i mean just like

standing in front of balls, taking them on the chest and stuff. I was like, man, my kid ain't ready for this thing. I was like, this is, I'm going to be talking to a psychiatrist for him. And, and like, you know, they're, they're kind of digging into these kids and, and, and.

you know, Jack showed up late and it was intimidating for him. He's young. He showed up late one day and he kind of had a meltdown. He was like, I don't want to go out there. Like these kids are too far along in practice. And, you know. You have these moments where you're like, man, you just got to get out there. We're here. I don't care what you do, but you can't turn back. You can't let the fear, the anxiety beat you. Anything else can beat you, but not that. And he did it.

I was sure that these coaches were going to cut him. They didn't know him well. And he's sitting there like kind of crying on the sideline. And they got like 13-year-olds there getting ready for something much more serious. Yeah, I mean like something different. But I remember like this, this coach, this guy, Taj, who's a local coach who I did not know at the time. And I honestly thought might be psychotic when I was watching him run the practice, you know, like I wasn't sure he's like.

And after the practice, they have these meetings where they all sit around. I was like, man, this is all intense. And then he tells Jack, he's like, Jack Bernthal, stand up. And I'm like, I see my little, almost seven-year-old dude stand up in front of 40 kids who are teenagers. And I'm like, oh.

god this yeah this is the moment yeah like i'm seeing the moment that's gonna destroy my child yeah and this guy taj who's like pretty pretty intense guy about baseball um and is doing it totally different than i coach on the other teams and do He was just like, you know, Jack Bernthal, tell all your teammates why you were afraid today.

What happened today? Not why you were afraid. What happened today? You had a hard time. Tell him why. And I was like, oh God, here it goes. And Jack's like, uh, uh, uh. My parents are going out of town this weekend. I was like, I don't know where he pulled that. It wasn't true. We had never talked about it. Literally, my man just made up a sentence to take the spotlight off him.

And this coach, Todd, is like, okay, okay. And then he like turns the rest of them and he's like, hey, everyone on this team, first of all, you're Jack's family. He had a hard day today, but did you see how he got out there? Number two, every one of you guys is going to have anxiety. Anxiety is real. And here's this like hyper alpha male talking to young boys and talks about, talking about anxiety.

Being real, you're going to get up there in the bottom of the seventh inning, be down two runs, you're going to be up. That might be your anxiety moment. It might be something else. It might be somewhere. It might be personal. Whatever it is, everybody feels anxiety, and it's the kids. who step up and walk into practice when they hit that anxiety moment and push through it and do that thing. Yeah. And he's giving this like motivational, I mean, I had already planned to like.

either figure out like what baseball team we were going to join after this. And suddenly like my kid walks out of there like chest held hot. He was like, he was celebrated for crying before practice and then walking onto the field and having an okay practice. And dude, it turned his whole view. That's like a far cry from how we, yeah. I mean, that's not how we parent. Like we like pull our kids aside and we're like, pull it together, kid. You're embarrassing me. You're embarrassing everyone.

you know like and and he took this tact of public building up yeah so i for me with the kids sports thing it really taught me Um, that one taught me, I don't have all the answers. When you find people are like really good, like role models for kids, like really good leaders for kids, kids who can like galvanize and motivate kids these days, good coaches, good teachers. It's like, dude, it's such a great.

they're out there, man. Like they're totally out there. And, and I just think it's like, we're at risk of just like trying to like take on too much ourselves. And again, we're the experts. We're the only ones that know what's right for their kids. We've got to like navigate, manipulate their entire existence, you know, to keep them free from any kind of, you know, and it's like, dude, like, you know, like throw them out there. Yeah. Yeah. No, it, it's, um, it is the.

the sort of aspect of not getting so wrapped up in the result either. I mean, quite frankly, I don't care if Jack is a good baseball player. It literally means nothing to him, means nothing to me, whatever. If he wants to do it, he can do it.

This idea that my kid had a moment that he... Because that's what sports really do. In the end, so few of them are going to be paid to play sports. That ain't... the end goal you're looking for, but the goal that, that, you know, a little boy, a little girl can walk out with that self-confidence with that kind of, um,

That idea that they can go, that practicing matters, that working at something matters, that being good at it matters. Lean on your teammates, be somebody you've leaned on. That stuff is really cool. And they're competing against stuff we weren't with kids' attention, right?

now yeah you know i mean these coaches these teams are competing against a kid watching videos and playing video games all day like that's a but There seems to be, even in art, there seems to be a little bit of a pushback with some of the wokeism and some of the...

Where do you see that going in medicine? I really heard what you were saying before in terms of you have to have a diverse field of people that you study. But in terms of equity and filling quotas, The college campuses right now seem to be in a pretty crazy place. How has that affected your life? How does it affect the hospital? Yeah, I mean, certainly this question is front and center in every field right now. And I think the idea that medicine would be immune to the same pressures.

political pressures, you know, is not right. I mean, we feel the same thing that everybody else feels in trying to figure out what's right and what's wrong. We were raised in such a, what I think, a cool way in this respect. I mean, we sort of, I think, you know, you talk about privilege, like being privileged is to grow up in a place that is diverse.

And yet people really don't focus on it. Like any of these diversities, like that is lucky as hell. Straight up. Um, and as you get older, you see how rare it is. Yeah. It's crazy. It's rare. Yeah. And, and you know, I think about like growing up, I just look back like my group of friends. I mean, think about that. The group I grew up with since kindergarten, my closest group of friends, like, you know, Matt Nemat is like.

son of a Egyptian guy and a Lebanese woman, Teddy, Korean family, Neil, you know, dad. black guy from Georgia, mom, a DC public school teacher and Jason, you know, grandfather. That was my group. Jason's grandfather was like a leader of the civil rights movement. Sterling Tucker. You look at that, like that's better than the United Nations, right? Like none of us ever.

Thought about it, knew about it, nothing. And everyone was standing in each other's houses. That's right. It was nothing. It was literally nothing. It was do the right thing. the best idea wins, the best, whatever it is. Judging what you should be judging. That's right. Like your integrity, you know, your work ethic, your grit, you know. You know, I have a strong bias. toward the idea that our job really needs to be to open opportunities at early young ages for everybody.

But by the time we get to professional schools, I think the shift from focusing on opportunity to merit and achievement just slowly should be shifting as you get older. And the idea that at the end of this funnel, we can admit more people from diverse backgrounds. into medical school and that's going to solve equity issues, I think is fool's gold. It makes a pretty picture when we show our class and we've got more diversity that you can see when you look at the class.

But it oftentimes is either not achieving real diversity, right? You're getting people who may look different, but may have come up in the exact same background. Or sometimes it's... putting people in a position that they didn't earn and making them diminish what they're doing, put them on an uphill battle, whatever it is.

That has to be such a small piece of things at that late stage. But how do we address all the opportunities early on that didn't give kids the same opportunities? And so for us, it's interesting. I mean, what I really focus. our side on is getting out in the community and getting exposure and interest in diverse groups into medicine and healthcare early right like we partner with

Um, with, with Gareth's group, a place called home, like we're bringing, there's a thing we, I mean, our orthopedic group built a high school. It's actually called orthopedic hospital magnet high school. That's about taking kids from. kind of that area that we're in down there in South LA and, and getting kids to see the opportunities. If you didn't grow up around a hospital, we didn't grow up around a hospital.

You don't know the jobs that are in a hospital, the opportunities. Would you know what being a... a scrub tech in an OR is, what being a radiologist is, or radiology technician, or being whatever. I mean, there's a huge industry in healthcare. It's the fastest growing industry in the United States. These are huge opportunities, but in so much of the country, they don't see that early on.

So whether we're going to train doctors out of this and getting to grade school kids and high school kids, what we can do is get exposure to these young kids. And let the ones who are really gravitate toward that, get the ones who gravitate toward academic achievement. You know, we want to see high school kids from these areas. If they gravitate toward it.

they should be having resumes and CVs like the kids who are in Beverly Hills. Yeah, yeah. Right? Because the kids who are in Beverly Hills, their parents are calling us and saying, hey, can my kid come and volunteer in your lab this summer? Like that ain't the kid. Right. Right. Right. Right. That clearly ain't the kid. Right. Right. You know? And so they come in and they volunteer and they say, I worked in this immunology lab as a seventh grader. Right. Like.

what did you do there? It doesn't matter. It's like, I worked in this immunology lab. And so if we can get the kids early on, so I mean, my view of that, it's, it's, it's a simplistic answer, I guess, but it's. You know, those of us who are lucky enough to be in professions that there is interest in at this tail end, that there's a big push to diversify the tail end, I think spending way less time on that.

And way more time on introducing the field and the opportunities early on so that people can gravitate to it who may not have that opportunity. Yeah, yeah, yeah. Anybody else?

do you think standing in the way of us like solving some of these like curing some of these diseases is it money is it willingness like is there like if you could break it down something right now to get that forward Yeah, I think the, I do think there's a fundamental intrinsic kind of structural problem with how we do discovery right now, like how we do drug discovery.

that really the fundamental goal of curing a disease right now, that's not the goal of most scientific studies. The goal is incremental gains. And so there's this feeling. that it's like anything else. It's pattern recognition. And it's, you know, when Netflix, I've been picking on Netflix today, but like when Netflix picks, what else do you say about Netflix? Picks a movie, when they pick something to buy, right? they often buy the thing probably that's very similar.

to the things they bought before that have worked reasonably well. And so there's kind of this incrementalism with the whole process of discovery. I think our structure is starting to figure that out, where if the money is all behind... saying, I'm doing this and it worked, right? Like this is just like the last thing that worked, but this much better.

it becomes very easy to fund and to study and to push forward. It doesn't lead to breakthrough. It leads to nominal gain. And when the back end on the pharma side is purely that... If you can show in a cancer drug, if you can show that mean survival, that average survival is two days longer with your new drug B than the standard drug A, you have the entire market. right? Everyone is going to immediately, all insurers will buy that drug at whatever price you price it at. Is that good?

Do people want two extra days? Of course. But does that encourage taking a risk when you get the same market share? You get 100% of the market. If you get two day advantage or if you cure the disease and curing the disease takes a lot more risk, a lot more work, a lot more thought than to make a drug that is this much better. And so I do think. That kind of pushing that idea on the back end, these sort of moonshot ideas, you know, funding, putting real funding for things that are...

paradigm shifting. One of the interesting things, I don't know how much time we got, but one of the interesting things is we used to do all of science in a very siloed way where you'd say, I'm a lung cancer researcher. Right? And so it would be about the tissue type. I'm a lung cancer researcher. I'm trying to study something that solves lung cancer. So for me, I'm a sarcoma guy. That's the type of cancer that lives in bone and muscle and the spine. Sarcomas were always way understudied.

Because there's a lot more people with lung cancer than there are with sarcoma. Like that end product is a lung cancer drug that improves survival two days. That's the market, right? Why would you study something that a thousand kids a year get? or 2,000 kids a year get among the sarcomas. And what's happened recently in cancer research, which is really cool, is that we've started to discover that what tissue type these things come from.

probably doesn't matter nearly as much as what drove, what's driving the cancer. And there's common themes that drive cancers. And so now... We take something, I'll give you an example. There's something called infantile fibrosarcoma. And literally there's a hundred kids, maybe 200 kids a year. I don't know what the number is, but it's hundreds, not thousands with infantile fibrosarcoma.

right? It's this terrible disease. Your kid gets born with an aggressive, rapidly growing, you're talking about infants, rapidly growing cancer. You, you hugely morbid. It does. It's not like a cannonball. It's infiltrative. It's like the roots of trees. So you do surgery, you cut it out. It starts regrowing again. You got to decide, do you put a three day old on chemotherapy? Are you, it just.

was this kind of nightmare disease that didn't kill kids fast but just mutilated them like you just and one of one of some researchers found that this rare disease that has no market for a pharma company, but there was this one fusion, there's this thing called an Ntrek fusion, that the cells did this one swap, we have a drug that can block that swap.

We have a targeted therapy that might work for this disease, right? And so then you get to this place where you're like, well, should a company make that drug? Is it worth going through FDA approval, all this stuff for the 100 or 200? Well, of course they should.

Are they going to? Maybe. Probably. But maybe not. And so this fusion... though what's so cool about and i love this story and and our team uh noah fetterman was sort of part of this story and it's just such a i i love this this story because what we found in doing this. was the drug companies started to do these basket trials where they started to say okay this fusion this ntrek fusion that we're treating does that exist in more common cancers can we find it anywhere else can we

find other people who we would never historically have tested a sarcoma drug against a lung cancer or a breast cancer. What we're finding is that it's a small percentage. It's a little less than 1%. But 1% of solid tumors seem to have this fusion driver. And so you have this drug that was developed for 100 kids with this rare disease. But now suddenly, because that pathway is important...

in all these other really common cancers, there may be a huge market there and a lot of people they can help. And so pharma is really interested in it. So it's generated this whole buzz around rare disease that now rare disease where we... are only rare because of where we put our silos, right? It's rare because this is what we call the tumor. But as our understanding of tumor biology and how it works grows.

We start to see that it's common pathways that we can maybe treat. So now everybody's interested in rare diseases because they highlight important pathways. So it's a really cool... path to kind of how science is changing and how funding for research is changing. And I think all of it was just us opening our eyes and communicating a little bit better that these drivers transcended.

You know, you worked in a lung cancer lab and I worked in a breast cancer lab and why would we ever talk? But now we're realizing that small percentages of both of these are identical probably. That's cool. So it's kind of a cool way. So I think, I think structurally as that goes and there becomes more funding for intelligent drug discovery, that's not, that's sort of this idea of figuring out the mechanism.

and then taking the mechanism and blocking it, when we can do that, it lets us then test that mechanism rather than just taking all the drugs off the shelf and just seeing which one hits and funding that. So I think that's changing, but probably more than you. Wanted to talk about that. Huh? I mean, I understood a little bit of that. I saw you starting to look out the window. Huh? I got you. Nah, bro. It's good, man. Nah, it's good. I mean, you know. Shut up. Let's talk about baseball. Nah.

what uh yeah any other anything else you guys good what was the moment in your endeavors of becoming a doctor that you were just like this is this is a little more analog than i thought Because you've done like field hospital stuff. I mean, you've been hacking limbs off. I think that's super interesting.

Question and topic. I mean, look, surgery, plain and simple, is assault and battery with a deadly weapon. Like, that's what it is. It's just like, that's what surgery is and the only thing that makes it legal. is that you've got the patient's informed consent. You know? Like, that is... And so, everything in surgery is anchored on trust. Everything. And... And the idea when you step away from it that someone is going to give you their loved one or themselves and say, put them to sleep.

Take a knife and cut into them and do what you can do to help them right now is a crazy concept. And I think remembering that every time a patient... gives you that consent is a really healthy dose of reality.

And, you know, we think about it all the time. And like this idea of informed consent, you know, informed consent when somebody walks out and they're like, so the risks of surgery are bleeding, infection, nerve damage. We could injure you. You could have wound healing complications. You could have a DVT, a PE. or a heart or, you know, heart attack, stroke or death sign here. Right. Like that. So I think with all of that, there is no question that there is a, um,

There is a crudeness to it. There is sort of a barbaricness to the concept of surgery. The flip side is that well done operations are an orchestra. You know, I mean, they are, they are beautifully orchestrated things. And the number of people working together, you know, this is like a race car pit crew, you know, fast moving, super efficient, super thoughtful.

really, really well orchestrated. There just aren't many things in life that you can see that many people working together when the pitfalls are in every turn. You go left, not right. At any point of that, a big, big, big problem happens. And it really, really rarely happens. So I think the thing that dawned on me that really changed my... pathway in medicine is that I realized in medical school that people...

are so, so, so obtuse and unaware of the risks of medications they take. We have such a good sense of the risks of surgery because it's tangible. But like people put anything in their bodies. Like people will take a pill and that has no risk, right? Like these are some toxic, toxic things. And at least surgery to me... it always felt like the preparation and the skill set that goes in it can mitigate the risks.

There's nothing we can do about the risks of a pill. If I give you some sort of medication to take, that is the risk that the pill has with your body. I'm giving it to you and whatever happens, happens. That to me is horrifying. Right? But for me, the idea that I'm in control, it's like, do you want to be in a self-driving car or do you want to drive the car? Right. You know, for me, like, I feel more comfortable having the wheel. Yeah.

And so for me, surgery, as crass as it might look, all those risks are controllable. I mean, if you... handle that appropriately you are decreasing that risk and i didn't have that opportunity in some of the fields that were medicine-based Like, yeah. Yeah. And that, and, and there's a moment, there can be moments all the way through. I mean, it's amazing. We sometimes, you know, you have people who did college pre-med courses, medical school.

get into residency and you're talking about a decade of additional training and then somewhere in residency, they're like, and I think I'm going to go be a banker. Yeah. You know? And you're like, really? You know, you did it. So that moment can come at any time that you either say, this isn't for me or this part of medicine isn't for me. I think it's one of those things that, you know.

We don't have any medical people in our family, really. And so I didn't know much about this. But I guess one of the things I've seen on this end is how many people find really good pathways in medicine. even if it's not being a doctor. And there's a lot of ways you can contribute medically in research or in industry or in whatever.

And so there's a lot of ways that if you find that providing patient care itself is not for you, which more and more doctors, honestly, I think are these days. I mean, I think there's a real challenge right now. That the pressures on physicians to see, you know, especially medicine doctors, less surgeons, but the pressures to see more patients in less time to get them in and out to be seen as sort of.

how many did you get through in a day as the metric to success like that is just when you look at medicine that way yeah it's a pretty unappealing pathway for people yeah yeah um but I don't know. I mean, I think that's always been the...

the beauty of surgery is you just, it's such a privileged position, right? You close the door and you don't have your email and you don't have anybody pinging you. You've got a job and it's like anything else. You get to be singularly focused. What's the most fulfilling thing about it? I mean, what's the thing that like, what's the best feeling? So, so for me, um, every single surgery you do, you go in knowing what the point of that. So if you're doing it right, you've prepared in a way.

that you know what the singular part of that surgery that's going to be the hardest is. Every surgery has one. And that's the way I prep for cases, is I look at the imaging and I say to myself, where is it going to be closest?

Where is the part that I'm too close to the spine here and I'm too close to the tumor here and I only got a millimeter to work in? Like that is the part. And so for me, the part of surgery that is the best is when you... get to that it's actually not when you beat that part it's not when you're past that part it's when you get to that part and you say i knew this was going to be my challenge i'm here i see it

And this is exactly where I expected it. That feeling of saying now it's just a performance issue. Like now it's just getting through it. That's never, but, but. that i went in knowing exactly what was going to be the tight aspect of this yeah for me is um is the best part of the case is is just sort of this feeling of i prepped for this part yeah i know this part is here

I know this looks close and I totally know what we're going to do to get through this part. That's just like a- Truly psychotic. That's the best part. Nah, like that's crazy. That would be like horrifying. Like the part where like if you make a- That's the part you train for. Yeah. Like that's the part. So it's not, it's, it's the best part because you know, you, you looked at the case and what's scary in surgery is that there's going to be something you didn't expect.

that's that's what's scary is that is that this is going to look different than you imagined it when you looked at the imaging when you looked at the mri and when you look inside the patient it's different like that's scary um but but you know turning something knowing that you know once you're that you've really visualized it right and that you're in there and you're you're at that point i think that for me is um

then it feels very easy. I also did want to ask you, man, just about Southern California right now. I know you had an opportunity to leave.

i know recently like you know somebody kicked in your window and and robbed you and stuff like that you guys went through that and um you know good friend of the show bob diemer and the police really showed up and and and and i'm just wondering you know like our house was broken into a bunch when we were a kid and i feel like it was just sort of like something

Just kind of got glanced over a little bit. I mean, I think there was like a bunch of times that happened and it never was really a big thing. But, you know.

I know this was a big thing for you and your family. And I know, like, I live up in Ojai. Like, I'm just wondering, like, how do you feel? I mean, when you trace the entire sort of, from the last time we got together, from... sort of like the whole defund the police movement to where LA is right now as a city and the crazy unhoused population and people with severe mental issues out on the streets.

And also just like, you know, enrollment in the in the police. So like, what are your feelings towards that? What are your feelings like raising your kids in Southern California? How did that event kind of, you know, affect the family like and going forward? What are your thoughts on that? Yeah, I mean the event of having our house robbed was

I think the thing, it's like everything else. It's like when you have a big thing happen, it's only a small piece of it that like touches that visceral point in you.

and you kind of focus in on something small interestingly not something big i mean i you know they they broke all the the glass door and came in and ransacked the house and you know we fortunately we just don't have that much stuff in the house but they but like we got home it was about 10 o'clock with the kids and i remember like my kids walk into that and

Like I looked my kids in the eye, you try and contextualize things, especially for young kids. And, you know, immediately my reaction was, Hey guys, like these are people who don't have anything. they're desperate they did a really bad thing here but they're not here to hurt anybody they came and took stuff and they would never mess with kids things like they're here to take something from anything of mom and dad's that has value and

Look, was it the right way to contextualize it? I don't know. That's kind of what I came up with at the moment. Right. And then two minutes later, I hear both my kids. kind of screaming, two of the three, screaming, crying upstairs because these guys took their Legos and took my, you know, at the time, four-year-old daughter's...

you know, Target bracelets that are worth $2. Right. But they like cleaned out kids. Right. And for me, it was like, that was that visceral moment when you're just like, man. Like this is just, you know. So once that happened, we started kind of obviously being a bit more aware. of some of the security stuff going on in Southern California and LA. We hadn't been hugely paying attention to it. And I try and steer clear of...

some of the apps and websites that kind of make you too neurotic about that stuff. Um, we saw this stuff was going on pretty, pretty regularly all across Southern California and, and, um, you know we connected with deemer and some of the police officers and talked to them about uh the context it's happening in and the world right now and then and what they're up against and you know i guess um you know through that experience and since.

You know, I think it's one of those things I've always felt I had an appreciation for the police and the order they keep and the social order that they're responsible to uphold. And they have been extraordinary.

in sort of in in being there in ways that you know like i said before with cancer it's like it's not binary right it's not like you beat the cancer you don't you can offer a lot of things as a doctor yeah that didn't cure the disease and like these cops are not coming saying like you'll never be robbed again right you're gonna live in a safe community these guys we're gonna catch these guys they're not talking about outcomes but what they are talking about is

How can we help explain to your kids what happened, what we do, how we're here, how can we demystify this, how can we show you what... how we approach it, tips we have, those things. And look, it sort of meant a ton to Julie, to my kids, to me that, you know. These are not, it's like everything else, man. These, these are people like the police officers are people and they're not some blanket organization that behaves one way. And every one of them wakes up every day and has a choice.

And they're trying. They're really trying. But I don't know. For me, man, Southern California, I love so much about it. It has to get its act together with this. Yeah. Like it has to. Yeah. And, and we got to get to a place where the police are empowered to establish social order. Um, I just, I, I don't care what your politics are. Yeah. that gets to a place where if they don't, everyone who can moves, moves. That's right. And then you get to a place that nobody wants to be. That's right.

You hope for good leadership in police organizations because a lot of times you celebrate good cops. But, you know, sort of binary. Every one of one is good and every one of one is bad and this is good and this is bad is crazy. But we got to start kind of telling the stories of the guys who are out there risking their own lives for everybody else.

And making it so, I mean, they're in a situation now where like, you know, it's the only way they win and protect themselves is to not engage. Totally. you know and it's like how do you ask them to do we we built that we built that structure so i don't know you know i try in our little way to make all of the police department you know like that that goes back to that military thing it's like our our

Hospital is open to everyone. But we do like we we hear when police officers, firefighters, military folks, you know, we are going to move, move, you know. every boulder we can to get them the best access immediately to the best they can get because um they got a tough deal right now yeah yeah um are you guys good thank you nike thanks very much man Done good, man.