MAHA: What’s Real, What's Fake, What's Unclear? ft. Cremieux
Substack statistics blogger Cremieux has built a big following online for his takes on medicine, college admissions, and more — all while operating under a pseudonym. Now, Cremieux is going public on the Charlie Kirk Show with a sweeping interview on almost every controversial topic imaginable, from IQ tests to what health supplements work and which ones are nonsense. Cremieux gives his statistically-informed takes on anti-depressants, Ozempic, Vitamin D, and far, far more. Watch every episode ad-free on members.charliekirk.com! Get new merch at charliekirkstore.com!Support the show: http://www.charliekirk.com/supportSee omnystudio.com/listener for privacy information.
Hey everybody, Charlie Kirk here live from the Bitcoin.com studio.
Cremu on the show.
You're gonna love this conversation or you're gonna hate this conversation.
He says stuff that you might not like, you might not agree with, but it was a fun, spirited conversation.
He's not a fan of a lot of the Maha stuff.
Worth you listening to, taking notes.
If you don't like it, email me freedom at CharlieKirk.com.
If you want to listen to a podcast where you agree with the guest all the time, this might not be the interview for you.
But I think you guys want intellectual stimulation.
You guys want to be challenged, so I think you'll love it.
Email us as always, freedom at charliekirk.com and subscribe to our podcast.
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Okay, everybody, we're going to love this conversation.
Joining us is Cray Mu, who is a bioinformatician.
That's right.
What is that?
So I basically just make software for geneticists.
It's pretty boring.
It's like being a glorified software engineer.
How did you get into that?
That's interesting.
So several years ago at a conference, I was pretty critical of some of the presentations there, and a VC came up to me and he said, do you think he can do better?
And I go, oh, of course I can.
So I switched my field entirely over to working on that.
And so you have a lot of hot takes.
So you're known as Cré-Mu online.
Who is Cré-Mus?
So some people call him the Abraham Lincoln of France.
He was responsible for a lot of sort of classical liberal initiatives, very much what you would see among like a lot of the more progressive founding fathers, where he, for example, banned slavery in the French colonies.
He did a really interesting thing where he gave the North African Jews the ability to get French citizenship and then come over to France.
He emancipated a lot of people and did a lot of interesting things, very pro-market sort of guy, very pro-freedom in general, and just a wonderful historical character from the 19th century.
So you have, we have a lot to discuss here.
And by the way, I love reading your stuff online.
It's very interesting.
Thank you.
It's provocative.
It's contrarian.
And so you are picking apart our supplement stuff here.
So you are a bioinformatician.
And so, for example, let's say someone's taking vitamin D. You think that it's probably either overrated or not necessary.
Is that right?
Almost certainly overrated.
Unless you have osteomalaciation, unless you have brittle bones.
Oh, no.
Probably nothing is going to happen.
But people say it's good for mood or depression.
There's no correlation to that?
There are correlations, and that's the thing.
There are tons of correlations.
Why does it not determine causal?
That's the wonderful mystery.
So we know that people who are healthy tend to have lots of vitamin D. They have high levels, and people who are unhealthy have low levels.
But when you do a real trial where you give people more or you watch people over time and really carefully and you monitor their levels, there's just no relationship between the levels and changes.
There's no effect of the treatment.
There's just really nothing there.
And when you go really deep into it using like genetic epidemiology methods, like for example, this thing called Mendelian randomization, this is a way that you can get causal information about how drugs work from genetic data.
You see nothing.
There's just nothing there.
For the overwhelming majority of people, there's no effect.
It's good that we fortify our food because we can prevent osteomalasia, the weak bones, brittle bones and stuff.
But otherwise, you're just not going to get much benefit.
Do you think it has, does it help with serotonin production?
Maybe in the limit.
That's the thing.
If you go down to people who are very, very deficient, which is a very small minority, then yes.
So if you're like an old person in a home that hasn't seen the sun or has a restricted diet.
Yeah, you'll have to find people who are really weird in terms of, you know, just relative to the general population.
But for most people, you won't get any benefit.
Interesting.
And so, and you say that because the studies don't bear out the conclusion, not necessarily there's a study that shows that there just hasn't been, has there been long-term studies done on vitamin D?
There have been tons of studies.
There are hundreds of trials on vitamin D, and they seem to do, it seems to consistently show practically nothing.
But there's a lot of hype because there are tons of studies showing these correlations going, oh, look, people with more vitamin D, they are healthier.
Do you think it's because they have healthier lifestyles and therefore it's the core, yeah?
I think so.
So they're outside more.
Is exercise something that you would say is good?
Absolutely.
Okay, so at least we agree on that.
Absolutely.
How about sun exposure?
Probably good.
I mean, you need it.
There's great data showing, I actually know a lot of people in the Bay who they get lamps in their homes to emulate the sunlight.
So is there studies about sun exposure?
There are, yeah.
Okay.
So, but by getting sun exposure, you might get vitamin D, which might just be an effect of something else that is positive.
Yep, it could be something else that you're getting.
Like, people who live healthy lifestyles tend to have good vitamin D levels, but supplementing the vitamin D doesn't seem to do much of anything.
That's fascinating.
Yeah, it's kind of like not even for testosterone production.
Not really, no.
You heard that before, I'm sure, though, right?
Oh, I've heard it tons.
Yeah.
It's funny.
There are all these claims, and there's a lot of hype, a huge amount of hype.
During COVID, for example, people were saying, oh, vitamin D is going to save you from COVID.
And no, no, no.
They say it interrupts the cytokosine storm or something.
I'm going to get all the words.
Cytokine storm.
Yeah, I'm going to get all of that, but yeah.
So like your immune system going into overdrive, they say it disrupts that.
No, that's not preserved.
How about zinc?
Zinc is great.
You need zinc.
But if you supplement a bunch, I don't think you're going to get very much unless you're sick.
In which case, take it right as soon as you start feeling sick, and it might help a little bit.
There is limited stuff on this, but there's still something.
There's some indication.
And it's not really going to hurt, so why not supplement it?
It's also very cheap.
Yeah, and you can get zinc and meat.
I mean, you can get pretty much everything you need in meat.
Yeah, so you're not necessarily a vegan proponent?
No, not really.
I am a big proponent of lab-grown meat.
I advise a lab-grown meat company.
Really?
Yeah, and I like lab-grown meat and all that.
And it's going to emulate meat, and it'll be, I think it'll be great in a few years, but it's just not quite there yet.
Like, it's very expensive.
And the thing is, I want every vegan to start eating lab-grown meat the moment it's available because they have so many nutritional deficiencies.
Like omega-3s and CoQ10 and vitamin B. Absolutely.
Are those the three major ones?
I forgot.
Amongst many others, right?
Yeah, iron.
Iron is basically.
They lack creatinine and creatine.
They lack taurine.
They just lack seemingly everything.
So yeah, I was going to ask, I'm sorry to interrupt, but you are a believer in the amino acid benefits, right?
So taurine, lysine, do those have potential benefits?
So you get them in your standard diet.
You'll generally get them from your diet, yeah.
And the thing is, if you have a good diet, you're very unlikely to be getting a lot from different supplements.
There are limited exceptions.
Like, I mean, so I think actually a good heuristic is, do bodybuilders use it?
And if the answer is, yeah, the biggest bodybuilders use it, then it probably is a good supplement.
Like testosterone will help you build a lot of muscle.
Sure.
Creatine will genuinely help you put on muscle.
Creatine has cognitive benefits as well.
But especially for people who are vegans, vegetarians, who have restricted diets, because they lack that stuff and it seems to help them a lot.
For people who have normal diets, normal omnivorous diets, they tend not to get very much benefit from creatine.
How about resveratrol?
No.
Why?
Oh, man.
Those studies just did not hold off.
There was a fad for a long time in the anti-aging community.
Goodness, there was even some fraud there.
Tell me more.
I don't really know too much about it.
It's really before my time.
It's still hyped, though.
It is still hyped, which is baffling to me, but it's considered like one of those cautionary tales about hype nowadays.
Is there any downside?
Not really.
So just it's one of the, like a lot of supplements, they don't have real big downsides.
They just have no upsides.
So the downside is you pay for something that doesn't do anything.
So but the argument for resveratrol, again, I'm just a layman here, is that that's, you know, they hype red wine and grapes.
Isn't it just an accelerated antioxidant, which is good for you?
Antioxidants can be very good for you.
And that's actually one of the funny things about seed oils.
They contain antioxidants, which helps with the supposed oxidation effects.
So are you pro-seed oil?
For heart health, yeah, I am.
The trials do tend to say that ASCVD, atherosclerotic, coronary vascular, like heart disease is helped by switching from animal fats to plant fats.
I don't want to do that myself, but it does help people.
So if you're at very, very high risk, I would suggest going to seed oils instead of animal fats.
Do you think the general population would benefit more from tallow than from some seed oil?
They would probably be hurt by tallow on average.
Tell us why.
Well, the reason is saturated fats are quite bad.
They're very bad.
In fact, the hypothesis that LDL causes heart disease has held up incredibly well.
Oh, so you're a cholesterol truther.
Yeah.
I mean, all the data.
It gives you a hard time.
It's actually interesting.
So a lot of the drugs we know about today, statins, PCSK9 inhibitors, azetamibe, various different drugs that we use for handling cholesterol, we have great studies that are based on how we found them.
Like the PCSK9 inhibitors specifically, they were found in these French families.
They had a mutation that like knocked out production of it.
And they had, well, it did the opposite.
They had very, very high cholesterol.
Or sorry, no, I'm thinking of the French families.
They had low cholesterol.
And it was discovered some large, like almost 11% proportion of African Americans had a variant that dropped their cholesterol levels very low.
And then a smaller proportion of whites had another variant that did like a smaller effect.
And all these interesting variants related to PCSK9 had meaningful effects.
And so interesting thing is, we can just put the product of that gene in a drug, give it to people, their LDL goes down.
Their all-cause mortality improves.
They become more likely to survive.
And if you give it to people who have hypercholesterolemia, like naturally extremely high cholesterol, the number of deaths by age 40 is way, way lower.
So you can compare families over time.
You can say, oh, you, the parent generation, didn't have statins or PCSK9 inhibitors or azetamide or anything to lower your LDL.
And like a sixth of them were dying by age 40 from heart conditions.
And then you look at their kids who had statins from a young age, and it's like, oh my God, they're all surviving to age 40.
They're not dying from preventable heart conditions.
And it's just very clear evidence like that.
Like it's nice little natural experiments.
We also have wonderful trials and we have more genetic epidemiology stuff too.
One of the wonderful ways we know statins are safe is because there are some people who basically naturally have statins, like the effect of statins.
The statin, it works through the HMG-CoA reductase gene, produces an enzyme that breaks down into the HMG-CoA and then mevalonitate.
I'm probably mispronouncing.
And that's how you, if you block that pathway, if you reduce the function there, you get lower LDL.
And naturally, some people have way less function there.
So they effectively have like a low dose and sometimes a very high dose statin for their whole life.
And we have long-term cohorts where you can go and look.
Oh, this guy's totally healthy.
Trump.
Trump?
He's taking statins.
I know.
I'm saying.
Yeah.
But I mean, you wrote about this, didn't you?
With him taking statins?
Yeah, it's interesting.
I mean, he should be taking statins.
I feel like most old people.
No, but his cholesterol is amazing.
Because of the statin.
Well, I'm saying, I'm affirming your hypothesis, though.
Absolutely.
I don't think it's because of his diet.
No, it probably isn't.
He has a diet that I've heard is very high-in-saturated.
We only know he's taking statins because he disclosed his medical record to the world, which is awesome.
I love the.
Are there any downsides to statins?
Not really.
People have proposed a lot of downsides, but the genetic epidemiology stuff gives us very long-term evidence that there's really no harms.
Like people have proposed, oh, there will be these downsides from observational cohorts where they have mental issues.
And then you look in the trials and it's like, okay, that doesn't pop up ever.
So we're going to, so that probably isn't real.
And then you look at the people who have naturally very, very low LDL.
They're also fine.
They have no mental issues.
They don't have any lower IQs.
They don't have anything wrong with them compared to people who are otherwise similar.
So with LDL, correct me if I'm wrong, isn't cholesterol in the sequence of creating testosterone?
It is.
Yeah.
Steroid hormones are made from cholesterol.
You do need some of it.
So but then would chronically low cholesterol brought to you by seed oils or whatever result in lower testosterone?
So that's the thing.
LDL, no.
You could probably get your LDL as low as you want.
You'll be fine.
HDL?
HDL, you want that to be fairly high.
And so LDL, have you read the book The Cholesterol Myth?
I haven't.
Yeah, I'm not an expert here.
But there is a growing community that thinks the cholesterol fixation is over.
I'm sure you've heard this.
I have heard this a bunch.
Yeah.
There's a lot of people who believe it.
Again, I'm not an expert here.
I'm throwing it up against you.
Yeah.
So the conciliance of evidence just says, no, it's fine.
For years, I had gone along with a lot of these sort of contrarian takes of like, oh, if you have a keto diet, you'll actually do a lot better.
You'll be a lot better off in all these different ways.
And there's all these mechanisms.
But in the past few years, I've given a lot less shrift to mechanisms because mechanisms are not a substitute for the statistical evidence.
I need to see in a trial saying like, you take, give the person this drug, we do this thing, your mechanism plays out and the person has the effect you expect.
But in the trials, if it always shows the opposite of what they predict, then I just think they're wrong.
What do you have to say to people that say we don't trust the trials because there has been some corruption in the medical world for a decade?
What would you say to that?
Run more trials.
Fund more trials.
Have them done by more important people.
Or look into them, correct?
To see if they were confused.
What red flags do you look for when you look through trials?
Well, I mean, one of the most obvious ones is small sample sizes.
When you have a very small trial and you have big conclusions from it, that is a very big red flag.
When you have massive effect sizes that are very unrealistic, for example, Cohen's D of five, that's a very, very large effect size.
Like a Cohen's D of five is like the difference in taste preferences for samples given ice cream flavored like poo and flavored like vanilla.
It's a very large difference.
And there are studies that purport to show effects that large, and I feel like that's just not real.
And in virtually every case, it isn't real.
There are very few things with effects that massive.
That traumatic.
Yeah.
And when you see that in a trial, that just big red flag.
An effect like that is like, there was actually a funny one a few years ago about country music causing suicides.
And I was like, can't be real.
The effect size is like 3.5, which is, again, enormous.
And if it were true, every Dolly Parton concert, and I'm borrowing something from here, from my friend, would be like a mass suicide.
People would just be killing themselves.
So when they say stuff like that, I don't believe it.
I tend to throw it out.
Well, I can't stand country music.
Send me that study.
So methylfolate?
Folic acid fortification of food, very good.
Methylfolate supplementation for adults.
Any neurological benefit?
You probably won't get very much.
If there's something, it's going to be quite small.
But the wonderful thing is folic acid fortification of food has been very good for reducing the rates of birth defects.
Fewer neurotubule birth defects, babies coming out disabled at birth.
That's wonderful.
And all we have to do was change the diet a little bit.
SAMI, S-A-M-E, which is S-adenosin something, which is used for depression.
S-A-M-E.
I'm afraid I don't know it, but it sounds like something adenosine, it's a vitamin.
How about oregano or saffron?
Oh, nothing.
Nothing.
Oil of oregano doesn't kill any bacteria?
No, it's not really going to help you.
I mean, it might help in like a lab setting, but if you start taking it as a supplement, you're not going to get anything from it.
How about a daily olive oil shot?
This became pretty popular after Starbucks started promoting it.
I saw a bunch of this and it just tasted awful.
Yes.
I had it a few times because I was like, I'll try the different drinks they have.
Couldn't stand it, but I was happy to see.
It doesn't actually do anything either.
So you would say that olive oil supplementation, no benefit.
Yeah, for most people, it's going to be nothing.
The thing is, most of the conclusions you get in trials are going to be like these population representative samples or samples you get from a hospital of a condition or something like that.
Like they're selected in some way or they try to be unselected and then they go, nothing for everybody.
But there might be some subpopulations that could benefit from pretty much any supplement.
How do we say, so I have two questions.
How do you long-term study preventative supplementation?
Meaning, I'm just curious.
Number two, have you factored out genetic specificity to how some people, for example, there's something called the MFR gene, MFTR gene mutation, that methylfolate is supposed to have.
Yeah.
Is there any truth?
So take it one by one.
How do you long-term do trials for preventative supplementation?
And then we'll go to the second question.
For that, you just have to run a long trial.
If you have a hypothesis, so you have a scientifically led discovery of something you think will be preventative for this or that, then you run a long-term trial.
That's really all you can do.
Or you look at a longitudinal cohort that has variation in use over time, or you pay people to start using in a cohort you're monitoring over time.
That's about all you can do.
So the study designs are all pretty limited.
They're all just long-term things.
The other thing with genetic specificity, so for general population trials, you randomize them.
You run an RCT.
That means you have one group getting a placebo or an alternative treatment, and one group like standard care.
So for like diabetes-related drugs, we give people, we don't give them a placebo, we give them insulin instead of the other thing.
Sure.
So you give them placebo, whatever, and you give them the active drug.
And you compare these general population samples, and they're randomized so that there's no genetic variation, you would hope, at a large enough sample size that matters across these two groups.
But if you want to stratify that way, you have to go ahead and test them beforehand.
Or you can do a post-hoc test where you test afterwards and you get data on like what variations of this gene do they have.
And then you see, did they have larger or smaller effects?
Often when you do it post-hoc, you'll have too small of a sample to actually find very much.
You'll have low statistical power.
So you'll end up with conclusions that are iffy because they're just weak.
But if you actually go into a trial ahead of time and you stratify them by their like some known genetic variants you think will modify the effect, you can pretty easily do that and you can just go ahead and see if it actually leads to like a larger or smaller effect.
Is there any truth to the fact that certain gene mutations might make you more likely to benefit from certain supplements?
Absolutely.
Massive, massive.
Actually, it's interesting, statins.
About 30% of people, it's a very large portion, get myopathy from statins.
They feel weak.
And this is so common that tons of people have gone through heart disease because they prefer not to feel weak.
And for some people, it's actually debilitatingly weak.
They can become incredibly weak due to the action of just a few genes or just a few mutations.
For example, in the HMGCR gene that is where we know the mechanism of like statins works from.
And we have treatments now, well, they're being developed, they're not actually out yet, where you can interrupt on like that pathway from HMG-CoA reductase to movalonitate, where you can supplement the end product and it doesn't increase their LDL or anything, but it does give them back their muscular function.
So there's massive genetic variation that augments the effects of drugs.
You see this for antidepressants, you see this for statins, like I just said, you see this for PCSK9 inhibitors, you see this for many, many classes of drugs, even for lots of anti-cancer agents, response to chemotherapy, tons of things.
Usually the genetic moderation is modest.
It's very small.
In rare cases, it's serious side effects.
It's, for example, about a small portion of people are allergic to a form of natural dye, cochineal-based dye from like a little beetle, and they'll just die.
So, yeah.
Are we doing gene testing before prescribing pharmaceuticals?
Generally not, because for most things we prescribe, there's no reason to, or there's not a big reason to.
And what you'll find is that people, for example, if they're a low responder to a certain antidepressant, they'll just switch off it after a month or two.
They'll be on it for a little while, they'll get their treatment, and then they'll go, oh, this isn't working for me, Doc.
I need to go on something else.
And then you switch them.
That's how it's been handled.
But if we can predict ahead of time, which we can do now, we can actually start doing that.
We just need to get more people genotyped and then have their doctors be able to learn how to use that information.
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So you mentioned antidepressants.
Let's just ask this question.
What is causing the, are people actually more anxious and depressed, or is it a sampling error?
It's an interesting form of error.
So a lot of it is social contagion in the sense that nowadays people say they're more depressed than they are.
There's some evidence in the U.S. for a real increase in depression, and this has to do with suicide rates.
Yeah, you can't fake that.
Yeah, you can't fake that.
That's not a fakeable thing.
But in other countries, you don't see the same increase.
So it's curious.
Like, we see the same introduction of cell phones, which has been proposed as a reason why teen girls are getting depressed.
But we don't see the rise in suicide rates.
So it's interesting.
Now, when you actually go out and measure depression using a standardized questionnaire, you'll see that people respond more aggressively nowadays than they used to.
So they'll say, oh, I'm very depressed.
Whereas in the past, the person with the same amount of depression would have said, oh, I'm okay, or I'm sad a little bit.
But they've changed how they respond.
And there's been a lot of impetus, a lot of social reasoning that goes into, oh, it's cool to be, for example, autistic now.
So you say, oh, I have autism.
I've self-diagnosed.
Neurodivergent.
I'm neurodivergent, yes.
People say this stuff all the time now, but it's just not based on a lot.
And a lot of times, it's interesting.
You can go and profile these people who are purely self-diagnosed, and they are very different from the people who are clinically diagnosed.
So, for example, for autism, those people don't really have social deficits, the people who are merely self-diagnosed without a clinical diagnosis.
They differ radically from the people who actually had a doctor go.
Or banging their head against the wall or something.
Exactly.
So would you say that depression is a growing problem in the West, or is it overblown?
Considerably overblown.
I would say the suicides still give me pause and they make me think it is a growing problem, at least in the U.S. Where we don't see the same thing in Sweden, I say, okay, curious.
That kind of helps us narrow down on why it happens.
like it's not going to be the cell phones because they have the same thing there.
Could be something about their social environment that is different in terms of...
Yeah.
You do, I think so.
Well, yeah.
Well, I mean, tons of different drugs work.
Like SSRIs work.
The thing is that they have side effects.
They don't work for everybody.
In fact, for the heterogeneity and how well those work across the population is incredibly significant.
If they're working, why are people still depressed?
There are other reasons to be depressed.
Okay.
Yeah.
I mean, so you don't expect it to cure the whole thing.
Like, the effect size of a common SSRI might be 0.3D, which is a modest but real, sizable effect.
It'll help a lot of people.
It'll help some people to not kill themselves.
But for the average person, it might just not do very much.
And the thing is, the effect size is very small in general for people who don't have diversional blood.
So what is it, a selective serotonin reuptake inhibitor?
That's right.
So why can't you just get 5-HTP and tryptophan from your diet?
What would the difference between the two be?
It probably doesn't actually act along the same mechanism of action.
So tell me why.
Well, a lot of these supplements, you take them and you excrete them in your urine.
They're not processed.
Right, but you take turkey.
so you eat a bunch of turkey, right, which is a tryptophanic agent which helps create serotonin, right?
Different type of tryptophan.
Is that right?
Yeah, in that case, it'll be processed very, very differently.
It will not lead to the same sorts of effects.
To the production of serotonin.
Yeah.
So it's actually a funny thing.
A lot of people think that.
Interesting.
I didn't know that.
Yeah.
A lot of people think, oh, I'm taking this supplement, and thus I'll get the effect that this drug that has the same name nominally has.
And this is really common with vegans and omega-3s.
They'll go, oh, I'm taking omega-3s.
And it's like, wait, no, you're not taking icospotinoic acid or dexacinoic acid or arachidonic acid.
You are taking, like, you're taking some like linoleic, alpha-linoleic acid.
You're taking stuff that doesn't convert to what you actually need in humans.
It might in fish, but you're not a fish.
And it's very hard to get it from like seaweed and stuff.
The bioconversion.
Algae.
Algae, yes.
Very poor bioavailability.
More bioavailability in pregnant women, but that's just like not that great.
So then, let's say depression.
What other non-pharmacological pharmaceutical interventions help with depression?
Would you say?
Community, friends, exercise, sun exposure.
Yeah.
Socializing.
Being around people is good.
It can help.
It can especially help you with the most risky behaviors, the suicides and everything.
The really, really big thing that helps with.
Having a community is very important.
Like joining clubs, doing drives on campuses where they say, like, oh, come join this club and have some community and all that.
That can be quite helpful for people who otherwise don't.
Because if you're allowed to wallow, you might do dangerous things.
We have some interesting experiments from in Israel.
Suicides were way less common if they started confiscating soldiers' guns on the weekends.
They would say, oh, don't go home alone and all this.
And people who are like in traditional communities, not the Hulanim, they more often had those connections or whatnot, and the effect is smaller for them.
So you see, if you let people wallow, they'll do bad things.
And so the Zoloft, Xanax, would you also say?
They work.
The thing is, they're not panaceas.
They're not miracle cures for anything.
All these drugs work in a limited sense where they don't work for everybody.
They don't work perfectly.
But they are going to save lives if we prescribe them to some level.
Do you think there's anything troubling that one out of four teenage girls are on one form of these drugs?
Yeah, I do.
I think it's over-prescribed.
So yeah, so tell us why.
Well, for one, we know that genetic heterogeneity where we can sort of predict if something will affect you.
Some people just shouldn't be on certain drugs, and they're going to be taking them long term because they're getting a placebo effect.
And it's like, oh, that's just causing the downsides for you.
You are not a responder to this.
And we should have been able to predict that, but we aren't there yet with sequencing everybody and getting them this information.
If we did more of that, that'd be great.
We would be able to tell them that ahead of time, get them on the right drugs, help them to tailor their drug dosing, their regimens, everything like that.
But we just don't.
It's a really new thing.
So it's no surprise it's not been really massively adopted yet.
Do you think we're over-prescribing drugs in general?
Yeah, I think we do for a lot of things.
Which ones in particular?
Oh, my goodness.
Well, the antidepressants were a good example.
The thing is, I also think there are under-prescriptions.
So I think we are under-prescribing statins, for example.
Some drugs are not available enough because they don't have a generic form.
So Trilogy is an inhaler that would help a lot of people.
Budenicide or what is it?
It's a number of things.
I think it's four different active ingredients, but it works really well for suppressing their, it actually works for a lot of different respiratory things, but it works for a lot of the respiratory.
So it's an oral steroid?
Yeah, it is.
Yeah, it's like budenicide.
Yeah, exactly.
I think that's in it, but I'm thinking there are a lot of things.
That's the most popular oral inhaler.
But we also, inhalers with small amounts of steroids in them, like not just albuterol, those work a lot better, and we're not getting those out enough.
We should be switching people over to newer medications, but it's difficult because of costs and everything.
Like stuff, in America, we tend to pay a lot for drugs because we introduce them really early and aggressively.
Like a six-month wait for drug is invented and drug goes to market might be six years in the UK.
And during that time, people are going to suffer through using crappy drugs they shouldn't really be on or that they might be able to replace or they might be able to get a treatment for something.
Fascinating.
Yeah.
Some people might be able to get treated for conditions and then never have to use the drugs again and they should be able to get off, but they can't afford the treatments.
What else are we under-prescribing?
Well, I think we're under prescribing GLP-1s.
That's a big one.
That's big contemporary.
Ozempic?
Yeah.
Is there any downsides to Ozempic?
There are downsides in the form of nausea.
That's a transient side effect for most.
Does the food waste in your stomach?
No, no, it doesn't.
That's a weird myth.
I don't know how that came about.
But when you have gastroparesis, you still have to excrete it at some point.
You have to defecate.
It's not going to just get stuck there.
Yeah, they say it like rots in your bowels or something.
Yeah, that's wild.
How is GLP-1 different than a semaglutide injection?
Or is it the same?
Same thing.
Okay, got it.
Semaglutide is a GLP-1 RA injection.
Yeah.
The way they work is neural brainstem agonism of the GLP-1 receptors.
And now with the newer drugs, they also do GIP, which binds to a similar area in the brainstem.
And it actually, they have a lot less GLP-1, but they're still more effective because of this GIP stuff, which is an insulinotropic drug.
And the mechanisms of action are so interesting to me because it feels like they treat practically everything that is modern American chronic disease.
Like, oh, you have weird insulin spiking.
You have a lot of bizarre problems, like pre-diabetes, you have metabolic syndrome.
And it seems to act on practically all of that.
Like for most pre-diabetics, they get normal glycemia by the end of the trial.
And that's like, it's like 96%.
The most recent trial I look at for terzepatide, I think it's 95% or so for semaglutide.
It's just incredible.
Like it's devastating for chronic disease.
It basically rolls it back.
And the side effects are mostly transient.
Like the gastroparesis is not one that tends to stick with you for a long time.
And Zofran can help.
I'm not sure about that.
You're not a Zofran fan?
I haven't looked into that specifically.
Well, Zofran is a great anti-nause.
It is great for nausea, but I don't know if it specifically helps with that.
All I know is I take Zofran if I ever get to the stomach fluid.
It works.
Well, the thing with gastroparesis is that.
It's also an inhibitor.
It blocks The serotonin receptors in your brain.
Interesting.
Which, I mean, for whatever reason, that blocks the vomiting response.
Ah, I could see that helping with vomiting.
But I'm curious about, I don't know if it helps with the gastric emptying stuff.
Yeah, I have no idea.
Because the reason is, the gastric emptying does slow down your uptake of drugs.
The classic test they use, the proxy test, is they give you some aspirin and they see how long it takes you to excrete it.
So there's so many questions, and you're super smart.
You know this better than I do.
Would you agree?
I want to go down that path further, but let me take a step back.
Would you agree that we're sicker than ever?
Yeah, I would.
Okay, so you agree with Bobby Kennedy's beginning hypothesis?
Absolutely.
And I agree with Bobby on a lot of things about this.
Yeah, why do you think we're sicker than ever?
Obesity is mostly it.
It is almost entirely the fact that American people are so fat.
Why are we fat?
We eat a little bit more than we used to.
The amount that you need people to eat more compared to 1980.
So in 1980 to now, we've gotten a lot fatter.
The amount that everybody would have to eat every day to explain the entire rise is about one McDonald's double cheeseburger a day.
So the argument that Maha people would make, and I am not suited to defend this beyond the statement, is that the food has become less satiating through genetic modification.
Have you heard this argument?
I have heard it, but it's not true.
There's absolutely nothing to it.
Then why did we not eat as much in the 80s?
We didn't have as much variety in food.
That's a really great thing.
You ever heard somebody go, oh, I'm full, but I think I have another stomach for a piece of cheesecake or something?
I hear it all the time.
Yeah.
Whenever you have variety, you can eat a little bit more.
Wonderful nutritionist Stefan Guyanette has did a great book, The Hungry Brain.
He is a wonderful epidemiologist in general for all this obesity-related stuff.
And he talks about this a bunch.
He goes, you know, the mechanisms of society, they don't really work when you have a huge amount of variety and everything.
It's very easy to keep eating when you have all sorts of crap to eat.
And everything is so hyper-palatable.
It's way more palatable than it used to be.
What do you mean by that?
Yeah, it does.
Yeah.
And we process food in a way that makes for delicious tasting food.
Even if it doesn't have direct consequences, it's still, you'll be eating more and you'll be getting fatter.
So you think it's a quantity problem, not a quality problem?
Absolutely.
Absolutely.
Do you buy into the standard American mythology that when I go to Europe, I'm able to eat more and feel better?
No, I don't.
Not at all.
I think people are just walking around more and eating less, generally.
So Joe Rogan said on a podcast recently that when he eats pasta in America, it feels like sludge.
When he eats pasta in Italy, it feels like he could run three miles.
Is that just him being on vacation?
Probably a placebo effect, yeah.
Enjoying the vacation, enjoying the nice Italian air.
But if millions of Americans feel that way, they're just...
I think they're just fooling themselves.
Why do you see them?
Tell us why.
Make the case.
I think part of it is the social contagion of it.
There's no real reason for this to happen.
So why is it happening?
I think it's because somebody said it, and other people are like, oh my God, I feel the same way.
It's kind of like with many conditions, like the autism self-diagnosis, they go, oh, you like trains?
I really love trains too.
I think I might have that.
I think I feel the exact same way.
And then they just psych themselves out.
But if you were to give them, like have a great Italian chef come in with his ingredients, have them choose everything, give it to a sample of people, and then have an American chef come in and make the same thing with typical ingredients you might use, I think you wouldn't be able to tell the difference.
And I would love to see this trial.
No, has it ever been measured?
No.
But they should.
I think it'd be funny.
There's just been no interest in it for somebody.
Because the argument is what?
And I do want to talk about glyphonate.
But the argument is what, that they don't spray their food the same way we do?
They use glyphosate.
But there's some pesticides they don't use or something.
I don't know.
They could be a little bit.
What is the case they make?
Well, it depends on who you're talking to.
There's a lot of variation because some people know, for example, that some point they might believe has been debunked, so they go on to some other thing.
And they want to maintain the belief.
That Italian pasta sets better?
Yeah.
So they come in with different reasons.
And you push them back on that argument and then this argument and that argument.
You keep going through all the different arguments and they just are still insistent.
Oh, no, it's better.
Is there any merit to the argument that our food is poisoning us?
In the sense that it's very palatable and you eat a bunch of it, yes.
But in the sense that there are all these toxins in it, very likely not.
So you say that if you eat a good diet, what is a good diet?
So a good diet that is nutritionally complete will probably today include meat.
Unfortunately, vegans and vegetarians are just going to have to deal with some insufficiencies.
It's practically inevitable.
There are some things you just cannot get.
I totally agree.
And you mean chicken, fish, and steak?
Yeah, chicken, fish, steak, especially fish.
I really love fish.
I'm a big believer in fish.
So we totally agree.
Absolutely.
I think fish is like the secret super weapon of the West.
Yeah.
And I love steak, but it's not as healthful as fish.
Fish is a little bit better.
I eat fish every day.
Good.
Now, do you have concern about mercury poisoning?
Somewhat.
I don't like to eat swordfish multiple times a month.
Or tuna?
Tuna, a little bit less.
If you have that done with aquaculture nowadays, it's totally fine.
Really?
Yeah.
That's actually a great way to increase production and reduce costs.
What, you mean farm-raised?
Yeah, exactly.
Is there a difference between wild-caught and farm-raised salmon?
Yeah, less of the natural pollutants you'll find out there in nature.
There are tons of things.
Really?
So you actually like the farm better?
I do.
Because you can control the environment.
You can control what they eat.
You can make sure that they're not gross.
You can make sure they're not bottom feeders.
So when you have a Chinook from Alaska, it actually might be less.
It might be.
Less healthy.
That's one of the funny things.
A lot of unnatural things are quite a bit healthier than the natural alternatives.
Like with red dye, the synthetic one we know is very safe.
But the one that we get from Coach and Eel will kill a small proportion of people.
It's just not as good.
But a lot of people, they fall into this weird mental trap where if it's natural, it's healthy.
But tons of natural things are not healthy.
Like it's not healthy to go and smoke a bunch of weed.
It's not healthy to go and do cocaine.
You'll get a heart attack.
But like people go, oh, well, it's natural.
It should be great, right?
But no.
So we are fatter.
Would you say obesity is the driving force of our sickness?
Yeah.
Obesity and everything around it.
Very much so.
Is there a correlation between obesity and depression?
There is.
Yeah, absolutely.
Totally agree.
And obesity likely causes depression, has a causal impact on us.
I completely agree.
Yeah.
And if you fix it, you're very likely to reduce depression rates.
That's right.
One of the wonderful things we can see with these randomized controlled trials and these drugs is, God, people are a lot happier when they've gotten a lot less fat.
So you're a GLP1 advocate.
however, would you say there's a concern to give like a 13-year-old a zombie?
I would.
Yeah, I don't like the idea of giving it to kids.
And they're trying to push that.
I know.
I'm just kind of instinctually against it.
Me too.
The thing is, it probably is good health advice.
Unfortunately, we know that early treatment for a lot of things does help kids.
Like with the statin example, those families where they have hypercholesterolemia and the kids inherit it because it's a genetic condition.
When you give them statins from like age five, it is really good for them.
Like they are way less likely to die young, and that's important.
Right, but that's a genetic problem, right?
So I'm talking about a kid that like, and maybe I don't know, he's eating like crap.
He's eating donuts, he's eating McDonald's, he has, let's just say, a lot of insulin resistance, which I want to ask you about.
Oh, yeah.
Very good combat that.
Yeah, I would love to get your thoughts on that.
Wouldn't it be better to say, hey, let's fix your diet before we start getting you dependent on the injection?
It'd be nice, but the problem is to control the kids' diet, you have to intervene on the parents.
And intervening on the parents is difficult, as we've seen from the inability to intervene on them in general.
So if we were to get obesity rates down macro, what would that mean for all the other health outcomes?
Beautiful improvements, just wonderful things.
So the CDC's cost estimate for the direct medical cost of obesity in a year is $173 billion.
That came out in, I think, 2022 or thereabouts, so up it a bit for inflation.
Other estimates are usually a little bit higher.
Industry estimates are extremely higher.
And estimates that have the indirect costs in there, like presenteeism where you're not working at work, absenteeism where you're not going to work, just being lazier, having all sorts of productivity reductions, less employment from being fat.
If you handle all of that, the benefits to the American economy would be a little over $1 trillion a year.
And that's a pretty standard cost estimate.
The most extreme ones I've seen were upwards of about three and a half billion.
So you would say that solving obesity is one of our...
Absolutely.
Tons.
People are way more sedentary.
A lot of that has to do with the jobs.
They're just not as physically demanding.
And they don't need to be.
We should have people going and exercising outside of work if they're not able to do it in work anymore.
Food pyramid.
Is that great?
Okay, so we agree on that.
Yeah, I really don't want to.
It should be reconstituted.
It really should be.
I think it was made on pretty bad advice.
The large amount of grains is just not that pleasant.
I would like to see more vegetables relative to grains.
Like all the grains is, Carniferous ones.
Not carniferous.
Cruciferous grains.
Whatever.
No, no, no.
Yeah, those are great.
I love spinach.
Broccoli.
I love broccoli.
Cauliflower.
I love cauliflower.
I love pearled cauliflower.
Delicious.
Golly, my wife makes just all sorts of delicious stuff with that.
It's so good.
So grains are carbohydrates, which brings us to insulin resistance.
Yes.
Is that a problem?
Massive.
And it's basically stemming from the same thing.
People are eating too much and they are causing desensitization of their pancreas and stuff.
They are becoming pre-diabetic.
They are effectively managing insulin very, very poorly.
And acting on that does help with their obesity.
It helps with everything else because so much is downstream from that.
It's all, there's this whole thing about metabolic syndrome where it's just a very vague condition.
There's actually no real good definition of it, but it's all in the orbit of that.
And if you fix any part of it, you seem to have effects on all the rest.
So like before GLP-1s, the big miracle drug was metformin.
It goes, oh, it helps with everything.
It helps with that.
It helps with everything downstream from it.
And all those downstream benefits are just amazing.
Like you're even going to cure like a lot of adult acne and stuff.
It's just going to be amazing.
So would you, so yeah.
But it's all related.
I guess the question is, your take is drugs that work is probably a better solution, this is your take, than mass dietary changes.
I think so.
The main reason is it's very, very difficult to get people to actually stick to dietary changes.
When you tell them, oh, change your diet in this way or that way, only people who are like in the upper strata, the upper crust, tend to actually follow the advice and stick to it reliably.
And even then, they tend to not do so very well.
Like adherence to New Year's, New Year's resolutions.
The average diet people start on, they're off it by six weeks.
They're just, they're off.
They don't want to do it.
They don't stick with it.
They don't stick to their gym memberships.
In fact, the vast majority just never get used.
And how do you motivate people?
It just seems practically impossible because we've been telling them for decades.
Like we even tell them in the latest advice from the HHS, just, hey, don't eat ultra-processed foods and stuff.
We've been saying this for ages, and they still do it.
And you agree we should reduce ultra-processed foods.
It's curious.
We don't have a good definition of it.
There's the NOVA categorizations, and those have been like the go-to for a lot of people.
Yeah, how about like the big three, which is like white bread, cereal, and donuts?
I think we should eat less of that stuff just because it gets tempting.
People eat too much when they have it.
And it just tastes good.
So why stop yourself?
But I think people should stop themselves more.
And I think cutting back on those options would help.
But the thing is, if you cut back on options, you kind of just, I don't like taking away choice.
I would like people to have a way to choose more, but also choose the right thing.
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What do you think about blue zones?
Fake.
Tell me.
Entirely fake.
This is everything.
Yeah, so like the, what is it, Loma Linda or whatever in California and Greece, all fake?
So Loma Linda is not exceptional.
It's about the 74th percentile.
Ooh, is that coffee?
That's for me.
You want one?
I would love a coffee.
Yeah.
Thank you, thank you.
Do you want creatine in it?
Do you put creatine in your coffee?
No.
No.
That would be fun.
I do take creatine, though.
I take it black.
Thank you.
Creatine is great for you.
Absolutely.
Keeps on a little waterway, but great for the muscle.
What?
Great for muscle building.
You have to drink a lot of water when you're on creatine.
Yeah.
And it causes you to retain a lot of water, too.
That's right.
It increases water retention.
I do it for the neurological effects.
But keep it going.
If you have a good diet, though, I don't think you get the neurological effects from that.
It's almost all seen in vegetarians and vegans.
Yeah, I want you to finish that point.
I found the greatest leap of neurological improvement of mental acuity, memory, and stamina when I started doing more fish, more olive oil, and more healthy fats.
Nice.
That for me is when I saw, because I was really low on fish for my whole diet, and that's where for me it was a huge level up.
It's so good.
I'm a big fan.
Especially salmon.
I do salmon almost every night.
Love salmon.
Love salmon, love swordfish, love tuna.
I love everything that you can, like I love a good tuna steak.
I love good food if it's good for you.
Anyway, you're talking.
So, Loma Linda, not actually that exceptional.
The Seventh-day Adventists.
Yeah, exactly.
And they love, oh, man, they really love.
I have this in my upcoming book, so you have to debunk it for me.
I have a whole book on the Sabbath.
Oh, really?
Yeah.
Do you like the Seventh-day Adventists?
I use them as a test case that being a sabbatarian can help your health.
That pausing for a day can actually improve your health outcomes.
Yeah.
So I love fasting as well.
I used to fast a bunch.
I'm a big fast.
So you're a believer in fasting?
Yeah, I just like it for the feeling.
I feel like it's an easy way to lose weight.
Does the data show fasting is good?
Yeah.
It's a great way to lose weight.
We're in agreement.
And the more rapidly you lose weight.
It's not waste the weight, though, but it's good because it creates, your whole body goes into almost a replenishing mode, right?
It might lead to autophagy at a meaningful scale.
But that's after like four plus days of fasting.
Yeah, which I don't do more than.
But you're going to make a point on blue zones.
Yes.
Sorry.
Let's get back to that.
So Loma Linda, not that exceptional, focused on a bunch.
It's at about the 74th percentile thereabouts for U.S. counties or whatever it is in terms of life expectancy, which is not amazing.
Like, why should we focus on the 74th percentile?
We could just probably go even further out.
But then the thing is, those percentiles are unstable year to year.
They do change quite a bit.
So the 99th is probably not going to be the 99th in 10 years because people will die.
It'll change.
Nicosia, the one down in Costa Rica or whatever, it is pretty much vague.
Let's define a blue zone.
What is a blue zone?
Oh yeah, sorry.
So I can't believe it.
No, it's okay.
Blue zones.
So blue zones are these areas that have been proposed to basically have the secret to a long life.
People there are supposed to have been living very long lives for a very long time.
They live well.
They enjoy their communities and they eat.
They don't have to eat in like crazy ways.
Sometimes they smoke even and stuff.
They just do all sorts of things there that are somehow all conducive to hell.
they live really long lives.
But most of it turns out to be Yeah, that's the thing.
I know where Blake gets all this stuff from now.
Blake, I figured it out.
I found the source.
Yeah, I popularized this a little while back, and the guy who documented a lot of this stuff, put in all the legwork, he recently got the Ig Nobel Prize, which is a yearly kind of joke Nobel they give out for funny findings.
Like there's a woman, Herculana Hosel, who a few years back got one for grinding up monkey brains to count the number of neurons in them.
It's just a very funny little thing, but it's real science.
And this guy, he went through and he documented, oh my God, this blue zones are like super fake.
So Okinawa, they go, oh, you can live to like 110 there easily.
It's like, well, I don't believe that.
That's one of the poorest areas of Japan.
And their life expectancy officially is much lower than the rest of Japan.
It's like, I just don't believe that.
They smoke a lot there.
They weird.
So the government went out and they were like, oh, we're going to go interview some of these, you know, super, super old, way older than 100 years old people because we want to learn about their life experiences.
It'll be cool.
Have like a little documentary.
And they funded this documentary.
And then it turned out, oh, we're finding a lot of corpses.
We're finding a lot of people who have been rotting in a room.
Here's your coffee.
Thank you so much.
Excellent.
All right.
They found all these people were just being used to collect checks by their living relatives.
And sometimes they didn't exist.
And so this prompted, okay, documentary is over.
Government goes out, reviews a lot of this.
And now they send out letters every year to ask people, hey, are you still alive?
Can you verify you're alive?
They sometimes give them little medals every so many years to make sure if you're really old, you're not just scamming the system and actually dead.
And so is there nothing to like the Mediterranean diet walking around all the time?
Really?
The thing to the Mediterranean diet is that it's popular.
And as things become popular, healthy people adopt them because they're like, oh my God, I better do the cool new healthy thing.
And it generally has principles that aren't terrible, right?
Yeah, yeah.
The thing about restricting your diet is you limit all that availability of different weird foods and everything.
Yeah, totally.
It's easier to satiate yourself.
So if you don't have a million options because you're not afraid of the e-that's how I eat, basically I'm a Mediterranean diet guy.
There you go.
Well, if you have that limited diet and it goes, oh, I can only eat these things, then you're very unlikely to overeat.
Correct.
If you put people in a chamber with nutrient paste, they'll eat enough of it to live and then they won't eat very much and they'll probably lose weight because it's dull.
It's not an exciting diet, so they're not going to eat a bunch of it.
And it's great.
That works.
And so the big problem that is facing us is an overindulgence, obesity.
Absolutely.
And it creates all these downstream health problems.
That's right.
And yeah, please.
Yeah.
No, that's basically the gist of it.
It is just we are eating so much.
And some people are eating a whole lot more than they really should.
And we've measured this.
We have, yeah.
We have great measurements.
The nutritional health examinations, the NHANES, it's a great study that's done every couple of years.
They ask people, please just log your calories and stuff.
And the calories people eat have gone up.
And the activity they do has gone down.
So on both ends, you're getting fewer calories out and more calories in, and then your stomach is growing and growing and growing.
Alcohol.
Bad for you.
I don't drink, so make the case.
Well, all the stuff.
Is it fair to call it poison?
Absolutely.
It is poison.
Ethanol is poison.
Yes, absolutely.
That is 100% it is poison.
Alcohol is ethanol?
Yeah.
I didn't know that.
Yeah, it's poison.
I thought ethanol was derived from corn.
Corn alcohol.
Is all alcohol corn-based?
No.
I was going to say it's alright.
You can make alcohol in a lot of ways.
I was going to say, okay.
But I guess you get ethanol from other...
Okay.
I just.
Yeah, yeah.
It's alcohol.
So alcohol in the engines and all that.
If you put it in there without the treatment or whatever for your engine, it's going to blow it up.
Not blow it up at all.
So are we drinking too much alcohol?
Absolutely.
There's a lot of binge drinking these days.
It's pretty bad.
So brief background on why people thought it was good for you.
Pretty much the same reason they thought vitamin D is great for you.
But there's less downsides of vitamin D. Yeah.
Like if you can dose it, it's not going to do anything.
You're just going to put it.
If you dose alcohol, you got big problems.
Yes.
Any alcohol you drink is going to be bad for you.
All of it is bad for you.
There's no lower limit at which it's good for you.
Like I still drink alcohol because it's fun and it's enjoyable and like you want to drink because like everybody's drinking and some stuff tastes good.
Not beer or anything like that, but some liquor tastes good and all that.
So it's like, great, I'll drink.
But it is bad.
It is all bad for you.
People thought based on selective studies, they were like, oh, people who drink a little bit, they're healthier.
I hear this all the time.
Oh, a glass of wine a night.
It's good for the antioxidants.
Yeah.
Oh my God, they say this.
It's actually funny.
We have comparisons of the effects of drinking wine versus drinking beer during pregnancy.
And it turns out, oh, women who drink wine during pregnancy, they didn't have higher IQ kids.
Don't extrapolate from this because it's clearly a selection effect.
You should not drink anything.
You shouldn't drink anything.
It's all downsides.
But the reason is selection, because wealthier women drink wine and poorer women drink beer.
Yeah.
So it's why would a why would a if a mom is drinking during pregnancy, that's it's bad either way.
Child abuse?
I mean, it's like.
I think it should be considered that, yeah.
I totally agree.
Yeah.
Some jurisdictions consider it that way.
Some jurisdictions recently have been lifting their restrictions on that.
Are you serious?
I should lean in on that.
Blake, we should get in on that.
Yeah.
Because that's active potentiality for fetal poisoning.
Exactly.
It's very bad.
It just has no upsides.
It's all downside.
It's a terrible, terrible thing to do.
But some places have started making it so bars are now allowed to serve pregnant women.
It's their choice to do it.
They can say no, and they should say no, but they're allowed to serve, which is nutty.
We are.
And we're binge drinking a lot more too.
There are more teetotalers, which is nice.
These people are going to be fine.
There are more people who are just drinking insane amounts too.
And people in general are drinking a little bit more.
And so we had Prohibition once, and Prohibition actually...
Yeah, I'm a Prohibition truther.
Good.
I've read the books.
Good.
So you're familiar.
It did reduce rates of cirrhosis, and they never actually went back up to where they are.
Well, really well.
Here's my thought crime on prohibition.
Yeah.
Yes, it increased gang violence.
What caused them to do it in the first place?
So why would a population go and do a constitutional amendment?
There must have been a really big problem.
Rooting tooting saloons.
What was the problem that caused, what was it, the 23rd Amendment, 22nd?
A lot of it had to do with men mistreating their wives.
It was women-driven.
Yeah.
Women were the power behind prohibition.
21st Amendment.
Yeah, they would actually go and bust up saloons that the men would be at after work or sometimes when they should have been working.
And they would break the bar and break the stills and everything and try and tell men, get out of here.
Don't go home from the saloon drunk and beat your wife.
Come home and be a good father and all this stuff.
And saloon culture was just very bad.
When they did break that up, homicide rates went down because men were just going there into these pretty much men and prostitute only establishments and just being violent, being drunk, being adulterous, very much so.
And it was just bad.
It was a bad culture we had.
We changed it overnight with temperance.
What is worse, would you say, for society?
A society that smokes or a society that drinks?
Society that smokes.
Okay.
So you're not a tobacco truther?
No, tobacco is just...
Do you think we were skinnier?
No, I'm talking about no cigarettes.
And I want to get into weed, but do you think there's any truth that we were skinnier when we were smoking more cigarettes?
Yeah, because it is an appetite suppressor.
Absolutely.
It contributes a very, very small, but real portion of the increase in obesity over time.
The reduction in smoking did that.
It's interesting.
I mean, like, it did make people skinnier, but it's not worth it.
It causes cancer.
You have a one in four chance to get lung cancer.
Why is weed bad?
I just think it's a loser drug.
I used to think, oh, we'll legalize it.
It'll be fine.
But the gateway drug thing that I heard growing up that everybody said, oh, it was fake for many years, it seems to have been real.
It seems to have been a true thing.
People really do get unheard of drugs and you make them available.
If you just legalize weed, okay, fine, but you're still going to find that a lot of people waste their lives on this stuff.
Totally agree.
Most of the downsides of weed are due to selection.
Losers smoke weed.
When you make it available to them, they will go smoke it.
Most of it is not the weed making their lives worse.
It is that losers want to go and do this stuff.
But even still, it's still pretty bad.
Like kids, when they have it as teens, they pay attention less in high school.
They're less likely to go on and get a college degree.
They're less likely to do well on various tests and everything.
They're less likely to graduate on time.
Just downside.
And that's illegal use, too.
So when you make it legal, it increases illegal use, honestly.
It's a very funny effect because it becomes more socially acceptable to do it.
So people who are like under the age limit or people who are otherwise ineligible, They will go and get it illegally, you know, or they'll be able to buy it from someone who resold it to them or anything like that.
And it's just been a big mess.
And anywhere that it's come with the also legalization of, or decriminalization, I should say, is more common, of hard drugs, it's been terrible.
It's been atrocious.
It's led to like just, I don't know if you've been to SF when it had really, really bad problems with that.
It's a walking dead, yeah.
I was in Berkeley, like, golly, around this time last year, and I was just walking around.
I was going to go get Boba with some friends, and we passed by a McDonald's, and there's a guy outside who has needles near him, and he has the little, what do you call it, the band around his arm because he had just injected, and he was jittering up everywhere, and he was just drinking a coffee, too, and it's like, you clearly just did meth or something, or not meth, but heroin.
And there were people conked out on the sidewalks.
There were people you have to step over.
It was atrocious.
And every city that decriminalizes has the same thing.
Portugal, they say, oh, it's a success story.
But they do it differently.
If you are using it in public, they'll arrest you.
And they'll put you in like rehabilitation program or they'll throw you in the drunk tank, basically.
They don't take it.
They took it more seriously than we do here when we try to decriminalize.
And I think that's part of the failure is that we adopt an incredibly progressive liberal attitude towards it where we, when we decriminalize, we go, oh, we just wanted to decriminalize.
That's all we wanted to do.
Where Portugal does it, they go, oh, we wanted to not enforce this stuff.
We're going to beat up vagrants still who are using drugs.
We don't have the gumption to do that too.
And if we did, I think it'd be a better situation.
But either way, it's turned out pretty bad.
So I want to keep running through supplements, but let's take a detour to a fun one that's on my mind.
Are more people getting autism?
No.
Very likely not.
So I'm going to give you a quick spiel on autism.
So 1943, Leo Conner or Canner, a lot of people, Germans, they Americanize their name and all that.
They changed pronunciation.
He names autism for the first time, and his criteria for it is super restrictive.
To get a diagnosis of autism back when the Connor criteria came out, you had to have symptoms of having an extremely low IQ.
Social aloofness, for example, is typically only found in people who are mentally retarded with an IQ of less than 35.
So super mentally retarded.
And that's where you're totally unaware of any social cues or anything.
You're like unresponsive.
That's a physician almost.
Yeah, pretty much.
But you also have to have a symptom of a relatively normal or high-range IQ, which is these strict repetitive habits, like organizing everything in your room near bedtime.
And it's like, how do you have this co-location of two symptoms that are on the opposite ends of the IQ spectrum?
That's why almost nobody got diagnosed before we had the DSM-3.
The diagnostic statistical manual, third edition.
Yeah, they introduced the first autism diagnosis to the mass market.
Before that, they had like things that were sort of similar, like schizophrenia diagnoses, but they were too dissimilar to modern stuff to really be comparable.
Then they started diagnosing more, and the criteria were a lot more lax.
You had to just be a little bit, as we know, modern autistic.
It was more strict than it is nowadays, but when they got around to the DSM-4, they introduced stuff like Asperger's, which is like mild autism.
Someone who's a little high IQ and a little quirky, they're autistic now.
They weren't under the old criteria, but under the new stuff, oh, yeah, give them a diagnosis and start giving the parents all the social services that entails.
And the other big thing is when the IDEA Act passed, when we, this act where you have to go out and your schools had to actively identify students with mental disabilities, that led to a massive, massive increase in diagnoses.
It led to huge numbers of increases in single years sometimes.
So like Massachusetts, for example, they had a year where they had a nearly like, I think it was a 300 or 400% increase in the number of diagnoses they reported up to Congress, consistent with the acts they reported a year, because they just changed how the baseline was calculated.
So you have all these things that are methodological factors that contribute to the increase.
And the increase is just in diagnoses.
When you go out of your way to use a consistent criteria, like the criteria of the DSM-4, and you go out into the community and you go, okay, hi, random person on the street.
I'd like to diagnose you with autism or I'd like to see if you qualify for diagnosis.
And you pay them a little bit to be in the study or whatever.
And you do the same thing for adults and for kids, you get incredibly similar rates.
You don't for the most severe forms of autism, but that's because those people tend to, unfortunately, die very young.
The guys who are banging their heads against the walls, you said earlier, like that, they do tend to die young.
We have seen an increase in those diagnoses, though, and you might say, oh, well, is that the real increase in autism?
It's like, no.
That's because we incentivize that.
A lot of that is people who are getting substituted into an autism diagnosis.
Because we give parents, for example, in California, you get a lot more benefits for an autism diagnosis than you do for a mental retardation diagnosis.
So if your kid has mental retardation, you can convince a provider to diagnose your kid with autism.
And suddenly, ba-bam, you get access to a lot more social services.
your kid gets treated better in school.
They end up with a lot.
If you are a caretaker, you get nearly $10,000 a month.
Yep.
And we see a lot of exploitation of this.
For example, in Minnesota, the Somali community has been greatly exploiting this recently.
In 2018, they would never do that.
They would never do that.
They've figured out in their community how to get a diagnosis for their kids because it gives them a lot of benefits.
The provider spending in, I think, the two cities area was about $6 million in 2018, or it might have been the whole state.
I'd have to look back at the report.
But it went up to like nearly 200 million in just a few years, like by 2024, or 2023, actually, that's what it was.
And there have been fraud cases about this.
There have been people getting arrested for it.
There's all sorts of people are getting found out that they're doing this.
So you would say there's nothing to the argument that we used to have like one in 30,000, now it's one in 30.
There's been no increase in brain inflammation.
No, not really.
There's been a systematic effort to start diagnosing people that started only very recently.
And because you tend to under-diagnose adults, because like we just don't care about adults, like there's no reason to go out and diagnose all the adults, but there is a mandate to diagnose all the kids.
You have to diagnose it by law.
So but is it ever so their counter-argument, if I had like Dr. Means here, you know, who wants to be the next surgeon general, she would say, have you met her?
I don't know if you met her or not.
No, I bet Callie, but I haven't met Casey in person yet.
They would say that the criteria of the last 10 years hasn't changed.
Incorrect.
Well, the thing is, so they're correct in that the diagnostic statistical manual five has been the addition we've been on, but the incentives to diagnose have still increased, and they're increasing, and the awareness increases.
Like, it's not just about the manuals themselves, it's about campaigns like Autism Speaks, where you try and get the population to know about autism.
People had no idea what it was before 1980.
Now, everybody knows what autism is.
It's a meme.
You can go on TikTok and find people self-diagnosing, giving instructions on how to self-diagnose.
Or you can even find that it's really kind of crazy.
You can find instructions on TikTok on how to go to a psychiatrist and get diagnosed.
You can find people psyching themselves into it.
And these cultural trends clearly lead to way, way more diagnosis.
Parents being incentivized.
When schools, when states pass these reward for diagnosis, like laws that reward diagnosis in schools, schools tend to increase the number of diagnosis by 25% in a single year on average, which is enormous.
That's so huge.
And it's just because each head that is autistic is a boon for the school.
That's just how it is.
We keep incentivizing it and the rates keep growing.
So for parents that say that there are just noticeable more speech delays between kids now than there were 20, 30 years ago, that's just not really true.
That doesn't bear out.
It doesn't bear out.
If you look at actual symptomality, which we do have data on, you don't see really any difference over time.
In fact, it's wonderful.
I love the Swedes for this, and the Danish and the Norwegians and the Finns.
They trust their government a lot to collect a lot of their data.
Like their personal data is very well collected.
And it's all linked to their health records and everything.
And we have data on parental, like the same questionnaires we give to parents here for autism that prioritize them to go to get a diagnosis.
They give those to whole population registers, like thousands and thousands of people.
And we see, oh, the reported level of the autistic traits over time, or even the clinician, like measured level in some cases, is the same over time.
It just doesn't drift.
So the population is as autistic as ever, but the number of diagnoses in those same cohorts just ticks up and up and up and up in a way.
And I think that, plus the fact that when you do a systematic effort to diagnose under a given criteria, you find the same rates for adults and for children, I think that really just heals the deal.
Like it's hard to argue against that in any credible way.
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What is an issue that we are underdiagnosing or underemphasizing?
So that's the thing.
We don't know if the increase in autism diagnoses is under or overdiagnosis.
There's a genuine case to be made that some kids were underserved prior to diagnosis becoming a big thing because there are some things you can do to help autistic kids.
I'm not a psychiatrist, but I know that they have plenty of things that actually do help.
And I've looked at some of the effect sizes for the treatments and whatnot.
And they help them with their behavioral problems.
They help them to graduate school and stuff.
They help them with a lot of things.
So were those kids at one point underdiagnosed?
I think the answer is probably yes for those kids.
Nowadays, where we're getting autism becoming less and less severe because we're diagnosing more and more marginal cases, I feel that there is a lot of overdiagnosis going on.
and especially when it leads to unnecessary medication.
Like, I'm not a big fan of the over-diagnosis with ADHD, especially because there are...
I think it's a scam.
They have been, a lot of them have had pharma contracts.
I'm not against big pharma.
I love pharmaceutical companies that do great stuff for us, but it is true that they are clever.
They might do a lot of smart, good things, but they also lie a lot.
They do a lot of things that hurt people.
For example, there was the opioid stuff a while back.
The epidemic on that is going down now.
We are handling that, which is lovely.
It means fewer overdoses.
Good.
The company that started that, which has now been sued out of existence, and well, sued into being just a fund to pay out people they hurt, they went around and lied to doctors and told them, oh, it's not addictive.
There's no evidence it's addictive.
And then what do you see?
About 5% of people who were prescribed these drugs after a surgery got addicted for a short amount of time, usually, but sometimes a long amount of time.
And then a lot of time they transition to other drugs.
So they do lie.
They do mess up stuff.
And they do overdiagnose these kids in the sense that there are some number of them that we know transition from these drugs to harder drugs.
There are a good number of people who go from like ADHD drugs, which many will need.
Lots of kids will need them.
They can't focus otherwise.
Like Ritalin?
Yeah.
Ritalin and Adderall and like a lot of other drugs, they just work.
They actually do work great for a lot of kids who do need them.
But the kids who don't need them, they're getting not much upside.
A lot of people do use the drugs for focus reasons, like they're on the job and they want to focus better.
And fine, let them do that if they really want.
But the moment it becomes forcing something on a kid and the parents being told they must do it and all that, I'm not a big fan.
There are good cases where you should because the kid will fail otherwise, but I do think we give it out too often.
And so you would say then the autism emphasis is just a major diagnosis scam?
A lot of it is.
A lot of it is scamming.
I mean, especially when you see like the welfare fraud related to it, like the Somali case in Minnesota is one of the most well-documented now, and it's very, very bad.
There is really no good reason for them to be going out and getting practically all their kids diagnosed with autism.
It's clear that they're doing it because it gives them money.
And is there any truth that there is less autism in the Amish community?
No, not really.
They do have autism.
People say they have zero, and it's like, no, we have diagnosed cases.
They just don't get modern medical care.
They don't seek it out.
So, of course, they're not going to be diagnosed.
They're not in our schools.
They're not in our hospitals and everything, unless on rare occasions they are.
But they're just not getting all the well visits kids get and everything.
They're not, no, there's really nothing to it.
It's a difference in the medical care they receive.
So if you were to go and do a community study on them and to go out of your way to diagnose everyone, I think you'd see pretty high rates.
So, I mean, your contention is that the one in 30 number, I mean, this is one of the greatest medical malpractice issues of a civilization.
Yeah.
It could be.
The thing is, again, there are some kids who do benefit from the services received after the diagnosis, so it's hard to say.
What percentage?
That's why it's hard to say.
We don't know.
We need to do studies on how often that stuff actually helps.
We know the heterogeneity and how SSRIs help with depression.
We know that the bottom 30% get like nothing, and then the top ones get big effects, and the middle gets just like meh.
But we don't know what it is for autism.
We don't know how well the services they can provide in schools affect them.
So we don't actually know, like we don't have an empirical margin that we've estimated on which to diagnose.
But if we did, that'd be great.
That would allow us to diagnose appropriately, like appropriate for a given symptom level.
So we could tailor the care better.
So in some ways, your message is actually very empowering, that a parent might be being told their kid has autism and they don't.
Yeah.
Is that correct?
Oh, absolutely.
That is definitely.
So let's talk about that.
So that has happened to my parents right now in the audience where a doctor is like, well, your kid has autism, and it might actually be a lie.
Yeah, absolutely.
The thing is, with the criteria being so low, being so easy to get diagnosed, like just based on a few symptoms that are just often kids being normal.
Total normal child behavior has been pathologized in a lot of ways.
There are tons of kids who are certainly misdiagnosed because they're obsessed with trains and they love their...
Why does that mean you're autistic?
I don't understand.
It's just kind of a meme.
It's not really about trains.
It's about particular obsessions.
And I think people, parents overstate obsessions a lot of times.
They're worried about their kids and they go, oh, my kid is obsessed with video games or screens or trains or anything like that.
But they're just interested at a pretty normal level.
And we're treating that pathologically because we're too concerned these days.
Parents are hovering too much and they're too concerned about every little thing in their kid's environment, every little thing their kid does, and they over focus on it.
And they don't give their kids the space to be normal and develop normally, or they should.
So then, if you had your way, how would you then approach this autism issue?
I would let the public know.
Golly, the diagnostic threshold is incredibly low, and we don't need to diagnose so many people.
And we need to start doing the studies to figure out what we should diagnose because we don't really do that.
We just do stuff on how to diagnose or, oh, I saw this thing, and we all in the psychiatric practice agree it's real, and we would like to start diagnosing this.
So in order for the people that think that autism is increasing for it to be true, it would have to be standardized across ages.
Is that correct?
Because you said if you pick adults, they do not have the same.
No, no.
So the adults do have symptoms.
It's just that in this very, very severe cases, you're less likely to get adults who have them because they would have likely died younger.
But for most symptoms, they do have them show up for adults.
The exceptions are things that are age-gated, like must start presenting symptoms before age 30.
You can go back and sometimes look in an adult's case file as if they had them that far back and see, oh, they do have something consistent with autism.
And that does happen, but it's somewhat rare.
Also, sometimes adults do intend to go out and get an autism diagnosis because it does lead to higher disability payments.
We saw this during the Great Financial Recession back in 2008, 2009.
Lots of people who were on Medicare, Medicaid started seeking, not Medicare, sorry, Medicaid, started seeking out autism diagnoses, more benefits.
So it's fascinating.
Let's go through the supplement stuff and we'll close Holly for that.
We have a lot more to talk about.
Yeah.
Turmeric, ginger?
Probably not going to do very much.
Might be a good way to increase your metabolism very, very slightly.
Burn a few more calories, but not going to do very much in general.
What about coffee?
See, I love coffee, and I love caffeine, but it's not really going to benefit you a lot.
Doesn't it speed up your metabolism, though?
Caffeine does a little bit, but it's not terribly large.
It's not going to cut off the bottom.
Any benefit to the antioxidants in coffee?
Not really, no.
It's just not going to do very much.
How about drinking a bunch of water?
Not going to do a lot.
After a certain point, the thing is, you're just not going to get these benefits.
They have diminishing returns severely for practically everything.
I can't actually think of anything with non-diminishing returns.
But that's kind of hard.
That's a silly thing to say in general because the dose makes the poison.
Oftentimes, one of the things you see in a lot of circles, like in terms of worry about stuff, is, oh my God, for example, aspartame.
They go, oh, aspartame breaks down partly into formaldehyde.
Well, formaldehyde is not bad in the quantities you get from drinking a Diet Coke.
There's aspartain in that in LMT.
Totally fine.
Aspartame is totally fine.
It doesn't have any biological way it could be bad for you.
It's all aspartane as poisonous.
Some people say that, but the thing is they think formaldehyde is just generally bad for you.
And it is bad if you drink like the bottle they would have in an embalming office.
But it's not bad for you if you get it in the quantity you get from like eating an apple, which you do get.
You get it from a lot of your food, but it's not bad because the dose makes the poison.
It's such a biologically meaningless amount that it's not going to do anything to you in a million years.
How about saunas?
I love saunas, but the benefits there are really sort of minuscule.
You've heard about the Norwegian sauna study?
Which one?
The long-term one where they measured guys people over 30 years?
I haven't seen this.
I did look at a meta-analysis of the very, very few number of trials on this, and they're all really small.
And it looked like there was basically just nothing there.
But I still love saunas and endorse them.
They're great for losing water weight.
How about training?
Like working out, bench press.
Oh, excellent for you.
Yeah, yeah.
strength is good.
And in fact, a lot of these Strength is good for everything.
I don't know about the brain benefits, I actually doubt them for depression because a lot of studies have recently been coming out and they've been saying, oh, the depression benefits are really overstated.
And that's whatever.
Interesting.
I used to think it was a big thing, but meh, running gets my mind off things, but it doesn't actually seem to help much in the trials.
Strength training is just good to have in general to prevent a lot of aging-related decline.
Like lower back problems really are very, very common.
I have a lower back issue.
You should have been deadlifting more.
Yeah, I know.
Yeah, I tell everybody, deadlift.
I can't deadlift now because of my back.
Oh, no.
I'm sorry.
That sucks.
A lot of people, especially if you're young right now, you should be going out and doing lower back exercises.
Don't strain your disease.
I agree.
I agree.
You should train your back because if you don't train your back, you will end up an adult who is miserable.
Like when you're older, my back is a disaster.
Oh, sorry.
That sucks.
L4L5 up against the sciatic.
Oh, no.
It's terrible.
Yeah.
That's one of my big strength training pieces of advice.
Are you?
Everyone.
So is there any, let's finish on supplements.
Anything that you recommend take?
No vitamin C?
We get enough of it in our diet?
For most people, you're going to get pretty much everything fine.
Even if you're sick.
With that one, actually, it doesn't offer many, many, but if it's if you're sick.
So asorbic acid, nothing?
No, zinc is actually the biggest thing for if you're sick, which is weird.
You don't see that emphasized.
If you're sick, how about lysine?
Probably not going to do very much.
Even though it's a spiral replicated inhibitor, no?
Not going to do very much.
It's not going to become bioavailable in the way you want it to.
A lot of things, it's funny, a lot of supplements, like multivitamins especially, they don't tend to do very much for anything.
You look at the trials on heart disease and it's like bupkis, nothing, no effect at all.
Why?
Well, what if you take these vitamins intravenously?
That is an interesting question.
I don't see many people doing that, so I don't know.
Because the absorption is much different.
Yeah, it is very different.
I'm curious about that, but I don't have an answer for you.
How about NAB?
I love taking NAB shots whenever they're available because everybody's just like, oh, we'll give them to you.
And I'm like, great.
Because I go to a lot of conferences where they have the rejuvenation clinic things.
They're like, oh, you want to get on a saline bag and you want to do all this fun stuff.
And I'm like, oh, go to the oxygen bar.
And it doesn't do anything for me.
And I don't think it does very much in general.
But not going to say no.
Hyperbaric oxygen.
Potential benefits, yeah.
I see great data behind that.
Yeah, there do some things.
I had a concussion eight years ago.
Yeah.
And I did 120 sessions of hyperbaric.
Helped a lot.
Materially, you could see it rebuilt the back of my brain.
Interesting.
Yeah.
There's a lot of non-hocus pocus data behind hyperbaric.
I think the hocus pocus, though, is for when people say it'll help with autism.
I had a friend growing up, and he had Asperger's, and his parents had hoped that this would cure his autism.
They kept him on a carb-free diet because they read some paper and they bought a hypobaric oxygen chamber.
It was like a little pod thing in their basement.
And they put him in it multiple times a week and just didn't do anything.
For that, nothing for other outcomes, like recovery stuff.
But doesn't keto help you if you have seizures?
It can.
That's one of the interesting things.
It can help you with that.
Because there is data to support that.
That a ketogenic diet can help you if you have epilepsy, right?
Yeah, and that's very odd.
I don't know why it does that.
It must be carbohydrates.
It has to be.
Sugar.
I mean, you're cutting them out, so it must be.
What is causing the rise in cancer in young people?
Diagnosis.
We are actually getting much, much better at.
So there's not a material rise.
There's not really, no.
This is one of the big things I keep emphasizing to people.
The cancer death rates, which is the thing you should focus on for young people, they're going down.
But I mean, let me, so like, I don't know enough about it to materially challenge you, but wouldn't, I mean, 25-year-olds are getting cancer more.
We diagnose more.
We screen more.
We do more indirect things at active screenings, like we get more x-rays and whatnot.
We can do more various scans of all sorts, and we see this stuff more often.
But wouldn't we have caught it within 10 years?
Well, if 10 years pass, it could be too late.
No, I know, but so the cancer death rates are not going up?
No, they're going down considerably.
But isn't that just because our treatments are better?
No, it has a lot to do with screening.
In fact, most of, so actually, it's a great example, cervical cancer.
Between the 1950s and 1990s, our treatments barely got better at all for that.
But 70% improvement in survival.
Why?
Because we're doing PAP smears more often.
I say smear, it's weird.
I should call it a, it's like putting a lot of vague pap smears.
We were just catching it more often.
And the big thing nowadays is that we vaccinate for it, and that has done incredible things.
That vaccine is amazing.
Which one?
Gardasil.
Okay.
We are going to eliminate cervical cancer in our lifetimes.
Some countries will see zero cervical cancer cases among those.
Is Gardasil hepatitis B or no?
HPV.
Human papillom, okay.
Yeah.
Papillomavirus.
Yes.
We're beating it.
It causes a 100% reduction in a lot of preclinical.
What is your take on the COVID shot?
It was an amazing engineering feat.
I love the Operation Warp Speed as a way to accelerate stuff.
I think we should have way, way, way more acceleration of getting treatments out there.
In fact, there's a guy I met last year.
Unfortunately, he's passed away now.
I met him shortly after he had a glossectomy.
They removed his tongue entirely for some terrible cancer he had.
Jake Seliger.
He did a lot of blog posts while he was going through this.
And he tried very, very hard to get access to novel treatments that could have let him live a few months longer.
Right now in Montana, they're trying to pass the Seliger Act, named after him.
His wife is getting it done, his widow.
And I hope it succeeds.
It's a right-to-try act.
It would allow people to access more cures more quickly, even when they're not through their trials yet, if they have the conditions that these things might help treat.
And who knows, if that had been around nationally, he might be alive today.
I don't know.
He passed away a few months ago.
It's very sad.
But there are lots of people like that who can't access treatments because they're not doing it quick enough.
The FDA is generally too conservative with approvals.
They wait too long and people die.
They wait too long and generics aren't approved.
They wait too long, partly because, for example, on generic drugs, you know who wrote the rules on generic drugs?
Is the large pharmaceutical consortiums run by the people who make the prescription drugs?
I believe that.
It's very, very bad.
We have this thing, the PADUFA, the Prescription Drug User Fee Act amendment.
And it's how we fund most of the FDA.
Most of the FDA funding comes from paying the regulator to do an efficient job going through the approval process and getting the drug on the market.
And this is a good way to align the incentives of drug manufacturers and people who, like the regulator who allows you to bring the drug to market.
And this is where, this is great.
It leads to the FDA being efficient.
They take about less than 180 days to approve drugs that have shown they work, get them out there, start saving lives.
But for the generic drug user fee amendment, GADUFA, the designers of it were the large pharmaceutical companies that are most likely to use PADUFA.
And if a generic comes to market, it erodes your profits.
It makes it so you are competing against somebody who produces something for pennies on the dollar compared to what you make.
So if you're charging a huge amount for a therapy and somebody who comes along and makes a generic, then they screw you.
So JADUFA is designed such that you start paying the FDA immediately instead of after you've gotten the drug approved.
PADUFA, you pay after you get it approved.
They do the review and then you pay them for as long as there's not a generic.
But the generic, like the generic part, really bad.
The GPHA did a lot of the designing and the GPHA's members are largely huge pharmaceutical companies that have an interest in making sure there are no generic drugs that reach the market.
Were there any downsides to the COVID shot?
Hmm.
Myocarditis in young men.
We did see myocarditis That's not just the diagnosis.
That's legit, yeah.
We had to have very, very large population cohorts to see that, but we eventually did see it.
It was pretty clear.
And especially with the Moderna shot and the J and J one.
But the Novavax is fine.
The Pfizer shot was more fine.
But the thing is, the myocarditis risk for young men was pretty low in absolute terms, like very, very low in absolute terms.
And if you compare that to the risk of getting myocarditis from COVID itself, it was a lot less.
So you don't believe in any of the turbo cancer stuff?
Oh, no, none of that.
That's all fake.
None of that.
In fact, the cancer rate started going back down when we started getting the drugs introduced and everything.
So we're good on that front.
And what I love, sorry, I want to get back on track to, I forgot to mention, Operation Warp Speed could be used to accelerate the introduction of vaccines for cancers.
The mRNA platform could be an amazing way to develop, for example, we have in trials right now, there's going to be a vaccine for skin cancer.
So if you've had skin cancer and you've gone into remission, you take the vaccine and it prevents you from getting it again with almost 100% efficacy.
Like you'll just never get it again, which is amazing.
How many boosters did you get?
I think I got one.
Why not all nine?
All nine.
I feel like I just got lazy.
I haven't gotten my flu shot this year either.
Does the flu shot work?
It does.
Yeah.
It's interesting, though.
During COVID, we actually eliminated the common strain of the flu just because people were punkering down in their homes.
But isn't that a little weird?
It is weird.
Yeah.
Maybe there was something else going on.
Well, no one was getting infected with it, so it's like...
Because they were still going down about somewhat.
But why don't they get the flu?
Yeah, good question.
I don't know.
Luck of the draw.
You're the man with the answers, though, right?
Yeah.
Well, no, I don't think so.
I think of myself that way.
But the strategy.
Do we give kids too many vaccines?
No.
I think we should probably give better vaccines and more.
Because I think we should be using vaccines to prevent cancer.
I'm a big believer in one of the projects BARDA wants to fund, government agency that does great frontier biological research.
They want, I think it's about $23 billion, to fund a platform to manufacture vaccines for any virus that shows up in the known viral families the moment it comes out.
So if we get another big viral pandemic, they want to be able to mass-produce a vaccine that we already know is safe because we've done the trialing on it ahead of time and everything, that we can get out in like a week rather than having to wait again.
So they want to be able to prevent anything bad from happening.
And I feel like we should do more stuff like that as a public health measure.
We should be able to stop everything in its tracks.
We should be able to destroy cancer entirely by preventing it.
We should be able, like Gardasil is amazing.
I think it's a really, really good thing for preventing HPV.
We should have one for herpes.
We should have one for the Epstein-Barr virus because these viruses lead to a lot of downstream effects that are very, very bad.
And the transmission for a lot of those happens right near birth.
It's when you're young.
So Epstein-Barr you typically get, almost everybody has it.
And you get it typically from like your mother's kisses, which is sad.
Your parents shouldn't have to think about, oh my God, what if I give my kid cancer in 50 years?
Because you see a lot of Epstein-Barr in cancers.
We should be able to say, no, we're done.
We're cutting off that forever.
No more transmission of future generations of herpes viruses.
No more transmission of anything like that.
We should kill it.
I think we should be more aggressive with vaccination in terms of destroying diseases that have plagued us for a long time because we can now.
And we're just, we don't have the balls to do it.
But we should.
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Any downsides to vaccines?
Current ones?
No, not really.
One of the common complaints is like the MMR vaccine causes autism.
That does not hold water at all.
That was initially came out in 1998 as a Lancet paper by this guy, Andrew Wakefield.
He had a financial interest in getting people to stop using the MMR so they would use one of his vaccines plus another one instead.
And very compromised and very much a lot of fake data in there.
Turned out there was nothing to it.
We now have very, very large population register-based sibling studies where one sibling is vaccinated and the other one is not.
And we see no difference in autism rates.
And a lot of parents Will stop vaccinating their kids for autism when one of them is diagnosed and they have subsequent kids.
They'll be like, oh my god, I'm never going to do it again because it must have been the vaccine.
And then, no, the autism rate is the same in their subsequent kids.
What do you have to say to critics that with the COVID shot, that the guarantee was that it would prevent transmission?
Yeah, I don't know where that came from.
Well, I do know that.
A lot of it was lying on their part.
Like, Fauci did lie a bunch.
And Walensky said it would stop transmission.
Yeah, a lot of people lied.
I don't know why they lied.
Like, I don't know why they thought that was a good idea.
I don't believe in lying to the public.
I feel like whenever you're a public health communicator and you do that, you should basically just never communicate anything again.
The moment you start telling lies is when your credibility is gone and when you should not be in the public sphere at all.
The fact that Fauci thought it was a noble lie, we've seen the emails now and everything.
We know he thought it was a noble lie to say that it would stop transmission in his tracks.
And he might have had reasons to believe this, but we know he later on did not.
That's when you should stop being a public health influencer of any sort.
Does the COVID shot suppress your immune system?
No, not really.
No more than any other vaccine does.
You have a lot of post-viral, like after you get a vaccine injected, you tend to have like a down day, and this happens for all sorts of vaccines.
But anyway, sorry, I meant to mention other vaccines like the polio vaccine wasn't perfect anyway.
It didn't provide like permanent sterilizing immunity.
People think of it that way for some reason because we mostly eliminated it.
But if we had more polio cases going around, people would quickly learn, oh, it never did that.
It just allowed us to manage transmission and symptoms better.
And people who caught it young, historically, were able to fend off some of the worst symptoms if they got it later.
And the vaccine basically mimicked that.
So if they got it later, they would have low symptomality, which is what the COVID vaccine did.
It reduces symptomality.
Like you become less likely to have a severe case.
You're more likely to stay off the ventilator and not die.
But it doesn't, actually, it was interesting.
You could see over a few months, the sterilizing immunity it did provide initially faded really quickly.
I think it was within like 90 days.
It was down to being practically nothing.
But the protection against severe side effects lasted a long time.
What, and then we'll move on to the other non-healthcare stuff.
What do you think is the biggest health problem besides obesity facing our country?
Good question.
I think it's heart disease.
And I think we're actually about to win that fight.
I'm actually very confident we're about to win that fight.
So heart disease is the top cause of death, and it is imminently defeatable.
We know the causes of it.
We have the ability to treat part of it right now, but all of it we don't have the ability to treat.
Some people can't take statins because of the myopy I mentioned, and there's no generic PCSK99.
There are no PCSK9 inhibitors that are generic.
They're too expensive.
And a lot of plans, unfortunately, insurance plans, sometimes will say, oh no, even though you have the side effect, we're not going to give you a prescription for PCSK9 inhibitors because they're too expensive.
We're going to keep you on statins or nothing.
And people are like, well, I guess it's nothing then.
I don't have the money for it.
So they just end up with worse hearts.
The other thing is some people have high LPA, lipoprotein A, which does also cause heart disease.
And there's been no treatments for that until very recently.
And we now have five treatments in the pipeline that are highly effective.
One of them is a small molecule.
That means it's an oral drug.
Pillowly you take it once a day.
The other one is an ASO, which is a shot.
You take it, I think, once a month.
And the other ones, the other three, are amazing.
They are siRNA therapies.
And what they do is they're a shot that basically, what it does in effect is it gives you the appearance of having the genotype, the genes of somebody who's a lot more fortunate than you.
And if you have high LPA.
Because LPA is genetically high.
You can't really do anything lifestyle-wise to affect it.
It's just like a death sentence eventually.
You'll have heart attacks down the line.
But now we have drugs that could reduce the amount by 98% or so with a once every six month shot.
We also have siRNAs, not generic yet, but in a few years, for LDL, they do effectively the same thing.
They give you the genotype of somebody who is a lot more fortunate for genetic reasons for six months or so.
And that is amazing.
We are about to defeat heart disease.
We are on the cusp of eliminating most heart attacks, most stroke, most clotting and everything.
It's just about to be gone.
I think that's amazing.
That will extend life expectancy dramatically.
It's going to be so good.
Okay, I want to get into affirmative action, but there's actually one other thing Blake reminded me.
You said the fertility crisis is a major problem.
Absolutely.
Why are we less fertile than ever before?
A lot of it is social.
There's really been no decline in biological correlates of fertility, like your sperm rate or your ability to conceive.
People are just delaying having kids.
They are doing things that lead to fewer marriages.
They don't sanctify marriage as much.
There's been a decline in religiosity.
A lot of factors are implicated in this, and they're all social.
They're cultural.
The fact that religion alone, the decline of that has been significant.
Used to be go to a church, meet a nice girl, and get married.
And then when you're married, you're quite a bit more likely to have kids.
If only because, thank you so much.
All of one, too.
If only because accidents happen more often, because you're not using protection in marriage often.
But correct me wrong, are testosterone rates lower today than they were?
I mean, no, they're not.
So all those studies are wrong?
No, so there generally, there really aren't a lot of studies on this.
We have some cohorts where we track testosterone rates over time.
And the thing is, people are like, oh, look, there's been a massive change because we changed how we measure it and we changed our sample size.
But are sperm motility rates not going down?
Not meaningfully beyond what you'd expect from the increase in obesity.
Because the articles or the studies, they allegedly show a major catastrophic decrease in sperm motility.
A lot of this is down to methodological things, like measuring things differently.
Or in the case of sperm, there is some reason to think that obesity is involved.
Because obesity does lower your...
That's legitimate.
Yeah.
And just being, like reducing people's obesity rate, or the obesity rate is going to be enormous for this.
Don't be fat.
Exactly.
So what would you say?
We have some trials on this, by the way.
On what?
On the GLP1s for fertility stuff.
In men, it does improve sperm parameters.
Or just don't eat as much food.
Exactly.
Same thing, really.
So I guess what would then be the solution to the fertility crisis?
And you're saying more people are getting IVF because they're just getting married later?
Because fertility clinics are experiencing a boom.
They are.
That is a fact.
Yeah, yeah.
Past age 35, there's the unfortunately named term geriatric pregnancy.
After that age, it is quite hard to conceive.
And people are waiting a lot longer because they're getting, for example, more professional certifications.
One of the silly things we've done is extend education rather than accelerate it.
Some places, for example, in Switzerland and Germany, there are some locations where they have reduced the number of required years of high school.
This results in no academic downsides.
Like the kids are still just as prepared as ever.
You just cram more stuff in less time, but they regain two of their years of adulthood.
Instead of graduating at 18, you graduate at 16.
You push back everything, and you are more likely then to get married, have kids at an acceptable age to have kids.
And that leads to just more fertility down the line, which is a lovely little consequence of making your life better, I think, because you spend less time in school.
So you would say the reason why more people are doing IVF or fertility treatments is just that they're trying to have kids when they're 33 versus 23.
Most of it will be that, yeah.
Some of it'll be genuine issues.
People are treating infertility more often instead of just trying to brute force it through that.
IVF treatments are more available now.
They are cheaper than they used to be.
The prices have come down a lot, so it's going to see more use.
And it's more popular, too.
Like there's a lot of cultural emphasis on the fact that it's available, and people are just going to choose that because they can.
Is having children equally as important of a societal value as it was 30 years ago?
To most people, unfortunately not.
The number of ideal children people report is down a lot.
And a lot of that has to do with the fact that they have fewer kids and they experience being around fewer kids.
When you see people who have, like, say you're a younger sibling, or an older sibling, sorry, and you've had to do part of the child rearing with the little baby and you hold the baby a bunch, you're more likely to have your own kids down the line.
You have more family values related to this.
We have some ways of doing causal inference on this with family size fixed effect models that are really interesting.
But basically the gist of it is if you have the exposure to more babies, then you're more likely to want to have more babies.
And if you accidentally have twins instead of something else, your ideal number of kids that you report goes up.
Or, for example, if people around you start having a lot fewer kids, the number of kids you will have is likely going to decrease.
We know this in part because of a lot of unfortunate quasi-experiments in China, where the fact that they tried to limit their fertility so aggressively resulted in reductions in fertility.
Initially, the first phases of doing this, they only restricted the Han majority, the ethnic majority's fertility.
But in areas with a lot of Han, the minority ethnic groups, they also had reductions in their fertility.
But when they were themselves in the majority, they did not see these reductions.
Which is to say, the effect of not being around as many babies, in this case from the Han majority, was to want fewer babies and to have fewer babies.
It's a massive social thing, and it's very sad that people have decided they want fewer kids.
Yeah, I completely agree.
So let's go now to affirmative action.
Yeah.
What?
Yeah, and Harvard in general.
What is the discrepancy between what a white student had to do to get into Harvard versus a black student?
Quite a lot.
A standard deviation, right?
Yeah, it's possibly more than that of the extremes in selecting in.
The reason being, well, at Harvard, so if you were a white student with a legacy, legacy gives you a huge boost.
That was about equivalent to a black student in general.
And if you're a black student with legacy status, you are almost guaranteed to get in if you have anywhere near acceptable academics.
You basically got a free pass if you had reasonable qualifications to get in for a person in your cohort, which is pretty wild.
What would be the average test score that a white person would have to do versus a black person?
The white students who were getting in were getting nearly perfect scores.
They were getting upwards, like upwards of 1550 usually in these recent cohorts.
And the black students were getting considerably less, nearer to the 1400s, which is still impressive nationally, but it is far, far less than the white students.
And so many rejected white students had higher scores and higher qualifications among allotted dimensions.
Like they tended to have higher GPAs, tended to do more extracurriculars, they tended to be evaluated by alumni a little better.
Harvard had three interviews, and two of them were with alumni, and one of them didn't exist.
It was the personality evaluation by the office, you know, the admissions office.
And it basically was an arbitrary way for them to say that Asians had bad personalities so they could justify rejecting them.
But the alumni said Asians had better personalities on average than white or black applicants, and so they should have been invited more.
So then, what would you recommend as the way to proceed with Harvard?
I don't believe what we're doing right now is the correct move to start off.
Like, we really should not just be taking away all their funding.
The simple thing that we need to start with is the NIH and other funding authorities need to start separating the funding that goes to administrations and the funding that goes to research.
Because the fact that we're pulling research funding is devastating.
Harvard has their hands in a lot of very, very important research.
Like what?
Make the case.
Making tons of drugs for one.
That's a big one.
But like a lot of the stuff we know about bulk.
Right, so explain to our audience, what do you mean that colleges are making drugs?
Oh, so they do a lot of the rudimentary discovery.
So for example, to bring back to GLP1s, they were discovered based on some guy's weird interest in Gila monster spit.
Like Gila monsters, the big lizards that you can, that like will paralyze you.
He just wanted to break down what was in there, and he found this wonderful compound that has now been turned into a drug that a lot, millions of people are using.
And they do that basic research, the basic fundamentals of a lot of things that lead to stuff down the line.
Why can't the pharmaceutical companies fund that themselves?
Because it's a high cost.
They really don't have enough money for it.
The returns on pharmaceutical R ⁇ D are abysmal.
They are very, very low.
They're actually below the cost of capital right now, so they're not a good investment.
We've recently had a little bit of a reversion in the long-term trend towards declining returns due to the GLP stuff because they've had a huge boom.
We had a bit of a reversion due to the initial glut of funding that came when COVID started.
But otherwise, it's just been a dagring a lot.
It's been a decline that's continuous for many, many years.
And it's because it's very difficult.
It's hard.
actually making discoveries is really tough.
And if we don't fund the basic research, we're just not going to find a lot of stuff.
Like a lot of our anti-cancer drugs are just because the government was like, oh, cool, we're going to fund your lab to do brute force breaking down of every sea animal you have available and seeing if any of it helps with cancer.
And that has worked.
That strategy of just funding crazy ideas does work.
We know a lot of things work just because somebody had a weird idea.
They got a grant for it.
The government paid.
They were like, whatever.
And it turned into something down the line.
The researcher generally doesn't profit directly from it, but other people who learn from them and learn from their mistakes sometimes will.
What percentage of Harvard research would you say is valuable?
Practically everything in the hard sciences.
I say just slash all the sociology.
How much of the money goes to sociology?
Not a lot, actually.
It's a small portion.
Most of the money does go to harder stuff.
A lot to biology and chemistry and physics.
Hasn't the woke stuff infiltrated the hard sciences as well?
It has.
So then why should we keep funding it?
We should fund the good stuff in there.
I think we should definitely get rid of funding the woke stuff.
What's the difference?
Well, the difference is real discoveries that lead to theoretical progress.
Like the studies that underlie the Manhattan Project were great to do ahead of time.
We funded those labs for many millions of years.
Oh, I know, but that was a bunch of white guys doing it.
At Harvard, we trust them.
Why?
We don't trust them right now.
And we shouldn't trust their administration.
Well, that's what I'm saying, is that they're not hiring based on merit.
Their researchers are not what they used to be.
Potentially, but in the hard sciences, they're still pretty good.
It's evident when people are pretty bad.
Like, there are people who do, they do astronomy, they say.
And all of their work has been talking about getting women into astronomy.
And that is not worthwhile working.
You should be studying astronomy itself, not studying how to involve women more.
So Harvard's sitting on a $55 billion endowment.
Not all of it's liquid, but they could still sell assets.
Oh, yeah.
What is the case then that we have to keep on sending money?
Because that actually isn't that much money.
In the long run, they will run it out if they keep doing a lot of research.
So $55 billion, why is it our problem?
The ROI on that research is still very heavy.
Well, the ROI for pharmaceutical companies is, yeah, for sure.
No, no.
Most of the ROI from new drugs goes to people.
It's because those drugs do allow them to extend their lives or live better lives or live more productive lives.
But we don't get the profits of that, right?
So we're socializing.
We're socializing returns is what it is for a lot of these things.
Yeah, so help me understand that.
So biotech investors do well.
Oh, they do pretty poorly on average, typically.
I mean, they still put money in it.
They do, they do.
They wouldn't keep putting money in.
I get pitched on biotech all the time.
Most don't invest in most of it.
It's mostly.
They wouldn't keep on investing in it if there was no return.
I think a lot of them cope into it.
They think something is going to work.
They aim for moonshots and big things, but the typical returns are very, very bad.
They are below the cost of capital.
I made a graph of this recently on one of my recent blog posts, actually my most recent one, about how 23andMe, the acquisition by Regeneron is a great idea because it will help them to make their R ⁇ D a lot more efficient if they use it well.
But I don't know if they're going to.
I'm hoping that they do.
Time will tell.
But in general, the rate of return is below the cost of capital, which means that it is not profitable.
They're losing money on average.
It's a really rough situation right now.
And we can do a lot to change that.
We're getting out of a biotech winter.
I agree.
But shouldn't have, but hold on.
We should never have entered a biotech winter because we've been funding the hard sciences so much, right?
No, most of the biotech winter, I think, comes from over-regulation.
For example, the cost of gene therapies.
I have recently been helping a lot of companies with this.
They want to reform GMP, good manufacturing practices, because those regulations add a lot of cost.
More than half the cost is just due to compliance with that, apparently.
And great.
We can reform to a model like Australia's, which apparently is a lot lighter, and this seems to be easy to implement, I guess.
But it's still high quality.
It ensures the drugs are good without imposing massive costs on people who are developing gene therapies and when they want to run a trial.
We can also make it easier to recruit people.
For some reason, we've decided to restrict recruitment.
I think a lot of the ideas in healthcare that add a lot of cost come from weird sort of quasi-socialist ideas in the past.
Like there was a health economist in the past who said a hospital bed built is a hospital bed filled.
And the idea there was if you make some new medical resource, people just use it.
So we shouldn't make as much.
So he proposed certificate of need laws, which require you, if you want to be a doctor who goes into a new area and you want to open a practice, you have to ask your competition, hey, is there unmet demand here that you need to practice for?
And of course they're going to say no.
So too many areas of too few medical practices.
And these sorts of laws are, they impact everything.
They impact trials.
Not the certificate of need to law directly, but laws like them.
They impact trials.
They make it really, really hard to do stuff.
And repealing them will, I think, lead to a massive improvement in that area and make it less critical for us to fund all this stuff.
So Pfizer, AstraZeneca, Moderna, Johnson, I know J ⁇ J, those are all American companies, I think.
AstraZeneca is Swedish, I think.
Yeah, okay.
But Pfizer is definitely American.
Yep.
So is J ⁇ J. Yep.
Those two together, probably, what, $500 billion market cap?
Huge.
Why can't they fund their own research?
Because it is just too expensive to look at everything.
Take out a loan.
Take out a loan.
Seriously, I mean, so you're $500 billion of market cap, collateralize your stock, take out a $5 billion line of credit.
Problem is, the likelihood of actually getting those returns is just too low.
That's the market, though, right?
A lot of what we do nowadays, in order to overcome this cost issue, is we in-license things from China.
So, for example, Nova Nordis, Danish company, would be a good idea.
That comes from my question.
If we invent a GLP, why is it that the Danish company is worth a trillion dollars?
They're the ones who got the patent.
And they are, I think we funded the research.
A lot of it was the government.
American government?
A lot of it was Harvard, actually.
I know, but hold on.
So you're arguing.
The American government.
So we just made a Danish country a trillion dollars.
That doesn't.
It doesn't help your case.
No, it doesn't.
We should get that back.
think we should march in and take the patent with Baydol, which is another topic entirely.
I think we should actually...
So we funded the rise of a trillion-dollar foreign company.
We Did so we should stop doing that?
No, I think we should actually do it more because the social returns are still larger.
If you can make people not fat, the returns to that are huge.
Yeah, I mean, but you see what I'm saying?
Like, we're not here to fund foreign companies, right?
The thing is, Americans want it.
So it's funding the creation of a product that Americans could want.
On this particular thing, I think we should be beating up Nova Nordisk right now.
They've done a lot of good.
They've put in a lot of work.
They invested a lot of their own capital developing this thing, and they've had a lot of failures, too.
I was going to mention CAGRI Simma is one of their proposed improvements on Simagglutide, Ozimpic, and it failed.
They in-licensed it for billions of dollars from a Chinese company.
They did all the trials, and they turned out to not be any better than Simaglutide.
So they lost a lot of money on that.
And their stock has been tanking ever since.
It tanked like 6% in a day when the results came out.
And like, that is a good, if a small company had done that, they would have gone bankrupt.
And going bankrupt is the norm for these small medical researchers.
Like their Alzheimer's last year, Cassava, I think was the name of it, or Sassaba or something like that.
They went bankrupt overnight because their trial results came back.
Bupkus.
Billions lost.
Evaporated.
It's part of the welcome to the market.
Yeah, it's very bad.
I don't know if it's bad.
It's healthy, though, right?
The thing is, though, it leads to this conformity.
There's a conformist strain in, actually this is a great, I'm glad you brought that up.
There's a conformist strain in pharmaceutical research.
It's worse than anywhere else, any other area of research, because it is so strict.
You are likely to fail to an extreme, extreme degree.
And there's likely to not be any benefits to your company.
It'll be to somebody else's company, maybe down the line.
That does happen all the time.
Some company fails and someone else harvests it later.
Royvant, that's Vivek Ramaswamy's company, their whole model is look at the secondary outcomes that were affected in trials for failed drugs and then go, ah, we're going to get it approved for that indication, helping with that secondary outcome.
And that has worked really well for him.
He's made a lot of money from it.
But the conformist attitude I'm talking about is that these companies are so hesitant to do anything that is not like heavily expected that they just don't invest in obvious things.
So obesity is a great example.
Nova Nordist's CEO, and I quoted this to Blake the other day.
He, and I can find the quote, it's really bad.
He does say we're not going to like search for drugs that help with obesity.
He says it's a social and cultural problem.
And so to treat it, we need a radical restructuring of society.
Novo Nord, he said radical restructuring of society.
That is an exact quote.
It's in there.
Not a pharmacotherapeutic cure.
And it's like, wait, that's your whole thing now.
You're just, you're selling weight loss stuff.
But years ago, that was the attitude.
It was until some researcher pushed them really, really hard and continuously, they weren't going to do it.
You know, one of the biggest lies being sold to American people right now is that you're in control of your money, especially when it comes to crypto.
But the truth, most of these so-called crypto platforms are just banks in disguise, fully capable of freezing your assets the moment some bureaucrat makes a phone call.
That is not what Bitcoin was built for.
That's why I use Bitcoin.com.
I just did a major transaction on it.
They offer a self-custodial wallet, which means you hold the keys.
You control your assets.
No one can touch your crypto, not the IRS or not a rogue bank, not some three-letter agency that thinks it knows better than you do.
This is how it was intended by the original creators of Bitcoin.
Peer-to-peer money, free from centralized control, free from surveillance, and free from arbitrary seizure.
So if you're serious about financial sovereignty, go to Bitcoin.com, set up your wallet, take back control, because if you don't hold the keys, you don't own your money.
Bitcoin.com, freedom starts here.
So to circle back to the universities, what is an efficient way to make the colleges stop discriminating?
Beat them down by...
So this policy proposal has made it to Trump's desk, and he needs to just sign it.
This will fix it right away.
Tell me, I was with him yesterday.
iPads reform.
We have an iPads.
Integrated Post-Secondary Educational Data System.
We have a data collection thing, and I can show you what he needs to sign if you want to push that on him.
It just needs to get done.
We have a data collection mechanism that already exists and does allow you to gather the requisite data to find everybody red-handed.
You can catch every university inflagrante delicto if you force them to report all the necessary outcomes to indicate if they're discriminating.
And we can already do this through an existing system.
It would take no extra effort on our part, and it would just put a little cost on the universities.
It's minimal.
All they have to do is report the data, force them to report the data.
We have that authority.
We can tell them no public funds until you start reporting this, that, and the other data.
And the exact data has already been detailed by...
So for example, we have some idea.
So Harvard, after the Students for Fair Admission case in 2019, they had about 31% of their student population be black.
Yep.
A white, white.
Yeah.
White.
And it basically stayed the same.
MIT, their black population collapsed to like 4%.
Am I correct in this?
And it should go down more because we know that it's not.
But they're directionally going that way.
So that little sample size was evident that someone was following the Supreme Court decision.
Oh, yeah.
Someone was not.
Am I correct?
Yeah.
And lots of different universities, we have their emissions data now, and a lot of them have followed it.
They've followed the advice.
They've done what they're supposed to do.
But so many aren't, and that's bad.
And none of them is doing it as well as they should.
They are all still discriminating to some extent.
And we have to stop that.
And iPads will help.
iPads will help.
It's very, very easy.
We have everything that we need to collect written up.
It's already hit Trump's desk.
He just needs to sign it.
Someone needs to tell him, hey, reminder, sign this order right away.
and we can catch them all, people will go out of their...
Republicans don't seem to know this, but data collection is the way to win a lot of political battles.
Liberals have known this for many years.
Democrats, they mandate data collection in a lot of areas from healthcare on down to education because they can use it to catch people and start a legal case.
They mandated the collection of certain test score data back in the day for schools because they wanted to be able to sue for disparate internet stuff.
They wanted to be able to sue for all sorts of things.
They mandate you, me, and everybody else reporting weird data that they can use in like citizen action.
A citizen, a law firm, somebody can go and file that case, make that money.
They can make social change through torts, through the legal system.
A lot of the regulation we see these days is because of some, frankly, often dumb legal decisions that were funded basically by the government because they produced the underlying data.
They mandated the collection.
What data should we start collecting, especially on crime?
On crime, we should have more up-to-date data.
The fact that we don't is very weird.
It makes it very difficult to actually get a lot done in crime.
Like, you can't tell when something works.
And if you want to tell when something works, you need to be able to have the updated data, or else you've got to wait years to figure it out.
If you want to have adaptive policy where we can rapidly change our direction on things.
Yeah, we only get the murder numbers for the past year about a year later.
Yeah, and that's not efficient at all.
Some people have tried to create live indices that give you a week delay, but it's just not very effective.
And they have to update all the time.
We actually, I think the biggest area where slow data collection kills is the CDC's death index, which is supposed to be a live updated index of dead people when people die, but they don't update it very quickly.
So you might wait, if you're running a trial and you want to track, do my patients in the trial live or have they dropped, why have they dropped out of my study?
You want to know, is it because they died?
And you might have to wait a year.
And during that time, you could have had, you could have gone to the FDA and been like, hey, actually, our drug works so well that we can stop the trial early and start giving it to people.
But you can't because the death index is so slow.
What is the, we've got to go rapid fire because we have another.
What is the number one proven way to stop crime?
Oh, man.
Arrest people.
Put them in jail.
I thought we have too many prisoners.
We don't have enough prisoners.
Now he's speaking my language.
Too many prisoners is always a relative to what?
Stupid left-wing talking point.
It's a very bad question.
So they'll say this, and they say this in Oxford, that we have a certain amount of the world's prisoners.
You've heard this whole expression.
They draw these graphs where like America's off the charts, and it's like, yeah, because we're a lot more violent than everywhere else.
We are very, very violent.
We have more guns than we shoot more.
So do we have an under-imprisonment problem?
We do, very severely.
It's funny.
So the big reason for the reduction in the crime wave that happened near the beginning of the 20th century is because we started incarcerating more.
We started putting crazies in asylums.
We started putting wackadoo violent people in jail.
Very simple.
And we had a reduction that led in part to the crime wave in the 1980s.
And then we had an increase that led to the reduction afterwards.
If you incarcerate a lot of people, you will have a reduction in crime because you'll put away these big offenders.
If you have like a certain number of offenses, they'll just lock you away for a very long time.
It's all right.
You gotta love the Dutch.
Yeah, it's like three strikes, but better.
They managed to reduce a lot of their violent crime by about 25%, I think, by just arresting super offenders.
And that's trivial.
That adds almost nothing to the jail population, but it puts back, it gives you back communities.
It gives you back inner cities.
It gives you back huge swaths of the American everywhere that is violent.
You can even do gang crackdowns like they did in New York, and you can immediately see 20% reductions in all violent crimes in the city.
So we need more prisoners, more people arrested.
Absolutely.
We are under-imprisoned right now, and we are under-policed.
That's even bigger.
So America has more of an under-policing problem because we're afraid to pay for a lot more officers.
I totally agree.
The weird thing is Europe, they police a lot more relative to their crime levels than we do, which is weird.
Why did they have so many more police, which allows them to incarcerate less?
Because having police driving around, that's a deterrent.
If you have a police doing a patrol in a gang-riddled neighborhood, they are less likely to shoot.
It's so obvious.
I mean, these people are so dumb when I talk to them on campus.
They're like, oh, police cause crime.
I say, okay, let me ask you a question.
Let's pretend that you're a gangbanger and you're about to shoot up another rival gang.
And you turn the corner and there are two cop cars.
Are you more or less likely to do the gang shooting?
That's right.
This is not hard.
And they say, oh, they'll come back later.
Okay, then less likely.
Yeah, exactly.
This is not hard stuff.
And most violence is fruit of the moment stuff.
It's not planned at all.
It's exactly.
Well, the gang stuff, yes and no.
Even still, a lot of the gang stuff.
So tell me, what do you mean by that?
So very little violence is premeditated.
People don't generally go out of their way to plan out a murder.
They tend to do it in the heat of the moment.
It happens from a fight, an insult, somebody getting drunk and doing something.
Sure.
Somebody on drugs.
But isn't the gang stuff like tonight we're going to go shoot something up?
So there is some premeditation.
There is some premeditation, but gang crime is not actually anywhere near the majority of our crime problem.
It's mostly like random one-offs.
And those, you prevent them by like locking up the crazies away for their earlier offenses.
Carrying weapons.
Yeah.
Defend yourself.
Well, actually, the great thing is you could just police carrying weapons a lot better because a lot of them carry weapons when they shouldn't be able to.
They're not allowed to because they're a felon.
They have prior offenses.
If you lock them up for those prior offenses, you will stop them from doing the more hideous crimes like actually killing someone.
So we're very lucky on this program.
We spend a lot of time with President Donald Trump.
What executive orders do you think he should do?
iPads is one.
Just start nailing them off.
I'll pull up my list.
You have a list?
Good.
I do.
Yeah.
Let me just pull this up real quick.
So another.
I think you'd be an Android guy.
There you go.
So he needs to do the iPads executive order.
That's a great one.
That will cripple a lot of the bad things that, like the discrimination right away.
That's simple.
Another one is he needs to address the academic publishing cartels.
You mean like Springer nature and stuff?
Oh, yes.
He needs to crush them.
And he can crush them.
He has the right to.
So we did a whole segment on Springer.
What do you mean by crush?
Tell me.
Ah.
So they have extreme profits for no good reason.
They should not be profiting like they are.
We have an executive order typed up that needs to hit his desk, immediately needs to sign it.
You need to tell me who wrote that.
I'll show you afterwards, actually.
Yeah.
Okay.
Sorry.
There are several here that I will show you.
So crush the cartel like Springer nature.
Yes.
You can actually mandate that a lot of research start becoming publicly available.
They shouldn't be able to charge.
Then just get closer to the mic.
They shouldn't be able to charge fees to access a lot of the research because if it's publicly funded, it is actually publicly owned in a meaningful way.
Like the government has legally the ability to say, hey, that paper cannot be behind a paywall.
I want it now.
And they can reclaim it.
And they can do this for most research.
It's published.
They should do this immediately.
And then democratize it.
Yeah.
And then they should say.
Exactly.
And they should say, you cannot spend public funds, like your research funds, on article publication fees.
If you want to publish an article, you should not be, you shouldn't use your research funding on this frivolous thing that doesn't need to exist.
The add-on from these journals is almost nothing.
They don't do much editing.
And the peer review they get is free.
It's voluntary stuff from other researchers.
So it wastes their time, too.
It makes our research dollars much less efficient.
So what would you recommend the president does with the academic?
Because I have had friends that I really trust say this is a huge issue.
Yeah.
I will show you the exact details on this afterwards, but we have a lot of things that are written in here.
Basically, force all code and data into public repositories, prohibit using funds on academic publishing, and reclaim all of the research that has been hit with public funds.
That should have been done a while ago.
There's some stuff at the NIH that should be going on at this.
They are going to remove, for example, their one-year embargo on their research.
There needs to be effort done on making data transparent.
So papers published with funds from the government, they need to immediately be made to require all their code and the providing of data.
They need to open up a lot of data that is out there that is arbitrary.
So this is actually great.
A lot of research is arbitrarily stopped by bureaucrats.
Their reasons?
They don't have to provide them.
They don't have to say why they're denying you, a given researcher, access to some data set maintained by the government.
Could be they don't like you because you're white.
That's exactly it.
And that actually has happened to a few people.
Of course it has.
There was going to be a lawsuit two years ago about this, and then they were like, ah, whatever.
We'll just not do it.
We'll wait for stuff to happen.
Some of the researchers wanted to investigate the relationship between BMI and education, and they wanted some genetically informative models, so they wanted to get access.
You mean body mass index?
Yeah.
They wanted to research this.
And the NIH said no, and they were like, what's the reason?
They're like, we don't have to tell you.
So whatever.
You're not allowed to do it.
These bureaucrats can just say no for whatever reason.
Are there any correlations between somebody's race and their BMI?
Oh, yeah, considerable.
It's interesting.
Black men tend to have about the same BMIs as white men, but black women tend to be much, much more obese than white white men.
Is it just because of dietary or is there a genetic reason, you think?
It's ultimately dietary, but we don't know why.
So the thing is, if something's dietary, it could be heritable too, meaning like the disposition towards liking sweet foods.
There's a genetic component to that.
So people who like more sweet foods might be disposed towards wanting to eat more of them.
Is there anything to the IQ differences between race?
Considerable, yeah.
The evidence is really dispositive these days, and people get really worked up about it.
It makes a lot of people very, very offended, but every time you test it, you get the same result.
What is the result?
The result is about a one standard deviation gap in IQ between blacks and whites in the U.S., about 0.5 standard deviations between Asians and whites.
Asians do a little bit better, and about 0.66 between Hispanics and whites or Hispanics do a little bit worse.
And that's just how it's been for the, I mean, as long as we've measured it.
In fact, even using proxies from literacy tests back in like nearly the 1870s, like they were given as part of the census, you can see the same sorts of gaps.
They're similar in magnitude.
It's been around forever.
It's how it is.
If you want to address it, we have to stop clamoring about it and getting worked out about it.
How do you raise IQ?
We don't know yet.
Genetic engineering is the most likely means.
Embryo selection, choosing to have the smarter kid among a set of embryos if you're doing IVF, a lot of things like that will actually make material differences.
They're the only things we really know about.
Remind our audience what a standard deviation is.
A standard deviation is going from the median to about like the 67 percentile or so.
So it's moving up quite a bit.
Do the IQ differences between races, does that happen across the planet or is that just to America?
It happens across the planet.
And there is differences in selectivity.
So like, for example, the UK gets relatively elite Africans as immigrants, and they get relatively elite.
A lot of Nigerians.
Yeah, they get, oh yes, a lot, because it's the biggest source country in Africa.
It's the most populous.
It's the most populous.
And it's part of the Commonwealth.
So they will get a lot of those.
America gets the most brilliant Indians.
We actually have their test scores.
We have their test scores on the joint entrance exams to the IITs, the Indian Institute of Tech.
And the higher their score on those exams, the higher their rank in the whole country, the more likely they are to immigrate.
And in particular, the more likely they are to immigrate to America.
So we get the smartest Indians.
But their national IQ is just very low.
We don't see those people, though.
What do you think caused the genetic differences in IQ?
A lot of it's probably drift.
A lot of it has to do with selection over time due to socioeconomic stuff.
So for example, in the not so distant past, people who were a lot better off had a lot more surviving kids.
They didn't have any difference in fertility or anything, but infant mortality used to be extremely socioeconomically stratified, where if you were, for example, in Poland, the Jews there, they tended to live quite well.
That's where my family is from.
That's where our last name is from.
It's in Poland.
They tended to live quite well, and their infant mortality rates were low.
And the higher up within that community, the lower the rates were.
So you had more surviving kids.
And the upper classes over many generations would replace the lower classes.
This is Gregory Clark's thesis for why people became, why we had Industrial Revolution.
We reached a point where we had hit some threshold and the good traits for being economically successful had proliferated enough throughout the population because the poor people in every era didn't survive very much and the richer people did.
Why do you think people get so worked up on IQ differences?
They overvalue it.
They value, oh my God, that person's more intelligent than me.
That can't be.
They refuse to believe in intelligence differences unless somebody's like a clear genius like John von Neumann.
They hate the idea of being lesser or anything like that or being perceived in certain ways.
They attach so much emotional valence to it when it should just be a simple thing.
We can do a lot of policies that reduce the importance of IQ differences.
Like in Sweden, when they scheduled people to get vaccinations during COVID, that led to a reduction in the IQ stratification of vaccination rates, and that led to a reduction in the IQ stratification of mortality rates.
So those lower IQ people were dying in a lot of counties, but in Uppsala, where they pre-schedule everyone, the lower IQ people were more likely to go out and get the vaccination, and they were more likely to stay off the ventilators and survive.
Fewer serious side effects in that county.
And there are a lot of policy options like this that allow us to make those differences less significant.
The longer we treat them as taboo, the more likely we are to just continue contributing to the plight of people who have low IQs for no fault of their own.
Yeah, and so, I mean, again, I don't even have much more to add to that.
I just, I mean, Douglas Murray wrote about this extensively.
Is there any irrefutable, is there any contrarian data we might be missing here in regards to IQ differences because it gets people so worked up?
They say it's not true, it's a hoax, it's a scam.
I think we're actually missing out on a lot of the policy experiments we could be using here.
So you can very simply go out to a hospital and gate the Wi-Fi with a short little optional test or whatever.
And you can learn about a population of Medicaid users or Medicare people.
Anything like that.
You can learn about cognitive decline in simple ways if you just normalize testing.
But this stuff is so taboo that it's hard to implement these simple data collection programs or anything that could result from those programs.
It's like we've cut off a tech tree because we're afraid.
I meant Charles Murray, not Douglas Murray.
Oh, yeah, sorry.
I was confused.
I was like, what did Douglas Murray?
Big difference.
Yeah, notable.
Yes.
So let's now go to closing.
I think that will sufficiently piss people off.
I think, yeah, you saved the worst for last.
You challenge yourself to write a blog post in a single hour.
Tell our audience about that.
And just tell more about kind of what you do and how you do it.
I mean, obviously, you have a remarkable grasp of these topics, and it's impressive.
So just tell us more about yourself.
Thank you.
To the extent you can.
So I don't want to give away too much.
I know you have to be careful.
I'm completely on your team there because the bad guys are bad.
They are very bad.
Golly, just yesterday I got mailed something that was very rough.
I'll tell you about that later.
So the thing is, I don't like to waste a lot of time.
When I have a job and I have to work and do a lot of other stuff, there's a million projects I'm involved in.
I advise a lot of companies on various things, and I have to manage my time pretty carefully.
If I waste too much, then that blows away my day and it blows away my productivity.
It makes me feel pretty bad.
I feel down if I waste too much time.
So I try and constrain myself to about an hour, or if I know it's going to be a longer post, I'll do two hours for a lot of my posts.
And I have a little timer after I've made just simple Python scripts.
I write it all up in WordPad, and it automatically closes it and deletes everything if I don't do it in the allotted amount of time.
And I think that's a pretty good way to manage my time.
It forces me to stay on topic, think about it ahead of time, manage all the thoughts in my head, really line up how I'm going to do the post long before I've actually done it.
And I don't make any notes because I think that's cheating.
But I will, like, sometimes I'll make graphics a few days ahead of time, like showing off something from a paper, and I'll include that in the post, and I'll be able to go and reference it and bring it in.
But I don't usually make things for a post during it because I'll be on a time crunch and I'll have made it ahead of time and thought about it and all that.
And you're mostly a sub stacker.
Is that fair to say?
I mostly do substack for my writing, yeah.
What would you say?
This is my last question, and we do have to dash.
I think we've been almost two hours, almost.
What topic do you think is most intellectually not explored on the right?
Ooh, wow.
That's a really, really good one.
So I'm going to give a really, it's going to sound odd, but I think deregulation is underexplored.
I think that the right talks about it a bunch and they mention it, but they don't know the specifics and they don't think about it.
They don't think about the function of bureaucrats or how they work or how to reform our systems or anything.
And this is actually a thing where we really see a lot of lag among Republicans and libertarians relative to Democrats because Democrats understand the system and how it works and they understand what a direct final rule is or they understand the process to go through to change some regulation or pull a guidance document or anything like that.
And Republicans just have no idea.
And this leads to a major, major human capital problem.
Do you think it's a bigger problem that we just need to learn how government works?
Absolutely.
Yeah, I think Republicans especially have no idea how anything works that is crucial for them to change.
And it's led to Republicans not being the ones to staff their own governments.
So when a Republican comes into power, they tend to still have a bunch of Democrats working under them and they frustrate them.
They try and do things that prevent them from actually exercising their will and changing policies in the way that they need to.
And it makes them look less effective and it makes it harder for them to get re-elected and all that.
You're very bright.
To what extent is AI going to change our lives the next 10 years?
Probably a lot.
Very, very considerably.
It is going to make massive, massive differences.
My probability of doom is very low.
That P-Doom is what they call it in the UK.
I'm with you.
I don't think it's going to kill us all.
I don't think there's actually a medium for AI to do that.
But I do think there are a lot of ways that it can implement, like it can aid discovery of new glass.
Quantum computing, especially.
If they marry the two together.
new ways to do all sorts of things.
We can do so, so much if we have...
Probably very large, not in the next 10 years, but after that, yes.
I think in 20 or so years, we're probably going to see 10 to 20% disemployment, like people getting kicked off the job market and not being so useful.
So you said about 20 years from now.
Wow.
Some people are more bullish.
They think it's going to happen in the next five to 10 years.
But I mean, who knows?
It's all guessing, right?
Yeah, it is.
But we'll see.
Do you think it will lead towards an inevitable apex of totalitarianism?
No.
I'm hopeful that it doesn't.
That's my worry, though, is that if China achieves super intelligence before we see it.
GCI, CGI, or whatever.
AGI or ASI.
AGI, artificial general intelligence, ASI, artificial superintelligence.
If they reach that first, and a friend of mine, Jeremy No, he has written about this quite a bit.
His big fear is not that AI will go out of control like a sky net and kill us.
It is that China will get it and they will use it to beat us thoroughly.
And if the Marxists are in charge, then we are doomed.
Do you think it will eventually eliminate private property?
No.
I don't believe in any of that.
I think that's like a communist sort of pipe dream, that it'll make all of that superfluous and we'll live in Star Trek utopia.
No.
I think private property is actually essential to social organization.
I agree, but do you think it will, I mean, Andreessen flirts with this, that it will be the most effective war on scarcity we've seen in the modern world.
Oh, I think it will.
It will definitely be a war on Scarcity.
It'll make it so we live in an era of abundance that is unprecedented.
But I just don't believe that it'll fundamentally alter a lot of our social institutions, and it might even bring us back to something that's a little more palatable.
That's a very optimistic take.
I'm optimistic.
And I hope you're right.
Is there anything we didn't talk about?
How can people support you?
Talk about your Substack.
This was phenomenal.
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Follow me on Substack.
I don't have a Patreon or anything.
Do you have an email that you can give?
Because you're going to get a lot of spicy feedback on some of the COVID stuff.
If you subscribe to me on Substack, you can message me there.
My DMs are open to paid subscribers.
Great.
Very good.
And I'm sure you'll read any thoughtful critiques, right?
