November 14, 2020
[00:01:22] Podcast Sponsors
[00:04:09] Guest Introduction
[00:08:05] How Dr. Maroon Lays Claim to the Title “Burnout Expert”
[00:13:42] The Connection Between Burnout and Adrenal Fatigue
[00:18:20] A Day in the Life of an 80-Year-Old Peak Performer
[00:20:48] Using Hypothermia in Conjunction with Surgery
[00:22:28] What Inspired Dr. Rabin to Form the Board of Medicine
[00:28:34] The Number Needed to Treat (NNT) vs. The Number Needed to Harm (NNH)
[00:33:21] Podcast Sponsors
[00:36:38] Whether the NNT is Applied to Plant Medicines, Herbs, CBD, and the Like
[00:41:30] How AI Is Used for Human Optimization
[00:52:30] Psychedelics, Plant Medicine, And the Future of Healthcare
[01:00:30] Concerns About Psychedelics from The Perspective of The Neurosurgeon
[01:06:13] Neuroimaging to Diagnose the Executive Network of The Brain.
[01:09:10] What David And Joe Are Most Excited About for The Future of Healthcare
[01:17:16] Closing the Podcast
[01:18:34] End of Podcast
Ben: On this episode of the Ben Greenfield Fitness Podcast.
These are the type of things that I think we'll see emerging more and more that are going to make what we're doing right now in healthcare, just look like the dark ages.
David: Ultimately, going back to the Hippocratic oath, we swear to take an oath that says, “First, do no harm, not first heal people. The healing comes after the doing no harm.” And when we dissociate that idea of “I am disordered to, I feel sad right now, and here's why,” then all of a sudden, it creates opportunity to heal.
Ben: Health, performance, nutrition, longevity, ancestral living, biohacking, and much more. My name is Ben Greenfield. Welcome to the show.
Today's podcast is with a couple of psychonauts, Dr. David Rabin and Dr. Joseph Maroon, and we are going to talk all about–well, not just psychonauting, these guys are actually guys who are pretty well versed in stuff like plant medicine. Dave is well-known for introducing the Apollo, one of my favorite wearables for controlling stress to the world, but they're really trying to revolutionize healthcare, and they have some cool ideas that I think would be cool to share with you, which is exactly what I'm about to do.
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Well, folks, this should be an interesting episode because it's all about the future of healthcare, which might sound a little bit boring perhaps, but the folks who I have on this show, they actually have delved into everything from wearables to AI, to plant medicine, to a whole lot more. And so, I think this is going to be a thrilling discussion for you. The first guest who is joining me has been on the show before. We did this huge podcast a few months ago that was really popular on this wearable. I call it plant medicine for your wrist, but basically, it's the first clinically validated wearable. It's called the Apollo that helps you to do things like focus, and sleep, and meditate, and socialize. His name is Dr. David Rabin. He's an MD, Ph.D., neuroscientist, board-certified psychiatrist, and a health tech entrepreneur and inventor. He's been studying the impact of stress in us humans for nearly 15 years. And he's the co-founder and chief innovation officer at Apollo Neuroscience. He's also the co-founder and executive director of a very cool new medical board called the Board of Medicine. And we'll talk about that a little bit in today's show. So, he has an MD in medicine and a Ph.D. in neuroscience.
My other guest on today's show is Dr. Joseph Maroon. He hasn't been on the show before. I don't know why I didn't know about this guy because he's got a pretty impressive resume. Not only is he 80 years old and just finished–well, I don't know what number Ironman did you just finish, Dr. Maroon.
Joseph: I've done eight total.
Joseph: I'm down to half Ironman and Olympic distance now, Ben, in all honesty. My last Ironman was about five years ago in Hawaii.
Ben: But you didn't even start Ironman until you're like 50, right?
Joseph: That's right.
Ben: Wow! Okay. So, that's pretty impressive. And Dr. Maroon, perhaps because he's been racing Ironman so much, is also a world-renowned so-called burnout expert. Well, we'll talk about burnout quite a bit on today's show because he specializes in that. But he also is involved in the development of minimally invasive surgical procedures for diseases of the brain, the orbit, the spine, traumatic injuries to the central nervous system, brain tumors. He's actually the co-developer of ImPACT, which any of you who are involved in the TBI or concussion sectors are probably well-familiar with it. It's a neurocognitive test. That's the standard of care for concussion management in pro-sports like the NFL, the NHL, the MLB, NASCAR, and it's the only FDA approved test for concussion evaluation. As a matter of fact, when I was running a sports performance facility and was partnered with a sports medicine doctor at that facility for several years, Dr. P.Z. Pearce, we used the ImPACT test quite a bit at that particular facility. So, I'm kind of familiar with that one already. Dr. Maroon is also the neurosurgical consultant for the Pittsburgh Steelers for the past 30 years and the first neurosurgeon ever who was directly appointed in the NFL.
So, these guys together have been up to a lot. David Rabin was filling me out and now he's been amassing this dream team called the Board of Medicine, which is a 501(c)(3) nonprofit that's led by some of the world's leading experts across artificial intelligence, nutrition, psychedelics, and clinical medicine to develop this all-expansive approach that's a lot less myopic than the current medical approaches that weaves in the digital, the psychedelic, and beyond, kind of converges eastern and western medical disciplines. So, we're going to get into that and what that actually looks like on today's show. But before we do, a couple of things. All the shownotes are going to be at BenGreenfieldFitness.com/futureofhealthcare, if you want to dig into anything that we talk about, including my previous podcast about the Apollo wearable with Dr. David Rabin. So, that's BenGreenfieldFitness.com/futureofhealthcare.
And then, my burning question, pun intended, is going to be for you, Joe, and that is, what does it mean to be a burnout expert? That's an interesting phrase I don't think I've heard of before.
Joseph: Well, basically, Ben, it's a burnout expert is one who's been there and somehow has managed to survive. And when I finished my residency, six years of nerve surgery, four years of medical school, I was bound in my own ambition to become a very successful neurosurgeon. I actually did accomplish that over the course of the first 5 to 8, 10 ten years of my career. As you've said, I was appointed the team neurosurgeon of the Steelers and I was doing very significant research and profound hypothermia, and operating on aneurysms intracranially for very profound cold to preserve the brain. I was flying high, somewhat like Icarus. You might remember the mythological story of Icarus who once detained flight sword higher and higher until the wax melted from his wings and he plummeted into the sea. And I was riding pretty high kind of Icarian, you might say, in my mid-40s, and suddenly, my father passed away suddenly of a heart attack at age 60. And my wife left in the middle of winter to another city with our two kids and I had to quit neurosurgery all the same week.
My father bequeathed a dilapidated truck stop to my mother. So, one day, I was doing brain surgery on awake patients, and the next week literally, I was working in a truck stop helping my mother try to salvage a heavily mortgaged truck stop and wondering what in the world happened to my career. I muddled along actually for six to eight months. It took me a year to get out of overwhelmed, overworked, overcommitted, overstressed, which is essentially burnout. People asked, “Well, how do you reverse something like that?” The failure of psychotropic drugs, the failure of psychotherapy, and wondering what in the world. How did I end up here? There's a statement that every man's life is a diary in which he means to write one story that oftentimes writes another. And his humblest hour is when he compared the story as it is with what he vowed to make it.
And with me working in a truck stop in my 40s was not what I vowed to make my life. But you will appreciate this very much, Ben, because I was able to reverse the depression when the banker, who held the mortgage on the truck stop, called me and said, “Hey, Joe, let's go for a run.” And I said, “Run? I can't walk. I'm 20-pounds overweight, terrible insomnia.” And somehow, he forced me to go down to this track where I made it around four times. And I said, “Never again.” But that night was the first night I actually slept in about three months. And a little light bulb went off, so I went down the next day myself and went a mile and a quarter, then a mile and a half, then three for increasing it. And as I increased my mileage, my depression abated, my diet improved. I started feeling human again. And I learned to bike, I learned to swim, and that's how really, I got into triathlons not as a pursuit where I want to do this, it was life-saving for me. I've really looked into the physiology of stress. I've looked into what exercise does to the human brain, how to overcome stress. And well, William Osler, a physician many years ago, who said, “While preaching a doctrine of balance, I myself am a castaway.” So, when you ask how do I become an authority in burnout and balance? I myself was a castaway.
Ben: Interesting. And you wrote a book about all this called “Square One,” I know, that delves into what you experienced after becoming a world-class neurosurgeon and achieve success, and then delved into the darkness of depression that you talk about now. But when people talk about burnout, a lot a lot of times, another term that's used is adrenal fatigue. And I'm curious what your thoughts are about that because there's this idea that there's this catch-all term, almost like fibromyalgia called adrenal fatigue when in fact, in many cases, folks have just fine diurnal cortisol rhythms, but in fact, their HPA axis dysregulation is related to inflammation, or to glycemic variability, or to so-called stealth infections like mold, or mycotoxins, or metal overload, or circadian disruption, or electrohypersensitivity. When somebody comes to me and says, “Oh, I'm burnt out,” or, “I have adrenal fatigue,” or, “I have a hard time getting out of bed in the morning,” they're just like, there's so many things that one could dig into that could be the actual underlying cause for that. And everybody thinks, “Oh, my adrenal glands can't produce cortisol,” or, “I have some kind of like Addison's disease or something like that.”
But what's your take on how burnout would be related to adrenal fatigue?
Joseph: Well, it's obviously very directly related and you're very informed in this area. Walter Cannon was a physiologist in Harvard in the 1920s. And he coined the term homeostasis, the ability of the body to maintain stability under all circumstances. If the temperature drops or goes up, we still maintain our 98.2 temperature. Our kidneys work, our [00:14:13] _____ kept in balance. But also with stress, what happens? So, as you said, the adrenal, the hypothalamic pituitary adrenal axis, he discovered, as well as Hans Selye, another physiologist, that there's a massive outpouring of adrenaline. Cannon described the fight-or-flight syndrome. So, what happens when we're stressed? Well, there's an outpouring of cortisol from our adrenal gland.
Ben: Right. No. Also, DHEA, pregnenolone, there's a lot of stuff that gets released in that initial acute stress phase response.
Joseph: And initially, as you know, it's life-saving, it's fight-or-flight. However, when it's chronic and unmitigated, when you match adrenal fatigue, you could also say adrenal atrophy. And the adrenal glands literally atrophy, as well as the thymus gland, which is very important in terms of immunity. And Hans Selye discussed this in animals and in people, and coined the term stress or stress response, and also, what's called the adaptation syndrome. And the first response to stress is there's an alarm reaction, fight-or-flight. The second is resistance. And that's where you develop the ability to resist it. And if you don't, what happens? There's exhaustion and death. So, if you don't develop resilience on the second stage, there's exhaustion, and that's adrenal fatigue, atrophy of the thymus, and also the adrenal gland associated with peptic ulcer disease as well, and death. The Japanese have a term for this called Karoshi.
Ben: I've heard of that before. That's like work to death or something like that.
Joseph: Exactly. When they work 130 hours for Mitsubishi or whatever company that they're working for, their pride is so strong, they never go home. And literally, it's fatigue and death exactly, as Hans Selye demonstrated in animals. So, adrenal fatigue is exactly what you said, and it suppresses immunity, you get overwhelmed, your cortisol level. Then we know what excess cortisol literally destroys cells, particularly in the hippocampus, which subserves memory. So, people under chronic stress are a little confused, they have memory impairment, they literally are killing excitotoxicity, killing the cells in their hippocampus that subserves memory.
Ben: Interesting. When you were going through your depression and your burnout, did you do much testing of cortisol, or free testosterone, or thymus gland function, or anything like that and find that you had endocrine dysregulation or some of these issues?
Joseph: I really wasn't aware of what we're talking about at that time, Ben. I was trying to survive, literally just trying to survive on a daily basis. And I want to emphasize to the audience, it was that run around the track that saved my life. And that's what led to–I did a mini-triathlon and I felt like Roger Bannister breaking the four-minute mile. And then, I kept increasing the bar, but really because I felt good when I worked out. I was able to function at a high level because of my exercise, and meditation, and change in diet, and improving the relationship with my family. All of those things that I discussed in the book “Square One: A Simple Guide to a Balanced Life,” really turned my life around and led to the most contributory part of my career.
Ben: Yeah. And of course, I should name the elephant in the room, and that is that you tend to see the flipside, too, right? People will begin to exercise, sign up for an Ironman, and then paint themselves into this adrenal fatigued corner just through overtraining and through an imbalanced lifestyle.
So, you can play dangerously on both ends of the sector, which leads me to a question I want to have for you, being an 80-year-old high performer. What does your day actually look like right now? Are you eating a specific diet, taking certain supplements using a specific flavor of exercise protocol like high-intensity interval training or something like that?
Joseph: Well, I manage to get at least an hour in every day and on weekends, and I'll do two, three, four, whatever, depending on what I'm training for at the time. And my diet is primarily fruits, vegetables, lean protein, fish, Alaskan flown-in salmon, not Atlantic salmon, very little red meat, and very heavy in omega-3 fatty acids. I believe fish oil is one of the best anti-inflammatories, as well as curcumin, and very heavy in polyphenols. Barry Sears is a close friend who wrote “The Zone Diet.” And Barry is one of the most informed individuals I know in terms of inflammation. And as this audience knows, inflammation is the common denominator in the development of cancer, heart disease, Alzheimer's disease, and virtually most of the diseases of aging. So, whatever we can do, dietary rise, [00:19:52] _____, controlling stress, avoiding environmental toxins, too much alcohol, tobacco, contaminated air, like we have in California now, and hitting all four of those sides of the square, so to speak. I try to touch every one of those every day.
Ben: Got it. Now, you also mentioned something kind of interesting about hypothermia, which made me think about a podcast interview that I had with a neurosurgeon named Dr. Jack Kruse, who actually, he's doing a lot of surgeries with his patients, for example, literally on cold packs or on sheets of ice. He has a very interesting perioperative optimal surgical article that he's written that I'll link to in the shownotes. It's just fascinating some of the things he's doing in terms of loading people up on DHEA, and vitamin D3, and pregnenolone, et cetera, pre-surgery, and then also utilizing cold quite a bit.
You're the only other guy, the only other doc I've heard mention the use of hypothermia in conjunction with surgery or medicine. Is that something that you're using quite a bit, this concept of cooling the body?
Joseph: There's a long history of hypothermia. Actually, the principle behind it is that it lowers metabolism of cells and preserves them under stressful conditions better. We went through a big stage in brain surgery lowering the temperature of the body, cooling the brain. Like you said, like Aristotle said, “Hit the mean between extremes.” You can't go too low either with hypothermia. So, cooling is sometimes used in spinal cord injuries, but not profound hypothermia. So, mild to moderate hypothermia may have therapeutic benefits, but not profound.
Ben: Got it. Yeah. I mean, I personally used some form of hypothermia, meaning that I have an ice bath called a Morozko Forge that sits right outside my office. And I dip my head in that multiple times per day and actually do a lot of full body soaks, not only for the fat loss, and the nitric oxide, and the stress resilience benefits but also because cold has a pretty significant impact on the brain, reducing neural inflammation, reducing blood-brain barrier permeability. And I'm just a huge fan of cold for general neural health even if it's not in the presence of surgery. So, I think it's one of the best things you can do from a–kind of like as an alternative to nootropics and smart drugs, et cetera. So, it's super interesting how beneficial hypothermia is, especially for neural issues.
This leads into a broader discussion that I wanted to have with you guys. David, you reached out to me and told me about this Board of Medicine. And I looked into it, this concept of converging eastern and western medical disciplines I've always found just fascinating. I've talked about how I liked to approach life with one foot in the realm of ancestral wisdom, and the other in the realm of modern science, and weave in a lot of these things like biohacks and wearables along with plant medicine, and Ayurvedic, and traditional Chinese medical principles. And so, I'm curious, David, if you could fill my listeners in on what it is that inspired you to begin to put together this whole Board of Medicine concept.
David: Thank you for that. And I think that what you just said about your interest in this area is a big part of why our conversations have been so interesting together. I think the Board of Medicine really grew out of the understanding having been a western trained physician myself and working with western-trained physicians for the last, I don't know, 20 years, and just recognizing that western medicine is fantastic at certain approaches. And those approaches are typically focused on treating acute emergency issues, everything from severe mortal wounds and injuries to severe infections or infections of any kind, and really acute illnesses. Acute, by the way, I mean in the moment, these are emergency illnesses or issues that could result in death or severe disability if they're not treated very quickly.
We see examples of this all the time. COVID is a great example that western medicine is actually quite good at treating, or tackling in some regard if it's approached properly. However, western medicine has notoriously struggled with treating chronic illnesses. Chronic illnesses, inflammatory illnesses that what Dr. Maroon alluded to earlier, things like mental illness, addiction issues, issues of chronic autoimmune disorder, issues like burnout, for instance. We struggle to treat these chronic inflammatory issues that result in long-term pain and suffering, and ultimately, disability and often death. And so, what the Board of Medicine, what I noticed is that in my own training and through working within the western paradigm of medicine, I learned an incredible amount by surrounding myself with people like Dr. Maroon and these incredibly wise elders, for lack of a better term, that really have so much knowledge to pass on to us.
And one of the things that I learned is that people like Dr. Maroon are incredibly well-educated on holistic approaches that are not just western medicine approaches, which is what makes them such successful physicians. Believe it or not, some of the best physicians that I know are actually osteopathic physicians because they learn western approaches and eastern approaches together, and touch, for instance, is a very important part of the therapeutic process in osteopathic medicine, which is almost completely neglected in western medicine. So, I started to recognize particularly somebody who focuses on treatment-resistant mental illness, which are mental illnesses like PTSD, post-traumatic stress disorder, depression, anxiety, addiction disorders that over 50% of the time are not usually getting good treatment responses, or what we call symptom remission from the western gold standard of treatment, was that what works for these people more often than the westernized treatments are eastern treatments, which actually are more aligned with the Hippocratic principle of medicine than some of our western approaches to mental illness.
And what I mean by that is Hippocrates said, “Let food,” and I believe, “Let food and exercise be thy medicine.” He said, “Our job as healers,” and I'm going to butcher his quote because I'm terrible with quotes, but what the synopsis of what Hippocrates' teachings were, “is first, do no harm, let our treatments be focused on empowering an individual to heal themselves, or to learn how to heal themselves, not to become dependent on the healer, not to become dependent on us or the healing system.” And ultimately, that was what we saw happening myself and my colleagues saw happening, particularly in mental illness just as one example, or the way that we approach mental illness in this country.
So, being a mental health practitioner faced with patient after patient after patient who was just not getting better from the treatment programs that we were taught to deliver to these people really drove me to talk to my colleagues, to seek wisdom from my elder physician colleagues, people of lots of other disciplines, nutrition, which is often neglected in medical training, western medical training, meditation experts like Segyu Choepel Rinpoche, who we just had [00:27:39] _____ was Steve Jobs meditation teacher and a Tibetan Buddhist monk, who we just had the pleasure of connecting with yesterday again, and people of this variety who can share a wealth of knowledge. Also, tribal medicine practitioners I should say as well, and people who have a wealth of knowledge across lots of different disciplines to really focus on the only kind of medicine that Hippocrates really cared about, which is the medicine that actually heals people, the medicine that teaches people how to heal themselves. It was created as a way to help educate people about this.
Ben: You could almost argue, a lot of our current practice of medicine is almost in direct violation of the Hippocratic oath just because of the huge number of deaths and disabilities due to something like over prescription and misuse of opioid, narcotics, and benzodiazepines, which is a huge issue over the past couple of decades. The use of pharmaceuticals to treat those chronic conditions have a lot of adverse effects.
And one thing I'd love for you to point out, either David or Joe, is this idea of the number needed to treat versus the number needed to harm because I think that's a glaring issue right now in medicine.
David: Thinking about some of the medicines you just mentioned, Ben, benzodiazepines, opioid, narcotics, I think just for starters, it's important to remember that the pharmaceutical companies that make these medicines, which are useful for very specific indications, usually short-term not long-term use, however, when used chronically, they're extremely addictive and habit forming and damaging to cognition and behavior. And so, ultimately, what's important to remember is that doctors take the Hippocratic oath. We are one of the only folks that people interact with on a regular basis who are sworn to an oath to do no harm to others, and to focus on improving the quality of life for others in our community in the world.
There are very few, if not, no other professions that I can think of that take this oath going into their profession. Pharmaceutical companies do not take this oath. So, it's important to remember that pharmaceutical companies are their responsibilities to their shareholders, even if that means lying to the doctors who were actually prescribing the medicines, which is what happened in the case of opioids and benzodiazepines where they literally lied to the care providers and said, “These medicines are not addictive.” And of course many doctors and healthcare providers actually themselves became addicted to these medicines, like Demerol as an example, which is a very powerful opioid that really [00:30:15] _____ care providers. It's an incredible tragedy, which is why there's something like a multiple trillion-dollar lawsuits against these companies right now, which is unprecedented in history.
So, that's sort of just thinking about where we're at and why these kinds of institutions like the Board of Medicine, and we're not the only one, but why these kinds of coalitions have to exist to help share information that is actually accurate, and useful, and true for our communities and our physicians themselves about who is looking out for everyone else. And so, with respect to number needed to treat and number needed to harm, I'm so glad you brought that up because there could not be two more important statistics for us to think about and know about, whether you're a clinician and a healthcare provider, or whether you're a regular person who casually takes medicine for pain relief once in a while. And the reason why these numbers are important is because they are the two biggest most critical outcome measures from any clinical trial regarding a medicine. And so, what number needed to treat means that it's the [00:31:24] _____ you need to give a medicine or any therapy to see a significant treatment improvement response. That number we want to be low.
Ben: Right. So, the NNT, the number needed to treat, you'd want to be low. That's the number of people needed to be treated with the medicine to see a clinically significant reduction in symptoms?
David: Exactly. And the number needed to harm is the opposite, right? So, it's the number of people who is exposed to a medicine or a therapy of any kind, psychotherapy, of course, is included in this, to experience a risk of significant side effects. And that number we want to be very high. Unfortunately, with many prescription medicines–and again, I don't want to generalize too much because there's lots of great prescription medicines out there that we use, especially when used properly, but just thinking about SSRIs, for instance, selective serotonin reuptake inhibitors, which are one of the most common mental health medications, if not, the most common medication overall prescribed nationwide.
So, these medicines are used to prescribe to people who meet the diagnostic criteria for symptoms of depression, and often anxiety as well, and yet we don't explain to people that the number needed to harm is actually lower than the number needed to treat, which means that it is more likely that you will experience a side effect from taking an SSRI antidepressant than a benefit, significant benefit from taking the SSRI antidepressant. And just stop to think about that for a minute. That is pretty wild that we are not explaining that to people before we're signing them up for these medicines. And what is the most common side effect of SSRI antidepressants? It's that you can't have or experience orgasm anymore.
Ben: That's no fun.
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And oh, by the way, remember to take that survey I told you about at BenGreenfieldFitness.com/survey. It'll make this show better, and I would appreciate it. Alright, thanks to you, guys.
So, when it comes to kind of a more natural approach, or weaving in some of the eastern principles, or so-called ancestral medicine, if you look at something like the number needed to treat to see a clinically significant reduction in symptoms, has that NNT ever been looked into for plant medicines, herbs like valerian root, or turmeric, or ashwagandha, or say like hemp-derived cannabinoids like CBD or therapeutic mushrooms like chaga or reishi, things like that? Have those been compared at all in terms of the NNT?
David: So, I'm really glad you brought that up because the answer to that question is in most cases, no, because these studies are very difficult to do and they have to be done on a large-scale population basis, and those medicines oftentimes cannot be patented. And so, there's very few reasons for a pharmaceutical company to put millions of dollars of resources into doing a study of a medicine that is natural and is off patent for lack of better term. However, what's more important than the number needed to treat is the number needed to harm. So, when we're talking about hemp-derived cannabinoids as one example, hemp-derived cannabinoids or Phytocannabinoids like CBD, CBDA, the acid raw form of CBD, these plant medicines are very effective at improving outcomes in chronic pain and people with opioid use disorder.
And we have known this for a long time. And Dr. Maroon and I are actually working together with the entire team of the Board of Medicine to co-author a manuscript on this that will be submitted shortly. And meanwhile, physicians are so poorly educated about Phytocannabinoids and the endocannabinoid system that they do not realize that they have this option to provide people. And why is that important? Because you cannot die from taking too much CBD, and yet you can take so much CBD as much as you want that it could possibly help you get off of opioids, which can kill you. So, when you think about the number needed to harm for CBD is negligibly high, the number needed to harm from opioids is extremely low when they're used chronically, then this should be a no-brainer, right?
So, ultimately, going back to the Hippocratic oath, we swear to take an oath that says, “First, do no harm, not first heal people. The healing comes after the doing no harm.” So, if we can educate people about these statistics and how to understand what medicine to try, then we effectively–and I think this ties into the biohacker culture. This ties into a lot of the things that you educate people on, which is that if you can try a plant approach, a natural approach, a meditation approach, or an exercise approach, or something that can't hurt you or has a very almost negligible chance of hurting you, let's try that first before we get into the stuff that can hurt you. And this is the approach that we take with the Board, but of course with all of our clients and our practice as well.
Ben: Yeah. Well, I mean, some people will come back and say, “Hey, there was a study just last year that indicated that CBD could cause some pretty significant amount of liver damage.” And this was actually a rodent study in which mice given high doses of CBD showed signs of pretty significant liver damage within 24 hours and a few of them died. But, then, if you go in and you actually look at the study itself, they're actually being given about, I think, 2,400 or so milligrams per kilogram of CBD, which is hundreds of times more than would ever be used in just about any circumstance that I can imagine. And, that kind of tomfoolery has been going on for decades. Even the study on marijuana that showed that THC impairs brain circuitry, that was a study back at Tulane in the '70s, in that instance, there was actually part of that study where the mice, actually, they were monkeys in that case, but they were forced to inhale the equivalent of over 60 high-potency marijuana cigarettes in five minutes. And so, they suffered brain damage from suffocation and carbon monoxide poisoning. And then, they came out in the study and said, marijuana is toxic to the brain. So, you'll always be able to dig up research that might argue that there is a pretty significant NNT related, even some of these natural compounds. But, every time I dig into literature, it's either megadoses or something that's going in along with these compounds that's causing, or, I’m sorry, that NNH, that number needed to harm, to be artificially low. And so, it's one of those things where you always need to take some of the research with a grain of salt.
Now, that being said, I know that this Board of Medicine that you're putting together is not just focused on, say, herbs and teas and Ayurvedic supplements or something like that. You mentioned to me that you, guys, were also looking into the use of AI, for example. What exactly are you doing with that?
David: And, just to add on to what you just said about studies, I think it's not only that studies should be taken with a grain of salt. Sometimes, they are actually conducted and written in such a way to be very difficult to interpret. And so, one of the missions of the board in this regard is really to dissect. Who has the time? Most people don't have the knowledge. Most doctors don't have the time and most average people don't have the educational background to understand even how to decipher one good study from another bad study. And, they can be written in very convincing ways.
And so, really, what we're trying to do, in large part, one of our initial initiatives, is to dissect this literature based on non-psychoactive phytocannabinoids, like CBD, and help people understand, what is the literature that is actually relevant to understanding how this can be used safely, how to make safe CBD products, and what a safe CBD product looks like, compared to a contaminated or unsafe CBD product which is a whole other conversation, and really just breaking down that literature, which is what medical boards often do, to try to provide guidelines, not only for the physician and the clinicians, but also, for the public? But, getting into AI, I think this is really about–And, we have the pleasure of working with Dr. Ken Ford, who's one of the leading experts in AI worldwide and served as one of the scientific advisors for George W. Bush.
Ben: Yeah. I listen to his podcast, the Stem Talk Podcast.
David: Stem Talk.
Ben: Yeah, it's a good show.
David: It's amazing. And, he brings on some incredible guests that are in your wheelhouse, too, Ben, about, really, human optimization at the extremes, which is what he studies at the Institute for Human and Machine Cognition. And, it's really about understanding what AI is. Everybody talks about and we see on TV all the time that AI is this vision of these robots who come and take over the world by understanding who we are better than we are, and then, destroying us. But, we are so far away from that and that is such a poor misunderstanding of what AI can do for us, because AI is just about creating computers or computer systems that learn and sort of help us with some of the simple tasks that we have currently struggle with and forget to solve, to start with, national health crises.
So, one example of how AI can serve us right now, just to really bring it home in a practical way, is with wearables. So, as a clinician, we see our clients or our patients only once every two weeks at most; occasionally, once every week; but, usually, it's once every two weeks to once every six months we see our patients. And, we get an update from them in the office. They tell us how they're doing. How they're doing usually reflects what happened in the last week. And then, that's our data point.
So, that is not really that useful in getting an understanding as a clinician of someone's overall health in the long term. However, you throw an Oura ring on that person or a WHOOP or one of the more advanced Fitbits or even Apple watch, any of these kinds of devices, and you start to get a sense of how this person is doing on a daily basis when they're not in the office with you, how they're sleeping, how much activity they're getting, not necessarily in a perfectly accurate way, but, if you think about in terms of resolution of data points, we're talking now a daily resolution compared to once every month to once every week to once every six months. That is game-changing for the clinician to be able to go and see–and, I do this with all of my patients. Before I meet with them, I check their Oura ring data. I see how they're sleeping. I see how much activity they're getting, because they don't remember, they're busy, they're running companies, they're seeing patients of their own, they're running their own lives, taking care of their families, they're busy. So, I can log in, then. Again, this is just with my mind, I can see how they're doing and what I need to do to help them improve.
AI automates that process. We're really close, actually, to getting there, where we can start to have systems that look at data from our individuals on mass, not just our patients but across cultures, across large-scale communities, and start to actually understand public health problems. Why are some communities suffering more than others? Is it something in the water? Is it something in the air? Why does the Pittsburgh community have something like a 10% higher rate of autism in their children than other communities nationwide? That is something we need to be figuring out ASAPs. And, that is something that AI can solve. So, that's what we're really excited about and what we're working with Dr. Ford to start to usher into the healthcare community.
Ben: Got it. For example, one of my friends, Christopher Kelly, who runs the Nourish Balance Thrive service, they've even come up using an AI model that he developed, a software-based algorithm, that will take in, I think just a very simple eight to 10 basic blood parameters, and will actually make some pretty significant kind of longevity-based predictions, just from things like CRP or albumin, or white blood cells, just based on big data and AI. That's one good example. I forget the actual name of his service, but this idea of being able to take big data and make pretty efficient and faster decisions based on that, I think, is going to be pretty exciting going forward.
But, you guys at the Board of Medicine, you're not actually developing this type of services or software protocols or supplements or medications. From what I understand, you guys are more trying to put together a board that allows you to deliver peer-reviewed, evidence-based guidelines, correct?
David: It's a little bit of both. As you can see, we have a very diverse array of folks. You could check out our team, for anyone who's interested, at the BoardOfMedicine.org. So, some of us are actually hands-on as advisors, clinical advisors, helping to facilitate the development of some of this technology. Others of us are just sort of advising on the research front to help others, help the business folks, help the product developers, the people who know way more about building these systems than we do on the hands-on front to actually understand what is needed in public health, what information would be exquisitely valuable to us to really–actually, we had a great conversation with Tim Ferriss on The Psychedelic News Hour recently, and he said, to really bend the arc of humanity and human progress on the healthcare front, to be able to give us an opportunity, which, as a business person without having spent all of these years of treating patients that we have, you may not realize how valuable it is, understand how to really, as Joe was saying and you were saying earlier, rewrite their own story and understand that this is actually possible. AI has the capacity to show us this is possible. Psychedelics medicines, used properly, have the capacity to show us that this is possible. Apollo, as a technology, has a capacity, combined with all these other things, to show us that we have the ability to rewrite our own story.
So, that's really what the board is set up to do. And, because we're a non-profit, we don't have any business interest in any of this. There's no money that comes to us other than donations. Our goal is, really, just to facilitate progress for our civilization so that, hopefully, we can continue on enjoying each other and this earth for just a little bit longer.
Joseph: David, I might just add on to what you just said there. It kind of took the thought in my own head, is a saying that, “A good physician treats a patient's disease. A great physician treats the patient who has a disease.” In other words, the holistic approach to a patient and his disease. What that implies to me, primarily, is education. It's how physicians need to take the time to educate the patients, assuming that the majority of patients, once informed, will take the right steps and do the right things to protect their health. We know that's not always the case. However, that is the goal.
And, one of the major issues, or one of the things that the board does want to do, is to provide the educational information to physicians so that they can better treat the patient with the disease. And, hopefully, we will succeed in that. But, it still takes time for the doctor to educate the patients. And, too many doctors now in major health systems are on stopwatches. They have to see so many patients a day. So, that's why one out of four women in the country who come in with anxiety or depression are given an SSRI or a psychotropic drug with very little education, as David said, very little instructions about side effect, and not that much follow-up. Let's see if this helps. It's much easier to write a prescription than to educate and instruct the patient.
Ben: When it comes to some of these things, like AI or herbal medicines, I think people can kind of wrap their head around this quite a bit. But, in our last discussion, David, we talked about the Apollo, which is more of a technology-based device that uses waves of vibration to do things like increase heart rate variability, decrease stress, induce more rapid sleep onset. I've been using mine, literally, every day since our conversation. It's one of the few wearables that I actually do use every single freaking day, which I know sounds gimmicky, but I can't stop using the thing. It's amazing. But, I know that you kind of developed that because you have a history of study in psychedelic medicines and wanted kind of a wearable version of that that might not require the actual intake of a psychedelic, for example. However, because you're so heavily involved in MAPS, the Multidisciplinary Association of Psychedelic Studies, and you're involved with a lot of different research projects over there, where do psychedelics and plant medicine fit into the future of healthcare?
David: Again, going back to what we were just talking about, that Tim Ferriss so eloquently described in our conversation the other day, the idea that we can all rewrite our own story, this is what psychedelic medicine, this is what education offers us, this is what knowledge offers us. Tim provided us with this amazing metaphor, actually, after completing the, to my knowledge, I could be wrong, but I believe it's the fastest fundraise of $30 million for a non-profit research company ever in the history of medical research, which he raised for MAPS with Joe Green to fuel the commercialization of MDMA for treatment-resistant PTSD.
And, to catch everyone up, I think that, on this, the best way to answer your question is to really talk about it in the context of the results of the Phase 2 FDA trial on MDMA. So, MDMA is a methamphetamine-derived molecule. It's 3, 4-methylenedioximethamphetamine. It was discovered in the early 20th century, scientists at a pharmaceutical company not known what to be used for. Then, rediscovered by Sasha Shulgin, Alexander Shulgin, when he worked for Sandoz, I believe, or, possibly, Merck. Ultimately, it was found that this medicine was a radical and pathogenic molecule. It was a molecule that was capable of rapidly inducing a state of radical empathy and insight without fear, into ourselves and into others.
And, this was something that I believe was one of the greatest breakthroughs of mental health ever, because all the studies have shown with MAPS. So, when this medicine is used in conjunction with psychotherapy, not independently but in conjunction with a psychotherapeutic process, that facilitates safety and facilitates a foundation of empathy and non-judgment and self-acceptance, which is what the whole basis of our current practice of psychotherapy is founded on, can radically transform ourselves and our ability to see ourselves and our ability to rewrite our own story. It's an opportunity to warm the clay that may have been molded. And, this is getting back to the way Tim described it, which I thought was so eloquent, to warm the clay that has been molded by our past, by our childhood, by, possibly, even ancestral trauma, epigenetically passed on from our ancestors who might have experienced trauma in their lives that we can't even remember. And, it's an opportunity to molecularly, biochemically warm that clay, and then, have enough perspective, in a non-judgmental experience, to reform that clay into the shape that we see ourselves in actuality, without the attachment of ideas like PTSD, ideas like depression, ideas like anxiety, and the idea that we are fundamentally disordered.
Those terms are diagnostic terms that were meant to be used by doctors to communicate patterns of illness so that we could effectively treat people better. They were not meant as labels for patients or us to apply to ourselves as disordered individuals. And so, thinking about that, it's really an elegant process whereby we help people, using these psychedelic medicines, which is a big part of the MAPS trial, is to empower the inner healer, this ability of ourselves to heal ourselves, and by reminding everyone that this part of ourselves even exists in the first place and it's not disordered, and we don't have to describe it as disorder. And, when we dissociate that idea of “I am disordered” to “I feel sad right now and here's why,” then, all of a sudden, it creates opportunity to heal. Does that make sense?
Ben: Yeah, it does. The action, it reminds me a little bit of ketamine, for example. But, probably, a little bit more powerful in terms of its effect on, particularly, serotonin transporters. Although, I know that, also, MDMA, in particular, increases everything from prolactin to oxytocin to cortisol and serum as well. And, because of that, very similar to ketamine, everything you've just described, this is not like a baby aspirin that you would take on a daily basis. This is some type of therapy that would be administered under the supervision of a physician or a facilitator, because, often, the type of emotions and insight that come up during something like an MDMA session can be difficult or confusing to deal with if you're simply, whatever, at home by yourself using MDMA as therapy. And so, I’m curious with something like the Board of Medicine, are you guys also trying to standardize protocols, educate physicians, train facilitators, or anything along those lines?
David: This is absolutely in the works right now. Of course, we don't intend to reinvent the wheel. So, MAPS, as you alluded to earlier, they have created incredible guidelines about how to deliver MDMA safely, which is currently the practice of treatment, that is three administrations of medicine over the course of 12 weeks of pretty intensive empathy-based psychotherapy. This protocol works very well. And, just to highlight how well, people, veterans who are committing suicide at a rate of one an hour, which is a completely avoidable tragedy, and they've had treatment-resistant PTSD, on average, for 17.6 years. With just three doses of MDMA and 12 weeks of psychotherapy and this protocol that was created by MAPS that the board is supporting, the Board of Medicine is supporting, we see that, from the results, that, roughly, 52% of people who get this treatment, after being treatment-resistant for 17.6 years, are no longer meeting diagnostic criteria for PTSD after just 12 weeks of this treatment.
What's even more amazing than that is that, five years out without any further intervention, we see something like 67% of these people are now no longer meeting diagnostic criteria for PTSD. This is unheard of in mental health. This is like one of the holy grails of mental health, is to be able to give somebody a time-limited treatment that is literally teaching them how to heal themselves, such that when the treatment course is over, that they are able to take their healing into their own hands, feeling fully empowered, and then, continue on their path of getting better day after day, month after month, year after year. And, what we're seeing from these trial results is that it is actually working out that way.
And, I should say that this is not unique to MDMA. The MDMA studies, while being the most rigorous and the most fully developed so far, are showing results that are very similar to results that are coming from trials with psilocybin mushrooms, trials with ketamine, and trials with other medicines that fall into this category of psychedelic medicines. MDMA is just one of that group that facilitates this sort of self-healing paradigm shift that we so desperately need in the mental health space right now.
Ben: Joe, as a neurosurgeon, do you have any concerns about plant medicine?
Joseph: About plant medicine?
Ben: Yeah, like psychedelics, like MDMA, are you concerned at all about people harming themselves? Do you have any experience with this yourself or with your patients?
Joseph: I don't have any personal experience with it. But, I’m listening to David very carefully and my question arises is, we know MDMA, psilocybin, ketamine have, sometimes, incredible results. But, how do patients get access to this, David, with, I don't know how many psychiatrists there are in the United States, but you try to get an appointment with a psychiatrist and it's really not easy. And, their orientation is certainly not along the lines of what you're talking about. So, these hugely positive results you're talking about, how do we get this to those who really need it the most in volume basis?
David: Well, I think you hit the nail on the head, which is exactly what we're striving to do with the board, which is to help people understand the results from these trials that are so critical, trials going on at places like Hopkins, universities all over the world. And, once we help people understand the trials and the outcomes, and that people are actually able to have these radical therapeutic benefits, in-office, by the way, these medical medicine sessions are all provided in-office with clinicians, the patients are not sent home with the medicine, this helps to disseminate the knowledge and empower clinicians to be able to deliver this care more effectively. Of course, and we talked about this, actually, with Tim and we talked about it with Liana, who's the Development Director at MAPS, on the Psychedelic News Hour recently, which will be released sometime over the next few months as a podcast. So, you can all hear these conversations, specifically, about how to scale these treatments, which is a huge challenge. The most important part of all of this, the most important part of what we do with the Board of Medicine, and the foundation of psychedelic therapy in and of itself, and why we developed Apollo, is safety. Safety is the most important thing here. It is literally the thing, the stimulus, that is most fundamental, that turns the parasympathetic nervous system on. Safety is the trigger of turning on our recovery response nervous system that allows us to thrive. It allows us to sleep, to maximize our reproductive capacity, our digestive capacity, our creative capacity, and all the things that make our lives good, our empathy, our relationships. Safety is the trigger.
Threat is the trigger of our sympathetic fight-or-flight system, which we've been surrounded by altogether too much, creating the phenomenon of chronic stress and burnout. So, the Board of Medicine, founded in the Hippocratic principle of, first, do no harm; first, prioritize safety. And, MAPS as well, and also, I should say, Dr. Phil Wolfson, who founded Ketamine Assisted Psychotherapy, which I also practice, is really focused on how to educate clinicians as much as possible to be able to deliver these treatments safely.
Once we have reached the point of getting these to clients safely, then, we can start massively disseminating the training protocols. At this point, we don't know what the impact of giving MDMA to a million people is. We haven't been there yet. Everything looks great, so far, but we have to be patient with the process. And so, the Board of Medicine kind of sits as an intermediary that's a non-profit, like MAPS is also a non-profit, that doesn't have a financial interest in this, in a lot of ways help to usher in some of these treatments in the safest way possible.
If we can focus on safety just for a moment and remember that there isn't necessarily a rush, then, we can make sure that the foundation of trust in the healing process, which allows the healing process to really take hold, is restored. That trust is so essential. And, that's the first thing that we focus on with any client who comes into our office to work with us, whether you're a neurosurgeon or whether you're a psychiatrist or a meditation practitioner. The first and most important thing is trust with our clients. So, this is kind of really extrapolating that onto a much bigger picture.
Joseph: Well, I have another question, David. You're familiar with the connectome, Ben, the wiring diagram of the brain and our ability now with diffusion tensor imaging, structural magnetic resonance imaging, PET scans, and the kinds of very sophisticated high-level imaging we can do with the brain. There was a recent paper this year from Tokyo in which they were able to use these neuro-imaging techniques together with artificial intelligence and different algorithms to actually make a diagnosis of schizophrenia, ADHD, autism, and a few other disorders, I think, with about an 85 degree of accuracy, in contrast to the DSM-5 manual, which is a category of diagnostic mental states. Primarily, a lot of it is subjective.
So, I wonder, looking into the future not too far, if we're going to be able to do these kinds of neuro-imaging to get a really accurate diagnosis of what's happening to the default mode network, the executive network, the salient networks in our brain and the functional anatomy, and then, being able to modulate that psychotherapeutically and pharmacologically, that's what I speculating in not the too distant future.
Ben: Well, I personally think that's a perfect example of something like what the future of healthcare will look like. A case in point when you talk about the connectome, which is absolutely fascinating, just to be able to comprehensively map neural connections in the brain, almost like a wiring diagram for the brain. There's one piece of software that's just basic consumer-available software called EyeWire. And, I've seen it before. It maps neurons in 3Ds. You play a game, and as you're playing the game, it's using, basically, what they call morphological neuron data, which helps you model information processing circuits. And, all you're doing as a user is solving 2D puzzles, fitting these 2D puzzles. And then, as you're fitting together those puzzles, what's happening is it's literally mapping your own connectome. And, simple things like that, that's a perfect example of AI combined with machine learning and healthcare to do something as simple as map neuronal connections in the brain. So, these are the type of things that I think we'll see emerging more and more that are going to make what we're doing now in healthcare just look like the dark ages.
Joseph: I agree.
David: Absolutely. And, I think there's another, just to throw this in there, I won't take up any time with this, in reality, but people should check out the initiative by the NIMH, the National Institute of Mental Health, which has been going on for a number of years. Originally, the NIMH was founded with the purpose of treating shell shock or PTSD. They have created something called RDoC, which I cannot remember what it stands for. But, it's, I think, Research Domain-something Criteria. And, it's RDoC, which is a complete map of everything from DNA to molecular changes to hormonal changes to functional neural connectivity changes, all the way up and all the way down to really classify disorders and these illnesses and mental illnesses in a way that is much more consistent with sort of a much better overall picture, rather than looking at the subjective opinion of the clinician who's diagnosing based on the DSM. It's just another thing for people to tap into out there that's really fascinating.
Ben: Yeah, that is fascinating. And, the National Institute of Mental Health‘s Research Domain Criteria, RDoC, I’ll find that and link to it in the show notes, if you're listening in and you go to BenGreenfieldFitness.com/futureofhealthcare.
Joe and David, I would like to give you both the opportunity to kind of give almost like a lightning round overview of, if you were to close your eyes and dream up what you think is most exciting right now, either right around the corner or within the next year or five years or decade in terms of healthcare, what is it that you're most excited about that might go above and beyond something that we've already discussed, such as being able to map the neuronal connections of the brain, the increasing knowledge and use of plant medicine, etc.? What will be something you haven't brought up yet that you are super excited about in terms of technology or advancements, especially, in the field of healthcare?
Joseph: A couple of areas that I’m very interested in, and one is the immunotherapeutic approach to cancer, I think we're going to see huge advances in the immunological approach to cancer, capturing the body's own innate immune system, and use drugs like checkpoint inhibitors to really cure, stop cancers, hopefully, in the next few years. I know that's bold, but it is. And, the other thing is I’m very interested in the use of various energy sources, such as transcranial magnetic stimulation, direct current stimulation, photobiomodulation, energy sources, transcutaneously, that can be applied externally to the skull and brain using quantitative EEG to localize specific areas of damage or inhibition or over-activation, and using neuromodulatory techniques to, again, reorient fiber tracts and synaptic connections in the brain for emotional disorders and, also, for rehabilitation therapy. Patients with strokes, patients with spinal cord injuries, patients with various traumatic brain injuries, using direct current stimulation. Now, there's over 1,000 papers almost a year in this area to facilitate re-functioning, to get re-functioning back into damaged parts. So, I think these are two quick areas that come to my mind.
Ben: These forms of immunotherapy, I've read up a little bit on those, based on some of the work of Dr. Thomas Seyfried, for example. But, yeah, I think that's an extremely exciting area. There's a research article, or kind of an overview, an updated review of immunotherapeutic approaches for cancer therapy that I’ll link to in the show notes. And then, regarding the technology for the brain, Joe, you're speaking my language. I’m giving a talk in four days down in Lexington, Kentucky at a brain biohacking summit. Actually, one of the members of your guys' board, Dr. Matthew Cook, will also be presenting there. And, my entire talk is on tDC S, photobiomodulation, CES, and a variety of other biohacking technologies that can be used to enhance cognitive to function or decrease neural inflammation or enhance sleep patterns, etc. So, I also think that the ability of some of these wearables to enhance the brain health is pretty fascinating. And, for those of you listening in, I’m sure the recording of that presentation is something I’ll make available, if you just follow me on my website. How about you, Dave?
David: Well, how do I follow that? I think that something that you and I touched on briefly in the last conversation that we had together on your show was the idea of epigenetics and trauma, and the idea that we may actually be able to shift our own gene expression. So, in the same vein as what you're talking about, which is what you were just talking about in terms of technologies that facilitate neuroplasticity, technologies that facilitate changing our minds on a cellular and behavioral level and a learning level, also, going all the way down to the level of DNA and understanding how the changes in gene expression are critical to the way that we heal and the way that we change the functioning of the brain and the body.
And, I think that, from the work of Eric Kandel, who won the Nobel Prize in 2000, it's very clear that there are genetic and protein-based and, very likely, epigenetic relationships between the way that we form memories in our brains, as well as the way that genes are expressed. These things are intricately interconnected and tied together. New memories do not get formed without the synthesis of new proteins which come from the transcription and translation of DNA. So, I think, the future, as I see it, maybe this will be five or 10 years from now, but one of the studies that I’m working on with MAPS that I’m most excited about is comparing the epigenetic markers of trauma and stress response genes, pre and post different psychedelic medicines, pre and post different exposures to things like Apollo, because all of these therapies, psychedelics and Apollo, and also, of course, cognitive behavioral therapy with exposure, and that will be included ideally as well, is to really look at what does our genetic background look like or our epigenetic profile look like before and after we go through a trauma, which we know now, thanks to the work of many incredible scientists, including Dr. Rachel Yehuda, it is very likely to be encoded onto our epigenetic code and then passed on over generations, speaking of the ancestral stuff that we were talking about earlier.
So, I think that this really ties into the interface between, or really proving for the first time, through the search and the study of epigenetics, this fundamental and critical interface between science and spirituality that's focused around the biology of belief and how we've known for so long that believing that a treatment will work will make it that much more likely to work 30 to 50% more likely in the case of mental illness. And, this is what we call placebo. So, even Western medicine has a term for the effect of belief on our treatment outcomes and on healing. So, we are actually at a point where technology has come so far that we are able to evaluate this in rigorous scientific trials. And, that, I think, is the most exciting thing that I am looking forward to.
Ben: That's fascinating, the idea of combining science and spirituality with quantification and being able to measure epigenetics in the presence of some of these medical treatments and psychedelics and plant medicines. I think that's also incredibly exciting. And, I had one other thing I wanted to mention that I didn't get a chance to squeeze in that is related to the cancer-based immunotherapy that Joe had mentioned, there was one company I was looking at last month, called AngieX, which is using vascular-targeted biotherapeutics and, specifically, an antibody drug conjugate therapy for cancer. A guy who was on my podcast a long time ago, an astrophysicist named Paul Jaminet, I think he's actually working currently as the CEO of that company. And, I’m kind of watching what they're doing. I haven't invested in them or anything like that, just for full disclosure. But, I think that that's a perfect example. And, I’ll link to what they're doing in the show notes as well. That one's called AngieX.
I feel like, towards the end of this show, we started to delve into stuff that we could probably spend hours talking about. But, unfortunately, we're out of time. However, what I’m going to do is, A, I’m going to link to the Board of Medicine, as well as everything else that we've discussed, or you guys can go to the BoardOfMedicine.org to learn more about what David and Joe and their colleagues are doing over there. I’ll also link to everything that we talked about at bengreenfieldfitness.com/futureofhealthcare, and we'll also include a link to my previous fascinating podcast with David. I wanted to ask you, David, a little bit more about any updates on the Apollo, but we're kind of out of time today. But, I can tell you guys who heard that interview that I’m still addicted to that thing in a good way. And, any of you who haven't heard that interview or looked into the Apollo wearable, it's next level. It's a game-changer.
And then, for you guys, Joe and David, I want to thank you guys for coming on the show and just getting people's wheels turning and engaging this discussion and being involved with this Board of Medicine, because I think some really good things are going to come out of this, which is why I wanted to have you guys on the show, in the first place.
Joseph: Our great pleasure, Ben. Thank you.
David: Thank you so much for having us, Ben.
Well, thanks for listening to today's show. You can grab all the show notes, the resources, pretty much everything that I mentioned, over at BenGreenfieldFitness.com, along with plenty of other goodies from me, including the highly helpful “Ben Recommends” page, which is a list of pretty much everything that I've ever recommended for hormones, sleep, digestion, fat-loss, performance, and plenty more. Please, also know that all the links, all the promo codes that I mentioned during this and every episode help to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. So, when you listen in, be sure to use the links in the show notes, use the promo codes that I generate, because that helps to float this thing and keep it coming to you each and every week.
Dr. David Rabin, MD, Ph.D. first joined me for the episode “A Whole New Way To Deal With Stress, Trauma & PTSD In Just Seconds: The First Clinically Validated Wearable That Helps You De-Stress, Focus, Sleep, Stay Energized & Remain Calm.“
He is a neuroscientist, board-certified psychiatrist, health-tech entrepreneur, and inventor who has been studying the impact of chronic stress in humans for nearly 15 years, particularly non-invasive therapies for treatment-resistant illnesses such as PTSD.
Dr. Rabin is the co-founder and chief innovation officer at Apollo Neuroscience and the co-founder and executive director of The Board of Medicine. In addition to his clinical psychiatry practice, Dr. Rabin is currently conducting research on the epigenetic regulation of trauma responses and recovery to elucidate the mechanism of psychedelic-assisted psychotherapy and the neurobiology of belief. Dr. Rabin received his MD in medicine and Ph.D. in neuroscience from Albany Medical College and specialized in psychiatry at the University of Pittsburgh Medical Center. His wife, Kathryn Fantauzzi, works with him as the CEO and co-founder of Apollo Neuroscience.
Joining Dr. Rabin on this show is Dr. Joseph Maroon, clinical professor, vice chairman, and Heindl Scholar in Neuroscience at the Department of Neurosurgery at the University of Pittsburgh. In addition to being a world-renowned “burnout expert” and completing eight Ironman triathlon events since turning 50, he is involved in the development of minimally invasive surgical procedures for diseases of the brain, orbit, and spine; the prevention and treatment of traumatic injuries to the central nervous system; innovative approaches to pituitary and other brain tumors; complimentary and alternative medicine approaches to inflammatory diseases associated with aging; the prevention and treatment of sports-related injuries; and is co-developer of ImPACT, a neurocognitive test that is now the standard of care for concussion management in the NFL, NHL, MLB, NASCAR, and over 12,000 high schools and colleges in the United States. It is the only FDA approved test for concussion evaluation with 23 million athletes baseline tested to date. Dr. Maroon has also been the neurosurgical consultant for the Pittsburgh Steelers for 30 years and the first neurosurgeon directly appointed in the NFL.
Over the last several years, Dr. Rabin has been amassing a dream team that has become The Board of Medicine, a nonprofit coalition led by some of the world’s leading experts across many diverse fields of artificial intelligence (AI), nutrition, psychedelics, and clinical medicine that supports evidence-based strategies for harm-reduction in medicine and public health.
He believes that the future of healthcare in the 21st century is going to change substantially as a result of the current pandemic and that it is pretty clear that we are woefully underprepared for this as a healthcare system. The most significant change will be that most forms of non-urgent medical care will be delivered directly to patients/clients in their homes via telemedicine. He is already seeing this shift in mental health to include ketamine-assisted teletherapy and the integration of wearable technologies. As such, the future of healthcare is looking more and more digital and psychedelic with each passing day.
This podcast will focus on AI, psychedelics, and the convergence of Eastern and Western medical disciplines in current and post-COVID times.
During this discussion, you'll discover:
-How Dr. Maroon lays claim to the title “burnout expert”…08:05
- Someone who has been there, and has survived it
- Bound by ambition to become a successful neurosurgeon
- Flew like Icarus, then burned out with personal setbacks
- Overwhelmed, overworked, over-committed, over-stressed
- Every man's life is a diary; a diary in which we intend to write one story, but end up writing another
- His banker asked him to go on a run, which helped alleviate stress
- This eventually led to running triathlons; he credits this to saving his life
- Studied the physiology of stress, the effect of exercise on the human brain, how to overcome stress
- Joseph Maroon's book Square One: A Simple Guide To A Balanced Life
-The connection between burnout and adrenal fatigue…13:40
- Walter Cannon and Homeostasis: the ability of the body to maintain stability under all circumstances
- Stress produces an outpouring of cortisol from the adrenal gland (along with DHEA, pregnenolone, etc.)
- This is life-saving in an emergency situation
- Chronic stress results in “adrenal atrophy”
- Two responses (coined by Hans Selye): Stress response and adaptation syndrome
- Lack of resilience or adaptation to stress leads to exhaustion, or adrenal fatigue
- Adrenal fatigue suppresses immunity, you get overwhelmed with cortisol
- Excess cortisol destroys cells in the hippocampus, which serves memory
- People under chronic stress are confused, have memory impairment; killing cells in their hippocampus (excitotoxicity)
- Joseph's recovery and subsequent functioning at a high level was made possible by exercise, meditation, change in diet and improving relationships with his family, as discussed in the book Square One
-A day in the life of an 80-year-old peak performer…18:25
- Minimum 1-hour workout each day
- Diet is primarily fruits, veggies, lean protein, Alaskan salmon, very little red meat
- Omega-3 fatty acids; fish oil being one of the best anti-inflammatories
- Curcumin and polyphenols
- The Zone Diet by Barry Sears, a close friend and one of the most informed individuals in terms of inflammation
- Inflammation is the common denominator in the development of cancer, heart disease, Alzheimer's disease, and virtually most of the diseases of aging
- How You Can Use Cold Thermogenesis To Perform Like Lance Armstrong And Michael Phelps – podcast with Dr. Jack Kruse
-Using hypothermia in conjunction with surgery…20:45
- Hypothermia lowers the metabolism of cells and preserves them under stressful conditions
- Sometimes used in spinal cord injuries
- Need to find the proper balance when administering
- Morozko Forge that Ben has outside his office (use code BENFORGE for $150 off the retail price for any Forge)
-What inspired Dr. Rabin to form the Board of Medicine…22:30
- Western medicine is good at treating certain approaches such as acute emergency issues and illnesses
- Not so good at treating chronic inflammatory issues (mental illness, addiction, autoimmune, burnout)
- Eastern treatments more aligned with the Hippocratic approach than some of the Western approaches
- “Let food and exercise be thy medicine”
- First, do no harm
- Let our treatments be focused on teaching the patients to heal themselves
-The number needed to treat (NNT) vs. the number needed to harm (NNH)…28:30
- Certain pharmaceuticals are useful for specific, short-term use
- Addictive and damaging to cognition when used chronically
- Doctors are the only people sworn to an oath to do no harm to others (Pharma companies don't do this)
- Pharma companies have a history of lying to medical professionals
- NNT = number needed to see an improved treatment response (want a low number)
- NNH = number needed to experience significant risk or side effects (want this to be high)
- Selective serotonin reuptake inhibitors (SSRIs) prescribed to people with depression and anxiety; NNH is lower than the NNT
- A side effect is far more likely than a benefit
- This is not disclosed to patients
-Whether the NNT is applied to plant medicines, herbs, CBD, and the like…36:40
- Pharma companies have little incentive to invest in a study that would determine the NNT
- The NNH is a more important metric
- Physicians are unaware of all the options available due to a lack of knowledge
- CBD has a very high NNH and can replace opioids, which have a low NNH
- Some studies on the effects of CBD on the brain are questionable in their findings
- Studies are sometimes conducted and written in such a way that makes them difficult to interpret
- One of the missions of the Board is to decipher one good study from another bad study written in very convincing ways
- Breaking down the literature to try to provide guidelines, not only for the physicians and commissions, but also for the public
-How AI is used for human optimization…41:30
- Dr. Ken Ford's Stem Talk podcast
- Skewed perception of how AI interacts with humanity
- AI is about creating computers that learn and help with simple tasks that we struggle with
- Wearables are an example of AI put to good use
- Oura Ring (use Ben's link to save $50)
- WHOOP (use code BEN to save $30)
- Apollo wearable
- Clinicians see patients once every two weeks at most; occasionally every week; more common is every six months
- Patients' use of wearables allows insight into how patients do on a daily basis; how they are sleeping; their activities, etc.
- Resolution of data points into daily (as opposed to two-weeks or six-month) resolution is a game-changer
- AI will eventually automate the process of allowing clinicians to see how patients are doing; what needs to be done to help their patients improve; not just patients but across cultures; large scale communities
- Start to identify and understand public health problems in specific localities
- Why are some communities suffering more than others?
- Is it something in the water, something in the air?
- Why does the Pittsburgh community have a 10% higher rate of autism in their children than other communities nationwide?
- These are some things needed to be figured out and something AI can solve
- Christopher Kelly of Nourish Balance Strive
- Bloodsmart – blood test using AI to predict what is likely happening inside your body (and what might be going wrong)
- Chris Kelly's Machine Learning for Blood Chemistry Interpretation
- Board of Medicine
- Hands-on clinical advisers helping to facilitate the development of technologies
- Advice on the research front; help product developers understand what is needed in public health
- Bend the arc of humanity and human progress on the healthcare front
- AI, psychedelics, medicine, used the right way show us that we have the ability to rewrite our own story
- “A good physician treats a patient's disease; a great physician treats a patient who has a disease”
- It is much easier to write a prescription than to educate the patient
-Psychedelics, plant medicine, and the future of healthcare…52:30
- Dr. David Rabin podcast with Tim Ferriss
- Ferriss raised $30 million for the Multidisciplinary Association for Psychedelic Studies (MAPS) with Joe Green to research MDMA for the treatment of PTSD
- MDMA is capable of inducing a state of radical empathy and insight without fear
- Warm the clay that has been molded by our past, childhood, even ancestral trauma; to have enough perspective to reform that clay into the shape we see ourselves in actuality without the attachment of ideas like PTSD, depression, anxiety, and the idea that we are fundamentally disordered
- Board of Medicine is standardizing protocols, training facilitators, etc.
- War veterans with treatment-resistant PTSD see dramatic improvements after 3 MDMA sessions in the course of 12 weeks of empathy-based psychotherapy protocol outlined by MAPS
- Roughly 52% of people getting this treatment, after being treatment-resistant for an average of 17.6 years, are no longer meeting diagnostic criteria for PTSD
- 5 years out, without any further intervention, 67% of these people are no longer meeting diagnostic criteria for PTSD
- Unheard of in mental health
- Trials with psilocybin, ketamine, and others are seeing similar results
-Concerns about psychedelics from the perspective of the neurosurgeon…1:00:30
- How do patients get access to these psychedelics? How do we get these positive results to the people who need them the most?
- Psychiatric field is not currently supportive of it as a whole
- Board of Medicine hopes to clear the air on the efficacy of plant medicine
- Psychedelic News Hour podcast
- Safety is paramount in triggering the parasympathetic state
- Threat triggers sympathetic state
- Dr. Phil Wolfson, founded Ketamine Assisted Therapy (KAT)
-Neuroimaging to diagnose the executive network of the brain…1:06:13
- EyeWire, a game to map the brain
- National Institute of Mental Health initiative
- Research Domain Criteria (RDoC) – map of DNA, molecular and hormonal changes, to classify mental disorders
-What David and Joe are most excited about for the future of healthcare…1:09:10
- Immunotherapeutic approach to cancer
- Energy sources (transcranial magnetic stimulation, direct current stimulation, photobiomodulation)
- Neuromodulatory techniques to reorient synaptic tracks in the brain
- Epigenetics and trauma
- Comparing epigenetic markers of trauma and stress response genes pre- and post-psychedelics, Apollo wearable
- Dr. Rachel Yehuda: How Trauma and Resilience Cross Generations
- Biology of Belief by Bruce Lipton
- Dr. Thomas Seyfried
- Article: Immunotherapeutic approaches for cancer therapy: An updated review
- Ben's presentation at the Wild Health Brain Biohacking Summit
- AngieX: Vascular-targeted biotherapeutics, antibody-based cancer therapy
- Is There One Single Diet That Is Best? (And Why Something Called The “Perfect Health Diet” Heavily Influences Most of Ben Greenfield’s Dietary Decisions) with Paul Jaminet
-And much more!
Resources from this episode:
– Dr. David Rabin and Dr. Joseph Maroon:
- Apollo wearable (Use this link to save 15% automatically)
- Psychedelic News Hour podcast
- Dr. David Rabin on Tim Ferriss' podcast
- The Board of Medicine
- A Whole New Way To Deal With Stress, Trauma & PTSD In Just Seconds: The First Clinically Validated Wearable That Helps You De-Stress, Focus, Sleep, Stay Energized & Remain Calm with Dr. David Rabin
- How You Can Use Cold Thermogenesis To Perform Like Lance Armstrong And Michael Phelps with Dr. Jack Kruse
- Is There One Single Diet That Is Best? (And Why Something Called The “Perfect Health Diet” Heavily Influences Most of Ben Greenfield’s Dietary Decisions) with Paul Jaminet
- Walter Cannon and the Concept of Homeostasis
- What Is General Adaptation Syndrome?
- Karoshi or Death from Overwork
- Dr. Jack Kruse: Peri-Operative Optimal Surgical Considerations
- That alarming CBD liver damage study is bunk—and the media should know better
- To Be a Great Physician, You Must Understand the Whole Story
- Dr. Rachel Yehuda: How Trauma and Resilience Cross Generations
- Immunotherapeutic approaches for cancer therapy: An updated review
- Chris Kelly's Machine Learning for Blood Chemistry Interpretation
- The Zone Diet by Barry Sears
- Biology of Belief by Bruce Lipton
- Square One: A Simple Guide To A Balanced Life by Joseph Maroon
– Other resources:
- Ben's presentation at the Wild Health Brain Biohacking Summit
- Alaskan Salmon
- Omega-3 Fatty Acids
- Oura Ring (use Ben's link to save $50)
- WHOOP (use code BEN to save $30)
- Morozko Forge (use code BENFORGE for $150 off the retail price for any Forge)
- Dr. Phil Wolfson
- Eyewire connectome
- Brain connectome
- National Institute of Mental Health initiative RDoC
- Dr. Eric Kandel
- Dr. Thomas Seyfried
- AngieX: Vascular-targeted biotherapeutics
- Dr. Ken Ford's Stem Talk podcast
- Christopher Kelly of Nourish Balance Strive
- Bloodsmart Blood Test Using AI
–The Kion Daily Life Bundle: The ultimate Kion Bundle! Ben Greenfield and Team Kion’s go-to, everyday essentials. Includes Kion Coffee, Aminos, Lean, and the Clean Energy Bar. BGF listeners, receive a 10% discount off your order when you use discount code BEN10.
–Organifi Green Juice: Now you can get all your healthy superfoods in one glass…with No Shopping, No Blending, No Juicing, and No Cleanup. Get a 20% discount on your entire order when you use code BENG20.
–Ra Optics: Purchase a pair of Ra Optics Day and Night Lenses to optimize sleep quality, energy, levels, and health in the modern, electrically-lit world. Receive 10% off your order when you use my link.
–Clearlight Saunas: You can be sure that I researched all the saunas before I bought mine and Clearlight was the one that stood out from all the rest because of their EMF and ELF Shielding and their Lifetime Warranty. Use code BENGREENFIELD to get $500 off your sauna, free shipping, and a free bonus gift!