#231 - AMA #41： Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more
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Summary
In this episode of Ask Me Anything, Dr. Nick Stenson joins Dr. Peter Atiyah to answer some of the most popular questions submitted over the past year. They cover a variety of topics from medicine, aging, longevity, questions about your background, where it led you to where you are today, and more.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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access the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to ask me anything episode 41. I'm once again joined by Nick Stenson. Today's episode is
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a little different than the episodes of the past year. You've probably noticed over the past year,
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we've been doing AMAs around a lot of questions that have come in around the same topics. And then
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we go super deep dive on one topic, for example. Today, we do more of what we used to do traditionally
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with an AMA. We just noticed we had so many questions that we hadn't been addressing.
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And so we really batched them. And at the beginning of the episode, Nick is going to kind of walk you
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through what the questions are. So I'm not even going to really try to repeat that here. So if
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you're a subscriber and you want to watch the full video of this podcast, you can find it on the show
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notes page, which are of course, where we keep all the notes for this podcast. If you're not a
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subscriber, you can watch a sneak peek of the video on our YouTube page. So without further delay, I hope
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you enjoy AMA number 41. Peter, welcome to another AMA. How are you doing? I'm doing well. That's good.
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We got a little bit of a different vibe for this AMA. In the past handful that we've done,
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we've kind of focused on a few big topics or a collection of topics under one larger topics.
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And so what we've been doing in that time is just collecting a lot of questions that we think are
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really good, really interesting, that maybe haven't fit in one of the past AMA topics. Also,
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maybe that are as a result of one of the past AMA topics. And so what we did is we kind of flagged
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them all and we're going to try and get through as many as we can get through here. So it's kind
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of going to be a little more of an old school AMA on a variety of topics. And when we look at what
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we're hoping to cover, it's everything from medicine, aging, longevity, questions about your
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background, where it led you to where you are today. Also questions around how people should think
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about prioritizing all the various things in their life. We get a lot of questions where it's,
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you guys talk about ApoB, you talk about labs, you talk about screenings, you talk about sleep,
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exercise, nutrition, like all these tactics, and it can get overwhelming for people.
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And so we'll hopefully have a good conversation on how you think about that in your life and also
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with patients as people just try and sort through everything. And then if we have time, we're going
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to do an old school two minute drill, which is have a variety of questions, put two minutes on the
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clock and see if you can answer it in two minutes. The last time we did this was long ago with
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you and Bob, and I don't know if we answered any question in under two minutes. So we'll see if
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it's any different here today. But with all that said, anything you want to add before we just get
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into it? No, not at all. Let's just do it. But we're not on a two minute clock until you tell me,
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right? Yeah. These first questions aren't two minute clock. That's much like football,
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end of the game, two minute drill. So we have some time to ease into it. So the first question we got
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is one of the phrases that people have often heard you reference throughout the podcast
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in interviews with other people is this idea of medicine one to 3.0. I also know this is part of
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the book you're writing. And so it's a topic and a thought experiment that you think about a lot.
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And we received a lot of questions about people just saying, Hey, can you dive into that a little
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more, explain more about what you mean and why it's important for people to think about as it relates
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to their own medical journey. I think this would be a really good foundation for our conversation
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today. So maybe you can just walk people through what is that and how you think about it.
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I don't know where the idea really came from or when it came to me, but it was sometime writing the
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book, which started in 2016, but I don't think it was in the first version of the book. So there's,
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the book has really three versions. So I kind of wrote, there's a 2016, 2017 version that of which I
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don't think anything is preserved. And then there's a second version, which is sort of 2017 to 2020 of
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which some is preserved. And then there's the version of the book that ultimately will become
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the book is kind of the 2020 to 2022 writing. So I'm positive or nearly positive that the medicine
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1.0, 2.0, 3.0 thing came from the second version of that book. And it was, and remains this idea that
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says, look, we basically exist in three different phases of medicine. One of which we're, I think not
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quite into yet, but we're in the transition. So these transitions are far from discreet and they
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take, in some cases, I think the transition from medicine 1.0 to 2.0 took, I don't know, I would
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argue from the beginning to the end, 300 years. Okay. So what are they? So medicine 1.0 is when we
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had no idea of science. Kind of keep in mind, science is what? It's such a political term at the
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moment that that's really unfortunate, but science is a way of thinking. Science is not a person.
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Science is not an answer. Science is a process. It's a way that we look at the natural world around
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us. We formulate hypotheses about what explains them based on the physical principles of the
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universe. We design experiments to test those hypotheses and we measure the results of those
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experiments against the predictions of the hypotheses. And then we iterate and correct.
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It's important to understand that we're not naturally wired to do that, one. So evolution
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didn't prepare us to do that. It had no interest in us doing that. I've written at length about this.
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I think I wrote a blog post on this seven or eight years ago called Why We're Not Wired to Think
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Scientifically. I think we should link to that because I go into much more detail about the
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timescale of evolution and the process of our thinking. So prior to the invention of this idea,
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nothing that existed in medicine could be tethered to science. So anytime something happened,
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you had to come up with an explanation. That's why we have these wonderful brains that we do. We use them
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to come up with explanations for things that we see happening, but none of it could be linked
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to scientific fact or verifiable or testable hypotheses. So this is where you had sort of
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all sorts of crazy ideas. If you were sick, it was due to bad humors and was bad spirits and bad luck
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and all these sorts of things. But there was no sort of scientific basis for that. That kind of started
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to change in the late 17th century with Francis Bacon. But I would argue that the full transition to
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medicine 2.0 didn't actually take place until the advent of germ theory in the late 19th century.
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So that's about 300 years, if I'm doing the math right. No, no, no. I'm sorry. It was about 200 years.
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So we've got about this 200-year period where Joseph Lister, all the way up to Fleming and the
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discovery of penicillin and antibiotics, that to me is the breakthrough of medicine 2.0. So medicine 2.0
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comes from basically three things. One is the advent and acceptance of germ theory,
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the process of scientific thinking, and then really the crown jewel of medicine 2.0, which
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doesn't come along until much later, is the statistical machinery to enable randomized control
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trials. So again, because we're trying to be a little bit quick, I won't go into all the details
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and Bernard Fisher and all of these people who played such an important role in this, but that's
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basically the trifecta of medicine 2.0. And to be clear, medicine 2.0 has been an amazing
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development. I don't think any of us would be sitting here today without medicine 2.0. So
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I don't want to minimize it, but I want to acknowledge and just pass on, and the book
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talks more about this so we don't have to get into the great detail. Medicine 2.0 has really peaked.
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It's been very good at dealing with acute conditions. You get hit by a car,
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you have a life-threatening infection, you suffer an MI, a cardiocardial infarction, and you want to
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make sure someone doesn't die, and you want to keep somebody alive as long as possible. In that acute
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phase, medicine 2.0 is amazing for those things. What I argue is that we have reached the limits of
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medicine 2.0's capacity, and if longevity is something we are aspiring for, we need a new
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strategy. We need a fundamentalist shift as 2.0 was from 1.0, and that is to 3.0. And 3.0 is basically
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predicated on evidence-informed as opposed to evidence-based guidelines. It is predicated on
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absurdly early preventative measures for chronic conditions, which are now the dominant source of
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morbidity and mortality. It's no longer acute conditions, and it has to be highly personalized.
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So I'll stop there because, again, I could probably spend the hour now talking about that, but I think
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people now get the sense of what this is. And I'm arguing that we're not, of course, yet in medicine
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3.0, but we're now in that transition. And what I'm arguing is we should be accelerating that.
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And so it's interesting, right, because your medicine 3.0 isn't necessarily people are going to
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live forever. It's more so just a shift to the three things, like you said, which is personalized
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medicine, early prevention, and evidence-informed. Have you ever thought about what medicine 4.0 looks
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like? Is that even on your radar? Or is more of the focus is how do we make this huge shift to 3.0,
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which is going to create so much benefit for people? I don't think I have enough clarity as
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to what medicine 4.0 would look like yet versus things that I don't think I will experience in my
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lifetime that will just be a part of medicine 3.0, if that makes sense. And when you think about
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that transition, which you mentioned more slowly and now, do you have an idea of how far out you
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think medicine 3.0 is? Not necessarily at the individual level. So there's always a difference
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when people could access it versus the standard of care. Do you have an idea or any rough idea on when
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that turn to the standard of care becomes? No, I think it's too soon to say. It's really
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going to depend on how quickly people adopt and sort of basically demand change. And I don't think
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that's possible to predict. Let's use an example that's completely different, but I think if you
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could go back in a time machine, you wouldn't know, right? So if you went back in a time machine to
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1850, slavery is the law of the land. The country is completely segregated. I don't think anybody could
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have reasonably predicted the events of the 1860s and the events of the 1960s, which were two very
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important pillars in time as it pertained to slavery and ultimately segregation. You just couldn't have
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predicted that even though those are both very social changes. Now, maybe there's a historian
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that will argue, no, it was crystal clear in 1850 that we were 15 years away from a civil war and 100
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years away from a civil revolution. But I don't believe that. And I certainly don't think we can
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do the same here. On the book piece, I know you've been working on the book for a long time because
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I've known you during that stretch, but I wasn't necessarily aware of the 2016 to 2017 initial book that
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nothing made it really into the final copy. Not nothing. All of it went straight into the
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wastebasket. So for everyone who's been anxious, kind of banging at the door, good thing we waited
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a little bit to get that out, huh? Yeah. Love it. So the next set of questions we receive in one form
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or another almost weekly, which is even people who followed you for a while and people who are kind of
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newer to following you, they often will ask a variety of questions. They either might be in
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school, med school, really interested in longevity, might be doctors. And they're really trying to
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understand where your knowledge on this came from and how you've put into practice what you're trying
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to do with your patients in medicine 3.0. Because it seems like from knowing you, a lot of what you do
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with your patients didn't necessarily come from what you learned in med school and or what you did
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in residency. And so I think what might be helpful to people is just if you want to give people a
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walkthrough of your background and how it's led to where you are today, which is ultimately
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practicing medicine 3.0 with your patients. Thank you for listening to today's sneak peek AMA episode of
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