The Peter Attia Drive - #73 - AMA #9： NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more

00:00:00.000 Hey everyone, welcome to the Peter Atiyah Drive. I'm your host, Peter Atiyah.

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00:04:00.020 thank you for taking a moment to listen to this. If you learn from and find value in the content I

00:04:04.900 produce, please consider supporting us directly by signing up for a monthly subscription. Another

00:04:10.780 month, another AMA. Welcome to AMA number nine. I am again joined by the incredibly handsome Bob

00:04:17.120 Kaplan. In this episode, we talk about my history with Theranos. This is kind of a funny sort of sad

00:04:23.840 story. The estrogenation of men, a conversation around plastics and glass containers, takeaways from my

00:04:31.640 recent hunting trips, what books I'm reading and listening to at the moment, what advice I would

00:04:38.020 give my 25 year old self relating to mental health, my emergency protocol for when I get sick as a dog,

00:04:45.800 things that I used to be bearish about that I'm now bullish about or vice versa. Bob and I talk about

00:04:52.060 exercise in the quote unquote fat burning zone. Hint, that's a term I can't stand. And we end with a

00:04:59.960 little creatine supplementation conversation. As a reminder, AMAs are for subscribers only. If you're

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00:05:54.600 questions in time through future AMAs. So without further delay, welcome to AMA number nine.

00:06:03.060 Hi, and hello again, podcasters, subscribers. Bob Kaplan here.

00:06:06.960 Peter Atiyah here.

00:06:08.040 Oh, I didn't see you there.

00:06:08.900 I know, I know. It's hard. It's hard to see me in this getup.

00:06:11.320 I can see you. You're soiling green. All right, let's jump right into it. Two-minute drill.

00:06:16.400 Should I even say two-minute drill? It's a two-minute drill that might take longer. Not exactly Tom Brady

00:06:20.980 on these drives, but who's counting? Will you talk about your history with Theranos?

00:06:27.480 I think you alluded to this in that tweet.

00:06:29.060 Yeah. So in 2006, I was working in Palo Alto at a consulting firm, and a good friend of mine,

00:06:38.660 he had a connection to Theranos. And at the time, both he and I were considering jobs there in the

00:06:48.240 role of chief financial officer and me in the role of chief medical officer. This was very early days.

00:06:55.380 I don't recall what year Theranos was founded. I want to say 03, but it was still very small. And

00:07:01.580 I remember their office was next to ours. I think we were actually both on California Avenue in Palo

00:07:08.080 Alto. So the first time I went over there to meet with Elizabeth Holmes, I remember it was just a tiny

00:07:14.480 place. I think there were maybe 20 or 30 employees. And we sat down and looked at this black box that 0.96

00:07:19.880 they had and talked about a bunch of things that had to do with the business and the technology.

00:07:24.880 And we met again. And ultimately, I decided not to take the job for several reasons. One of the reasons

00:07:32.440 was when I did my due diligence on their investors, something came up on one of the investors that

00:07:40.140 someone I knew and trusted a lot, didn't have a lot of great things to say about one of their

00:07:44.080 investors. And when you're thinking about joining a startup company, that kind of stuff matters.

00:07:48.520 The other thing is I really loved what I was actually doing. So the hurdle rate for me to kind

00:07:54.440 of leave what I was doing had to be very high because I was super happy at McKinsey and really,

00:07:59.160 really loving the work I was doing. And then the third thing was I wasn't convinced that what you

00:08:06.480 could test in a box that size was interesting. So although Elizabeth was incredibly secretive about

00:08:13.360 what they were doing, and I was not allowed to look in the box, which of course, I and I'm sure

00:08:18.580 every other person that showed up would ask that question. Okay, let's actually see what's in the

00:08:22.540 box. That was a no go, even under an NDA. If people want a primer on Theranos, there's a

00:08:27.800 documentary right on HBO if they don't know the story behind it. That's right. Nothing I'm saying

00:08:32.040 now will be even remotely interesting if you don't understand why in the end, this is an interesting

00:08:35.260 story. I knew enough about diagnostics and I knew enough about the chemistry of it that I knew that

00:08:40.440 there was pretty much not going to be anything you could do on a drop of blood in a box that size

00:08:46.920 that was clinically interesting. And so in the end, the reason I did not go forward was I just didn't

00:08:56.380 think it was medically interesting enough. I thought, look, yeah, you'll figure out a way to do

00:09:00.560 a Chem 20 and a CBC and a few other things, but I don't care. Like you're not moving the needle in

00:09:07.700 terms of clinical medicine. So that was the end of that. So that was 2006. Now fast forward to 2014.

00:09:14.920 That's eight years later. Elizabeth is on the cover of Forbes. The most recent valuation of Theranos is

00:09:22.440 $9 billion. And I remember coming home and saying to my wife, remember that company I almost joined

00:09:28.260 eight years ago and she didn't remember. And I told her the whole story and she's like, oh yeah, yeah,

00:09:32.240 yeah. And I said, this is how much money we'd be worth today if I had taken that job based on my

00:09:39.060 estimation of how much dilution would have occurred in the cap table, et cetera, et cetera. And it was a

00:09:44.680 big number, like a life-changing number. And she was just like, oh, wow. You win some, you lose some,

00:09:51.280 huh? I was like, yeah. So I kind of never really thought about it again. And then fast forward to the

00:09:56.340 beginning of October, 2015, there was an event in San Francisco called the Vanity Fair or something.

00:10:03.580 It's like a Vanity Fair event. And this was back in the day when I was, a lot of my life revolved

00:10:08.480 around fundraising and having to be at events like this. So I was at this event and Elizabeth was the

00:10:16.380 main attraction of the event actually. So much so that Mark Zuckerberg also spoke, but he was at one

00:10:21.620 of the smaller breakouts. So Elizabeth was really the main attraction. And the night either of or

00:10:28.740 before her big, big talk, there was a cocktail party. And I actually wasn't invited to the cocktail

00:10:34.720 party because it was really only for the important people. But I was there with Tim Ferriss and he was

00:10:39.120 invited to it. So I got to be Tim's date. So Tim and I went to the cocktail party together and we're

00:10:45.400 just sort of playing patty cakes and in walks Elizabeth. And of course she's just swarmed by people,

00:10:50.320 but somehow over the course of the next 20 or 30 minutes, she ends up standing kind of right next

00:10:54.960 to me. And I'm thinking to myself, there's no way she's going to remember me because of course by this

00:10:59.620 point it's been nine years. But anyway, I said to her, I said, hey Elizabeth, you're probably not going

00:11:04.040 to remember me, but we met. And she goes, oh no, no, I remember you. Your name's Peter. She didn't

00:11:08.140 remember my last name. I barely remember my last name. So she's like, yeah, your name's Peter. And we met

00:11:12.280 in 2006 and you're a friend of so-and-so who was the person. And she knew everything. I was really,

00:11:18.820 really surprised. And I said, Elizabeth, that's unfreaking believable. How could you possibly

00:11:22.800 remember that? And she's like, oh no, no, I totally remember and blah, blah, blah. And I was like,

00:11:25.900 hey, well, congratulations on all of your success. It's just amazing. And she gave me her card and

00:11:30.380 she's like, look, let's stay in touch. I'd love to talk with you again, blah, blah, blah, blah, blah.

00:11:33.600 So this was like the first week of October in 2015. And I want to say that was like a Thursday night.

00:11:38.780 I think it was like a couple days later, early in the next week when the John Cario story in the

00:11:43.820 Wall Street Journal hit. And in retrospect now, of course, you realize that all of that stuff had

00:11:49.480 been brewing long before. And obviously Elizabeth knew this was coming in. You know, I got to say,

00:11:54.120 like, I think you don't come away from that documentary with a lot of empathy for Elizabeth.

00:11:59.080 I don't think that's the purpose of the documentary at all. But in retrospect, if you're going to try to

00:12:03.620 just, if do nothing else, but practice the art of having empathy for people who you don't think

00:12:07.460 deserve any, it's hard for me to imagine the cognitive dissonance she would have been 0.83

00:12:12.000 experiencing when on the one hand, she is at this event, which is a huge event, by the way,

00:12:18.060 the sort of people who were there. I mean, it was the who's who of everything. I remember walking

00:12:22.720 out of one of the sessions and literally almost bumping into Bradley Cooper, who, by the way,

00:12:26.720 is incredibly good looking. It's worth pointing this out, by the way, in real life, how good looking

00:12:31.600 Bradley Cooper is. I just want to state that for the record. It's almost upsetting how good looking he is

00:12:36.240 because you sort of think person's not supposed to be that good looking. But anyway,

00:12:39.220 and here she was as the headliner of this event. And yet in her mind, she has to know her world is

00:12:45.200 about to get really messy. Now, the flip side of that from a psychology standpoint is I don't believe

00:12:50.400 that Elizabeth ever thought she was doing anything wrong, which is not for a moment to say she shouldn't

00:12:54.500 be held accountable for what happened. I think you can be so delusional that, I mean, I don't think

00:12:59.160 Hitler believed he was doing anything wrong either. So the fact that you don't believe you're doing

00:13:03.440 something wrong doesn't in any way absolve you of the responsibility of what you've done.

00:13:07.020 But it's a very important distinction, I think, which is you are so delusional that you really

00:13:13.960 believe that the lies you're telling are for the better good. And therefore, I think Elizabeth felt

00:13:18.860 that this was just a temporary speed bump along the way. But anyway, it's sort of interesting.

00:13:22.960 We stayed in touch over email a couple of times in the ensuing months and obviously lost track.

00:13:28.340 But that's my little history of almost having gone to work at Theranos.

00:13:31.820 I think another thing that I thought about with that, watching the documentary is the people that

00:13:36.000 were on board. How could these people be so foolish and be duped and everything? I think 0.98

00:13:40.020 hindsight bias really plays a role there that after the fact, when everybody's looking at where all the

00:13:45.760 chips have fallen, people think. And to be clear, I want to make sure that nobody ever assumes I'm

00:13:50.120 trying to take credit for knowing the whole thing was a fraud. That I never suspected. Not for a second

00:13:55.120 did that ever cross my mind either at the time or in the years that followed. I just thought it was the

00:14:00.100 world's most uninteresting business in the history of civilization. Like point of care testing in a

00:14:05.540 drugstore for Chem 7 and CBC. I mean, I would have more interest in a business that specialized in

00:14:12.900 removing hangnails and nose hairs. That to me is more interesting than just being able to get a CBC

00:14:18.880 and Chem 7 at Rite Aid. My opposition to it was, I never suspected there was fraud going on.

00:14:24.500 And opportunity costs. It sounded like you had a good gig going too.

00:14:26.880 Yeah. I mean, in the end, our paths are our paths.

00:14:29.620 You have referenced to the estrogenation of man as one of the most important

00:14:34.260 yet largely uncovered trends. What is this? What causes it? And what can be done to fix it?

00:14:42.300 You can find all of this information and more at peteratiamd.com forward slash podcast.

00:14:47.560 There you'll find the show notes, readings, and links related to this episode.

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00:15:01.280 to, the most interesting papers I've read, and all things related to longevity, science,

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The Peter Attia Drive - September 30, 2019

#73 - AMA #9： NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more

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