Eric

I just dismissed it. I'm like, okay, well, I guess that happens lots of times. The spouse gets blamed for things.

She wanted to be here where Eric was. She wanted to sleep in his bed.

I was devastated. I was just so hurt. And I felt Eric was so betrayed.

Eric was very agitated. They had to put him in restraints. Watching my brother that way, out of control, it was horrible. It was the worst night that I can remember of my life.

Thank you, man.

Ann was feeding us information that Daryl was obsessed with her. We did think that it was possible that Daryl poisoned Eric and in the end was trying to get him out of the picture.

And I couldn't believe it. I thought, how could this happen?

I am scared. I am scared to death for Claire's well-being. At any moment, she could be poisoning Claire.

She threw away all of Eric's soiled clothing from his first night of being ill. She threw away all of the bathroom rugs. Instead of just washing things like any normal person would do, she threw everything away.

She was covering her tracks.

We needed to protect our granddaughter. We needed to take Ann out of her life, at least until... Claire's an adult.

Yes.

Ann, why don't you look at me? Why can't you look at me?

Why did you brutally murder my brother Eric? Poisoning him, watching him suffer. I think sometimes that you just can't explain it. There's pure evil in the world, and I think she falls into that category of pure evil.

He was laid in this bed with a tube in his mouth because they had tried to resuscitate him. He was cold. And I wanted to take that tube out. I wanted to cover it up because he was so cold.

He was a bit mischievous.

He would hide behind the couch when your boyfriends were over and, oh, I'm here.

I think Eric truly blossomed when he went to college. He got involved in biology and chemistry and research, and he found that that's what he wanted to do.

I had met some of the girls he had been dating prior to Ann. Then I could tell there was a difference when he introduced me to Ann.

He looks at me and he says, Mom, you always told me how much you loved me. But he said, I never knew how much you loved me until I had Claire.

I felt like there was no way that she could have done this to him. She loved him.

He was thrashing. And he started to cry. And he was like, why are they doing this to me? I remember laying on top of him physically. Because he was thrashing so much, and I was so afraid he was going to hurt himself. And I laid on top of him, and I just got in his face, and I said, Eric, you need to calm down. It's going to be okay.

Some friends of theirs had brought in some food. Ann was going to serve that and they were going to have that and have just the quiet time.

Because Eric said they were talking about that.

I woke up and my dad was just like on the covers, just laying there. Like there wasn't enough room to get in, I guess. So I just was laying there.

Yeah.

Wondery Plus subscribers can listen to Armchair Expert early and ad-free right now. Join Wondery Plus in the Wondery app or on Apple Podcasts, or you can listen for free wherever you get your podcasts. Welcome, welcome, welcome to Armchair Expert, experts on expert. I'm Mike Shepard and I'm joined by Lily Padman. Hi. Hi. Returning guest from the early, from the bygone era.

No, she had nothing.

She's like a newborn. She's amazing. Did you find her battery pack and her motherboard?

But man, it sounds like a pretty significant bit of heart disease. None of this sounds very mild.

Right. In the 60s, he would have died.

Well, one thing I found very comforting, and I'm leaping ahead a bit, but if I understood this paragraph correctly, we do know some markers for aging, some DNA markers that are good for aging. But you say that even if you were to have all 20 of those, really, it's going to be about 12% of the pie that's going to predict your lifespan or healthspan.

I found this deeply comforting because I don't come from a long line of old people. You and me both. Yeah, it's very scary. I think common wisdom growing up was, well, you get good genetics or you don't. I guess I was a little relieved that maybe at best is only 12% of the story.

You break it up into five dimensions that help with healthspan extension. And I guess, even though we've talked about it in the past, maybe we'll just delineate the difference between lifespan and healthspan.

If you could hike to 85 or be sedentary to 105 from 70 on, yeah, I think we would all likely pick very active with a little less time.

This is off topic, but to hear you say demented in the clinical sense, did that fly for you too? No, I like it. I never hear it in the actual. You're only saying someone's wacky, right? Like a young person.

Crazy, yeah.

That's what I hear. If you listen to the show, you'd hear it even more.

Every single episode. Okay. So the five dimensions that you break it up into are lifestyle, cells, omics, artificial intelligence, and number five, drugs and vaccines. So I just will say up front, I read Outlive, Peter Atiyah's book, and just loved it, probably because it cooperated my belief in what you should do. But at any rate, lifestyle has got to be the biggest chunk of this book.

Oh, okay, great.

Oh, great. I want you to flag those.

So I had an argument with Dr. Mike about this because I've had it and I'm pro. I understand... what your concern is, but I do think you can go into it with the right mindset, which is I'm not going to chase down everything. I'm not going to have a bunch of follow-up stuff.

I'm going to look for a big-ass tumor that we're going to monitor, and I'm going to go next year and see if that thing's exploding. I mean, I think there is some way to do it, but I understand it does set off all this medical intervention that potentially has more downsides

You got to be strong mentally to have it, is my argument.

But Eric, I smoked crack for years. I smoked cigarettes for 20 years. Like I needed a good scan. I stand by my scan. Found out I had scoliosis. I was like, oh, that's cool. I had no idea. It's extreme.

But that's like saying driving Mercedes are bad because only some people can afford them.

Yes. Ideally.

It can be dangerous for your arteries. Not the protein itself, but what you're eating to get the protein?

Well, Lane Norton, anyone that's into bodybuilding would. The most important part of those studies is every single keto plant-based, all diets, all the meta-analysis, if you control for protein, they all work the same. That's really, really relevant. And that's Just uber consistent.

We're giving you liquid death. I know. The irony. There's something wrong with that picture. Is that your super cute Bronco out there? That's my daughter's. Oh, I like it.

Surely.

Well, what we could agree, and the only thing I was going to borrow from the book, is he points out we got great with vaccines and we got great with treating with antibiotics a lot of different diseases. What we all now have to deal with is these chronic four disorders, obesity and diabetes, heart disease, cancer, and then neuro, which are in your book.

So these are the four that are going to most plague us now. We're not going to die of... cholera or some medieval disease anymore. These are the four that we got to really focus on. And lifestyle is hugely impactful for the four horsemen.

We have the best we've ever had.

Oh, in a good way.

The only one that troubles me is the muscle loss. Yeah. That's the only thing you gotta really be on top of.

Also, I like that there could be a good way.

Right.

Although, okay, so I was arguing with a friend recently and he said, oh, I don't want to be on that because I hear you might have to take it for the rest of your life. And I said, are you stressed out that you have to drink water every day for the rest of your life or that you got to eat food every day for the rest of your life? There's a lot of shit.

You got to brush your teeth for the rest of your life. I think that's a weird mental hiccup.

Yeah, yeah. I don't know if you remember, but sales of those Broncos exploded after that. Oh, yeah. You couldn't get your hands on a white Bronco. No kidding. Oh, yeah. Ford couldn't make them fast enough.

Am I right in that the diabetics have been taking this medicine for 15 or 20 years? It's not as new as people think.

Also, the precarious origin of the medicine having been invented by a company that's primary source of income is insulin production. And the fact that they even allowed this drug that potentially was going to cannibalize their real business. All of it's very interesting.

You could have seen them almost killing this thing because they're like, well, that's just going to destroy our insulin.

What was the appeal that you beat like OJ? That's a great question. I think just seeing a vehicle on display for such a long period of time, and I guess it looked formidable. And I think young men were like, oh, yeah.

OK, so in lifestyle, let's go through some of this stuff. So diet, you're taking a real magnifying glass to a lot of these things that we're already aware of. When we talk about diet, let's talk about ultra processed food and sweeteners a little bit.

My kids bring home stuff sometimes. I'm like, how did they even think of this? Let's construct this product. Yeah. It was like Reese's Pieces Cups Popcorn. And I was like, well, you're damn right that's going to be delicious. But how did they do it?

There was a 60 Minutes on long ago, and the segment was about food additive chemists. They're basically perfumists, really. And they take this group of them to an orange grove in California. And they're watching them all take one off the tree and peel it, and then they're tasting it. And this one scientist says, oh, yeah, it's this, breaking down all the things.

And he said, now, we wouldn't design it like this because you'll notice the taste lasts for a really long time. It stays in your mouth for a bit. And we want something that goes away almost immediately after you experience something. the nice taste so that you want to replace it. And I was like, this is actually nefarious. It's not just I want to make it taste good.

I want to make it taste good for a blip. So you have to have more immediately. How are you going to compete with a brain trust like that, figuring out how to make you eat as much as possible?

What's the mechanism that would be happening?

Yeah, yeah. Someone should do some social science on that.

Yeah. How are you? It's been a while.

By the way, this GLP one, there's so many things that are auxiliary to it. One of them being, you've read these articles where these food companies are now worried that people are not going to be eating junk food as much.

They have to have a game plan in place So isn't that weird?

We're both going to service our own pet projects. Hers is alcohol, mine's weightlifting.

Sure.

That's what we grew up with. One glass of wine is good for your heart.

As well as everything else in the store. Yeah, exactly.

We were independent for three years. Then we were at Spotify for three years. And now we're at Wondery.

Now, I love this because I am an abuser of caffeine. So tell us about caffeine and its impact. This is, I think, the shocker. This is the only good news in your book, I think.

Where are we at on red meat versus plant-based?

I think primary care physician for a while.

Yes. Anytime you study humans, it's just such a messy business. It is. So you go red meat. Okay. Well, what's your red meat consumption? Well, if we look closer, it's like, well, red meat consumption is largely probably happening through hamburger consumption. And now when we eat hamburgers, what else do we eat? People eat French fries with hamburgers.

Like how you're parsing out the red meat, as opposed to if we studied anyone who only eats a plate of ground beef, that's a hard person to find.

Right.

I don't want to lose you as a friend.

I eat a lot of red meat. Oh, okay. I eat a lot of meat. But also I'll add, I have psoriatic arthritis. I do not want to be an immune suppressant. I was for years. It took me seven years to figure out what was triggering it all. So I have a diet now that works for me and I don't have to be on any medicine and I don't have any symptoms anymore.

Well, I can't eat gluten. I can't eat garlic. I can't eat peanuts, a list of things. But what the result ends up being is, yeah, I have a pretty low carbohydrate diet because I can't eat pasta or bread, but I'm not afraid of a potato or some rice. Yeah, that's all right. And my cholesterol right now is great.

And this is, there have been a few guests that have really captured our heart.

All my markers, and I'm spoiled in that, were in a study with Dr. Richard Isaacson for Alzheimer's. So I'm getting a lot of work done there. I get a lot of blood panels. Things are good.

But I do eat an amount of red meat that would really break your heart.

And that's the most exciting part of this chapter is with the help of AI, for people to actually know what diet they should be on, to me, seems like would be one of the most helpful things.

Oh, did he? Because it was quite a mystery.

Yeah, the notion we'd have a food pyramid for 300 million people is a fucking fantasy.

And I think it's been the great frustration with consumers with the nutritional sciences in general, which is we're wanting them to have a magic bullet for all humans. And of course, that's why they contradict each other all the time. And there's no consensus in that field. It's a very frustrating phenomenon. field to monitor.

But it's because we are so individual, and that's really going to be the answer probably.

And what will that AI model look like? Will that be a combination of it having mapped your genome, you're wearing some sensors, it knows what you're eating? How will that come together?

Even when you ask people to say what they ate, they need help. And also, it's a tall order to ask people, like, don't eat carbs. Well, wouldn't it be great if they said, oh, no, you can have as many potatoes as you want. Stay away from rice, and you're allowed to have this. That's a manageable approach for people. Right. Oh, I think that'll be a breakthrough. Okay.

Is that true? No, that's not true.

I have to ask because my wife will want to know this the most. Environmental toxins. How serious of a concern are these?

Was that other person making stuff up me? Yeah, probably.

Okay, so I need more influence. When I get in these debates with her, I go, I'm not arguing at all that we're not measuring more plastic in the body.

But I hope it's gotten to you over the years. We talk about you quite a bit and we have such a warm spot in our heart for you. That was such a lovely interview the first time. Thank you. So last time you were here promising us that we would be completely without a need of a doctor. Our smartphone would be doing all of our stuff. And here we are six years later.

So the body was rejecting.

Yeah. Yeah. Where would you be getting all these plastics other than you're drinking from a ton of soda? And are we actually seeing the result of massive soda consumption or the plastics in the bottle that the soda came in?

I do. I'm the only one in my family. The whole family is like all plastics. I'm like the old man.

She's on it. I'm the only one that's still drinking out of the plastic water bottles.

I know. I have these blender cups and I fill them up over and over again with protein shakes and stuff.

I don't know how someone is two standard deviations above or below the plastic consumption. It comes in your can that is aluminum, but it's got a plastic line. Like how on earth is anyone taking in more or less?

There's so much happening. You get fatigued on all the problems we have. The fires thing happened, right? Big panic in my house. And I'm like, it's going to cut however many years off our life, but it's going to cut that many years off of every single person we know. In some weird way, I go like, yeah, but we won't be uniquely punished for this. It's everyone. It's everything.

And where are we at on that before we move on to... We have a bone to pick.

And an illusion that you can escape it. So maybe I've surrendered everything.

We fall in love with their spirit.

Yeah, okay, so we nailed the lifestyle portion. We skipped exercise, but I talk enough about that. Social isolation, we've also had Vivek on a couple times talk about that. That's really relevant. But let's talk about cells and what's coming our way and what's going to help us.

Yeah, you think it's destroyed, and you even say there's damage within these organs, and you would think that would be permanent.

And that's with altering your T-cells or suppressing your T-cells? These are B-cells. B-cells. I'm sorry. What are B-cells?

I didn't want to be on it. I'm trading this for cancer potential or I'm trading this for an infection. And you're having to increase them, which is the nature of them.

Yeah, did they find that MS has this triple whammy if you've had Epstein-Barr and herpes?

Okay.

And it just starts eating your myelin sheath?

Oh, Jesus. So even having the human involved in the system made it worse?

And Eric Topol's like at the top of that list. We think he is the cutest person alive.

I bet it's both, right? Because I do think half of the art of AI is learning how to prompt it. It's such a specific way to communicate. And I've only been dabbling in it. And I'm learning as I go how to get a better answer out of it.

We couldn't do that before.

It's not an infection.

And then now we get into artificial intelligence.

We're going to direct our resources and our mindfulness on this.

Do you think a lot of people will be listening and going like, yeah, that all sounds great. Some people are going to get access to that, but there's no way it's going to get democratized to a point where I'm ever going to be able to.

How significant was it?

They say like 80% of your lifetime resources you spend in the last couple years of your life.

We could spend all that money on defense. Well, that'll sell it, sure.

So we talked about GLP-1s, the T-cell engineering.

Are we in an age where we might get a vaccine for every type of cancer at some point?

Right. We basically train your T cells to identify this preemptively.

Because the AI is just in the room listening and handling all that stuff.

Every time I have someone equipped to answer this question, I have so much curiosity around senescence. Okay. Because the great mystery to me is if you have this process, mitosis, and it makes an exact replica of itself, why on earth at some point does it stop making an exact replica of itself? What is the process?

And the one thing I heard on NPR one day, it was like an hour-long story, and you quote him a ton in your book, is this guy who started erasing layers of the epigenome in mice. And he was erasing so much that initially it would put their body into a state of being like a baby and their organs would grow too big. And then it was learning to dial back how much we erase from this.

Because you accumulate garbage and flaws in your epigenome, yeah? Yes. I know already you don't care about living to 200. You're right about that. I already know you don't care. I am fascinated by that.

I got one wow out of him, and I'm going to sleep like a baby tonight. Continue.

Could save the career path in a way, because every time I interview a doctor and I ask if they would push their children into medicine, almost all of them say no. It's very disheartening to see how few doctors want their kids to pursue that.

Three billion, you said it right. There you go.

A 96-year-old that's like, either make me young tomorrow or I want to die in a week. That's who you're looking for, I guess.

It breaks some of our previously held tenets of biology.

Outrageously smart. He is a cardiologist, a scientist, an author, and the director and founder of Scripps Research Institute. His books include Deep Medicine, The Patient, We'll See You Now. That's what we had him on for last time. And now his new book, which is out, Super Agers, An Evidence-Based Approach to Longevity. This was a blast.

Yeah, that's incredible. Eric, you're so impressive.

Okay, go ahead. But I want to make sure we get them out of here in a reasonable time.

Okay, then I'll save how much I adore you and I'm impressed. Go ahead, peptides.

What peptides? Thank you. Which peptides?

This will dovetail beautifully into why I would recommend this book to people. Because you are an optimist, but you haven't drank the Kool-Aid.

It's a very, very moderate approach with a lot of optimism. And I think this is the book for Monica.

Several of the peptides are in his book.

People are on samoriline.

This is how upset he is before he finishes the one.

I'm going to make a counterargument. You guys aren't going to like it. Many of these peptides, these are off-label uses of peptides because they saw different results from studies that weren't even addressing this in the exact same one the GLP-1s, which you love. It was not designed for what we're using it for, but we started noticing something.

Tessamorelin. This was developed for HIV patients. What did they find when people were on this? They had a reduction of abdominal fat. That was just a side effect they found. Very well studied, administered. It's been used for 40 years. It's a very well-known peptide, and it had this auxiliary effect of reducing abdominal fat.

Yeah. Then we could get into how many studies there are that abdominal fat is a huge indicator of future for horseman stuff. This is the Dr. Isaacson. This is a dementia.

We'd have to go through each and every one of them, but most of them weren't developed for the thing that it's being used for.

Latisse, this eyelash thing, was a glaucoma medicine that they found, oh, everyone using it has beautiful eyelashes.

What you're upset about is that there isn't the data for the off-label use. But there is plenty of data for the peptide itself in the other application. In the same way that the GLP-1 had a ton of data for diabetics before, as you said earlier, they were refusing to study it for obesity.

But you're at a stage where you're going, we should try it for obesity. And you're going, there's no study for obesity. It's for diabetics. And it's like, now we're post that. It turns out, no, that was great for me.

Well, because I've slept like shit forever. So that's my hunch there.

I'm just pointing out you have an argument for one thing that you feel solid about, which was GLP-1's work for diabetics. It wasn't being studied for obesity. It is very safe. And now it turns out it's great for obesity. So we are at a phase with many peptides where the off-label use is just now happening. And it's already been studied for these other things to be safe.

So now we're just at the point where we're going to evaluate them for the off-label use. use, but you guys are going, no, don't use it for off-label because we don't have that study yet. It's a little contradictory to your embracing of the GLP-1s.

It seems like we need AI to be able to prescribe us medicine. And I guess we could have a bucket of that medicine, non-narcotic or whatever things you would not want to be gamed or be dangerous. Where were we at with that? And that's ultimately what you would really want is you get a thorough examination, ask all the same questions as the doctor would ask you.

So where the data is totally fine. Yeah. But a pessimism about that the data will prove out to be not real, I don't think is warranted. I think it should be given the same neutral opinion that the GLP ones.

I agree. That's a huge problem.

It's like, I hate that the government regulates. Okay, well, now it's been stolen from you. And what do you want now? You want a regulatory committee to come in and chase down your money and give it back. So everything you liked about it, you now are a victim of. And now you want all the regulation.

I totally agree with that mindset of I just want anything that's not that thing I hate is ridiculous and dangerous.

Yeah, I'm of the opinion there are hidden jewels. And I agree with you that they're being overused and without a doctor.

But there are good doctors who do believe in some of the ones that have now a great off-label use that will ultimately, in my opinion, be just like the GLP ones.

Yeah, yeah, yeah, yeah, yeah. I've been outnumbered a few times in this, but that's okay. I can handle it. Now, my closing statements. You're so impressive. Your body of knowledge is mind-blowing. Reading the book and then also just what you can bring off the dome, it's mind-blowing. And I think you have real integrity and a great heart.

And I'm really, really delighted you're a voice in this space. I loved getting to meet you the first time and I'm so glad you came back the second time.

Oh, that's nice.

Oh, wonderful. Well, we'll have you back for sure. You're going to write another book and you'll give us more fun information.

Door is always open. I really encourage people to read your wonderful book, Super Agers, An Evidence-Based Approach to Longevity. Again, we got bogged down in the bad stuff. It is a very optimistic book.

You take some pictures and then it says you need this topical ointment. Go pick it up here.

Yeah, absolutely. All right. Well, thanks for coming.

Okay, you want to hear the thing that I screen grabbed?

Okay. This is a callback to our period underwear episode.

Thanks, baby girl. That's cute.

Right. Or front butt?

And if anything, it's like you have your big butt and then you have a miniature butt up front. It looks like two little butt cheeks if you really look at it. God.

Yeah, yeah.

Even when you're saying it, I'm like, well, no, not that one. You could just go the boobs. I'm like, no, no, everyone knows those are beautiful. And then the... What?

I mean, I think, obviously, the penis is the most ridiculous part of the body. The placement's goofy. It looks silly. Yeah.

It's so interesting. Yeah. Um... What else? We're both in white.

Fun. The top is like, it looks like the inside of a sweatshirt.

It's fuzzy.

And you're in eyeliner again.

You're not in eyeliner again.

What?

Yeah, you look like you looked the other day. I mean, now I'm noticing, yes, the eyes were an extra bit. But yes, it's still something a little different.

Cheek filler.

I would not have guessed that. Okay. Under eye concealer. And lipstick.

Every fucking time I leave the house, I'm in lipstick.

Yeah, like...

If you're in triage, you only have time for one application.

It's going to be lips.

What about cover-up?

Sure, a little pop. Remind people what's happening. Yeah. Yeah, I'm gonna say this with the utmost gratitude. I am so happy I live with all women. It's such a blessing. I'm glad I don't live with a bunch of men and boys. And I'm blessed to work with you all day.

Right, like one rung above over the counter.

But sometimes the spirits blow through town.

I don't mean period.

Now, it would be easy to blame period. And in a few years, I will be able to blame period.

No, because neither are my daughters. Oh, oh, oh, oh, oh. But sometimes the spirits, just the emotion spirits blow through town.

And all the ladies are so emotional. And I, as the guy, I'm like, what has happened? Is it weather, moon, food? Is the well poisoned? What?

That would be incredible. Now, I am curious because in your own history, you famously left the Cleveland Clinic in 05 because you were sounding an alarm that there was this drug, Vioxx. Yeah. That was quite detrimental to patients.

You know, I'm clutching at straws because I'm not sure what it is, but it'll just be, we have these days where everyone is very emotional.

upset or just like well can you assign your emotions so can you give an example because maybe i can help maybe i can tell you what's going on okay so um boy and i keep really trying to evaluate when's when do i have to stop talking about my kids because they're old no i'm not sure It's very hard for me.

It is. But I'll just say because whatever. Yeah, like just indiscriminately. You know, D-Money's got a zone or it's almost maniac. It's like she's laughing really hard and then all of a sudden she's crying. She's completely upset. She's on a roller coaster. She's on a big, big time roller coaster. And then we had... Now, Lincoln had her play last night, right? The sixth graders put on a thing.

It's like an art show.

And then they've made these enormous papier-mâché heads. And when I say enormous, they're the size... of 10 basketballs.

And they have to go on stilts on the, someone wears them. Lincoln was lucky enough to have one. And they're the Greek gods. And then there's a play and a dance.

Really cool. First song they kicked us off with was Seven Nation Army. Oh, yes, you do. Do I? Jack White. Is it the White Stripes or just Jack White?

Oh, it's the toughest, coolest song. And all these little Catholic schoolgirls are fucking rocking to the most badass song. Wow.

She had like this contraption on to hold the head up. I'll send you a picture, of course.

Pictures and video. You know, D-Money can't even get through that thing. We got to go outside a few times. I'm on the verge of going like, hey, everyone had it together for your thing, but I know that's only going to make things worse. I can't really see anything.

Then we get home, and I don't... Lincoln had that thing on her thing for a very long time, and her legs hurt in a way that, honestly, it seems like she would have had to have been shot with a shotgun for them to hurt as bad as they did. And again, man, groin pain.

All of it's possible, but it's a grand mal meltdown, and I got to carry people upstairs, and the other person's already thing, and then Sweet Belle's just home from New York, and she's frazzled, and there's too many suitcases, and I'm just... And I, the guy perspective is whatever I say is going to make it worse. I can't think of a magic thing. Yeah. That's right.

And I need to just accept that people are emotional. And I do that. I'm not trying to talk anyone out of it. But I can see how these patterns emerge, which is just like, I just say less and less and less. And I'm more and more scared to just interact with anybody. And so I find that like, I'm just quiet for like eight hours, which is really funny.

And then I go to bed and I'm like, you know, hopefully we'll wake up tomorrow and everyone will just kind of be reset for whatever reason.

It's just one of the very funny gender gappy things that I think is really interesting. And I don't know what it is. And it's just funny to be the solo male in this situation.

That's the great thing is that— Throughout my life, I generally would make that my, I would be the cause of that. That's my knee jerk. And I think that's why people's emotions are so insufferable to me is that I convince myself it's because of me. I knew it was not because of me, luckily. So that's a huge load off my shoulders.

Because if you can figure out a way that it is your fault, then it really is kind of grueling. Yeah. Now that I experience it, I like kind of go back in my head and I think of all these like dads I knew who just were like, I hadn't heard him talk. They just stopped talking because they just are afraid they're going to make it worse or whatever.

Yeah, you know like when the hero in the movie is like walking away and the explosions are happening. And the cool thing to do is not look over your shoulder. You just got to keep strolling. I think that's a little bit like that.

It's kind of a funny experience being a guy a lot of times, you know?

Like there's many times where I look at myself and I'm just kind of laughing. I'm like, look at this guy. You're just kind of like wandering from room to room hoping you don't bump into anyone. Yes, oh yeah. And like a little panicked when you do, when you're forced to say something.

What also happens is, And maybe you should just always grant everyone. This is like, they build up, you build up trust with one another and they are demonstrating who they are over a long enough period of time that you can really, you have a lot of data to talk yourself out of it, which is like, I know these kids. They're not wimps. They're not, they're not easily defeated, you know?

Yeah. In 2004. You were victorious in this.

So it does get easy over time because you start to see the actual character of your kids and you're not as worried as much.

Yeah. But all to say, You end up just being really quiet. And I just think that's really funny. I think it's really funny.

Walking on eggshells. Yeah.

Oh, I'll add one other thing.

I also have to be realistic about the trade-offs and the rewards. So the joy of having these girls is like I get to be so affectionate.

And loving all day long. That's like the apex of it. And so, yeah, you don't get that. You don't get like just the good emotions you want to swim in all day, which I do, and not have the other side of the coin.

All anyone's looking for in life and what is comforting and get you through all of it is if there's any sense that you're getting even fractionally better and you're committed to getting better, then there's like this ultimate tolerance for it. I think it's when someone's not going to change at all or it's getting worse. Sure.

Yeah.

Oh, beautiful.

Yes.

Totally. It totally makes sense. I was having kind of a funny thought, which was, When you meet your grandparents, they've already been through this whole thing, right? So you meet them and you kind of think you're meeting, the original them. But like, I think about my Papa Bob, he was so quiet sometimes. Yeah, yeah, yeah, yeah.

And I just kind of thought he was a quiet guy at times, but I now realize, like, I met him way into the game. This is his second time around with kids in the house and the whole thing. So it's like, he, I don't even know, who knows what my grandpa was like at 25.

Yeah, he just learned to be quiet over time. And I think that is the trajectory of all men if they're gonna succeed.

With men or me? Just me.

Okay.

Yeah, yeah.

I have moods. They just, they show themselves. Their phenotype is different. It's just a different version. And I know a lot of guys that's like this. It just tends to, again, we do the same thing. We get quiet. We isolate.

And then we, we, what feels like is we abandon or we retreat.

That's almost our version of being moody or, or having big feelings is I'll just, I'll remove myself from everyone.

And I will soothe with something that's generally solitary. Like I don't want to be around everyone when I'm depressed or in a mood.

Sure. Carly?

Okay.

Okay.

And your pursuit of that then exposed this other problem that you got immersed in, which was this interconnectivity between the institute you're working at and the pharmaceutical company.

I think you guys are comfortable around each other having big emotions. And then what's scary to you guys is when we just vanish.

That was it?

Okay, my update is that he just did Dr. Mike's podcast a few days ago. And Mike said to me, I saw the picture of you and Eric and it's the cutest picture ever.

Oh, my gosh. Yeah, I really wish he was my dad.

I mean, I already have a dad, Tom Hanson.

But just look how sweet. We could have so much fun lifting weights together and doing father-son stuff.

If he's around. Yeah. He's a busy man.

He had brought a sleeveless tee because he's been lifting.

Yes. And I said, not only yes, do I want to do that, let me go grab a tank top. Yeah. So I did a little wardrobe change. And his daughter took the picture.

Yes.

And what happened? Did you just, like, at some point, did you go, like, I got to stop bothering this guy?

Oh, sure. Yeah, that makes sense.

Yeah, yeah. So does everyone else. I mean.

Laziness.

Spearheaded.

I wish I could cite something right now, but I have run across numerous articles that talk about just the overall efficacy of the drugs that are passed by the FDA. And it's abysmal. I mean, it's truly, truly abysmal.

We're talking like 20% of people will actually benefit from them. You know, really, really low. I guess when the doctor prescribes me something, I think like, well, this thing works. That's why they're prescribing it.

And in their defense, no, they're going to try that. It might work. And then if it doesn't work, they're going to try another option.

And they're just knocking out. But I think the general public thinks medicines do the thing they say they're going to, like 100%. Yeah. It's not.

In the 80s.

This is current. Yeah. I'll admit it changed in the 90s and it got different.

Lopsided.

Yeah, that almost doesn't happen.

As are men's rectums. So bottoms get it way more than tops get it.

Yeah. Fissures, openings, friction.

Well, because the receiver tends to get it more than the giver.

It would be harder for you to give it to him because he has far less openness on his penis than you have in your vagina. And you have more fissures and openness in your rectum than a penis is going to have.

Then we would be apples to apples. If men and women had sex anally to vaginally.

Well, this is how it seems like making out.

And a lot of like suction noises and stuff.

I'd like to try it.

Who's that?

Hello?

No, come in.

Are you okay? Oh. Oh. Well, when you come, I don't see you and I hear... I did also think for a second you were crying. I'm assuming you've come in crying and someone just assaulted you.

It's double whammy. You came in to the podcast space, which you don't do often.

Look at me. Look at one of these cameras. Come over here and look at that camera.

She's already crying.

Yeah, we would love to think there's a wall between research and big pharma and even hospitals and big pharma. And this kind of showed that if there's a wall, it's permeable at best.

Yeah, we're proud of you, too. We're so proud of you. It's hard. Those bike rides are hard.

Right?

No, this is great actually because it's for Eric Topol and it's about longevity.

Doing it for you, Eric. This feels now scripted almost.

Scripts.

Tomorrow morning.

I filled it out too in case we missed it.

Tell me what you want to say to Mom, and I'll write it.

It's good training.

So, okay, you left in 2005. 20 years later, do you think this problem is the same, less, or more?

And the Cheshire Cat. I'm like, that kid definitely auditions. He's probably been on TV. You know, because we're in LA. The White Rabbit. Oh, White Rabbit. Yeah, yeah.

Well, I was telling Delta before the play, the night before, she's like nervous. And I said, I just want you to hear from me. What impresses me is putting yourself out there. I do not care if you're good. If you remember your lines, what is admirable is putting yourself out there. And you will do that because you'll show up. So there's really nothing to be nervous about from my approval.

Did anyone from Purdue go to jail?

Oh, meaning like it's a fringe astrology thing. It's an evolution of astrology.

I think it's just a way.

Salt settled.

Great job. Great job. I'm very proud of you. That's the hardest workout.

What's that from?

I will produce, I will cite the many articles that say it's great for you.

I love him. We can't wait to do it again.

With probably more gains.

I hope he's bigger than me in the next photo. That would be incredible. He's going to have to up his protein intake.

All right. Love you.

Follow Armchair Expert on the Wondery app, Amazon Music, or wherever you get your podcasts. You can listen to every episode of Armchair Expert early and ad-free right now by joining Wondery Plus in the Wondery app or on Apple Podcasts. Before you go, tell us about yourself by completing a short survey at wondery.com.

It correlates beautifully with however much money the drug makes is what exponent it goes up by, really.

So I guess I asked that question in pursuit of wondering, will these big institutions, big insurance, big pharma, the networks, will they try to put up roadblocks for this drug? very democratized access to AI in phone medicine.

Yeah, you got beds that are telling you how you sleep in your O2 level. I mean, we're getting there.

Okay, so I have an unpopular view, especially being a liberal. People love to hold up the UK's national health system or Canada's. You're looking at what sector it's beneficial to. If you're looking to generally just raise the overall access and health, I think it's very effective. Right. But I think you can't ignore the fact that anyone that needs something for real comes here. That's also true.

And friendly dust-ups between Eric and I, because I'm on one side of the spectrum. Sure. Please enjoy Dr. Eric Topol.

We are also leading in so many areas. So all of this is built on this highly profitable system. So I think to ignore that aspect, and I have lots of friends that live in England. They're not all wild about it. I have lots of friends in Canada. They're not wild about it. What we get sold on here, just talk to folks that live there. Not everyone's wild about it.

But I think the tipping point would be if those countries did embrace all this and we saw... Oh, no, you actually want to go there and use that because, again, the AI is catching the tumor at 78% accuracy and our doctor is getting it at 50. If it becomes superior because the tech is so much better, I think the current argument that holds sway kind of falls apart.

Is that because their access to data?

There's no tiers to the system.

Okay, so your new book is Super Agers, an evidence-based approach to longevity. This is right up my alley as someone who turned 50 this year.

Well, that's very kind of you to say, but my most optimistic self doesn't think that I am not minimally halfway over on the ride. And I put a lot of thought and effort into trying to see as much of my kid's life as I can. So I'm really, really interested in this. You start the book with two patients, Mrs. LR and Mr. RP. Why do you start with them and what is interesting about them?

Yeah, it's almost impossible to do, right? To find someone who's 90, who's not had any, even the stat in the book is 95% of people over 60 have one chronic illness and 74% of people have two by the age of 60.

I can hear you.

Oh, yeah. Mid-century modern. It's my little office here.

This is a new house.

Oh, maybe because of.

This is about 10 years ago. So there's a few characters, obviously my wife being one of them. She's kind of social butterfly, the opposite of me, Texas girl, Southern, everywhere we go, she's talking with people and people love her. She's adorable and got dimples, blonde hair. So Basically, wherever we go, she's finding friends and I'm trying to lose the friends she's making.

And so we moved into our new house. We left the city of Rochester to move to a little town right on the outskirts of it. We were just so excited because it was tucked away. It was quiet, not a lot of hustle and bustle from the city. So we were just really excited to move in. The house was set back a little bit. So the driveway was a little bit longer than everyone else's.

We get there and obviously we're making friends right away. My wife's talking with all the neighbors. Everyone's super nice. There's one particular neighbor right next door to us. Her name's Betty. She's about a 60-year-old Italian woman. Seems really sweet. We kind of hit it off talking at the end of the driveway, neighborly things. Everyone's really supportive in our neighborhood.

And there was another neighbor across the street. His name's Randy. He was kind of like a bachelor guy, retired, but only like 47, 48 years old. So he retired kind of early. I think he worked for like the sheriff's department or something. Real nice guy. So late summer, we just moved in. The neighbor next door, Betty, brings over a gift. And it's a little broom, dustpan and a Frisbee.

Oh, interesting mix. Yeah. We're like, OK, great. Thank you so much. That's nice. I found it odd because the only thing left in our house previously, you know, we moved in. It was empty. It was a couple of cans of paint and a dustpan and a broom and a Frisbee. What?

But this is the only thing in the home. Weird. They moved out and left.

I work a lot of evenings and weekends so I can come home and Mandy and Randy and Betty will be outside chatting, maybe having a little smoke break, having a cocktail, that kind of thing. Fall rolls around. Betty starts asking my wife, can you take out my dog once in a while when I'm running errands? They have a few cocktail hours, things like that. She's a stay-at-home mom, my wife.

So it was just nice that she was hanging out with other retired people and had some company during the day and while I was at work and things. It was just a pretty typical fall, nothing too crazy. Winter rolls around and I'll shovel her driveway once in a while. Everyone's helping out.

Randy comes by with his snowblower and we'll clear the end of each other's driveways after the big plow comes through and we're all helping each other out. Betty would ask my wife for a couple of rides to the doctor when it was snowing or things like that. And

That's when I was like, maybe you just tell her no once in a while, even if you're available, just to make sure we're not on a trajectory that's untenable. Yeah. Good fences make good neighbors kind of approach. Just another couple of things that sparked my curiosity in my office was in the front of the house.

So I could kind of see at the end and Betty would stop the mailman and talk for like an hour to the mailman. I'm like, this is not sustainable here. You know, I just can't imagine like, why would the mailman wait that long? Maybe he's lonely. I don't know. He was a younger guy, but then the mailman started showing up in street clothes to her house. That's a little weird.

I don't know if you're supposed to have a relationship with the mailman like that. So spring rolls around and I see an ambulance across the street at Randy's house there. And it turns out he died suddenly. Oh my goodness. At 48? Young guy, you know, he smoked 10 packs of cigarettes a day, it seemed like, and 30 coolers light a day kind of habit. So we weren't surprised.

But I guess he had a heart attack, called his dad a few hours before saying he was having some issues and then passed away. That was really sad. He was a real nice guy. Missed him. And that's kind of when things got a little weird. We started seeing Betty in a robe all the time, not really out and about like she was walking her dog. She would just walk her dog to the end of the street.

And then one day she just came out just yelling at kids playing basketball in the middle of the day. And I walked out there and was just like, you know, oh, hey, calm down and give yourself a heart attack. She was really worked up. Again, another checkmark.

maybe things aren't as stable as we thought here and then she started yelling at us from the fence waiting for us to like drive by on the driveway and kind of yell right at the car she's yelling that my wife killed randy oh my god she has some theories yeah wow that we ruined the neighborhood everything was good until you arrived for like the bad luck or something.

So that's when I was like, okay, no more connection. Let's just ignore. I had a 10 year old son at the time. I told him Betty's sick and we kind of left it at that. Well, early summer now, I came home late at night, pulled in the driveway, got out of my car and it was just terrible smell. This is bad. You know, is it my trash can or something?

We're about 300 feet from one of the Great Lakes, so you can get some kind of terrible smells once in a while. It's summertime. I'm like, oh, that's weird, but I'm tired. It's late. I'll solve this problem tomorrow. Maybe we'll be gone. I wake up in the morning. I get some errands to run at Home Depot. I hop in my truck that was parked in the driveway the previous night.

I still smell this terrible smell. I'm like, what is this? Look around, look in the trash can. I just can't seem to find it. I hop in the truck. I go to Home Depot. I take this road. It's through a park, very windy, 25 miles an hour. I'm driving on this road and someone just passes me, double line, shouldn't be passing me, gives me a dirty look. I'm like, what's going on?

Sunday morning, everyone relax, keep driving. I come to a red light and I see this truck behind me and then he kind of backs up and then pulls alongside me. And this truck was like a farm truck. The doors don't match the paint. There's two gentlemen there. They're real kind of dirty guys. And he kind of makes this motion like a hitchhiker or something motion. Wasn't sure what exactly he was doing.

The light turns green. I'm like, what is going on today? Why is everyone just looking weird? And I pull into the Home Depot. I go past the entrance. And again, I just noticed everyone looks so angry today. I'm just so confused. Pull into a parking spot. step out of my truck. I took a few steps and it just, it hit me, the smell. And I looked down and tied to my bumper. Is a dead animal.

Oh, my God. I've been dragging this animal through my town on a Sunday morning. Through my town. And everyone's trying to tell me. And that's why everyone's so angry and passing me.

First, I thought it was my cat.

And I was in shock. Did get a closer look. It was a raccoon. Wow. It was tied around its neck with like a USB cable and then like a wired mouse then attached to my bumper. Oh, my goodness. Oh, my God. Wow. And again, I'm looking around. Everyone's looking at me. I got nothing to say. I'm in shock. You know, people are clenching their kids in the Home Depot parking lot.

Like, look at this monster dragging roadkill. And then I'll call him the Home Depot angel. The guy who's collecting the carts comes over, kind of breaks the silence as the crowd is gathered around me. And I'm unsure what to do. Everyone else is unsure what to do. And just looks at me and goes, looks like he caught something. Oh, that's a nice icebreaker, I guess. Yeah, he's there to help.

And he's like, no worries, man. I'll be right back. Comes back with a bucket and a shovel. We cut this guy loose.

And he scoops him up, puts him in the bucket. Oh. And he's like, I'll take care of this. I'll throw it in the dumpster.

I was in shock. What I did is a few days later, I gave him a good review. Oh, my God.

put pieces together and realized that she must have at night, her or someone, maybe the mailman.

Possibly to put this kind of roadkill attached to my truck underneath so that I wouldn't see it until I pulled out and pulled away. And then I just went down to the police station the next day and was like, I'm not concerned about this woman hurting us, but that's a lot of diseases on this raccoon. Yeah.

She moved a few years after that. And then we moved a few years after she left.

They came over to the house. The police talked with her and some of the other neighbors. I just think about all the signs. Everyone is kind of warning us. Even the previous owner of the home kind of just left what they gave her, right?

She said something about it being good luck. It gives someone a broom or something. So they're saying it was good luck and then the people leaving it behind.

Oh my God, that is so funny. I was not bringing that to my next home.

Which?

It was very interesting. Wow. I thank you for letting me tell that story. Hopefully it was somewhat interesting. Oh, it's incredible.

Oh, wow.

My wife really got me into armchair expert. We pretty much only listen when we go on road trips and she kind of created a monster. She's like, you know, can we listen to music once in a while? I'm ready to binge on experts on experts and she needs a little bit of tunage and relaxation in between. Oh, that's delightful.

Yeah. Can she pop in and say hello?

My beautiful Southern bride. Her name's Mandy. Hi.

Coming in hot with the booze.

Oh, my first line in a coat that's bright. Found simplicity in a world that's tight Concurrency's smooth, it's out of sight In gold we trust, it's a coder's delight Memories clean, no garbage in sight Gloriotines run like a horse in the night Static type that makes the airs light. In gold we code and our futures bright. Hey, with gold we're building dreams. Light and fast it reigns supreme.

In this language clear and lean. Gold with the flow, it's a coder's dream.

And I figured, oh, OK, why not just get that VM from the Linux team? What could go wrong? And so, yeah, I administered a server to deploy these apps on for years. It got so popular that I became in way over my head, even though I am a Linux geek on the side. I run Linux everywhere, but And over time, we ended up getting an enterprise product for that.

But it just goes to show you this opens so many doors for people. And now a huge part of my day job is to build these really slick, you know, interactive applications that may use R as a front end only or may interact with HPC environments. But R is the foundation to tie all that together is absolutely amazing.

You absolutely can. Yeah, absolutely. I've done that. I've done very business intelligence-like looking dashboards with some of the latest and greatest in their bootstrap design toolkit that they're exposing now.

all the way to, like I said, these really comprehensive end-to-end, take your data, tune an algorithm, launch the analysis on a cloud or internal HPC cluster, and bring it all back with some interactive like Plotly-based visualizations or other types of interactive displays and let the users download that for a standalone report. It's all possible, and it's absolutely amazing how all that works.

Okay, and I'm assuming because R is not really OO, right? There are parts of it that are, absolutely. Oh, there are? And there are different ways to do it. That's what gets really interesting.

And we'll make sure to link in the show notes for those that want to get into the internals of R. Hadley Wickham, who is arguably one of the most prolific R package developers in the community, wrote this book as a way for him to kind of share the way he's been developing on the language. It comes with a paradigm called S3 under the hood.

which kind of has it's it's in between a traditional object oriented programming and a more of a expressive language. And it does some things that may make a purist programmer think, why the heck is it doing that with nonstandard evaluation and the like? But then it's got other systems that are more rigorous and also extension packages that are trying to bring it a little more rigor, such as R6.

And there's a new one out there called S7 that's trying to consolidate it all together. So it's got a long history. And depending on your needs, you might do one system versus the other. The S3 system is great for just the interactive data analysis, get my data frame in, do a quick plot on it, do a quick table on it, and you can write it in very few lines of code.

Whereas the more rigid structure is great for, as I said, these web application development, these more comprehensive packages that are doing a lot of internal processing. That's where things like R6 and this new S7 system are coming to play here.

No, you get to choose your own adventure here. So I would say, yeah, the flexibility of how R is built in terms of what I call its base install are absolutely tailor-made for those interactive data analysis. You might be familiar with Jupyter Notebooks or IPython type workflows.

When you combine R with a package called R Markdown, you get that very similar experience of creating these dynamically created reports with interactive code chunks, but it's very expressive in that language, absolutely.

Yeah, so RStudio kind of came about 12, 13 years ago where there had been attempts at IDEs in R before, and some worked decently well on specific operating systems. Heck, of all things, I remember there was a plug-in to Notepad++, of all things, to interact with R for the Windows users.

Hey, Notepad++ got me through grad school before I learned Linux, so my goodness. There you go. But RStudio came around as kind of building an IDE that was literally tailor-made for R itself instead of trying to be a generalist. And it's had its place. I won't lie. It definitely helped adoption of R in the enterprise, having that first-in-class IDE that you can install.

Very likely. It's going to take care of everything for you, having like the code editor, the interactive help browser, you know, installing packages for point and click and looking at visualizations. Yeah, you can do all sorts of wonderful things there. The company behind RStudio, like I said, they rebranded the Posit.

They have launched a new IDE called Positron, which, get this, is a variant of VS Code. Who would have thought? But it is happening. It's so in beta right now, but it's trying to be, you might say, a generous home for more than R itself for data science, so i.e.

You could say that. And it's taking the best of VS Code but putting their own spin on top of it to make it more tailored to that RStudio-like experience. It's coming a long way. It's got a lot of potential. I am using it as kind of like a dev test for some open source projects. And because of the extension system, you can make that anything you want.

So I think they built this as a way that they learned from RStudio that, yeah, it was great for R. But the reality is, Mike, as much as I am an R evangelist, a lot of people love interoperability. They love to hop back and forth between R and Python or R and Observable or R and other frameworks. Positron is their way to make that a reality under their toolkit. Interesting.

You know, and I admit it somewhat doesn't sit well with me at some point. But then again, I can't deny that it is up the game of so many dev stacks. Oh, yeah. And I was an early adopter of it, too, when that R extension came out for VS Code. And in fact... Another thing that kind of changed my dev life about a few years ago was the idea of dev containers in VS Code.

So then I could potentially not even have R on my host system, but via Docker in the dev container, install R, install the packages, install extensions, and have it be a self-contained environment. I couldn't believe it, but it actually worked.

Yeah, I've heard that too.

That is a testament in and of itself. And I've actually been playing with WSL as well, of all things, for a really important external collaboration to get an R environment with Docker installed as a test for our colleagues in regulatory. So there's lots of great opportunities with this type of technology. And R is definitely well suited for those workflows, as I found out. So good.

You literally said it. It is. There is a package called RM to help fill that gap for a given project. This is a good example here is there may be a project that I have where it's literally more of a traditional data analysis, get a report out, send it to a stakeholder, but do it through our scripts or in our markdown report or more recently a Quarto engine, which we can talk about sometime.

But then I have different needs for these shiny apps where it is a software stack, right? I have dependencies that are going to be tailor made to that shiny app that that other project does not care about. So our end is kind of like ours answer to, you know, pip or virtual environments. I'll be it. I think they do it a bit cleaner.

But again, I'm biased, but it has been a huge help to making sure that for a given project, especially for my day job stuff. I can be assured that I can have that dependency library self-contained in that project. And no matter what happens on the host Linux infrastructure with what I'll call the central library of our packages, that particular RM project is isolated.

I can do whatever I want with that. I can opt into package upgrades. I can opt into package downgrades. But I get that flexibility. And without RM, I do think R would be in much worse straits for production use. So it has become a huge part of my toolbox to make sure that I'm doing effective dependency management. Is it perfect? Like I said, nothing's perfect, Mike.

But it sure is a heck of a lot better than trying to manage these R libraries yourself and hope for the best that you got that symlink correct when you're loading that into your R session.

Yeah, yeah. I've had nightmares upon nightmares when somebody asked me to help debug what's going on, where they load a package and they say, wait, it can't be loaded. And wait, I thought I installed it. No, it's because you had this weird cryptic version in your home library that's masking the LDD libraries that the hero package should be loading.

Many hours have been spent trying to fix those issues.

I'm more of a honey person, but boy, oh boy, I'm glad to be here. We both were in pretty dire straits earlier when we wanted to record this, so I am super thrilled to be on here.

Oh, yeah, the immense pain from that. And I wish at my day job they would let me have a Linux-powered laptop. Unfortunately, it is Mac, and I've done my best to play that game, but I am so spoiled by what I can do on my home environment with my Thaleo running. Now it's running NixOS, but Ubuntu before that, I had so much more control over it. You're a Nix convert, are you?

It took a bit, but ironically, I'll bring it back to R here. There is a great person in the community named Bruno Rodriguez has made a package called Rix that will let you install development environments in R via Nix packaging. It is absolutely mind boggling that this all works. I've been beta testing that already has some good success with it.

And by the way, for those listeners, this is actually not the first time that Michael and I have had a conversation on various podcasts in the past, especially our love for a spiky-haired blue mascot and the company around them. But as a lifelong listener of Coda Radio from episode one, this is a super thrill to be here.

And I got big plans to hopefully bring that to industry later on because I think it's a game changer as well.

Yeah, and I was skeptical, just like many other people, but of course, shout out to our friends at Jupyter Broadcasting. They're the ones that first hooked me into it, and I thought, well, that's great for the early adoption of Linux in general, but What about data signs? What about R? And then Bruno comes along and does this Rix thing. I'm like, are you kidding me?

So then I install, I'm like, oh my gosh, this actually works. Oh, mind blown. Okay.

I would say understand that there can be a lot of variability in terms of how certain workflows are conducted just at the lower level. So as I mentioned, one of our greatest strengths is the community of packages, right? Well, even in the realm of just data processing and data munging, There are like different avenues you can take with that.

There is what's become known as the tidyverse family of packages that try to have a more unified syntax or how you do that end-to-end data ingestion, munging, processing, visualization in a very literal pipeable type of syntax. But then you've got other languages that are leveraging or other packages that

leveraging, say, C++ on the backend to do more sophisticated processing, but with their own kind of DSL inside. So you might get overwhelmed if you try to use all this at once. It's good to try things out and then see what style suits you best. Because like in the realm of data processing, there's a great package called data.table that has been one of the mainstays in R for years and years.

But its DSL is completely different than what this tidyverse family of packages offers to you. So I'd say be prepared for that variation. But once you find something, don't feel bad about sticking with it. I know lots of great developers and statisticians, data scientists out there that love the data.table approach and more power to them.

I personally think the Tidyverse approach is a bit more intuitive to a new data scientist and a new person coming to R. But you have choice, right? It's just like Linux. You have all these choices for what you want to start developing in. So I'd say just be prepared for that flexibility.

And once you find something, don't feel ashamed about sticking with it because you can do lots of awesome things. with so many parts of the language. It almost makes my head spin when I do this podcast every week and seeing what people are doing that I had no idea was even possible. So the choice is good, in my opinion.

Ah, yes. The feels. Yes. Oh, God. Just say, come on.

Exactly.

Right.

That's all they do. Because that's all they want to do now, I know.

Every time I think we covered it, there's something new to talk about there.

I'm sorry, Mike.

Yeah. Great for content, nonetheless.

Wow. I knew one of these would happen, but this is opening my eyes to a whole new world here. This is really cool. And these folks are extremely passionate.

Oh, man. So many hours back in grad school, I was honking on that between breaks and classes. That was an amazing time. Sneaking that in my Jansport backpack. Oh, dude. Rock a Jansport. Rock it.

Yeah, it's actually been a few different things. I started in podcasting with literally DR Podcast, so no one can take that away from me. It was the first one ever way back in 2012, 2011. I remember I started that one year before my first kid was born. And then, as you well know, life changes quite a bit after.

What could possibly go wrong with that naming, right?

Oh my goodness. Just imagine hooking this up. You know, we didn't really get to it, but I had my adventures in live streaming a few years ago and I would occasionally play hot shot racing on my stream and well, shout out to Martin Winpress for getting me in that racing league a few years ago. But nonetheless, just imagine having like this as some fun break between dev work and streaming that out.

Oh, that's really slick.

No, I have not. I may have heard the term once or twice before, but you've literally just opened my eyes to this very tantalizing new world.

And what honestly this means to me is that this would be the closest you could ever get to say one of your kids being introduced to what the Game Boy was like with an actual physical cartridge instead of you just throwing the ROMs on an SD card or something and really just get that feel for what it really was like for the old timers like us, Mike. I mean, this is really neat.

You had to bring me down, didn't you?

No, I think our eight-year-olds are probably very close in age, because I remember when you mentioned that on the old Coder Radio, my kid was born a few weeks apart, so I imagine everything is similar here. He is addicted to Minecraft, and I'm afraid you're right. Within five minutes, he's like, where's Minecraft?

You get a kid and whatnot. But yeah, that was my first foray. And honestly, I started it as a way to It was almost like learning out loud, as they say. I was still pretty new to R at the time, but I figured, well, Linux podcasts have helped me immensely in my journey in grad school. Why not be the first to do this? So that was my first foray in sharing my love for R out there.

I did. I did. And it was tough at first because there is a very well-known plugin for Emacs called ESS for Emacs statistics that I did use for a good year or so back. And this is well before that RStudio IDE came out. And I was looking for a way on our Linux environment at work to kind of have that. you know, terminal-ish like experience, but yet have an IDE like experience.

And at that time, Emacs and ESS got me so close. But I tell you what, those keyboard shortcuts just royally made me, you know, so confused. So then once I started to learn Vim a bit better, which was admittedly easier to do for quick text processing, I never looked back, Mike. I have to say I saw the light.

I do admit I have a very close colleague at the day job. If he hears this, he's probably going to read me fits because he is like the one Emacs user in our group. So sorry, the other Michael that might be listening to this, but it is what it is. He knows it.

Don't get in my ideas.

You're not wrong there either, but yeah, I can see where you're coming from.

Nah, who needs that?

It's not a direct parallel, but sometimes when you look at all these lower-level JavaScript frameworks, it just makes your head spin almost equally similarly. So that's why I'm glad I know enough that I need to be dangerous, so to speak, but I don't have to be the ninja of all the 1,000 JavaScript frameworks out there. I just know enough to get the job done.

Oh, boy.

And then since then, I've done a couple of different things. And my most current one is called R Weekly Highlights, where we talk about the latest happenings in the community and kind of a news and discussion format. And it's been awesome.

Oh, the many hours I've wasted trying to learn that system. My gosh.

Yeah, cruft or crud is an understatement. But yeah, ironically, there are some R packages out there that try to be a front end to bringing those custom frameworks of JavaScript in. One called Packer, I believe there's other ones out there. And I tried them a bit, but they still even made my head spin.

So when I just do my Shiny app development, if I need some JavaScript, it's still vanilla JavaScript for the little custom thing I have to do very rarely.

Well, I mean, I opened the door. You did open it.

But I will say the other great innovation recently that I've been hooked on, maybe you're not quite as hooked on it as I am, is WebAssembly is now starting to take the data science community by storm, even in the R community. I do like WebAssembly.

Absolutely, yes. There is a package called WebR. to help bring these bindings and combine with a package called Shiny Live, where I could take a Shiny app and make it like a traditional Shiny app, but with Shiny Live, automatically create the manifest needed to make it a WebAssembly-powered app.

And with the right runtime, just boot it up in your web browser, local host it with a port, and you are done.

off to the races and i cannot believe how cool that is i even shared a web assembly power shiny app with the fda of all people in a pilot submission we're waiting to get feedback on it but even they are excited about it and you know how regulatory can be they could be a bit slow on the uptake but no they're excited about this that's shocking i mean you're selling them something new and they're not like well to call you back in 18 24 months

Oh, I had all the expectations. This is going to be like, yeah, Eric, that's a great idea, but not for like 10 years. But no, they're like, you think you can do it? I'm thinking we could try. And sure enough, we can. So yeah, I changed my dev life there too.

Oh, yeah. I had lots of fun with that when that came out.

So what is R? Yep, we could be here all day for that, but I'll keep it pretty brief here. It actually has its origins much like Unix itself from Bell Labs in another language called S that was jointly developed by John Chambers and some other great developers way back in the 1970s. as a way to have a pretty domain-specific expressive language for statistical analysis and data processing.

I mean, I can say that. Yeah. You better watch yourself, Mike. You may jinx everything for us.

Yeah. Recently, when I was having that adventure in the live streaming stuff, those stream decks are pretty darn useful, not just for live streaming. That can actually automate a lot of cool stuff on your system with a point click of a button. I was not sold on it, but then people like, like I said, Martin Winpress and others convinced me and I bought one of those and now I got...

through linux a way to map you know custom shortcuts to it even without nix os of all things so i can launch a program launch any arbitrary set of commands it is that one unexpectedly changed my my workflow a bit so yeah the stream the stream deck is is right here on my system i'm here to stay oh man i i uh i'm definitely thinking he'll get it one

Yeah, I mean, I do have a bigger model and that was over 200 when I bought it. So maybe the smaller models in between that more elegant range or more accessible range. But again, once I started using it, it's hard to imagine life without it. So it ain't just for the streamers, folks. It can actually help your dev workflow too.

Yeah, you got it. You got it. And with these programs, they can interface with any number of these screens they could toggle back and forth with all the button mapping. So yeah, cover me convinced. I was skeptic, but it's here to stay. I love it.

Oh, you know me. I'm always eager to talk shop on data and any other Linux geekery out there. And by the way, as you said on the outset, the Discord for Coda Radio, it's happening, folks. You should definitely join there if you haven't already. I love it there. But yeah, if you want to find me, first, my podcast is called Our Weekly Highlights. We'll have a link to that in the show notes.

But if you can find me on social media, I am on three major things. Blue Sky with at our podcast at BSKY.social. I'm on Mastodon with at our podcast at Podcast Index.social. And I'm on LinkedIn from time to time. Just search my name and you'll find me there. Sounds good.

And that's the whole gamut, too. You've been getting some great feedback on the show since the revamp and lots of great tech questions out there. And of course, we're going to throw our love for little Sonic and Sega there, too, from time to time.

Yeah, yeah. We'll save the listeners for that one.

Oh, always a pleasure, Mike. I'm really glad to be here. And best, you know, great success on the future episodes. And I'll be one of the first to listen every week. Sounds great. Talk to you soon. Thank you. Bye-bye. Bye-bye.

And fast forward quite a few years, there were changes in how S was licensed. It became part of a vendor after that.

And then in the mid-1990s, two gentlemen at the University of Auckland in New Zealand, Ross Ahaka and Robert Gentleman, were inspired by S and decided to make an open source language that was basically taking the best of the S language and making it completely open source and community developed. And that became R. And so it's got a long history. But honestly, fastening forward to today,

R is standing on the shoulders of open source and the fact that, yes, R itself has everything you need to do a nice data analysis, visualization, import data. It's a community of over 25,000 packages at the time we're talking here. They can turn R into almost absolutely anything of what the language you want to do. I have lots of ideas on where this is going in the future.

And it's greatly helped me in my daily work. And it's super inspiring to see just how far the community has taken the R language itself and to be able to do some really cool stuff with it across the board.

You bet. In fact, they call it the Comprehensive R Archive Network, or CRAM for short, where basically you boot up R. You could say install.packages and put the name of the package, download it on the spot. Now, there are some really important differences to note between CRAN and, say, PyPy or RubyGems. CRAN is curated by humans, i.e. the R core team.

So it's not just like you have an idea for the package, you write some R code, you ship it out and get it installed right away. You have to pass a lot of checks to make that happen. And there are automated ways to do that. But they're running the checks on their side, too. But admittedly, you were talking about kind of the Rust controversy on the Linux kernel.

There is a bit of controversy, I would say, from time to time on the CRAN network where some packages do get archived for sometimes some very esoteric reasons that actually have nothing to do with the package itself.

I did use Emacs back in the day. I knew it. Rejected, gone. Rejected, gone, yeah. Since I've seen the way with Vim, but that's another story.

Oh, we will. Yeah, so there was actually a package that was archived a couple weeks ago by a good friend of mine in the developer community, not because his package had a problem, but because a dependency package that his package used. had a problem with a bin bash prompt of all things. You'll have to listen to the latest R Weekly episode for our details on that.

Nonetheless, my point here is that there are some advancements to make our packaging a bit more modern to take the best of PiPi and parts of CRAN and try to make a more... I'll say clear system for contribution. Some of those are called our universe and a new one that's coming in the works called multiverse that I'm keeping an eye on. So CRAN has had its warts over the years.

It still would not be where it is today without it. But we're seeing some modern approaches that I think are going to take the language to another level in the near future here.

So the good news is your app as it is, if you don't need to change it, can still be used as is. What happens is if you needed to update anything and you try to install that.

Yeah, an ongoing thing. If you try to install it again, R itself will get mad at you and say, oh, that's not available anymore. And there's a custom way to get an archive of a package. It's more convoluted, but it is technically possible. But it is an issue that could affect people, especially, like you said, in an ongoing project.

or a production setting where you have to update your dependencies. But that's where, again, some of these projects like our universe are stepping in to give a more automated way to host these packages with a slightly more automated structure, but with best practices. on top of that. So I'll make sure I'm linking to that in the show notes. So it's an interesting time.

But yeah, R is not without its controversies, just like any big open source language.

You know, I dare say there may have been one attempt at trying to get this distributed as a malware setup and it was shot down faster than a snap. So yeah, that is obviously one benefit of having this human in the loop. So that's why I can't discount their importance.

Albeit there have been some rather esoteric, questionable reasons why certain packages got flagged, whether they're new or they've been existing for over 10 years and in some esoteric build. cough, cough, Solaris, ends up having a hissy fit about it.

I'm sorry. I just can't resist. They're already down.

Yep. And truth be told, many of the users of R are just going to install a package the moment they see it mentioned on a blog or whatever setting. So it is advantageous that it is on a reputable repository, but R does let you install packages from GitHub directly if you're inclined. And yeah, that's where you have to have a little more of a careful eye, so to speak.

Yeah, I mean, certainly, like I said, it had its roots in academia, like I said, at University of Auckland and others in that space. But I would say in the last 10 years, certainly in the last five years, there's been explosive growth in how art can stand, you know, hand in hand, shoulder to shoulder with some of the other languages, as someone might typically say, is a production ready language.

We are going to mention the infamous Python. I'm sure as we go along here, the knock has always been, well, R is great to prototype that algorithm, but you got to put it in Python for production, right? I think those days are over. I think we have enough tooling, enough resources, and enough experience with putting R in highly important positions.

production workflows, whether it's for machine learning, whether it's for web applications, which I'd love to talk about. And now, even in the future, there are even R packages that are interfacing with the rest of all things. So there is lots of opportunities to use R in production now, and it's really exciting.

It was only a matter of time, right? It was only a matter of time.

Bye.

Call me jaded by all the virtual environment garbage I've had to endure over the years.

Oh, yes, there is. It was about maybe 10 years ago or so at this time, a new R package came out from a company that at the time was called RStudio. Now they've been rebranded as Posit.

but they had developed a package called Shiny, which was a way to take a React-like expressive web language or paradigm for developing web apps and bring that to as an R package so that with just straight up functions, I could create an interactive dynamic web app without having to know a lick about JavaScript, CSS, or the like. It changed my dev life.

I've always been curious about doing cool things on the web. And in grad school, I did some very archaic things with PHP and MySQL on the back end for some grad school projects. Don't get me started on PHP. Oh, gosh.

Oh, lots of wars on that one. But then when Shiny came around and I was able to build this little Hello World app with an interactive histogram with a slider input, I could not believe it. I just could not believe it. So then I quickly show some colleagues at work about this. Suddenly they want me to spin up a server to host these apps.

It all comes full circle. What, baby? You don't want to give me a hug? Is it actually? That's his wife. Yes!

So you're not going to give me a welcome home hug, baby? You're going to have the weird Tourette's kid who's, he's always, he's got an Adderall addiction, Connie. Hold on. He's hooked on pills.

Mother time? You just know everybody's age? Fuck you, Connie! You guys are your best friends with him? What's his birthday, then?

Okay, so you know the difference between 16 and 17. Good for you. Good for you, baby. That's why he's so pretty. He's so smart. He's still in the flower pot. Yeah, exactly. I'm going to have to shuffle over and come give me a kiss. Hey, Toby, pancakes, right? He loves them. I'm fucking with you. I'm fucking with you.

He gave me a big handful of Adderall, and I took all of them. Sweet, I took all of them, and I drank those highlifes like you said I shouldn't, but I did.

Don't touch me, boy.

Uh-oh, just doing overtime today, boys. Another day in the office.

I'll tell you, Connie, some days I wake up, I wish you were gone. Some days I wish I'd wake up and Sandman would take you away in your dreams.

Make me a sandwich. Oh, God. Hey, give me the remote. Oh, okay. Fine. Hey. Go get, uh... Go plant a flower. Oh, my God. Okay, fine.

She was too submissive to him. I like to think he's just like, yeah, go on, shoot. Hey, go check out the trash.

Give me a cosmic brownie from the pantry.

Fuck.

Whatever. Jesus, just fucking use better help if you have to. Fuck.

Yeah, I've just been watching the Zubuck commercial over and over again on repeat.

I was just picking up papers.

Do you think that she might feel that other women are boring?

That I'm fun or that I think other women are boring. Okay.

I can't remember the language you got from your book, but it is something I've heard before. Just the idea that one person is reaching out there and the other person is – like one person is extending more than the other basically.

I see what you're saying. Yeah. I guess it puts the owner, it, it takes the pressure off of me and like, it kind of makes it more even in a sense.

Yeah, I see. So much of the value that I feel like I can bring to the dating table is something that would be like for someone I've known for a long time, you know, like emotional support or like just being someone nice to hang out to. I guess it's just like opening and making that strong first impression is something that is hard for me. But I feel confident in the other stuff I mentioned.

Yeah.

No. I've wanted to since I read your book. I wanted to be like, hey, you look really pretty and I wanted to talk to you. I like that.

um i guess just talking to potential dates and then in a um in a in a live setting you know like in um at a bar or something is something that i i tend to struggle with i guess if you can help me out with that um you know whoever's listening yeah also on top of that

Um, I mean, I usually start with like saying like, Hey, I like your dress or something like that.

Oh man, I don't, I don't know. This is not, this is not my forte. That's why we're doing coaching. Exactly.

Um, that she has lovely hair.

I've grown up to feel like saying that is objectifying.

Yeah, I mean, the past couple of times I've gone to this one club near where I live, it's just like, it was decently loud. It was crowded. I'm not too used to clubs, but it was like, Like I, I would go up to a woman and I'd like, I'd like, I'd say like, Hey, is this your first time? Or so something like that. And you know, like, cause like they were at like a Thursday events, right?

Right. Would I stand out in a bad way if I did that? I don't know. If I did that to a few women in a bar, do you think they'd be like, oh, don't talk to that guy. He's just making weird advances.

I already do, but I just mean like, yeah, I just mean like, would it affect my ability to hold conversations later on in the night? I guess I don't follow your question. I don't know. Like if I, if I get like a reputation in the bar for being eight, For advancing too much, I wonder if it would throw people off.

Yeah, yeah.

Yeah.

So it's like, Hey, is this your first time at a Thursday event? They're like, yeah. I'd be like, hi, I'm I'm blah, blah, blah. And they're like, oh, you know, and I'd say, ask the usual, like, what do you, what do you do? Who do you talk to? That, that type of thing. I'm sorry. What do you, what?

your friends that kind of thing um and uh but then after that it's kind of it's kind of a struggle to keep going and you know the questions like you know what do you do for work that that type of thing what do you do for fun they're a little they're a little boring i don't even like asking them so i feel like even then my heart's not all my heart's not all there so it can be a little boring and like i guess maybe like the momentum stops and like i feel like

I do remember this story because I think about it like, because I try not to stare as much because of that story. If I'm not going to approach them, then I just make sure I do something else. Or I approach them. Or it gives me the guts to approach them.

Yeah.

Yeah, that's true.

Yeah. I am. Yeah, I'm kind of in the middle. I try to say hi to people, but I don't... Like my friends and stuff, I try to like, it's only when like, I know someone that I try to like encourage like gatherings and stuff like that. I'll, I'll make plans.

You know, I think, I think again, it goes down to like, I'm good at, I'd be good at things down the line if I were like to date someone, but it's just like starting out is so hard.

Um, I don't keep count, but maybe like six to eight. Okay. That's great.

Yeah. Yeah. Um, yeah. Uh, I'm trying to think, uh, My friend has said that it's like, analogy-wise, it's like rolling tape, right? Because once you get that part of the tape where you can pull off, then it's a lot easier.

Yeah, yeah. I've been trying to go more often.

it's kind of something where it's like, well, well, it was good talking to you, you know?

Okay. I'll keep that in mind.

Okay.

Yeah.

I don't know. I think the most I get stuck is near the beginning when it's like... When it's like those, um, those basic questions, you know, like the one, oh, what do you do? That type of thing. I think maybe I'm too stuck in terms of like, and this is something that goes with my, um, with my social, um, just being friends with someone as well, you know, like just starting out. Okay.

I don't have a consistent way to get out of that loop of like, what do you do for work? What do you do for fun? That type of thing. Okay.

Yeah.

Yeah.

Um, that's a good question. Um, probably not. I mean, I wouldn't outside, outside of, um, let me ask you this, you know, you know, Wonder Woman, right?

Yeah, there was a woman that same night who I approached, I said like, you know, like, hey, I like your tattoos. And she was like, oh, thank you. And I said, like, hi, I'm so-and-so. And she's like, hi, I'm so-and-so back. And it was like.

It's just like a tattoo of like... Maybe like a blob. It's like a monster. It's kind of like a ghost, I guess.

Oh, thank you. I got it after I saw this band in concert. Thank you so much.

Are you there when it came out?

No, I don't.

You don't know the source of your own name? I mean, not really. It's a common name. It's not really something that I've asked.

I don't know. I liked how you ad-libbed stuff about inventing Pac-Man. I mean, our brains are wired to like stories, so the story about your name is also... There's also something good that I should keep in mind.

Yeah, yeah.

Yeah, I did, yeah.

Yeah, no, no, that sounds about right, yeah.

I mean, it felt spontaneous. Okay.

Um, she was wearing a dress. She had like shoulder length, blonde hair. Okay. She was a little, a little shorter than me, maybe five, five, that kind of thing.

Yeah, 60 seconds.

Yeah, for sure.

It was Eric, then it was Pac-Man, then it was the 80s, then it was... I forget how we jumped from the 80s to your name.

Right.

Yeah.

I see.

I'm here to ask people on a date. I want to ask you on a date, I guess.

Yeah, of course. It's the inner quality.

I guess we can talk about dating apps.

It's easy. Um, what's not working with dating apps. I guess just the same thing that lots of guys complain about is just like, why am I not getting matches? That type of thing. Um, well, no, I mean, actually, no, let me start with something else. Um, in your experience, I just like, I get two in my head when I'm texting someone.

And like, you know, it ties back to being like, thinking about my fears too often. But it's like, I think too much about the social faux pas of like, double texting or maybe, or maybe texting too long, or maybe especially trying to find the right words to say. I just wonder, in your experience, if I'm putting too much weight on that.

Um, I try to be funny. I try to, um, well, I guess another faux pas that I see online would be like, you know, don't text her back immediately, you know, make it seem like you're busy, but like ignore that.

Would you think that way about me? Yeah, well, when you put it like that, I mean, I can see how it doesn't really matter that much.

I agree. Yeah. Before I, um, I think between setting this up and actually talking to you, I think I like looked over my profile. I think I just don't have enough photos of me doing like, just like Creating that value, I guess. I don't have photos of me that are traveling or participating in my hobbies and things like that.

I get self-conscious about smiling in photos, so it's kind of a difficult thing for me. I'm just trying to build it up slowly.

Probably not. Definitely not. At that stage, no. I mean, it's just not.

Um, it's just, um, It's a photo of myself in the snow. I went to the Midwest last month. It's just a photo of myself smiling. There's snow. It's actively snowing. I guess it's just the idea that whoever sees this is in California, so I guess it's just the idea that I like traveling.

I see.

It probably wouldn't matter.

Okay.

Probably not. I mean, it would put us on even ground, I guess. I mean, where I would go, I'd be like, oh, yeah. I mean, because it was my second time. I'd be like, oh, yeah, it's a nice place. I'd tell her about the event, which isn't much value either, I guess.

Oh man, those are the three. Okay, let's do a bonus one. Anything. I'm on the spot here, honestly. Are there pieces of advice that you haven't touched upon that you would give to someone like me?

There was one little nitpick about talking to someone in a bar. Because when you're on a dating app, you choose the ages of the people you want to meet. Is it fine to ask how old the other person is?

Okay.

I see what you're saying, yeah.

Okay. Yeah, I am afraid. I hate just knowing that that's my go-to. Like, oh, what do you do for work? I really want to break out of that.

I just like thinking about, you know, just the intricacies of like how bodies are made up, not just human bodies, but like, you know, just like just how complex organisms are. It's really interesting to me.

Any thoughts there? I'm into humor. I like humor. I've made women laugh on dates before. Cool.

i guess it's just kind of hard on the spot when i don't really know anyone a lot of my humor is maybe like we talk about a show or something i'm like like you know with my friends a lot of my humor is just like references to shows and stuff like that or like details about people that i already know so it's a little hard when it's like impromptu or like i'm just meeting someone

Oh, no. I think most of my humor is incidental. My friend will say something, and I'll say a pun, and they'll sigh really heavily and be like, why are you my friend?

Why does a cow have hooves? Because they're lactose.

Uh, yeah, I do. Okay. I mean, I've only been to karaoke once, but I like singing. Okay.

Yeah, yeah.

I've had a few stirring. Any other good ones besides singing or telling jokes? Like openers? Yeah, yeah, yeah. Or just types of openers, the ones that bring value.

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I read a couple of things.

Hi, Mel. My name is Eric. How do I create habits that will stick? So once I keep going, I'll stay with it. I want to make it easier.

Yeah, the Grail test.

Yeah.

Well, the problem is it's being marketed for people age 50 and older. That's wrong because most people age 50 are not at risk for cancer. And so they're going to get a test that is either a false positive or false negative. So it has little value unless you know you're at increased risk. And so another one that's being used totally improperly is a total body MRI scan.

No, no.

You don't want to do that because what happens with these, it's never been validated that it helps people to get accurate diagnosis of cancer. Again, it might be okay if you're at significant increased risk. What I would say is if you had a genetic protein and other family history and multiple dimensions of your data,

The problem with the blood test that your husband ordered is that maybe four or five per thousand will have an abnormal reading of a microscopic cancer. And out of those, half of the five per thousand will have already advanced cancer. The problem with the MRI is false positives. If you did the MRI after you had an abnormal blood test- Yeah. That might be okay, sure.

But you don't go ahead and have a total body MRI just because you're going on a fishing expedition because you could wind up having all sorts of biopsies.

So there's a thing called a polygenic risk score for each type of cancer. Breast, colon, prostate, lung. And these are very inexpensive. You know, you could get these for about $50 or so.

Polygenic risk score. Yeah. Okay. They basically will tell you your risk for a particular cancer. And there's about 10 different companies that offer these now. And they can even be done through saliva. You don't even have to have a blood test. So that's a good way to know about your risk in your lifetime. But again, you don't want to just rely on one layer of data.

You'd like to have other layers of data backing that up. And so that's where you can learn even more. And as you mentioned, like if your family history, maybe you have a trend going on and some routine blood tests going in the wrong direction. This is where when we have AI analyze all your data and point to say, you know what, this is your risk in your life.

This is the one for you to be on guard about. But right now we have some rudimentary data to help us understand who's at risk and what for. And so if somebody offered me an MRI, total body, for free, I wouldn't have it because it's a recipe for trouble. It's a recipe for finding things that you wouldn't want to find because then you have to chase them down.

And you could have complications, as I've had patients who then they had a liver biopsy and they bled many units. They had all sorts of things. And it was benign, of course. Unfortunately, we have celebrities everywhere. and doctors who are advocating these total body MRIs, and there's nothing, there's no proof.

They say they're going to do a trial, but they haven't done it, and we're not going to know for years. And until then, it's just anecdotes.

Yeah, you know, it's interesting. Here we are in Boston and the Mass General Brigham is supplying the polygenic risk score to their patients. They're the first health system to do that. And so they're getting a readout for their risk of the various types of cancer and heart disease.

And of course, soon it'll also be Alzheimer's disease too, that they will get that composite risk as part of their care, not like they get charged extra. All the health systems should be doing that. And again, they should be adding these other layers of data so that you know about yourself what to be on guard about and also to take action.

And this is a really critical point is that generally people might not be motivated to do all these positive things, but when they find out they have this specific risk, the chances of them going after it is so much greater. We've learned that from studies as well.

Absolutely. And just to mention, there was a big Finnish study where they took people and they gave them their polygenic risks for heart disease. And the people who got a high risk, they changed their lives. I mean, they did everything we're talking about today. So it wasn't that they were going to do it when they're healthy.

Only when they got something to tangible evidence for them, for those individuals, that's when action was taken.

The problem, Mel, is the things that they're not doing.

And so what we're talking about is poor diet with too much ultra-processed foods, for example, not nearly enough exercise, and that's both aerobic as well as resistance-type exercise. And then, of course, getting enough sleep, particularly deep sleep. Sleep is so much bigger than we had thought years ago, and having sleep health, particularly promoting deep sleep, is really important.

as we'll get to for brain health, that brain clock. So these are factors that not enough are paying attention to that we can do a lot today. And they're just the beginning of what I call this lifestyle plus, because there's so many dimensions. It's not just the three that we've been hearing about for so long.

So plus means, first of all, the devil in the details about nutrition and exercise and sleep. And then beyond that, things like social isolation. Okay. The environmental factors like air pollution, microplastics, forever chemicals, being out in nature, outdoors. So these factors are not just... you know, what we're eating and our exercise, those are paramount.

All these things have been associated with healthy aging. And so the woman in the book who's featured, Mrs. LR, here she is, she's 98, and she's the picture of health, cognitively crisp. She's doing her jigsaw puzzles and oil paintings. You know, she's amazing. And she is vibrant with her social group. Her kids... have died already and her parents died in their 50s. So it isn't the genes.

And that's one of the things that I think a lot of people feel they're doomed because they have bad genes. But it isn't. It's so much of this is our lifestyle that can override or independent of any genes that we have, be associated with a healthy aging process.

Exactly.

There is nothing that's been proven in people to promote the slowing or reversing of aging, whether they're pills or compounds or infusions, transfusions. None of that is proven to have an anti-aging effect in human beings. There's a lot of that that's been looked really good in mice or rats. but not in people. So we'll start with rapamycin. A lot of people are taking this drug.

It suppresses our immune system. That could be very risky to do that. And unfortunately, too many people are advocating that. There's nicotinamide, NAD+, a supplement. There are no data to show that it improves healthy aging in people. There's this epigenetic reprogramming, very elegant. It could cause cancer. It isn't in people yet, but it's certainly a risk.

There's senolytic drugs that take out our senescent cells. They're indiscriminate. They could take out bad cells out of our body, these drugs that do that. There's plasmapheresis taking young people's plasma and infusing it into old people's plasma to promote healthy aging and better cognition. There are clinics doing that. There's no data to support it.

There's all kinds of infusions of kind of multivitamins, and there's just no data to support any of it. And it's really unfortunate because people that believe this stuff are the prey. Not only are they expensive, but they are posing significant risks. It could be cancer. It could be immunosuppression. These are not things you want to play around with.

Well, so one of the most elegant approaches, which caught a lot of interest in the biomedical community, was the idea of giving genes to an old animal, in this case a mouse, and now extend it to other species. And these are known as Yamanaka factors because they have the ability to reprogram the organism, the cells of an organism.

Close.

These genes don't come from a younger animal. They just are known to turn the clock backwards.

And so the whole idea was, okay, we're going to inject these four into the animal and and we're going to take an older animal and it's going to affect all their cells and they're going to get young. And it happened. Say, wow, this is amazing, right?

it's actually pretty deep. So it wasn't just that their gray hair went away, but also the fact that at the organ level, they had, for example, their glucose regulation turned back to normal. Many of their organs show young look rather than having all the things that you would associate with a very old organism. So it looks great.

You say, wow, couldn't we just all take these Yamanaka factors and we would just get young? The problem is that when they were doing this, and this is now in multiple species, tumors would develop. And that's because when you turn back these cells into younger cells, you also are potentiating the risk of cancer.

And this, Mel, is the problem with many of these anti-aging body-wide interventions, is they introduce new risk particularly cancer, because there's a very close overlap between the hallmarks of aging and the hallmarks of cancer.

Yeah, so in the case that we're just talking about, the fancy term for it is partial epigenetic reprogramming. It sounds pretty big, right?

Yeah, yeah. But the whole idea is that when you make cells younger, a group of these cells to just take off, develop a clone of cancer, and then just spread. So the problem is that when you're trying to re-rig the body's aging process, you introduce new problems.

Exactly right.

Yeah, so I think where we're headed is that each of us will have, without added costs or very nominal costs, we will have all our data. It's assembled. It's analyzed by what we call multimodal AI, generative AI, and it'll tell us, This is your risk. This is what you need to be on the lookout for. And you're going to do these things.

And also, we may be treating you, like, for example, with an anti-inflammatory drug or, you know, we can talk in some of the specifics. But we've had breakthroughs, Mel. Like, for example, Alzheimer's. There's a blood test now called P-Tau-217. It's as good as having a PET scan of for telling us, are we going to have a risk for Alzheimer's?

So if you get that test, again, if you have Alzheimer's in your family, it's not good enough to know, oh, I'm at risk for Alzheimer's, but I may only crop up when I'm 95. That's not really important. What we're going to have with multimodal AI is going to say you're at risk for Alzheimer's.

And if you don't do anything about it at age 66 is when you're going to see, you know, mild cognitive impairment. So you can actually pinpoint the person and the time.

You got it. I mean, this is why we have the benefits of that long time to work with before the person gets the condition. And we have the layers of data which we didn't have before or the ability to analyze that. And then the surveillance tools, whether it's scans or whether it's... Further blood tests, clocks. Like, you know what?

If I have an organ clock that says that my heart is accelerated aging and then I do these things and I prove, oh, wow, I changed it. It's now going in the other direction. Wow. And it reinforces that you're on the right track. So this is where we're headed now. The science of aging has given us these metrics, whether it's this body-wide aging, epigenetic clock, organ aging.

This is the most amazing thing. All these years of practicing medicine, we keep talking about prevention. And we have nothing that we're preventing. It's secondary prevention. Oh, you had a heart attack? Now we're going to put you on this and that. We are talking now about primary prevention. That's the new thing here, that we can prevent a disease that was going to occur before it happens.

And that's the real deal, prevention.

Yeah, no, it's amazing. So the global burden of disease comes out of University of Washington. They've studied this globally.

And what we've learned is that overnutrition, which is really bad, having- That's a nice way to say what?

Obese or significantly overweight. Okay. undernutrition or malnutrition, and then poor nutrition, which is, as we talked about, the unprocessed foods, for example, those three categories collectively account for, they have shown in their work, one in five deaths. Yes, nutrition is fundamental.

Yeah, I'm glad you brought that out because this is a serious matter. We have the big food industry that markets this. Basically, because of the gut-brain axis, you eat these ultra-processed foods and you want to eat more. We've seen very careful studies that it promotes overeating. So that's bad enough in itself. But what it also does, it promotes inflammation in the body.

And so when you have that, that's when you have your glucose dysregulation and you can move on to type 2 diabetes. It also then increases the risk of atherosclerosis, heart disease.

Yeah, you're basically accumulating cholesterol plaque in your arteries, which you can get heart attacks or strokes. And it also, of course, has effects at the level of the brain, promoting inflammation the less than we want there. And the risk of cancer. And so all the data on ultra-processed foods, which it's not just that you can't read because of all these ingredients.

It's just that when you do read them, you don't recognize them because they're all foreign things that would never be found in your kitchen. Everything about these suggests that they're inducing a lot of harm. They're promoting aging. And one of the stories in the book I reviewed is there's a fellow named scientist physician in the UK, Chris Van Telleken.

And he wrote a book called Ultra Process People. And so he actually, remember that supersize me thing that I did? I went to McDonald's every day for.

Yeah. So this is what Chris did for 30 days. And he gained like 10 kilos, but he did brain scans before and after 30 days. And he did all these other inflammatory markers. And he showed that everything went off the track. I mean, in just 30 days of high ultra-processed foods. So all of us, we can't eradicate ultra-processed food, but we can bring it down.

It shouldn't be as it is now, 60% or even 70% of our diet.

No question. I couldn't agree with you more.

We want to cut down on refined sugar, particularly things like sugar-sweetened beverages. They also promote inflammation. If you see high fructose, you know, run away. We just don't want this. We don't want to be taking this stuff in. Okay. What about salt?

Yeah, salt is something that, you know, we have a very easy solution, which is a salt substitute, which is using potassium instead of sodium chloride. So we should not be, you know, adding salt ideally to what we're eating. Wait, why?

If you're at risk for high blood pressure, which most of us are as we get older, that's not going to help you. If you use potassium chloride,

Yeah, no, potassium chloride, the salt substitute, and that's all, there's nothing else in it.

It's perfectly healthy and it avoids the problem of the sodium intake and it's a lot healthier for you.

You're spot on with that summary.

And so, again, you've pointed out that in the ultra-processed food category, salt is often a common culprit that is part of that reward circuit. You know, it's part of, oh, have more, a lot of fat and salt and chemicals and emulsifiers, yeah. Right.

We don't have a free pass on those, unfortunately. As I reviewed, you know, there's uncertainties about them. Okay. So if you can avoid the sugar substitutes, that's probably better. But unfortunately, they're not as healthy as we had been led to believe. Right.

Well, here's some good news for coffee lovers.

This is the one that is the rare exception where, you know, we love it and it actually is healthy. I mean, this is actually kind of shocking. So, you know, I reviewed all the studies and there are a lot of them.

And what is striking about this, it shouldn't be that, you know, you should change your life to drink more coffee, but you shouldn't at all worry if you're having two, three, even up to four cups of coffee a day.