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Episode 175
The Doctor's Farmacy

The Future Of Medicine: Precision And Personalization

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Tap the subscribe button and new shows will be added to your library.

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It’s an exciting time to be in medicine, as we watch technological advances completely change the way we understand the body. There are revolutions happening on multiple levels: the “omics” revolution that looks at the interactions of the genome, microbiome, metabolome, transcriptome, and more; the digitization of data that involves tracking our biology through things like the Oura ring or a continuous glucose monitor; and the systems biology medicine movement that is reframing the way we look at preventing disease and healing the body at the root.

I was excited to sit down with Dr. Daniel Kraft to talk about a different vision that will integrate this type of information into the future of healthcare.

Dr. Kraft and I discuss so many intriguing areas of personalized medicine throughout this episode. One challenge with our current medical data is that it’s based on the “average patient,” which many of us are nothing like (and don’t want to be like). We can use personalized data, like how our blood sugar responds to certain foods, for example, to create a whole new approach to wellness with actionable information. I’m really excited about where this area of precision nutrition is heading and what it can do to optimize our health.

Genetics can play an important role in our health outcomes, but they are not written in stone. Dr. Kraft and I talk about how genetic variations can mean different things for the same disease, and that as we discover more about them on a molecular level we open up amazing prevention and treatment models.

We also get into the concept of “exponential medicine,” which helps us understand the pace of change we’re embarking on, how technologies come together to address pain points, and how this all integrates with incentives, policymakers, payment systems, and more.

I hope you’ll tune in to hear more about the incredible tools and systems that are changing healthcare for the better.

This episode is brought to you by TrueDark, BiOptimizers, and Higher Dose.

TrueDark Daylights help prevent eye strain and headaches from overexposure to junk light and TrueDark Twilights collection for nighttime helps you get deeper sleep. TrueDark is offering podcast listeners 15% off with code DRHYMAN15. Just go to truedark.com/hyman.

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn:

  1. Moving away from a reactive approach to healthcare towards an era informed by continuous data
    (1:13 / 6:34)
  2. Using our smartphones and other technology as integrative and preventive medical tools
    (4:46 / 10:07)
  3. How can we avoid filtering new medical data through outdated medical paradigms?
    (12:02 / 17:23)
  4. Promoting new medical paradigms by rewarding and incentivizing practitioners
    (16:35 / 21:56)
  5. Crowdsourcing medical data as the future of individual and public health
    (18:52 / 24:16)
  6. What is exponential medicine and how will it transform healthcare and behavior change?
    (22:20 / 28:14)
  7. What does the future of personalized nutrition look like?
    (33:30 / 39:24)
  8. Reimagining our approach to conducting medical research (
    (39:41 / 45:35)
  9. Covid as a catalyst for change in the future of medicine (
    (47:37 / 53:31)
  10. What will the patient experience of healthcare look like in 50 years?
    (52:21 / 58:15)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Daniel Kraft

Dr. Kraft is a Stanford and Harvard-trained physician-scientist, inventor, and entrepreneur. He is currently serving as the Chair of the XPRIZE Pandemic Alliance Task Force. With over 30 years of experience in clinical practice, biomedical research, and healthcare innovation, Dr. Kraft has chaired the Medicine for Singularity University, and is founder and chair of Exponential Medicine, a program that explores convergent, rapidly developing technologies and their potential in biomedicine and healthcare. He has multiple scientific publications and patents through NIH-funded faculty positions with Stanford University School of Medicine, and as clinical faculty at UCSF. Dr. Kraft is heavily involved in healthcare innovation, and recently founded Digital.Health, and is an advisor to several leading startups and healthcare organizations.

Show Notes

  1. Check out Dr. Kraft’s podcast with CVS Heath, Healthy Conversations

Transcript

Speaker 1:
Coming up on this episode of The Doctor’s Farmacy.

Dr. Daniel Kraft:
We’re all touching our smartphones and other consumer devices frequently. They can become a bit of our health bubble that can give you smart nudges over time to help nudge you in the right direction in ways that match you.

Dr. Mark Hyman:
Hey, everyone. It’s Dr. Mark. Most people don’t realize that our exposure to light has a huge impact on our health. That’s because we’re wired to respond to the changing position of the sun which regulates our body’s circadian rhythm and either helps us to feel energized and awake or let’s us know when it’s time for bed.

Dr. Mark Hyman:
But our modern always-on culture means we’re now surrounded by conventional LEDs, and fluorescent bulbs, and digital devices with brightly lit screens that emit junk light around the clock. My friend Dave Asprey actually coined that phrase junk light to describe the excess of blue light as well as green and violet light that disrupt our circadian rhythms.

Dr. Mark Hyman:
Junk light reduces our ability to produce melatonin which is a key hormone for regulating your internal clock, sleeping well, and even aging well. It’s important to realize we actually need to be exposed to certain amounts of blue light in the daytime, otherwise we may feel too sleepy or tired. It’s the excess of all that blue light along with other types that leads to a long list of potential problems.

Dr. Mark Hyman:
How can we get just the right amount of light throughout the day? Well, going outside is of course key, but we almost all work on computers these days and have our phones with us 24/7. That’s why I was really excited to learn about the TrueDark Daylight glasses. TrueDark Daylights are meant to be worn during the day.

Dr. Mark Hyman:
They come with either clear lenses that block 40% of blue light, or yellow lenses that block 75% of blue light. Some of these daylights also act as transition sunglasses that in addition to blocking toxic blue light indoors also have photo chromatic lenses that are darker when exposed to natural sunlight outdoors, and block 99% of UVA UVB rays. They double as sunglasses.

Dr. Mark Hyman:
With TrueDark Daylights you help prevent eye strain and headaches from overexposure to junk light, but you stay awake and alert. TrueDark also has a twilights connection for night time to help you get deeper sleep. These glasses use red lenses to block the full junk light spectrum including blue, green, and violet light.

Dr. Mark Hyman:
Right now you can get 50% off at truedark.com/hyman with the code Drhyman15. That’s truedark.com/hyman with the code Drhyman15. Now supplements are one of those things that I’m always being asked about. Is it worth spending money on them? Do we need them if we really eat well? Can your body even absorb them?

Dr. Mark Hyman:
The answer to most of these questions is it depends. There are definitely certain supplements I’d never recommend taking because they aren’t made in a way that your body can take advantage of and you just pee them out. And there are definitely some supplements we can benefit from because of our food supply even if we’re eating whole organic foods. Because that doesn’t just provide enough of the nutrients that we need for optimal health.

Dr. Mark Hyman:
A major one of those nutrients that I suggest people supplement is magnesium. Most soils have become depleted of magnesium, or there’s not organic matter enough to draw the magnesium out of the mineral rich soil into the plants, so it’s a tough mineral to get enough of through the diet. 80% of Americans are actually deficient or insufficient in it. It’s crucial for hundreds of reactions and enzymes in the body.

Dr. Mark Hyman:
It impacts everything from metabolism to sleep, to neurological health, energy, pain, muscle function and more. It’s really important we strive to get enough of it. Magnesium also plays a role in our stress response. Everyone I know could use a hand in better managing stress to promote better overall health. I like to call magnesium the relaxation mineral.

Dr. Mark Hyman:
My favorite new magnesium is from a company called BiOptimizers. Their magnesium breakthrough formula contains seven different forms which all have different functions in the body. There’s truly nothing like it on the market. I really noticed a difference when I started taking it. I’ve tried a lot of different magnesium products out there. I also love all their products and how they’re gluten free, soy free, lactose free. Non-GMO. Free of chemicals, fillers, and made with all whole, real, natural ingredients.

Dr. Mark Hyman:
Plus they give back to the community. For every 10 bottles sold they donate one to someone in need. Now that’s pretty awesome. Right now BiOptimizers is offering my listeners 10% off your order. Just go to magbreakthrough.com/hyman, that’s M-A-G breakthrough, B-R-E-A-K-T-H-R-O-U-G-H dot com, slash Hyman. And use the code Hyman10 to receive this amazing offer. I think you’ll love it as much as I do. Now let’s get back to this week’s episode of The Doctor’s Farmacy.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. That’s Farmacy with an F. I’m Dr. Mark Hyman and this is a place for conversations that matter. If you care about healthcare, the future of medicine, where we’re going, and what’s coming around the corner, and how our healthcare is going to be over the next few decades or even 100 years you better listen up. Because we have a great conversation today with a good friend of mine, someone I’ve known for a long time, Dr. Daniel Kraft who is a Stanford and Harvard trained physician scientist, inventor, and entrepreneur.

Dr. Mark Hyman:
He is currently chair of the XPRIZE Pandemic Alliance Task Force. He has been in practice over 30 years. He’s done biomedical research, healthcare innovation. He’s chaired the medicine department for Singularity University and is the founder and chair of Exponential Medicine which is an amazing medical conference all about the future of medicine that I’ve been at and spoken at.

Dr. Mark Hyman:
It basically explores the convergent rapidly developing technologies and their potential in biomedicine and healthcare. He’s published in lots of journals and is just a cool guy. He’s faculty at the UCSF Medical School and is involved in lots of innovation. He’s a pilot, which is cool like my dad. And he’s served in the Massachusetts and California Air National Guard, an officer and a flight surgeon with F16, F15 fighter squad. Because that’s pretty cool. Not many doctors get to do that. He’s just looking always at the future of where we’re going and how we’re getting there. Thanks for joining us on The Doctor’s Pharmacy Daniel.

Dr. Daniel Kraft:
Thanks a lot, Mark, for having me. It’s exciting to be here and to mix up our worlds again.

Dr. Mark Hyman:
Yeah. It’s great. You’re a major pioneering voice in medicine. I remember hearing you speak, TEDMED so long ago. You were painting a picture that was very refreshing to me because you were looking down the microscope at where we’re going, or maybe the telescope, or you had some special glasses on that allowed you to see what is the most important trends in medicine, and technology, and health, and what the future of medicine might look like.

Dr. Mark Hyman:
What does the future of medicine look like to you and how is healthcare changing with all our evolving technology? Because it’s changing so fast and yet we’re still seeing mass amounts of chronic illness, mass amounts of poor health that’s only getting worse. On one hand we’re doing all this great stuff, but other hand our population is getting sicker and sicker, and dying more and more. How do we reconcile that and how do we think about what the future could look like.

Dr. Daniel Kraft:
Well, first we need to start to look at where we are, and where we’ve been, and where we’re going. I think we don’t actually practice healthcare. We practice sick care. As we both know as clinicians more often we wait for the patient to show up with a heart attack, the stroke, a late stage cancer. We live in this age of intermittent data where you only usually collect that in the four walls of the clinic, or god forbid the emegency room or ICU, and that leads to a reactive mindset.

Dr. Daniel Kraft:
Where the future is heading, or starting to unlock and unleash particularly with COVID as a catalyst is to move to an era of much more continuous data. It could be from your smart watch, from your smart bed, from your Internet of Things home, from your mobile devices. That’s going to enable us much more personalized, proactive true healthcare that can start to happen any time, anywhere, arguably at lower cost with better health equity.

Dr. Daniel Kraft:
In a nutshell the future of medicine is at this convergence of new mobile technologies, new forms of data, everything from your physiome, digitomes, your microbiome to your genome. Hopefully not just the data but the insights that we can then use across a continuum to help optimize wellness to do earlier diagnostics, to do smarter therapies and then of course to apply to global and public health.

Dr. Mark Hyman:
I remember being at one of your lectures years ago, and I’ve stolen this because it just was so brilliant, where… I don’t know if you’re still using this framework but you talked about five converging trends in science, and medicine, and technology that were going to transform our approach to health and disease.

Dr. Mark Hyman:
They were in no particular order the Omex revolution which includes everything from our genome to our microbiome, to our proteome and transcriptome, and all the omics which we’re still plumbing the depths of. The quantified self movement which is the digitization of our data, not the intermittent data you’re talking about. In other words your Oura Ring, or your continuous glucose monitor, or your Fitbit.

Dr. Mark Hyman:
They’ll be more and more sophisticated tools. They’ll be able to track all sorts of things through our biology that are decentralized, democratized, and allow that data to be used to help analyze our state of health. Then there’s the systems biology revolution. Some people call it P4 medicine from Leroy Hood, or functional medicine. Network medicine. There’s a new textbook of network medicine out of Harvard.

Dr. Mark Hyman:
It’s this framework of redefining the body based on biological networks and systems rather than the typical organs, and specialties and diseases. You take all that quantified self data, the systems biology layer on top of that to filter the data, the Omex revolution, and you run that through our technology platforms of big data analytics and AI, and all of the sudden everything looks different.

Dr. Mark Hyman:
Because when you think about how traditional doctors practice, we do a physical exam which is pretty rudimentary most of the time. You can pick stuff up. Then a bunch of lab tests. But the lab tests we do are pretty basic. They’re often not really abnormal until you’re really sick. We’re looking at a limited data set of maybe dozens to at the most hundreds, when there are literally maybe hundreds of thousands of data points that we could be using.

Dr. Mark Hyman:
When we are missing looking at all that we’re literally just… Someone said traditional medicine is like trying to diagnosis what’s wrong with your car by listening to the noises it makes instead of lifting up the hood you know? I think this new framework that you laid out that I’ve borrowed and talked about is so profound. Can you take us down the rabbit hole of each of these things and how they’re going to transform medicine healthcare and our approach to disease?

Dr. Daniel Kraft:
Yeah. You’re spot on. It really is that convergence of multiple fields that enables all those elements. I love your point about what we normally do as clinicians. We get maybe a CHEM-20 or a CHEM-40. 40 limited pieces. We get [crosstalk 00:10:13] vital signs. That leads to our incremental medicine. But now in this exponential age with the power of even my… I’m holding right now my iPhone 2 that’s 12 years old.

Dr. Daniel Kraft:
It was amazing 12 years ago. Now it feels slow and clunky. Now our smartphone devices have become integrated medical tools. The camera can diagnose your urine. The microphone can diagnosis your cough. The camera can now pick up your heart rate, your heart rate variability, even potentially a blood pressure, your blood sugar.

Dr. Daniel Kraft:
The point being from intermittent to continuous is that normally as clinicians we get that spot check, but what’s really interesting of course in health is how do those data points change based on your base line? The Mark baseline versus the Daniel baseline might be quite a bit different. If my resting heart rate when I’m sleeping is detected by my mattress, you know it goes from 55 to 75 maybe something is going on.

Dr. Daniel Kraft:
The challenge is how do we take those digital bread crumbs, or your proteome, or other elements that might be measurable and changing, and understand, when are you shifting from normal to some early sign or disease so we can cut it off at the pass? Or understand diseases much more through their continuity. Now there are ways to detect hormones through your saliva. Voice is a biomarker.

Dr. Daniel Kraft:
It can sound… Your sound of your cough. Is that COVID or just a cold? Putting all this together, it’s still the early days. Because right now as clinicians we don’t want more data from our patients. We want the actual insights and information that we can-

Dr. Mark Hyman:
We want knowledge.

Dr. Daniel Kraft:
… do something with. Right. If I’m streaming my EKG from my watch you don’t want to see every EKG. You don’t want to be liable for that. What we’re starting to learn as we start to crowdsource, millions of people wearing wearables, millions of folks getting their genome done which has dropped from price, a million dollars 15 years ago to basically 200 US dollars or less, is to put that into the workflow of the clinician so you’re not overwhelmed by trying to read Omex and raw data from a sleep tracker and synthesize that using AI, machine learning, big data. To make it really actionable for your exact patient, not for the average patient.

Dr. Daniel Kraft:
Because none of us are of course average. We’re still in the early ages of this digitization and connecting the dots. It’s starting to unleash a bit, particularly with COVID and new forms of telemedicine, and our ability to connect the dots through our mobile devices into our medical records and beyond. But tons of potential. I would stress that we’re still early days and we need the regulators, the F word, the FDA to help unleash this, which they’re starting to do with software as a medical device.

Dr. Daniel Kraft:
We need to help the payers pay for some of these new… Whether it’s your Omex, or your digital exhaust, to integrate that into our care across the continuum, particularly on the prevention and wellness side, not just waiting for when disease hits us.

Dr. Mark Hyman:
Yeah. It’s such a different vision because I remember once sitting in my office talking to a guy who worked for fidelity and his job was analyzing financial data. I said, “How many in your field use computers to analyze data to make decisions about what to do with money?” He’s like, “What are you talking about? That’s all we do. That’s it.”

Dr. Mark Hyman:
I’m like, “Well, guess what? We don’t do that at all in medicine.” We’re relying on the person sitting in front of you, your doctor, healthcare provider who went to medical school who knows how many centuries ago, who may or may not have kept up with the 900,000 scientific papers published every year. Who is trying to see 30 patients a day and make sense of your story, and hoping that they’re going to figure it out.

Dr. Mark Hyman:
Whereas our possibility given the picture you just painted of interpreting enormous amounts of data, sifting that through a filter, making sense of it and having decision support for providers is just a whole new world. It’s something we really haven’t really barely touched. In functional medicine we try to collect a lot more data, and we try to understand much more data points, and filter that through the lens of [inaudible 00:14:01] medicine and systems biology. But it’s still only like a tip of the iceberg in terms of what we’re heading towards right?

Dr. Daniel Kraft:
I think we’re now entering this golden age of functional medicine, what you’ve been doing for years. Now you can actually get a true microbiome and measure that every day if you’d like to. You can understand someone’s metabolomics. I’m holding here, I just did my own CGM, these low cost cost continuous glucose monitors.

Dr. Daniel Kraft:
I’m not diabetic, but I can get insights into how I respond to certain diets, or foods, or drinking orange juice, or exercise, or stress. Particularly with nutrition which you’re so honed in on, now I think we can enter this age of precision nutrition where you integrate microbiome, genome, metabolomics, and really move from just a one size fits all diet to ones that really match someone’s physiology or their disease state.

Dr. Daniel Kraft:
I think it’s a super exciting time not just for the clinician who can hopefully not be overwhelmed by all this data but make sense of it, but empowering the individual, the consumer. We talked about quantified self, and yes right now on my phone I have my Oura ring, my Fitbit I’m wearing, my WHOOP and my Apple Watch. They give me [crosstalk 00:15:03]-

Dr. Mark Hyman:
You glow in the dark. You glow in the dark.

Dr. Daniel Kraft:
I do. It’s fun to compare how much they measure my sleep, you know my sleep score, et cetera. But that can give me insights to hopefully self coach my sleeping. I don’t need to go see a sleep doctor. Similarly if I have a medical condition like hypertension or diabetes I can now collect that data, blood pressure, blood sugar, and share it hopefully to my clinician. From quantified self to quantified health where that data can flow, be interoperable not overwhelming, and eventually crowdsource.

Dr. Daniel Kraft:
Just like when we’re driving now with Google Maps and Waze we can’t imagine driving without those now. We’re crowdsourcing our driving and location. If we can build a bit of Waze for healthcare, sharing what we have on our own health, or wellness, or disease journey with our fellow patients, patients like us, or clinicians to really make sense and not use again that sort of average clinical trial, a double randomized trial for a set of patients that really don’t match the individual.

Dr. Daniel Kraft:
One example that’s starting to happen is a company out of Israel called stuffthatworks.health is really building this Waze for healthcare. You can share if you have psoriasis, ulcerative colitis, [inaudible 00:16:06] conditions, plantar fascitis. I share what’s going on with my foot. I’m learning from hundreds or thousands of others who have plantar fascitis what might work for me.

Dr. Mark Hyman:
Wasn’t it like PatientsLikeMe and our friend Jamie doing that years ago?

Dr. Daniel Kraft:
It was, but now it’s more accessible. PatientsLikeMe started for very sick patients like with ALS, Lou Gerhig’s Disease. Now it can be almost any condition, and we’re starting to see what really works for different drugs, different interventions, whether it’s mindfulness training or a certain diet. Because not every patient is in the same subset. They might be older, different comorbidities. That’s the challenge with our medical data today.

Dr. Daniel Kraft:
It’s often an average patient. I think we’re now entering this age of precision personalized medicine using some of these new tools, some of these new diagnostics. What’s interesting as well is care is moving of course from hospital, to home, to our phone, to on and inside our bodies. The fact that now sitting on my desk I have a disposable PCR box that can diagnosis COVID. These sorts of home diagnostics have only accelerated in COVID.

Dr. Daniel Kraft:
They’ll not just be used for infectious diseases coming downstream. They’ll be used to pick up non-infectious elements and really give us a whole new lens for new forms of actionable information.

Dr. Mark Hyman:
Yeah. I mean well the whole issue is what is the actual information and how do we decide what to do? My challenge, and love you to answer this question, is if we get all this data but we’re still filtering it through the same diagnosis lens of conventional medicine which is based on these ICD-10 codes essentially categorizing people according to symptoms and geography. What symptom do you have and where it is on your body, or what do your lab tests show as opposed to the causes and the mechanisms…

Dr. Mark Hyman:
For example, Watson is this computer that beat the best chess player but also went to medical school. The Cleveland Clinic, they partner with Watson. I said the the developer of Watson, I said, “You know this is really great, but if you’re using this powerful tool, but using an old paradigm it’s almost like rearranging the deck chairs of the Titanic.”

Dr. Mark Hyman:
How do we get to a place in medicine where we are taking advantage of the new framework of systems biology and using that as the filter for the data as opposed to our current diagnostic model? Right now we have the filter of diseases, but maybe we need to think about a filter that looks at these biological networks and the dynamic interactions?

Dr. Mark Hyman:
The microbiome is the best example of discovery that’s blown up our ideas of disease. How does the microbiome cause heart disease, cancer, diabetes, Alzheimer’s, autism, autoimmune disease, allergies? You know I can go on and on. Depression. It doesn’t make sense. When you go to a psychiatrist you’re not looking at your poop, or the rheumatologist, they’re not looking at your poop. Maybe that’s where the answer is.

Dr. Mark Hyman:
That’s just one example of how our framework of disease is so outdated. But I’m wondering how you see, given all the trends that are happening, we move from that paradigm to filter the data to a new paradigm?

Dr. Daniel Kraft:
Well, you’re spot on. The paradigm, that’s also shifting, and how you define quote unquote disease. Something as common as type II diabetes, there are at least three different genetic subtypes who respond if you have type I versus type III you respond very differently to diet, medication, and other interventions. Almost every element from autism, to Alzheimer’s, to of course cancer.

Dr. Daniel Kraft:
Lung cancer isn’t just lung cancer. There’s probably a thousand, or a hundred thousand different molecular variations can now start to be understood at this molecular multiomic level. Which means we can then design both prevention and therapy to match them, including particularly on the prevention side. Very few diseases have one gene, like sickle cell or thalassemia.

Dr. Daniel Kraft:
Now we’re understanding this idea of polygenic risk scores, a base genome which doesn’t change. Many genes play a role in your risk for diabetes, atrial fibrillation, cancer, et cetera. I think part of our future in really truly functional medicine is to understand each patient based on their underlying genetic risk factors, also based on their sociome, where they’ve lived.

Dr. Daniel Kraft:
If you grew up in Beijing with lots of pollution maybe you have to change your screening for lung cancer and give that multiomic sociome, polygenic elements in a way that the clinician can adjust. The patient and their families can understand. Because it’s just completely overwhelming. And platforms like IBM Watson can play a role. But again they’re only as good as the data they’re trained on, and many of these systems [crosstalk 00:20:26]-

Dr. Mark Hyman:
Right. That’s what I mean. Yeah.

Dr. Daniel Kraft:
Yeah. If they’re only taking data from European Caucasians it may give you the wrong answer if you’re dealing with folks from Asia or from Africa by heritage. There’s big attention now being paid to not just health equity but data that’s collected in forms that match the population. One great example is the NIH has this All of US, allofus.nigh.gov is the website, where you can sign up as a data donor and share your genome, your medical records, your Fitbit data, and beyond.

Dr. Daniel Kraft:
That’s essentially like a Framingham trial on steroids. It’s going to be a million or more Americans and we’re going to learn instead of just from relatively healthy nurses in Framingham, Massachusetts, what really might be the best guidelines for you for high cholesterol, to managing hypertension, to cancer prevention, et cetera. Big challenges. Big opportunities. The data alone isn’t enough. How we analyze it and how we make sure it’s matching the folks you’re targeting at are key as well.

Dr. Mark Hyman:
Well, that’s right. You kind of have to have the overlay of the paradigm you’re filtering the data from, [inaudible 00:21:28] junk in junk out. I think that’s what I worry about is it’s so difficult for that paradigm shift to happen for traditional medicine. The Structure of Scientific Revolutions by Thomas Kuhn talked about this idea of paradigm shift in normal science and how difficult it is for people to shift out of the normal science, the normal way of seeing the way they see things. It’s like they have blinders on and it’s just striking to me how challenging it is to get people to come along and get the ideas of a new paradigm.

Dr. Daniel Kraft:
Well, part of the paradigm shift of course in healthcare, there’s many misaligned incentives. The practice of care is again sick care. You get paid to often do more biopsies, more procedures, more transplants to keep the hospital beds full, not to keep patients out. Part of that paradigm shift has to occur in the context of how the clinical care is performed. How do you reward the clinician? If they want to prescribe a connective blood pressure cuff or one that’s embedded in your smartwatch are they going to get rewarded for looking at that data and manipulating it, or will the AI system be paid for that can help tweak your medications, or 3D print them in your home?

Dr. Daniel Kraft:
Part of that paradigm shift has to be aligned with the practice of care, who’s doing it, how we get paid for it. Because in many cases the incentives are to treat the disease, not the symptom.

Dr. Mark Hyman:
Yeah. I mean we see that, for example in clinical care right now with diabetes. It’s one in three Medicare dollars which is spent usually on intensive treatments, medications, hospitalizations, surgeries, all the things that are needed to keep diabetics from getting more complications. Yet we know that food is the biggest driver of diabetes, and that for most people it is the biggest treatment.

Dr. Mark Hyman:
Yet we don’t provide payment for people to actually get treated with food. Which is striking to me. The guys in your study looked at food insecure diabetics, and Dana-Farber who’s now Google gave them $2,400 of food a year plus some support, and food [inaudible 00:23:18] for their family which doesn’t seem like a lot of money or food. They were able to save about, almost $200,000 per patient, and improve their blood sugar simply by providing the food.

Dr. Mark Hyman:
That’s really what’s frustrating to me is that we have a lot of the beneficial treatments that optimize health but we don’t pay for them. We pay for, well you know what we do in medicine now which is usually drugs and surgery.

Dr. Daniel Kraft:
Yeah, and Hippocrates said a long time ago, “Let food be thy medicine, and let medicine be thy food.” Now what’s interesting in this digital age, I’ve got on my desk here randomly my little Lumen device. I can track my metabalome if I’m ketogenic or not. I’ve got that CGM that I mentioned. There’s other handheld spectrometers that can wand your food and detect how many calories, if it has peanuts in it, if it has gluten.

Dr. Daniel Kraft:
Again that might lead to enabling all of us to use food as medicine or as health in easier ways, and to connect those dots, and again learn. I think that’s back to this idea that we can crowdsource. I used the Waze analogy earlier, but to the car analogy there’s all these new sensors coming into your car, 400 or 400 sensors.

Dr. Daniel Kraft:
You don’t pay attention to most of them. You don’t even know most of them. What you do pay attention to is when that check engine light goes on. That hopefully makes you take your car to the mechanic before you blow a gasket. I think part of this future of medicine will be that simplified user experience that can match the individual’s age, education, culture. It communicates in the right way to help nudge us towards a better diet, to getting checked up, to addressing a problem before it gets too challenging.

Dr. Daniel Kraft:
In the car model now we have Tesla’s which are essentially computers on wheels. When they are driving in they’re self driving or quasi self driving mode if they learn that they need to slow down on a curve they upload the map to the other Tesla’s when they do the updates in the cloud. There’s that hive mind element. Whether it’s with nutrition, or treating cancer, or diabetes the more we can start to cross-fertilize, share, connect those dots and update the maps for all of us we’ll do better across the nutrition side and every other element of healthcare including public health.

Dr. Daniel Kraft:
Our data out of Stanford and at [Scripts 00:25:20] can show that your smartwatch can find changes in heart rate variability and other elements that predict that you’re catching COVID before you’re even symptomatic. Imagine part of-

Dr. Mark Hyman:
Amazing.

Dr. Daniel Kraft:
… our future public health measures where we’re all part of that map going forward.

Dr. Mark Hyman:
Yeah. No. Definitely looking the quantified self stuff is interesting. I put on the levels of glucose monitor and tracked my blood sugar over a number of weeks. It was fascinating to see what I ate, when I ate, how it affected my blood sugar, when it was up, when it was down. It was really quite interesting.

Dr. Mark Hyman:
I’m not diabetic or don’t have any metabolic issues, but it was still very instructive about, “Oh, if I do this this is going to create a bigger spike or a bigger drop. This is how I keep my blood sugar even.” We know that for example keeping your blood sugar even is one of the key to longevity and health. It’s these spikes in insulin and blood sugar that really cause a lot of our problems.

Dr. Mark Hyman:
Or looking even at my Oura Ring and my heart rate variability, when I moved to Maui for the winter I really noticed over time is tarted to see my heart rate variability improve. In other words my metabolic health, my heart rate all improved as a result of lower amounts of stress by living in Maui.

Dr. Mark Hyman:
I was like, “Wow. This is really interesting. I am getting more stress-proof by simply doing the behaviors like sleeping well, and eating well, and exercising, and meditating, and just having a more balanced life than running around like a crazy man like we used to do before COVID.” You and I both were like that. It’s like wow, this really is something you can pay attention to and an impact.

Dr. Mark Hyman:
Hey, everyone. It’s Dr. Mark. You’ve probably heard me talk about how much I love infrared saunas on the podcast. They’ve been linked to many different benefits like better muscle recovery, calming of the nervous system, improved circulation, and even activation of the immune system to support protection and healing. Saunas also promote the release of feelgood endorphins that give you that blissed out feeling and give your skin a healthy glow.

Dr. Mark Hyman:
I think it’s fascinating that so many cultures around the world have some kind of history of sauna use, and I don’t think it’s a mistake. People have recognized for centuries that heat exposure and sweating has therapeutic effects. Now it’s easier than ever to take advantage of that ancient wisdom on a regular basis. I know not everyone has the room or the budget to have their own sauna at home so I was really excited to learn about infrared sauna blankets from HigherDOSE.

Dr. Mark Hyman:
It gives you all the benefits of infrared in an easy to use portable blanket at a much lower cost than a standalone sauna. The blanket’s so cool. It has a layer of amethyst to deepen the infrared benefits, a tourmaline layer to generate negative ions, and a layer of clay to balance heat, and a charcoal layer to bind pollutants as you detox.

Dr. Mark Hyman:
If you don’t have the budget or space for a full sized sauna this is an amazing and less expensive option to up level your wellness routine. HigherDOSE is offering my community and exclusive discount of $75 off with the promo code farmacy75 at higherdose.com. That’s higherdose.com with the code farmacy, F-A-R-M-A-C-Y, 75. Now let’s get back to this week’s episode of The Doctor’s Farmacy.

Dr. Mark Hyman:
What about the term exponential medication? This is something you coined. What does it mean? How do we leverage it to impact our health, and how is it going to transform healthcare?

Dr. Daniel Kraft:
Yeah. The framing of exponential medicine is to understand the pace of change. We mentioned earlier Moore’s Law, the power of computing in your smartphone is doubling in performance and half the price every year. The fact that our sequencing a genome or a microbiome has dropped from millions of dollars to a hundred dollars, the fact that our Internet of Things and connected devices are going up at an exponential rate…

Dr. Daniel Kraft:
Just a reminder for those who are not mathematicians our brains are fine thinking linearly. 30 linear steps I’ll be across my house. But if I took 30 exponential steps, 2, 4, 8, 16, 32, 64, by the 15th step I’d be at about 32,000 meters. But by the 30th step I’d be 26 times around the planet, a billion meters.

Dr. Mark Hyman:
Wow.

Dr. Daniel Kraft:
That’s sometimes the surprising-

Dr. Mark Hyman:
Wow.

Dr. Daniel Kraft:
… power of exponentials. What we need to keep in mind as we look to build our future of health in medicine is what’s going to be possible with the next generation of wearables, or Internet of Things, or 5G moving to 6G? The fact that we’re now seeing satellites now from SpaceX start to bring high speed bandwidth pretty much anywhere in the world? How do we think about drones which 10 years ago with toys now are delivering drugs and medications?

Dr. Daniel Kraft:
How do we think about gene therapy which now has accelerated with CRISPR and next generation mRNA therapeutics? A bit of the framework of exponential medicine. The conference I chair and founded is to get people looking at all those technologies, how they come together, and how you converge those to address challenges and pain points, and to learn from others that are doing it.

Dr. Daniel Kraft:
For example, we had our friend Leroy Hood there sharing his perspective around precision wellness that ties into a lot of your work, and where that might go. And how not only to have the technology, but how to integrate it in with the payment models and the healthcare systems, and the incentives, and the policy makers.

Dr. Daniel Kraft:
That’s a bit about the exponential ongoing. I would argue that many of the things that we had… It was actually 10 years ago this month I did a TED talk called The Future of Medicine: There’s An App for That. At the time I think here were 60,000 healthcare apps. Now there are, I don’t know, 600,000 or more. But what’s interesting is those have shifted from the consumer app for mindfulness, or maybe tracking your steps, to being medicalized.

Dr. Daniel Kraft:
They’re getting paid for. They are making FDA approved… There’s no app video games for treating ADHD that are approved, or for managing PTSD. We’ve gone from the shiny objects, and these are kind of cool widgets, to where they’re being integrated into care models. They’re being regulated. They’re being paid for. That’s a bit on this exponential.

Dr. Daniel Kraft:
Of course as clinicians in healthcare we’re often a little slower to adopt than if it was just a pure video game. Another fun example of an exponential many of us have experienced is virtual reality. You know six years, seven years ago the Google Glass was kind of a fun example. But now there’s Oculus Quest for $200, and VR can be great for playing video games, and putting grandma on a rollercoaster.

Dr. Daniel Kraft:
But now VR can be used for therapy to treat pain, or for medical education. You go into a virtual operating room and you practice your procedure just like a pilot would be on a flight simulator. These are examples of things coming together in surprising ways that we all need to appreciate and leverage into health and medicine.

Dr. Mark Hyman:
You know I think all these things are going to change healthcare, and change our approach to our own health. But being a little bit of a devil’s advocate you know we have all these great technologies, but technology in the end doesn’t save us. Because at the end of the day it comes down to the simple things that create health which are what we eat, how much we sleep and exercise, and our stress level.

Dr. Mark Hyman:
And a few other simple things like our nutritional status, and toxin load, and overall health. How do we get people to focus on those changes? Because right now as we started out talking about we have 80% of Americans that are metabolically unhealthy, 75% overweight. 6 in 10 have a chronic disease. It’s driving… One out of five dollars in our economy is healthcare dollars for healthcare. About 80% of that is for chronic illnesses mostly related to lifestyle.

Dr. Mark Hyman:
That’s the big question is behavior change right? We know what to do. I can cure someone’s diabetes. It’s not hard. Change your diet. The data is there. It’s not controversial. And yet it’s really hard to get people to do. How do we deal with that? How do we get exponential in terms of behavior change?

Dr. Daniel Kraft:
Right. Well, comment number one is of course technology only plays a role of about 15% of our health, and a lot of it are the core elements. Food. Sleep. Social connection. Diet. Putting on my pediatric hat for a second since I trained in medicine and pediatrics, we know now that if you give a child at six months of age not that cheaper white rice yummy sweet cereal, but if you give them whole grain cereal it changes their microbiome, their epigenetics, and the risk for obesity and diabetes goes down dramatically.

Dr. Daniel Kraft:
Number one, start young. I’ve got young kids. Sometimes they like their sweets but you try and moderate. But of course now we know we don’t need to be quantified self to know you’re supposed to exercise more and eat less. But for me the change is super hard. But what’s getting interesting now is we can start to use some of these new tools to become that digital coach that really matches you.

Dr. Daniel Kraft:
The avatar you might want is Einstein. I might want my mother as my coach, or… These avatars can feel real even if they’re just something living on your phone or through voice. I think what’s going to be part of this element in the future, we’re all touching our smartphones and other consumer devices frequently, they can become a bit of our health bubble kind of like your almost personal health avatar that can give you smart nudges over time to help nudge you in the right direction in ways that match you right?

Dr. Daniel Kraft:
I’m an INTP. You might be an ENTJ. We might relate to health information differently. If you’re a baby boomer versus a millennial how you communicate, how you have the user interface on the wearable app might be quite different. I think it’s a bit of a blending of all these things to meet people where they are and give them that power of why right?

Dr. Daniel Kraft:
If you can show them in the mirror not just you of today but you of the future, if you keep smoking, drinking, not getting enough sleep, stressed out, that can be a powerful level. That can be done with augmented and virtual reality today as well. I think it’s a blending of those tools, and now it’s a bit dystopian or big brother.

Dr. Daniel Kraft:
There’s even insurance companies, life insurance companies that will track your steps. If you’re walking 10,000 steps a day you might get a lower premium. There will be other financial, other incentives that come into play.

Dr. Mark Hyman:
I think we haven’t been asking that question enough when it comes to technology which is what is the signs of behavior change? I think you know BJ Fogg and others, Charles Duhigg from the New York Times has written about habit change, behavior change. I think we really are often ignoring that piece of medicine.

Dr. Mark Hyman:
Because at the end of the day if people don’t change their behavior none of these things really matter right? Because yes you can find a precision way to match this drug to this disease and that’s great. We mean to do that, and wonderful. But when you talk about the majority of what we’re suffering from in terms of chronic disease that’s not going to cut it.

Dr. Mark Hyman:
We need to get into the homes of people, and get out of the hospitals and the clinics and decentralize health. Like you said at the beginning we have a sick care system, not a healthcare system. Health really happens at home. Nigel Crisp wrote a book called Health Happens at Home, Hospitals are for Repairs. I think that’s a good way to think about it.

Dr. Daniel Kraft:
Yeah. I actually recently chaired a conference on the future of the hospital with a bunch of CEOs from hospitals and our takeaway was that the future hospital is no longer the hospital. It’s increasing virtualized. It’s moving to your corner pharmacy. It’s moving to your smartphone. I’ve been the host of the CVS Healthy Conversations podcast. A lot of it is bringing in other voices that you might not always hear from. It could be the pharmacist or the pharmacy executive struggling with, how do you manage everything from COVID testing to the social determinants elements, and equalizing care.

Dr. Daniel Kraft:
Because now we have the ability to connect the dots through the digital connected mobile age. It can happen in our home. More and more patients are being admitted to the home not the hospital for maybe a simple pneumonia. With the technology piece where when we were medical residents you remember we’d keep someone in the hospital for an extra day or two just to check their temperature or lab.

Dr. Daniel Kraft:
Now you can send them home with the lab, or a wearable device like this one that is basically an intensive care unit level patch that can stream their ICU level data and enable you to do a better job of that home based care from hospital to home, or hospital to homespital is going to be [crosstalk 00:36:42]-

Dr. Mark Hyman:
Homespital. I like that. Homespital.

Dr. Daniel Kraft:
I was going to say. Think about what do you have in a hospital? It’s usually like an IV pump which now can be converted to a smart pump at home. Some drugs which we used to give only by IV or subcutaneous infusion can go into a robotic pill that you might swallow and inject the biologic into your wall, into your gut wall. Our wifi now can pick up our vital signs.

Dr. Daniel Kraft:
MIT project by Dina Katabi showed that modifying wifi can pick up the vitals and behaviors of 10 or more people in the same home. Again a bit big brother but we’re exuding our digital exhaust 24/7 that enables us not just through the wellness side, but when folks have an acute or chronic medical condition you can manage them remotely.

Dr. Daniel Kraft:
Something as simple or common as someone just had a total hip replacement, or came home from the hospital with COVID. Is their wearable device showing that they’re walking more, doing better, or walking less? If you can intervene early on the folks that are walking less before they have a fall or other complication that could be a big changer as well. A lot of the new digital breadcrumbs will come from the home and enable us to do smarter, more wholistic and integrated care.

Dr. Mark Hyman:
One of the most interesting things was I was on a flight back from a conference with Mike Roizen and Dr. Oz. They were sharing this phone technology which is a sensor in the phone that detects your voice. You touched on that earlier. Which can tell you what your mood is, whether you’re at risk for different problems.

Dr. Mark Hyman:
It’s just fascinating based on the tone of your voice, the quality of your voice. We’re able to pick up data that’s going to inform us about, well maybe this person’s about to commit suicide, or maybe this person really needs some help with this or that. We can begin to really create a system that responds to the real needs of people in real time which is very different than our one size fits all approach.

Dr. Daniel Kraft:
Well, that whole field of voice as a biomarker, I mean the ones that have come out this year are the sound of your cough. Is that COVID or croup, or a cold? But mental health can be picked up. I talked to a startup in the San Francisco Bay Area yesterday. They have a way of picking up depression and scoring it based on your voice.

Dr. Daniel Kraft:
Then another advent that’s accelerated is digital mental health. They can then connect you to a platform that might help you manage your stress, or your anxiety, or PTSD, or your depression. And then have ways of actually quantifying that. Because mental health and the brain has been so hard to quantify. You can’t put people in MRIs everyday.

Dr. Daniel Kraft:
Another piece of voice, it can pick up signs of early neurologic conditions. Given the scourge of Alzheimer’s and other neurologic challenges what if you could detect 20 years before someone was symptomatic that they are likely to get dementia, maybe just like we give a statin for high cholesterol we’re going to start to give some of these drugs that reduce neuro inflammation, or can reverse and stop plaques early on in the progression. And use these biomarkers for voice, to your itracking, to your Omex, to truly move the needle on preventing these horrible diseases as well.

Dr. Mark Hyman:
Yeah. So true. I think what I want to dive into a little bit is is this whole field of precision nutrition. I just published a book called The Pegan Diet which is focused on two big concepts, which is food is medicine. It’s a biological response modifier. In other words it changes every aspect of your biology in real time.

Dr. Mark Hyman:
Two, personalization. How does the future look to you in personalized nutrition? What will we be doing? How will it inform us? Because there isn’t a one size fits all diet for everybody, so how do we begin to get to a closer approximation of what was going to work for us?

Dr. Daniel Kraft:
Well, I think as we start to understand nutrition at the true biological level which is relatively new the fact that we can all now wear a CGM. Glucose is only one part of course. How we can start to measure, even some people do it every week, their microbiome. We’re seeing seeing new ways to collect your microbiome from other parts of your gut as well.

Dr. Daniel Kraft:
We’re seeing the ability now to see the impact on other levels of biomarkers. I think hopefully it doesn’t have to get super complicated where you’re quantifying your meals every day but you get a bit of a best picture look at what’s really going to keep you healthy, optimize your health whether you’re training to run a marathon or you’re trying to reverse your diabetes, or reduce your risk of cancer or treat a cancer. I think the way it looks, it might be along the lines that number one our smart kitchens might be tracking some of this for us and maybe can even order the right meals or give you better points for shopping in healthy ways that already exist.

Dr. Daniel Kraft:
But ideally it becomes something that’s fun and integrated, and much more appreciated. Yes you can still go and have your fast food occasionally, and have that big chocolate cake. But we are understanding its real impact in measurable ways. We can integrate that into medical education, because we don’t get much nutrition in medical school. I don’t know… I think I had one hour at Stanford.

Dr. Mark Hyman:
Yeah. Yeah.

Dr. Daniel Kraft:
[crosstalk 00:41:06] a part of our healthcare prescription. Prescribing a diet for example will become much easier. That will be something that will be tuned. In some cases we’re going to want to modify things in realtime. One element since I trained in medicine in pediatrics is dosing. You might dose a meal, but also dosing your medications. Ideally we want to have folks off medications, but one technology I developed is a way of 3D printing your own personalized poly pills.

Dr. Daniel Kraft:
Someone who has [crosstalk 00:41:34] statin beta blockers [inaudible 00:41:35] vitamin D, yeah, you might imagine you can print that pill every morning based on their data, or even print their right dose of statin or Lasix into their breakfast bar or into their coffee.

Dr. Mark Hyman:
Amazing.

Dr. Daniel Kraft:
Ideally it becomes a little less hard to do and you don’t need to be a quantified self or tracking every calorie, or every cupcake.

Dr. Mark Hyman:
Yeah. Yeah. It seems to me that when I look about and I see what’s happening in the future of medicine nutrition, I think we’re going to be able to use a lot of different tools to assess a person’s individual needs right. Their genome which looks at enzymes, I mean 1/3 of our entire genome codes for enzymes. All those enzymes require nutrients or vitamins and minerals. And they require different kinds and different amounts depending on your genetics.

Dr. Mark Hyman:
That’s just one aspect. You can look at nutritional testing. It might be done through saliva, or urine, or blood, or transdermally, or through your eye, or who knows what we’re going to be able to figure out, and detect what’s going on with your nutritional status. Are you low in this or that nutrient? We’ll be able to look at your metabolic features, whether you’re prediabetic or not, or whether your blood sugar’s off or not, and even more subtle things that we’ll be able to measure.

Dr. Mark Hyman:
We’ll be able to look at your stool, and look at your microbiome which plays a huge role in how you respond to different foods. We’re going to collect all this data, plus our own family history and our own personal history. I think it’s going to look like a very different landscape where we’re going to be able to see, “Okay, you’re someone who may need to be on a higher fat, lower carb diet,” in other words you might be on a lower carb, higher fat diet. Or you might do well with saturated fats and you might not do well with saturated fats.

Dr. Mark Hyman:
You might do well with eating, I don’t know, blueberries and you might not be able to get away with eating blueberries. I think that is going to be a really breakthrough moment when people can start to get off of the dogma that they’re on around what they should or shouldn’t be eating and really understand that this is a personalized future both in terms of pharmacology but also in terms of nutrition and in terms of our own ability to personalize our wellness.

Dr. Mark Hyman:
We call it… Leroy Hood calls it scientific wellness. I just call it functional medicine. Dave Asprey calls it biohacking. We can call it exponential medicine. Whatever we want to call it it is what’s going on, and it to me is one of the most exciting things. I’ve been doing it for 30 years. I can see over that time we’ve gotten better and better at understanding what to look at, what tools there are, how to personalize these approaches.

Dr. Mark Hyman:
When we see the outcomes of those interventions it’s just striking to me when I work with my patients in that way. I mean I had one woman who was, for example, very overweight, struggling to lose that 20 pounds that she needed to lose. She was struggling because she was really having terrible [inaudible 00:44:21] with super high cholesterol, super high triglycerides, low HTL. Was really having trouble.

Dr. Mark Hyman:
She’s like, “I’m like, I’ve tried everything.” Well, why don’t we try a ketogenic diet? I basically put her on coconut oil and butter as 70% of her diet. And she literally transformed. Her weight dropped off 20 pounds just like that. She had a dramatic reduction of 100 points in her cholesterol, 200 points in her triglycerides. Her HTL went up 30 points which is unheard of.

Dr. Mark Hyman:
It was a miracle. Another guy who was a 50 year old biker who was relatively healthy but wanted to optimize his health, wanted to try a ketogenic diet. I’m like, “Okay. Try it and see how you do.” We checked his numbers and it was the opposite. He got terrible cholesterol particle number, really high. Small particle. The opposite of what you would see with this woman. Same diet, totally different biological responses.

Dr. Mark Hyman:
I think we have to be humbled by the fact that we’re just at the beginning of this discovery process. Soon these new tools and technologies will be able to really drive in a much more personalized approach to scientific wellness or health.

Dr. Daniel Kraft:
And one key part of that is the evidence base. There’s always a… I like to drink my coffee. Most of the recent studies say coffee is good for you but occasionally you’ll hear one where it’s not, or vitamin A or vitamin D. What’s interesting now in [inaudible 00:45:37] connected age we can all now become members of virtual clinical trials.

Dr. Daniel Kraft:
Whether it might be a form of new nutrition, or a particular medication that’s dropped off by drone and then your apps sense that. I think building the evidence base to match the potential is really critical. Now we can accelerate clinical trials and evidence as well.

Dr. Mark Hyman:
Well, let me challenge you on that because in the field of exponential medicine and thinking differently about the future, and understanding network biology our current two tools that we use aside from some animal studies are randomized clinical trials which are looking usually at specific interventions for specific disease in a specific population that may and may not be generalizable using a statin and 70 kilogram man from Kansas who all wear overalls basically as the perfect study, versus the real world where we see all sorts of size, shapes, colors and ages of people.

Dr. Mark Hyman:
The second tool we use is public health studies which are epidemiology [inaudible 00:46:34] large populations. We see trends over time. Again those are generalizable to a population but not to individuals. The randomized trials are specific to individuals but not super generalizable in my view.

Dr. Mark Hyman:
There was even a great paper in JAMA that kind of talked about this challenge with research. In the field of the future of medicine, whatever we call it, how do we reimagine research to be able to look at the complexity of biology and get out of this reductionist paradigm of just looking at the single intervention for a single disease, or the single drug?

Dr. Daniel Kraft:
The one example of that is Verily, Google’s spin out in health is doing the baseline trial where they’re taking, I think 10,000 plus volunteers looking at their digital exhaust from their wearables, their genome, their diets, their health history and starting to connect the dots and do a continuous clinical trial to understand health and also see disease in a normal distributed population at least [inaudible 00:47:27] that sign up for the study.

Dr. Daniel Kraft:
I imagine we can all be part of a continuous clinical trial going on potentially if your food intake is tracked by the future spectrophotometer on your smart device. We’ll start to opt in I think into more generalizable wholistic clinical trials. That using big data and multiple streams of information can give us better, less narrow insights that can apply to precise prevention diagnostics for therapy.

Dr. Daniel Kraft:
Huge challenges. How do you pay for it? What data do you look at? Then even in the form of nutrition one form of milk might be different from another depending on the cow. I wonder how we can start to standardize some of the nutritional components as well.

Dr. Mark Hyman:
Yeah. Right. Milk is in milk, is in meat. Meat is in meat, is in meat right? We’ve talked ab this in my book on another podcast, but you know kangaroo meat, or wild animal meat is very different in its biological effects than feedlot meat, where the feedlot meat raises inflammation. The wild meat reduces it. Or if you’re eating, like you say milk from a sheep which has A2 casein, it has different biological effects than a cow milk that’s A1 casein.

Dr. Mark Hyman:
It even gets more complicated about how do we begin to focus on that. But I’m sort of excited about it. I can tell you the more I dial in what I see in my patients’ data and lab tests the better the outcomes are clinically. I wish we had a way to really study that. At Cleveland Clinic we’re doing outcome data on everybody. I wish we had tons of money to study this. I know there’s so much money, like billions and billions, and trillions being spent on things like COVID. It seems like just a fraction of that spent on studying some of these issues in more detail would be so powerful.

Dr. Daniel Kraft:
Well, a question for you related to that. I mean functional medicine really is this integration of all these different fields, but healthcare is still practiced among specialists that often don’t talk to each other and they just… One specialist for the right arm, one for the left in some centers. How do we better integrate these elements so it’s not just your primary care doctors trying to struggle to connect all those dots, and how do we make functional medicine truly functionalized for every individual and almost clinician?

Dr. Daniel Kraft:
Are there ways you’ve seen that work? Because not everyone can spend the amount of time and the resources, and has the experience of Dr. Hyman. How do we create the AI version of you to help all clinicians [crosstalk 00:49:40]-

Dr. Mark Hyman:
Well, that’s what I was going to ask you because I agree. I mean I’ve had this unique perspective because I’ve had the privilege of working at Canyon Ranch which is a health resort where people are very affluent, and also in my own private practice where I saw people from all over the world and they could afford significant testing. We would do sort of an experiment.

Dr. Mark Hyman:
I would say “Look. Let’s just get this data and the more data we have the more we’ll know about your biology, and the more we’ll be able to personalize this approach and help you get healthy.” I’ve seen literally millions of data points on tens of thousands of people and it’s all in here. I can see those patterns in the data, which is what AI does. But I’m not that smart, and so I’m probably missing a bunch of stuff.

Dr. Mark Hyman:
And I have also seen stuff that I know nobody else has seen or noticed because I just had so much data. My dream is to actually get this convergence to happen where we somehow get the right people in the room who can use AI and the right AI programming to understand all this information that’s being fed into these big data fields of Omex, quantified self, systems biology, paradigm shifts, and create a decision support system for providers to say, “Okay. Here’s the thing you should think about.”

Dr. Mark Hyman:
“Here’s apartment with Alzheimer’s, and based on their history, based on these lab diagnosis the likelihood is that they probably have an insulin resistant driven Alzheimer’s.” Or this patient might actually have a Alzheimer’s is caused by some latent infection like [inaudible 00:51:03] is talking about, some low grade infection of the brain.

Dr. Mark Hyman:
Or maybe it’s from Lyme Disease. Or maybe it’s from heavy metals. Or maybe it’s a microbiome issue that’s causing brain inflammation. We’ll be able to then begin personalized nutrition in medicine and then come up with the right therapeutics based on those algorithms. That I see coming. I don’t know anybody who really is working on it. I’ve talked to Peter Diamandis and his group working on the personalized longevity programs that they’re developing.

Dr. Mark Hyman:
I’ve talked to Human Nucleus and folks down there, Craig Venter and his team, and now new team down there. They’re trying to get to this, but it’s tough. Leroy Hood tried to do this with his study, and [inaudible 00:51:43]. Unfortunately the business model didn’t work but he really has done this quantified data on 100 people, wants to do it on 100,000 people looking at all these variables and what happens when you start to impact these over time.

Dr. Mark Hyman:
Those are the kinds of things that have to happen for us to really move forward. But I think all the people you know and all the things that are really going on in the world, if somebody who had money could catalyze the research field in this way to put these pieces together that you talked about it would be transformational.

Dr. Daniel Kraft:
Well, one part of that transformation is it has to be part of the… We talked a bit about workflow. No clinician wants to be looking at all the raw Omex. I even went through the [inaudible 00:52:19] program. It was fantastic, but it was very intensive. You had one coach. They still looked at various fragmented sets of your data, your genome, your microbiome, your scan, your other element.

Dr. Daniel Kraft:
Hopefully the trick is, and you’ve told these stories of your experience with like heavy metals and mercury poisoning, what if the little AI computer decision support suggested for the primary care doctor in rural Idaho that, “Wow, this patient really keeps not doing well. Have you considered checking their mercury levels or other elements?” Sometimes we have so much misdiagnosis, so many folks get to late stage and it’s often fragmented amongst different specialists who never see the complete picture.

Dr. Daniel Kraft:
That I think if we can smartly start to integrate that into the workflow and ask those questions even before you see the clinician we’ll start to move the needle. That’s part of that paradigm shift.

Dr. Mark Hyman:
It’s pretty exciting. I want to get there fast because I see so much needless suffering, and there’s a huge gap between our current knowledge and current practice. We hear average of 17 years for things to get into practice from when they’re discovered in the scientific literature, or 50 years you know. Sometimes it takes a while.

Dr. Mark Hyman:
Lots of people are vilified or discounted because of that. But I think we’ll get there. I think your work is just so important because it connects the dots for people and helps them look at the future in a really different way. I want to turn the tide a little bit and talk about COVID with you for a minute because it’s really crazy these unprecedented social economic challenges.

Dr. Mark Hyman:
Given it’s also an opportunity to think about how to make a difference in our whole approach. How do you see COVID has been a catalyst for change when it comes to future of medicine? I have some ideas about that but I’d love to hear what you’re thinking.

Dr. Daniel Kraft:
Well, one lens is that it’s forced us to collaborate faster. I’ve been chairing the XPRIZE Pandemic Alliance Task Force which is made up of some amazing folks like you know, like from Dean Kamen to the chairman of IDEO, to the folks who head up life sciences for Intel, but also 100 organizations from small companies to academics, to Fortune 50 companies. To help address what are the challenges of this pandemic and how do we prevent future ones?

Dr. Daniel Kraft:
Part of COVID as a catalyst has been to accelerate new forms of communication, new forms of data. It’s from studying the genomics of COVID patients and figuring out what blood type might be causing more morbidity or susceptibility all the way to catalyzing new forms of diagnostics. We launched with Jeff Huber the founder of GRAIL cancer testing company, we started, and launched, and finished an XPRIZE for rapid COVID testing. That generated 700 different teams from 70 countries.

Dr. Mark Hyman:
Wow.

Dr. Daniel Kraft:
The winning teams, some of them were using the basic PCR, but they could make it faster, cheaper, better. Some were picking up ways to use smell as a screening test in various precise ways. Others were using breath and new forms of physics. COVID has forced us to be smarter, to collaborate faster. I think the silver lining of the pandemic is some of these testing solutions we talked about will lead to better diagnostics for many diseases.

Dr. Daniel Kraft:
Certainly we’ve learned around the vaccine element that it was amazing. January of 2020 we sequenced the virus. A month later we built the first basic vaccines, mRNA based that were into trials a month later. We have vaccines on the market less than a year later. I think the lessons that we’ve learned narrowing the gap from data, to insights, to action will serve us in the reinvention of healthcare going forward. It means we all need to use this as an opportunity to break open our old silos and do things smarter and faster.

Dr. Mark Hyman:
Totally. I found also our practice, we like many people when COVID hit were like, “What are we going to do?” Because people aren’t coming to the office anymore. Everybody is staying at home. We had to pivot to our virtual healthcare. We were doing some of it before but we switched basically to running our practice on Zoom which was pretty amazing. Initially almost entirely.

Dr. Mark Hyman:
Now people are coming in a little bit, but we were seeing that in the silos for example between states. Now we can treat people from other states. All these artificial barriers that are regulatory that have kind of limited medicine. Like you have to have a license in every state to treat someone in another state, or they have to see in you in person.

Dr. Mark Hyman:
I mean these are things that have been established and honestly have no really good reason for them. Now we’re seeing oh wow, we can do really good medicine online. Yes, it would be good to see the patient. Yes it would be good to do a physical exam, but I often do good exams online. I had a orthopedic consult with a patient and I saw the doctor was like, “Okay, do this. Do this bend. Here, do this.”

Dr. Mark Hyman:
It was like he was telling her how to do all the moves that would trigger whatever he wanted to trigger. It was like wow, we really have to rethink our whole approach to treatment. I also think the centralization of care, the democratization of care, getting care out of the clinic and the hospitals just makes sense.

Dr. Mark Hyman:
I asked the chief of staff at Cleveland Clinic years ago. I said, “Where do you see Cleveland Clinic in 10 or 15 years?” I see a Cleveland Clinic without walls, which is exactly what you were talking about before which was transforming where care is delivered, how it’s delivered, what kind of information we’re doing. It’s really the most exciting time I think in medicine. I’m just thrilled. It’s just frustrating it’s not happening faster you know?

Dr. Daniel Kraft:
Well, you know we do have to still make sure things are safe and effective. But on the telemedicine side what is exciting of course HIPAA released or relaxed some of its regulations so you can do a Zoom visit. Reimbursement models changed. I think part of our future telemedicine business now that many of us experienced both as clinicians and as patients is like, why do I need to go in for that little checkup when I can just do a Zoom chat?

Dr. Daniel Kraft:
But what I think is going to get exciting is before you even seen the clinician in the future you’ll have talked to the AI chat bot. Maybe you have abdominal pain and it will ask you 20 questions and figure out whether you really have appendicitis or not. It’ll already know if you had your appendix out, or if you’re pregnant. Also when you see the clinician they will potentially hopefully have months or years of your digital exhaust.

Dr. Daniel Kraft:
How have your heart rate changed from your wearable, or your Oura ring? What is your genome? It will not just be the face to face visit, but you’ll be integrating that with a whole nother set of tools and insights. Particularly in functional medicine how has your diet been? How have your bowel movements been? No one can quite remember that but your smart connected toilet might remember that. [crosstalk 00:58:10] part of your [crosstalk 00:58:11] integrated into what you see on the screen. Yeah?

Dr. Mark Hyman:
Okay. Take us forward 25, 50 years. I’m having a problem. Let’s say I’m having digestive issues, or I’m having memory issues. I walk into the doctor’s office, or I walk into our… What does it look like? I want to go get help. What does it look like? Take us through an experience of the patient in the future and how we’re going to come up with a way to treat that.

Dr. Daniel Kraft:
Let’s take something a little more complex to put together like an autoimmune disease, something like Lyme Disease, or rheumatoid arthritis. Often there’s many manifestations of that disease that are often hard to put together and hard to measure. Maybe a part of the future of diagnostics will be before you even know you have…

Dr. Daniel Kraft:
Number one before you even know about the problem it might be like Minority Report. Wow. You’re showing signs of early dementia or rheumatoid arthritis, or any other number of diseases. Just like in Minority report they won’t throw you in jail but they’ll send you the proactive intervention. It might be dietary. It might be in the form of exercise, or a video game for your brain.

Dr. Daniel Kraft:
But wholistically before you walk into the real doctor’s office or virtual one I think that digital bubble of data that you’ve been generating, your digital exhaust, your digitome will have been synthesized. It will have been analyzed maybe continuously, or maybe in realtime just around that question. It might have parsed your microbiome data.

Dr. Daniel Kraft:
Then when it’s going to start to suggest a therapy again it won’t be doing it on that average patient from Idaho who wears the blue jeans and drives a truck. [crosstalk 00:59:41] from folks with your same age, your other genomic cofactors, your sociome, your environment, and really suggest the precise intervention to help it from progressing, or the precise therapy.

Dr. Daniel Kraft:
In many cases that will no longer be the more generic, let’s say generically acting drugs which often have multiple side effects like steroids. They’ll be targeted to, let’s say your base omics issues. The mRNA technologies which are moving very quickly on vaccines are going to be applied to treating certain molecular diseases, and we’ll have much targeted therapies that might even be again printed at home to match what you need.

Dr. Daniel Kraft:
That’s a bit of that touch. I think we’ll still need the human in the mix. It’s not… Your doctor is not getting replaced by a robot, but the doctor using an AI or a robotic assistant will replace those who don’t. It’s a bit of a combination that’s going to really hopefully synthesize these things. We need to keep the human piece but leverage all these new tools for proactive, preventative, personalized any time, anywhere care.

Dr. Mark Hyman:
I love that. I hope it won’t be just rearranging the deck chairs on the Titanic and doing the same thing better, which is actually the wrong thing. Because we have an AI bot, but there’s one called AskMD that I’ve seen and it’s very good. If you have a headache it takes you through a series of questions and at the end you say, “Okay, you probably have a migraine. You should see your doctor and get these tests or do these potential treatments.”

Dr. Mark Hyman:
But that bot is actually operating off of the ICD-10 diagnostic code system which is based on the old [inaudible 01:01:05] paradigm of diseases based on symptoms and organs, not mechanisms and causes, and systems. We need an AI bot that does the latter in order to really create an exponential change in medicine don’t you think?

Dr. Daniel Kraft:
Yeah. Number one, yes exactly. Every disease needs to be recategorized out of its CPT code or narrow bucket. But the biggest potential I think is, you talked about rearranging the deck chairs on the Titanic. That Titanic was for the super wealthy unless you were in the steerage. What’s exciting about these new tools is they really can start to democratize healthcare around the planet from rural California to rural Rwanda, to the point where almost everybody has a smartphone.

Dr. Daniel Kraft:
That gives you not just access to information, but now digital diagnostics where the camera on your smartphone can take a picture of your urinalysis dipstick and diagnose a UTI, or [inaudible 01:01:47] find signs of kidney disease of you’re diabetic. It can provide you that telemedicine consult. It can drop off by drone that device, or vaccine, or therapeutic you might need.

Dr. Daniel Kraft:
That’s part of the exciting piece as well moving forward. Now we’re not all riding the Titanic, we can… As it’s happening in China there’s a platform called Good Doctor by Ping An that has, I think 250 million users now [crosstalk 01:02:06]-

Dr. Mark Hyman:
What?

Dr. Daniel Kraft:
… AI assisted virtual care that can connect them to human care when they need it as well.

Dr. Mark Hyman:
Yeah. That’s so fantastic. I can’t tell you how exciting it is to be alive and a doctor in this time, and because of this rapid transformation our worlds are going to look very different in 10, 15, 20 years. I mean think about it. We didn’t have an iPhone 13 years ago. There was no iPhone. Now it’s like what do you mean? Everybody’s got a smartphone in every corner of the planet pretty much right? It’s that level of exponential change we’re going to see in healthcare.

Dr. Daniel Kraft:
Yeah. Well, I just did the keynote for my Stanford Medical School Alumni event last week and I was realizing when I was a medical student, gosh almost 30 years ago or so, like yeah we didn’t have smartphones. We didn’t have wifi. We were still having slides for presentations. How did we… We couldn’t Snapchat or… I don’t know how we communicated, but [crosstalk 01:02:54]-

Dr. Mark Hyman:
We talked.

Dr. Daniel Kraft:
… 30 years later we’re still using… Well, we’re still using fax machines unfortunately. We still have… I had a cardiac study done about a year ago and I got my result on a CD-ROM? I don’t even own a CD-ROM anymore.

Dr. Mark Hyman:
I know. [crosstalk 01:03:08]-

Dr. Daniel Kraft:
Some of the elements of healthcare in practice are so ingrained that we need to break open the mindsets of medical education, of healthcare systems, of payers or regulators to really bring us to this age of exponential medicine outside of the realm of the fax machine which we’re still stuck with in many centers. It takes not just changing and seeing new possibilities but getting out of our old mindsets as well.

Dr. Mark Hyman:
We’re moving from fax machines to AI bots. That’s great. Well, Daniel thank you so much for your work in reimagining medicine and reimagining healthcare, and being a voice for a real change. You’ve been in the mix of it for a long time and I think your voice, it really sees the potential for a whole new system. It highlights some of the things that are happening on the fringes that are now kind of moving into the mainstream.

Dr. Mark Hyman:
Anybody who’s listening should check out Daniel’s work, should understand the importance of really looking at healthcare differently. Check out his new podcast with CVS Health called Healthy Conversations. He is the host and has all sorts of conversations about the future of healthcare, and really deep conversations with great people across the spectrum of healthcare from providers, to policy makers, to healthcare insurers, to behavioral therapists and pharmacists. Pretty much anybody who’s interested in healthcare you’re going to learn about a different way of thinking about things. Daniel, thank you so much for everything you do.

Dr. Daniel Kraft:
Thank you. It’s been a honor and a pleasure. I’ll just close with the thought that we can all be catalysts in the future of healthcare. You certainly have been. There’s that famous quote the future is already here. It’s just not evenly distributed. It takes all of us-

Dr. Mark Hyman:
That’s right.

Dr. Daniel Kraft:
… to get out of our… Yeah. It’s up to all of us to get out of our linear mindset and get into the exponential one. Find the tools and solutions that might match you or your family member with a particular medical health issue and help move those into this future so it comes faster than we might think is possible.

Dr. Mark Hyman:
Well, thanks Daniel. Those of you who listened to the podcast and love to share it with your friends and family on social media leave a comment. We’d love to hear from you. How has the future of healthcare affected you? Subscribe wherever you get your podcasts and we’ll see you next week on The Doctor’s Farmacy.

Dr. Mark Hyman:
Hey, everybody. It’s Dr. Hyman. Thanks for tuning into The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introduce to you all the experts that I know and I love, and that I’ve learned so much from. I want to tell you about something else I’m doing which is called Mark’s Picks. It’s my weekly newsletter, and in it I share my favorite stuff from foods, to supplements, to gadgets, to tools to enhance your health.

Dr. Mark Hyman:
It’s all the cool stuff that I use and that my team uses to optimize and enhance our health. I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else. I promise. All you have to do is go to drhyman.com/picks to sign up. That’s drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter. I’ll share with you my favorite stuff that I use to enhance my health and get healthier, and better, and live younger longer.
Speaker 1:
Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services.
Speaker 1:
If you’re looking for help in your journey seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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