You're mission at the moment to myth bust and call out disinformation as it relates to health care. Let's get into that. Okay. Dr. Mike Vershasky.
He's the actively practicing medicine doctor with over 25 million followers.
Who's created one of the largest health education platforms in the world?
Doctor Mike, what's the key to finding a diet that's going to stick?
There's two real things that you need to think about. One, calories in and calories out is true.
And this is important. You need to have the prevailing narrative that if you want to lose where you got to get on a running machine.
Nutrition? That's where the majority of the change will come from.
What's the medical advantage if I go to the gym every day?
Literally everything else. Is vaping dangerous? Yes. And no one knows this. By the way, this is why I do what I do.
But the more dangerous part of it is what's your POV or something?
They will make you skip on doing things that are healthy for you and supplement have side effects.
You have too many of them. We notice that they... But no one talks about that because you can't really sell them.
And then considering you can so much about your health, why would a doctor choose boxing?
Because I unfortunately lost my mom to cancer.
To ask the doctors to stop doing chest compressions on your mom.
That is not something that I wish on anyone. And I got into a very unhealthy mental state.
So boxing chose me instead of each choosing boxing.
And the circumstances that you lost your mother were she was given the all clear.
Did that experience change your perspective of the medical industry in any way?
That helps this channel more than you know. And the bigger the channel gets, as you've seen, the bigger the guests get.
Thank you and enjoy this episode.
Doctor Mike.
Considering everything you do from your podcast to all of the content you produce across your channels to the stuff you do in TV, everything.
Social media, all of it.
How do you summarize the overarching mission that you're on at this in this phase of your life?
The mission is largely to make sure that in the sea of misinformation.
My patients, my viewers, are getting the most honest, transparent and engaging information.
So that hopefully they can make the best decisions health care wise for themselves and their family members.
Why do you care?
When I was a medical student, I would go into rooms with patients and they would be being seen by some of the top doctors in the world.
I mean experts upon experts, credentials, published work, and the second the doctor would walk out after presenting all this accurate evidence based information, the patient would look at me as the med students say, what did he say or what did she say?
And I realized that the message wasn't hitting home. And I realized we need to do a better job as communicators in the health care space.
And then I said, well, TV must be the answer. Media training must be the answer.
And then I became a practicing physician in my residency program.
I started seeing people being influenced by those TV physicians in the wrong ways.
They would be promising miracle solutions to any problem. They would be having snake oil being sold to them.
They would think that they can skip out on taking their medications or going for treatments or making lifestyle changes because of a solution proposed to them for three easy payments of 1999.
And I said, oh, man, not only are we not great communicators, but we're being outedged by people who are trying to make a profit in this health care space.
And I viewed it as a mega problem. I remember in 2017, I wrote a blog post for the American Academy of Family Physicians.
And I said, the lack of evidence-based physicians online is going to create a world of a difference in our patients lives. It's going to allow misinformation to come in, especially in this section I called a gray zone where modern science doesn't yet have an answer to certain medical problems to certain medical conditions.
And they're going to come in and promise you solutions and they're going to be quite successful at it. What happened three years later, COVID-19 pandemic, misinformation pandemic, people confused, not knowing who to seek out for information.
And for some very strange reason, a doctor with only five years of experience after residency was a number one channel on YouTube being watched and giving the answers when people were now watching the CDC, they weren't listening to true experts. Instead they were falling for misinformation online.
And I had to be there to set the record straight. I couldn't believe that that happened.
For people that might not know who you're referring to when you cite that doctor, that is you. You reach a lot of people every month. You have 12 million subscribers on YouTube now. You have other channels with millions of people following you across the board. And that's happened in quite a short space of time.
What is it about you that you think has been so resonant with so many people as it relates to sort of medical information and spotting disinformation?
I think it's not one thing much like in healthcare. This would be a multifactorial situation. I think when I first started the reason why I got popularity was because I was an early adopter of Instagram.
And I would share my medical journey of being a med student mostly because I wanted to show people that you can have a life, a social life, a family life, a sports life.
And still go through medical school because I felt like there existed this stigma you have to give up everything to study medicine. And while I was doing that.
I got some followers on Instagram and at that point having 10,000 followers was a huge win because it was so new and being a broke medical student to go to a club and say, oh my god, I have 10,000 followers.
Let me in without paying the admission that was a win. Then fast forward just a couple of years later, I'm in my residency program Buzzfeed writes an article.
And they didn't write an article about me being the youngest doctor in my hospital. They didn't write an article about the fact that I did some medical research.
They didn't write about the fact that I was passionate about putting out accurate info. The title of the article was you got to check out this sexy doctor and his awesome dog. And I'm like, oh, that silly. No one's going to read this.
I thought it was cute. I'd send it to some friends. And then boom. That was the moment everyone was going viral. And it seemed like every outlet in the world was reaching out.
And when I say in the world, I'm not exaggerating like outlets from the UK from Budapest from Asia from every possible outlet here in the United States was calling for an interview.
And I very vividly remember all the talk show hosts were reaching out. And I had no idea about this world that there existed so much competition where I remember the Ellen DeGeneres show folks reached out and they said, if you do our show, you can't do the Steve Harvey show.
And Steve Harvey reached out and said, you know, if you do our show, you can't do their show. I talked to some friends. I'm like, I'll do the Ellen DeGeneres show. I think that'll be a cool opportunity.
And they do the pre interviews and me with the producers. I tell them about what I'm passionate about. And the day before filming, they call on they say, hey, we have some news. Hillary Clinton is announcing her bid for the presidency of the United States.
And she's doing our daytime talk show as the first talk show. And like the other guests were like pink and Jimmy Kimmel. So you're the one getting kicked off.
And I said, no biggie. I go on Steve Harvey. So I call Steve Harvey's people back and they said, oh, no, that was two weeks ago. We're not interested anymore.
And it was such a wake up call where the 15 minutes of fame statement was true. You were hot for a second. People were interested about this unique story. And then they move on. But I said, no way. I still have to push this because I've viewed it as an opportunity to get people to care about the information.
And I was drawing their attention to something else first. If you look at who's successful in media 20 years ago in the healthcare space, it would be unfortunately people who corrupted the health information for the viewership.
And it feels like you oftentimes have to corrupt something to get views. And I felt that if I could corrupt and have people come for the scandal of sexy doctor. But when they come for that, I instead give them some accurate information or maybe have them come for some comedy and give them some health information.
That was a way to get people interested because if we're being honest, healthcare information, textbook, science, it can be boring if you're not passionate about it. But if you can present it in a way like some of the amazing teachers that I've had over the years.
In a way where it's fun, it's engaging. They make it almost like a journey that you're going on. Suddenly you pay attention. You have a few takeaways. And then from those takeaways, you're better equipped to handle some of the things that couldn't come up with during life.
And I really took that to heart in the beginning and over the last five years have really studied what marketers have done so well in the commercial space or what those snake oil salesmen have done so well in pitching their misinformation and take those same principles, but bring them to evidence based medicine. Allow people to have fun while they're learning.
There's a lot of information out there as it relates to health. What is your sort of framework for deciding what you share and how you share it when there's so many a lot of these studies as well.
The methodology of the studies is often hard to trust because of the way that they're certain studies where they look at kind of they don't isolate one variable.
So you look at the study and it could be anything they say, you know, they you hear these studies about like veganism, for example, where they say veganism is is healthier, but that doesn't remove out all the other factors in that person's lifestyle. Maybe OK, maybe they're the reading less meat, but it's processed meat that they're having with fries and hamburgers, etc.
So how do you what's your framework for deciding if something is true in a spot and a sea of information.
And then I look at some new research, I treat it differently than most people would in the media space, and I also treated differently than an individual would treat it.
So if you're a news outlet and a breakthrough study comes out, they treat it like it's the answer to people's problems like it's the new and best.
And I apply it to the existing data and knowledge that I've gotten over the years through my medical education and position it in where it belongs.
So some research comes out.
It might make me lean in saying we need to move closer to a plant focused diet.
I mean that everyone needs to be on it doesn't mean we need to eliminate everything because in medicine extremes are rarely right.
Even when we're talking about optimization, you'll hear oftentimes people say, oh, you can boost your immune system.
You could hyper optimize this. No, no, hyper optimization is extreme.
Whenever you're going to those extremes, you start creating problems because that's how the human body works.
It works in homeostasis. It wants to be balanced.
And the enemy of balance is bad, but also perfect.
So what do you make of this optimization longevity anti aging, live forever culture that's emerged in the last couple years?
I understand where it's coming from.
We've made a lot of scientific progress.
We believe that we should have the answers to the one problem that is facing all of us.
And that's that life is not forever.
But I feel like the field has been corrupted.
And it's actually the way that health care has been corrupted across the board. So when we talk about health insurance, the pharma industry, anti aging industry, a lot of it has been corrupted with capitalism.
And I take and I say that as someone who's actually pro capitalism, but I believe health care is a commodity that cannot be uberized.
I love uber. I love lift. I love the idea of being able to call something on the man.
Doesn't quite work for health care.
You demanding what you want for your body when you're not the expert doesn't always yield the best results.
We've seen that time and time again. I see it with my patients when they come in and it's very clear that they have a viral illness, but they demand antibiotics.
Or they demand a medication that's going to help them live longer.
Doesn't exist.
We don't have yet the evidence to sell these things to people to explain them to people.
But there will always be a person who will take some new information, some preliminary data, data from an animal model from a petri dish and sell it as the next great thing.
This happened with the fountain of youth.
This happened with literally snake oil hundreds of years ago. And now it's happening.
The power of social media and the fact that this misinformation, a lot of times is insidious.
You don't realize that it's so bad and so problematic.
Because what it's doing is it's actually tricking people into not understanding how science works.
How when we put out a hypothesis, an idea of what we think could happen, we actually strive to disprove our hypothesis.
So if I say this glass of water here will help you live longer, I will actually as a scientist want to set out to prove that it doesn't.
And I will think of every way and I would bring on people to disagree with me and find ways that we could test that this doesn't work.
But right now on social media what you see is a lot of people just supporting what agrees with them.
What are some of those ideas that have proliferated across social media that irritate you the most and you think are most harmful?
I think the ones that create certainty in an uncertain world.
And I think that could apply to pretty much any field.
I talked about the gray zone earlier and I think the gray zone has changed.
30 years ago the gray zone was weight loss.
And if you put on any TV channels, especially late at night, there would be a fat burner.
There would be some grapefruit diet or some next great thing that someone came up with. But everyone forgets about all that.
People used to sell you nonsense to try and help you lose weight.
And all of it didn't work. It was not healthy.
Even if it made you lose weight, it was in an unhealthy way.
It ended up creating and fueling this almost eating disorder like cycle for most folks.
And then came out some medications like ozempic.
And people started actually losing weight with an FDA approved medicine that had real results.
Now you see less of those fat burnards, but you see more of a new gray zone anti-aging.
Science doesn't have an answer to stop us from aging.
We don't have the answers perfectly toward genetic code.
But boy, there will be a genetic test for sale that will tell you exactly what you need to avoid.
But the reality is, we just don't know.
And it's not sexy to say I don't know.
But I've been passionate about encouraging folks to celebrate those experts who come in and say,
here's what we don't know. But here's how we're working to get to those answers.
Because that's what gets me excited.
There's so many breakthroughs being made in medicine.
And we don't talk about those honest breakthroughs because they're not always exciting.
But if we could pair it with something cultural, if we could pair it with some comedy, with some fun,
I think we can get in front of a lot of eyes.
One of the first things you said there was about weight loss in ozempic.
And it's just incredibly relevant and widely discussed subject at the moment as ozempic.
I listened to the research on ozempic.
And I am someone that typically has a bias towards not taking medications if I can and pursuing a natural route.
And that is what we do too.
Yeah, which is understated in most circles.
As doctors.
Yeah.
So our training, for example, if you look at our, we have a reference called, let's say up to date,
it's a medical platform where we could go and get guidance on any medical condition.
And it could tell us what the epidemiology is, who gets sick with it, what is the diagnosis that we should do to try and make it?
Like what laboratory testing, what imaging we should do, what treatments work, first line, second line, third line, etc.
If we look at pretty much any chronic disease treatment, whether it's high blood pressure, sugar management from diabetes,
all of the first steps is lifestyle modifications.
That's what we're taught.
Is that because of the type of training you have to do to you, became, where is that all medical doctors?
That is all medical doctors.
But what ends up happening is twofold.
One, patients love a shortcut.
They love having a medication, potentially do the work that they may not be able to or don't want to.
You know, it's difficult to generalize here because some patients truly have difficult lives. They have three jobs.
They're a single parent. They're having a mental health crisis.
So they may not be able to do those lifestyle changes.
But then there's a portion of us who could do it, but prefer to take the shortcut.
And that's pretty human of us. We would like to get the shortcut. We would like to take the edge.
Is this such a thing as a shortcut?
In healthcare, no. And I heard you actually say it on your last podcast covering ozempic that there is no shortcut.
There are side effects and tradeoffs to everything and you're absolutely right in that.
There is no such thing as just something that is all good.
Hydration. You can't live without it.
Over drink. You'll throw off your electrolytes. You can damage your brain. You could lose your life.
Carrots. Healthy food, I would say.
Eat enough. You'll turn orange. Same thing goes for medications.
And that's why when people go and villainize treatments, medications, supplements, it just depends.
And there needs to be nuance. It's too hard to paint medicine with a broad brush.
But social media makes that really tempting.
That that non-azempic path.
If I'm not going to take the the new sort of fat burning logic pills or the appetite, I guess, I guess they suppress appetite.
Magic pills. That becomes another bit of still is a bit of a gray area in many respects.
Because we on the drug side of things, people now have an option. That's FDA-approved.
But if they don't want to pursue that path, there's still all of this other information around,
okay, I want to lose weight. And there's lots of opportunity for a lot of people to present them with solutions.
There's a roaring debate around calories, which seems to just be never-ending.
And I wanted to get your take on that. If someone was in your training when you've been advised to suggest lifestyle changes first and foremost,
if I'm trying to lose a bit of weight, I'm at risk of being diabetic or something, what would you say to me as your patient?
It would be hard to generalize it because it really depends on what pre-existing conditions exist,
what have you tried thus far, what works, what do you have time for, what do you have budget for?
On that point, I've tried thus far. Why is that, what does that matter so much?
If I have a patient who's tried dieting and failed, and I don't ask that question, and I recommend dieting,
they may not take the advice, they may nod because they want to be a quote-unquote good patient and leave and say, not doing it.
But if I ask that question, they can say they tried and failed. Then that gives me an opportunity to ask, what exactly did they try?
Did they try some really restrictive diet that's out there, carnivore keto, what have you?
And that set them up for failure, something that wasn't able to be sustainable, whereas now I can explain that, hey, the thing you tried actually set you up for failure,
and here's a more reasonable recommendation that we can try, and now I can actually be a doctor that recommends a dietary modification that could help them.
What's the key to finding a diet that is successful from your experience? What are the foundational factors of that diet that's going to typically make it stick?
There's two real things that you need to think about when it comes to dieting. One is, it's impact on your weight,
because calories in and calories out as non-sexy as it sounds, as clinical and cold and heartless as it sounds is true.
Second, you also need to think about the nutrients in your food, because if we just take one of those parts and ignore the other, we can get into a really bad place.
I can even see those grapefruit diets that people say, like, eat three grapefruit today and you'll lose weight. Yeah, you will, because you're under consuming calories. But is that healthy from a nutrition side? Absolutely not.
On the other side is, you can get enough protein, enough nutrients, but if you're overeating calories, you can get into a metabolic problem where now you're carrying excess weight and increasing your risks of all sorts of conditions.
So the goal is to get you in a place where it's balanced in both a caloric weight management standpoint, but also an ideally a healthy nutritional balance as well.
And what that means person to person is going to vary. It's going to vary based on the medical condition they have. Some patients who are anemic may need certain nutrients that someone who's not anemic doesn't need.
Someone who's prone to kidney stones may need a slightly different diet than someone who is IBS prone. So we need to always take into account that generalized advice isn't great when it comes to healthcare, especially when it's very easy to create
buzzies statements from truth in healthcare, like I said on a podcast now too long ago that exercise for weight loss almost doesn't matter. And that's a buzzies statement because on one hand it's true, but you also need to pair it with some nuance and say exercise has so many benefits outside of weight loss of why it's important to participate in exercise.
And the idea of way lost needs to come from nutrition. That's where the majority of the change will come from super interesting because I said he was so many people that have said that to me.
They've said that when you look at a lot of the studies exercise as a.
If you give prescribed someone exercise to lose weight, they probably won't lose weight. But I would definitely say that in culture, people see exercise as the many would see a wreck in the primary way you lose weight, they think you have to go for a run to lose weight.
And again, you've expressed the nuance there, but I've even I struggled with understanding that because over here people say exercise isn't super useful for weight loss in the studies, but then the prevailing narrative in society is that if you want to lose weight, you've got to get on a running machine.
That's because they're equating in their minds.
Health with a magazine cover. And health is not a magazine cover. They think that you need to have big muscles to be considered healthy. And while you can have big muscles and be healthy, you can have big muscles and be tremendously unhealthy.
So just looking at someone's appearance doesn't give you the full picture, just like looking at someone's weight doesn't give you the full picture, you need to know more. And when it comes to exercise and weight loss, let's just take for a very simple example.
I used to go to the movies when I was a kid, I loved it. I did it all the time. It is not unusual to eat a tub of popcorn, a little candy bar and a soda.
Well over a thousand calories. Do you know how hard it is through exercise to burn off a thousand extra calories?
Most of us are not physically even equipped to burn a thousand calories during an exercise session.
So it's just about the science of not being able to out exercise a bad diet.
What if I just eat loads of salads? I think I've been in that mindset before. I thought, well, it's just really I could have well, I've been in periods of my life where I've just eaten more and more and more good stuff, quite good stuff, things that I thought were good.
But I also didn't lose weight.
You were you're a really smart person. You're a person that wants to be as effective as you can in your podcast, in your communication style, and you're amazing at it.
You want to do the same thing with your diet and that hacks and tricks that you use in your business mind, in your communication mind, don't work for healthcare.
You cannot find the shortcut of the salad that's going to fix everything that bothers you of the probiotic miracle supplement. It's not going to be there.
That's why some of the minds that actually end up falling for the most simplest forms of misinformation are those who are really good at business.
Because the things that work very well in the business world and the communication space, don't work in healthcare because healthcare is not a commodity. Healthcare does not work well with extremes.
You cannot do something so good all the time without it having negative repercussions.
You want to be good, not perfect when it comes to healthcare. And the more you try and chase perfect, number one, you're going to get the negative response. But also number two, you're going to create anxieties, worries that are also toxic to your body.
So if you're very careful. So perfect. It's not only just an illusion. It's a toxic illusion.
I saw someone talking recently about the calories in calories out thing in the first comment was a lady who I think had a preexisting condition basically saying because my because of my preexisting condition, the calories in calories out thing does not work for me. I've tried it.
And then the health influence responded and said it works for everybody.
Both statements are true. Okay. Dialectics are common in healthcare where two opposing ideas can both be true. Someone can try and do calories in calories out, which through science works.
But the application of it can fail.
And thinking not about the application and like the science of it, is it regardless of whether I have a preexisting condition now regardless.
Preexisting conditions is part of the application. The individual is part of the application. I think she was making the case that because of that preexisting condition, that the maths of it don't apply to her.
Like it doesn't actually work on her body. It shifts versus the application is okay. It absolutely shifts. And that's the truth for most medicine. Like when I try and get my patients into a healthy blood pressure range because we know that having a resting blood pressure above a certain number predisposes you to having risks of heart attacks stroke all these cardiovascular conditions.
When I treat them with a medication after lifestyle changes either didn't work or they weren't able to go down that route.
We have this really unique knowledge public health wise, we know that controlling the blood pressure on a large scale will lower deaths significantly will lower heart attacks significantly.
By me, meditating this one patient. I have no idea if it's going to help this individual exactly. But that's because all we're doing in medicine is doing our best with the limited information that we have on hand.
Closing off on that point about exercise. So if we shouldn't be thinking about exercises a way to lose weight, what is this sort of medical advantage, the physiological advantage for me if I go to the gym every day and I'm active.
Literally everything else. If I could bottle the effects of exercise and sell it, which is person on earth. Happiness, mood, social connections, strength, ability to decrease cancer risk, decrease, increase ability to fight off cancer, increase longevity.
Literally everything else is the benefit of exercise. And I say that as someone who's been very exercise focused. But over the last few months I've kind of fallen off, I've gained some weight, I haven't been exercising as much as I want because sometimes life gets hard.
Life gets in the way things become problematic, mental health sometimes takes a struggle. And we need to be aware that that can happen.
The idea that we need to make every person perfect or if they're not perfect, they're failure, that's such a dangerous rabbit hole to go into.
How much exercise.
Going to very person to person, general guidelines say 150 minutes of moderate intensity exercise per week, which isn't a lot, two and a half hours.
Moderate intensity, meaning that you shouldn't be able to speak full sentences, maybe one sentence at a time until you're at a breath is a simple way to put it.
When you have such a broad view on medicine, well, I noticed that in your content. I was like, this guy really knows he really has a real much more broad view than the neuroscientist I spoke to yesterday, who's really focused on, you know, maybe one part of the body.
With that broad view, what are you concerned about in terms of macro social trends, the direction of travel that we're going in with our health.
We talked about misinformation and disinformation, but but actual realities of the Western healthcare condition.
First of all, I think it's important that we have both individuals participating and having a seat at the table, the broad view primary care physician and the single point expert neuroscientist like you had on your podcast before we need both.
In fact, where I'm able to gather my information from is from all those researchers that are putting in those hours at the bench, making sure that they're checking their biases, showing the flaws of their own research.
Without them, I am nothing, right? Like, where did I get my knowledge from from them? So we absolutely need to do this in a teamwork approach.
I think the big problem that we face today is two things. One, the loss of trust in our healthcare world. That's huge.
People don't trust healthcare advice. They don't trust our agencies.
Frankly, the loss of trust of doctors has been rather shocking over the last decade. And then second is it's more of a philosophical issue that I raise because I don't know where it's going to go where we've created this world of processed foods unhealthy foods foods that it causes to eat more and more and more and feel not satiated.
And then we've come up with a medication to solve that. We've created apps that pull our attention spans that allow us to focus 10, 15 seconds at a time before we swipe to the next thing.
Now a lot of people are requesting prescriptions for ADHD medications.
There's people who want to stay out all night and party and still maintain their physical gains. They get on testosterone early when they don't need to.
How hypermedicated are we going to get as a society to a point of actually harming us and I don't know the answer to it. I'm not smart enough to know the answer to that.
But I think it's a good philosophical question to ask ourselves.
Are you scared about what would happen if we had a pandemic that is 10 times more deadly than the previous pandemic break out now? Are you scared because of that loss of trust?
The more deadly the pandemic. A lot of times the less problematic it is. Is that weird?
Oh, OK.
So initial SARS virus was significantly more deadly than SARS-CoV-2, which is the virus that causes COVID-19.
So initially when the reports came out about the lethality rate of SARS-CoV-2 COVID-19, we said, oh, well, it's not as bad as SARS. We'll be OK.
Because most people with SARS got really sick, they lost their lives. But because asymptomatic spread was a thing with COVID, meaning that you could feel fine or maybe just have the sniffles and spread it, it killed millions more people.
And that's what that brings me back to that point of when I said insidious misinformation can be more problematic than true disinformation.
And when something doesn't seem so bad, that can we can allow it to go much further and cause much more harm.
Complacency can complicate and see and feelings of safety. Like, oh, well, this one's not as well. We're good. I feel fine. We're good.
But when you look at it and you zoom out macro, oh, my God, it's wrecking havoc across the world.
And I've actually equated this to vaping vaping is not as harmful as cigarettes on paper.
But because the odor is not as offensive, it's easier to hide. You could do it much quicker and get a bigger dose because it feels like it's not as harmful. Many more people can get hooked on it.
Is vaping dangerous? Yes. Why now? So many of my friends, I think three, three out of my six best friends, they're just like, they're just absolutely addicted. They never smoked interestingly.
That's the issue of it that it gets people who maybe would have been turned off by smoking to try. And the chemicals found inside are really rewarding to the brain, nicotine being a prime example of it.
And the more dangerous part of it is with kids who have a developing front the lobe, meaning that the part of their brain that is responsible for complex decision making is not yet fully formed.
So they're incredibly susceptible to anything that can build a tolerance of dependence and addiction to.
And it could change the chemistry of their brain moving forward. So we don't want to make it easier for them to start smoking vaping should be used as a tool as a way of getting you off of cigarettes.
Now, as a way of introducing you to cigarettes or nicotine at all. Is it dangerous for adults as well? If you're coming off cigarettes, no, it's a good choice.
But if you were never, all my friends that they never smoked. Yep. It's not, it's not something that carries value health wise and can only potentially harm.
Have they, have they done any, I guess it's super difficult to do studies on these kinds of things, but is there any studies that have been done around vaping?
There's been vaping related lung injury where that's its own diagnosis code now. There's been children that have been hospitalized with it.
There's been even technical problems of the devices blowing up in people's faces. So it's not the fact that I'm trying to fear monger here and say vaping is the devil.
I'm here trying to explain that vaping can be problematic because on the surface it may not look as harmful by comparison.
Everything is trade-offs. Everything is trade-offs.
It's interesting. When I see all my friends vaping, they're all in Dubai a couple of years ago.
And I thought, I passed me, because they will have these little disposable vape things.
Let me try it. I tried it and it was really nice. And I thought, I like again to this.
And if it's not unhealthy, because we all know that smoking isn't healthy, I thought, you know, you had to think, I was the harm.
I could have so easily gotten to it. Luckily, I just, I'm always skeptical when I don't know the side effect.
I would rather accept the side effects. And it'd be super clear than to someone say to me there's no side effects.
When someone says there's no side effects, I always...
Well, that's like the whole nature fallacy when someone's like, oh, but this is natural. First of all, what does that mean?
Because they say vitamins are natural, but they're made in a lab. I don't know how that's considered natural.
And also just because something natural doesn't mean it's safe. Arsenic, cyanide, natural, but deadly.
The ADHD point you mentioned.
Yeah. What are you saying as a doctor?
Over the last couple of years, the determined ADHD neurodiversity has seems to have become more and more prevalent everywhere I look.
It feels like I'm hearing a conversation right ADHD. Now, is that because there's been a social sort of heightened awareness to the subject
and now people are getting diagnosed more? Are we creating more ADHD somehow? Or is it somewhere in between?
Yeah, I assume it's something in between. I don't have a clear answer to it.
I do know that neurodivergence needs to be talked about more. And that's not just from the ADHD perspective. It's also from autism spectrum disorder situation as well, where its folks are going to be different.
And some people want treatment for a condition others don't. And we have to respect people's autonomy.
Even when we talk about something like vaping, if an adult wants to vape, as long as I can convey to them as their doctor, their risks,
and they want to be able to make their own decisions, no one lives a life where they say I'm going to take no risks.
Everyone has a different risk tolerance level. Everyone is comfortable with a different level of care in life. Some people want more care, some people want less care.
Even at the end of life, I have discussions with my patients for end of life care often. And a lot of times they're shocked by it.
They're like, wait, do you think something's wrong with me? I'm 30 years old. Why are you talking?
I'm not talking about the time to talk about it. When you're healthy, when you aren't facing a decision that you have to make right now,
that's when you're going to be able to spend some time and think about what kind of medical care you want.
You know, I'm a doctor here that became a professional boxer a couple of years ago. That is not healthy. I do not recommend it.
It increases all sorts of risks for head injury, chronic traumatic and cephalopathy. All of that is true.
It's a risk that I was willing to accept because I studied the risks. I accepted the risks. I don't doubt the risks, but it's something that I'm passionate about. And I want to go down that route.
Enjoying it. Very much so. It's a great outlet for me.
Why did you choose boxing? Despite the risks.
Yeah, I would say that boxing probably chose me instead of me choosing boxing. I did take Wando growing up. So I was in martial arts for eight, nine years.
And then when I was in medical school, I unfortunately lost my mom to cancer. And that was a really strong wake up call for me being in the medical field, knowing what it's like to be in the room to ask the doctors to stop doing chest compressions on your mom.
And that is not something that I wish on anyone. That's the worst thing you can experience, especially when my father was there also a doctor who was saying, no, keep going, but I knew it was futile. I knew we were causing more harm.
And in going through that journey, I got into a very unhealthy mental state. I didn't leave my house, except to go to class.
I came home. I was socially isolated. And after a period of three, four months where that was going on, I said, I need to get out of this.
I need to take my own advice that I give to people and take the advice that you need to have action before you get motivation.
And the action that I took was to go on guilt city. Do you remember that app? It's like a group on S cap where you can get a coupon to a class. And I got a coupon for a boxing class.
And I went and did this boxing session. And then I ended up boxing for 10 years after that session fell in love with the sport.
And then a couple of years ago, I ended up fighting on showtime paper review in front of an audience of 15,000 people. And it's been a unique journey.
So while it's easy to vilify boxing and say that it's problematic for some people, if the trade office right, it might be something that they could participate in and they could be very healthy for that.
Losing your mother. For anybody, I think it's just something that is unimaginably unimaginably painful. But in the circumstances that you lost your mother, where from what I understood, she was given the all clear at one point with her.
Yeah, so she had this unique form of cancer called CLL. And this is usually a cancer of old age, where you get diagnosed with it and you end up dying of something else other than that cancer.
And we had a unique more aggressive form of CLL where they needed to really ramp up treatment and her treatment took a toll on her body like she did not look the same post treatment. She did not feel the same, but it was all in the hopes of curing this cancer.
I remember very vividly, I was I was going to Memorial Sloan Kettering Hospital to pick her up one day and she actually fell waiting for me at the waiting area. So the doctor came down and talked to me, it's that maybe we should keep her observation for a day or so.
But overall, she's doing great. She's just very weak from the treatment and he shook my hand in that moment and said, she's cured. There's no more cancer in her body. Now we just got to get her to recover from all these treatments. And that's the greatest news anyone can hear your hopes 10 out of 10.
And just a few short days later, her weakness got so severe that she got a very unique type of bacteria called Graham negative in her blood causing Graham negative sepsis spread throughout her body.
She required the use of presser medication to artificially raise her blood pressure to prevent her organs from dying and it didn't work. And unfortunately she lost her life.
And at this moment, there was watching my father go through this who with my mom sacrificed their lives to bring us to the United States as immigrants gave up their lives.
He went to medical school for a second time in his life. She went to university after having a PhD in Russia to learn English and be able to teach students math here in the States.
It was painful to watch my dad go through it. So I think for the first few months, my focus was more on him than it was even on myself.
Did that experience change your perspective of medicine and the medical industry in any way?
Because in that moment, a doctor turned you and said, your mother is cured. And it wasn't the it sounds like it wasn't the cancer itself that did the harm. It was the treatment for the cancer that did the harm.
I never was mad at the doctor for saying that it would have been easy to in a situation like that where you thought you were good, but then it wasn't.
It taught me a lesson about how life can be cruel and take things away from you very quickly after just receiving good news. I remember sharing a meme on my Instagram that it had like you colon.
I'm actually happy right now. And then life colon. Hang on a second.
And that's kind of how life is. So it taught me to be able to bounce back from adversity and realize that you have to put one foot in front of the other while still being able to feel because repressing emotions in the short term is a valuable tool.
So if you're unable to function in terms of high stress in the moment, you could lose your life. You could make a really bad decision. You could harm others.
You might not be able to successfully hold down a job. But if you do that for a really long period of time, even that is a cute coping strategy can become toxic.
And it's getting into that point where it was becoming chronic and I was blocking my feelings of not mourning my mom, not having the proper process and for everyone that process will be different.
You moved in with your father after that.
Yep.
If I was a if I was a fly on the wall in that in that household at that time, what would I have observed?
You gentlemen trying to raise a dog very poorly. That's probably not what you expected, but I am in trying to always find some kind of way to help.
I thought by helping my dad redirect his feelings towards something else.
I got a Siberian Husky for him in that moment, which we always wanted a dog even my mom wanted the dog and he took some time to travel to more than my mother's passing.
And while he was doing that, I raised a dog a little bit for a few weeks, got her at least potty trained. And then when he came home, she was there.
He was typical Soviet father yelling at me and telling me why this is a bad idea, crying, which I never saw in my father before, obviously until the loss of my mom.
And then he started being happy.
And then he started saying, what should we call her, his focus shifted, his focus shifted to going for walks with her, which allowed him to think about my mom to not be locked into the house as so many people are when they're going through a rough time.
So while I think it was chaotic of us trying to raise this puppy together, it gave us something to bond around in a moment of tough times.
There will be a lot of people listening right now that are maybe in the throes of that grief or the throes of their own sadness or depression for whatever reason.
And it's when you're in the midst of the storm, when it's hard to see any way out. And you said some things you're very interesting, which is you said you realize that action comes before motivation.
If I'm someone that's in that situation right now, and I'm listening, what would you say to that person put on your shoes.
They'll you'll go somewhere doesn't matter where you'll go, Jim not Jim walk dog park, you can go to a dog park without a dog.
It's therapy. The biggest therapy that I think I've ever had and I've gone through traditional therapy was going to a dog park with my dog after my mom passed away.
It's such a weird thing, but animal therapy is real.
And you know who actually gave me that advice, speaking of dragons, then Barbara Corcoran.
She said that the way that she gets herself to exercise because she doesn't like to she hates it. She's very vocal about it, but she says next to her bed or her shoes,
athletic shoes that if she puts them on, she's like, all right, well, since I have them on, I may as well go exercise.
And that one little step creates that cascade look, will it work for everybody? Is this the miracle solution? No, but it's one step.
And even if you just do that one step and nothing else, the next time it'll be easier to put on the shoes and maybe try for the second one.
Putting on the shoes is hard as well when you're in that in showering is hard grooming is hard.
The basics of all basics is hard.
That's why when I hear advice like go make some friends online when you're feeling down. Oh boy, that's tough advice. That's not easy.
So putting on the shoes thing is simple in the sense of doesn't require others to be around you to judge you.
Doesn't have any steps after that just to put on the shoes. And if you're at that point, seeking help from a medical professional is about most importance because we've put this stigma where
if you go for mental health treatment, you're somehow weak, but if you go for treatment for a broken bone, you're not weak.
That stigma doesn't exist for it. And that's strange because both things can have problems arise with it, especially from a momentary point,
especially from a mental health standpoint, especially with the society we find ourselves in. Currently society is the most unnatural it's ever been for humans.
How would you describe the journey you've been on with your own mental health?
I don't know how I describe the journey. I would say just like most people, it's had ups and downs.
I would say the thing that's really thrown me for a loop is the social media world of it all because of how unnatural that that is, but I feel like a lot of people are working through that without even having a social media platform because at the end of the day,
these days, everyone's a content creator.
When you make a video and it gets millions of views, you kind of know what to expect, being a content creator, you have experience. But Johnny, Rebecca, someone else putting out a video on their social media at 16 years old, that too can get a million views.
And they're now ready for what comes with a million views. In fact, so many people, even in the medical community, reach out and say, how do I go viral?
Do you want to go viral? That's through a new, you'll mental through a bit of a loop.
Yeah, I was obsessed with it, checking it all the time. And I wasn't obsessed for it for the reason most people think I was obsessed with it from a place of growth.
I was like, even if they're 99% BS, there's some kind of truth. There's a kernel of truth there that I could take away and make myself better.
And you know, there is truth to that. I did learn a lot of things. I did prevent some mistakes. I've improved my content as a result of listening to negative feedback and criticism.
But I've had to in working with my therapist, carve out moments where I'm not in a place where that's acceptable from here right now, where you just have to say this, I'm not in a healthy mindset to look.
What was the symptom of the impact it was having on you?
I'm tremendous anxiety where you're just worried at all times and you're almost addicted to checking it because you want to be ahead of it.
You want to be safe. You want to be able to think of a response. And when you get to that point, you're never letting your mind rest.
You're always in fight or flight. And when you're in fight or flight, you're not resting, you're not repairing, you're not getting good quality sleep. Even. So I know how important that is.
I talk about it all the time. But as I said, you know, we're all now perfect. Doctors are probably the biggest hypocrites when it comes to their own health.
I guarantee you some of the people that have come on your podcast. I talk about sleep or talk about this.
They struggle with sleep. They don't do those things. Just like how some advice that I give I don't follow to the tea. My job is just to present the evidence.
So I know certain things that I should be doing better, but just because I know doesn't mean that I'm going to be 100% following it all the time.
Is this interesting thing that I was just thinking about as you're saying that there.
And I like a philosophical level. I think we're all kind of just passing our anxiety on to someone else. Like it's like energy cannot be destroyed and must be transferred. I noticed this because on my podcast, I have multiple guests that often disagree with each other.
And if I was to do a map of how those people are feeling, they're all suffering.
Well, that's just humanity as a whole.
They're all like really suffering. And sometimes those people are suffering because of someone else who's suffering. And then because of someone else's suffering.
It's almost like this chain of suffering because of misunderstanding a variety of different reasons. But I think as you said, humanity as a whole, the person that's leaving those messages or attacking you is probably also suffering in their own way.
Of course.
It's a real shame, but I can't see any way out.
Like the circle of anxieties and artistic way to put it for sure. But I think there's some truth to it.
Even from trauma, the odds are that if you've experienced a traumatic childhood that you will also potentially cause trauma to others goes up, that risk does go up.
That's also pretty common sense, even if you're not looking at the medical research, you could just say that if you've been hurt, Oz, or you can hurt people, what do they say?
What do they say? Her people hurt people too, right? I think that that's like that common sense logic that does get it right.
What's the, um, did your therapist give you any advice that's proven to be useful?
Well, the advice that you put perfectly in place of logging off, not looking at certain things at certain times of the day.
Like literally, I had to completely shut off my phone at certain times of the day because otherwise what happens is I would get into the cycle of, okay, I just finished in the hospital, I just filmed my video for the day.
Now it's sleep time and just before going into bed, let's check my phone one last time and search the social media sites, what people are saying, and it's like, why?
That's ultimately what I think probably got me healthier, like not looking at it was very good in moments of despair because during those moments, I was just so fragile and it would not be a good time to look.
But really where it got me is what got me is don't look unless there's something valuable you're getting from looking at it.
So now if I'm in a healthy place and I feel like I'm looking and I'm doing some kind of preventive task, I'm learning from it, I'm like, okay, I'm looking at it, but I'm looking at it with some kind of intention.
And that's actually true for all of social media.
I think he was on your show as well, Dr. Robert Waldinger, who ran the largest, the longest running study at Harvard of happiness, talked about the different usages of social media.
How if you use social media passively and you just look and consume, it can be rather disheartening and make you unhappy.
But if you use it to form a community to learn from it to better yourself, suddenly the social media may not have as bad of a health impact and can actually have a positive mental health impact.
So if I'm looking at the negative comments, I'd have to do that check in with myself.
Am I doing this because I'm actually benefiting from it or is it destructive in nature?
Have you ever wondered if there's something about you that makes you more likely to look at that stuff or to care about that stuff?
I've often wondered about that myself.
Yeah, I feel like I have.
I think it's a pretty natural thing. I think most people look.
I think for me, I derive so much value in the work that I do on social media because this was never meant to be a financial venture.
This was not some grand ideology that I had to make myself successful.
This was solely because of my frustration as a practicing doctor, which the first question ever anyone ever asked me when I got into social media is like, now that you're doing so well, you must want to quit medicine, right?
You're probably out earning it.
Yeah, but that's not why I do medicine. I work at a community health center.
Most doctors that do really well on social media either leave medicine or maybe do concierge practice or celebrity practice or something.
I work at a community health center where 50% of people don't have insurance.
So that's been my goal and social media is just a tool to help me with that goal.
And when I see negative comments, I viewed as a threat to that goal.
Have you ever considered quitting social media?
Seriously.
I pondered what life would be like.
But I just viewed it as a negative all around, not just for me.
I just view as social media such an opportunity to help people.
It's like me saying quitting medicine.
I don't want to quit medicine.
I want to be there for people. I want to be valuable and useful.
In fact, I think about myself as like a more practical useful person.
And every strength that everyone has can also be their weakness.
So sometimes I'm too practical and that impact to you as a friend, as a partner, as a family member.
So sometimes being too practical is problematic.
But because of my practical nature, I want to be useful to my patients.
So let's continue with this health related stuff.
Supplements and vitamins. I wanted to get your take on that.
There's a lot of you've mentioned supplements and a few times in this conversation.
Is that part of the gray area? Is that snake oil?
What's your POV on supplements?
I want to say like one sentence that is all encompassing and answers all those questions.
But it's really hard because there's just so much nuance with it.
Vitamins.
We can't live without them.
We need them.
Supplements, supplemental vitamins, are not necessary the huge majority of the time.
And are often sold by people who are praying on insecurities, promising shortcuts.
And I'll honestly people trying to get wealthy.
The evidence for almost all supplements, unless you have a very specific reason for needing to take them, is missing.
And what I've learned through my 10 years of being a physician and the hundreds of years of practice of medicine,
unless we're certain of some benefit, introducing new things, distracting people from things that work is not a good solution.
Is the harm of supplements that they don't actually work again with supplements is a broad word.
Is it the harm that they don't work or are you saying that we should be getting all of the things that we're supplementing from our natural diet anyway?
Or are you saying both?
Yes and you can get all of your nutrients, again, unless you have a specific medical condition from foods to they will make you skip out on doing things that are healthy for you.
Because you think you can take a shortcut, three, you're spending your limited healthcare budget that many people have a very limited healthcare budget on things that are very expensive, making a lot of promises.
And the thing that I'm most worried about is when we enter the space of people saying you need supplements and not true medical treatments for conditions that bother them or that affect them.
I'm not talking about myself, but if I'm someone that has a very, very limited diet just because of my lifestyle choices, whatever, would you recommend that individual to take a multivitamin supplement?
I probably wouldn't, but if they did, I wouldn't discourage them.
Did they work? That's what I'm trying to figure out.
And then the other point that I didn't mention is that there's harm.
Like you said, everything is trade-offs. There's no such thing as no side effects.
So supplements have side effects. They have interactions with medications. They can create health conditions. The term antioxidants.
Antioxidants are generally healthy.
You know, B vitamins are traditionally labeled as healthy.
You have too many of them. We notice that they become pro inflammatory.
But no one talks about that because you can't really sell that.
So what instead gets talked about is the promise of what they could do.
But there's harms that come from taking supplements, especially in our world where consumer labs and consumer reports go and pulls supplements off to shelves to find out that they don't have the ingredients that are listed in them because they're not regulated by the Food and Drug Administration.
They have some ingredients at five to 10X, what's on the label, like vitamin A, which is a fat-soluble vitamin, and can actually be really harmful.
So they're not regulated. They can cause potential harm. Their benefit, unless very clearly indicated, is in the air and not proven why recommend them, why sell them.
And I say this as someone who can make a fortune. I mean, you said to yourself, 12 million subscribers.
You know, I take a little boxing selfie fit and say the reason I'm this fit is because I take whatever thing I bottled up in my house put into those pills, whatever powder I want, no one checks it.
And I could sell it and become a multi-millionaire.
Is that true that no one checks it?
No one checks it.
Be supplements. No.
Like right now we could bottle up on the table our miracle formula. We can call it a miracle formula.
As long as we don't make a claim that a treat to specific medical condition that requires the treatment of a medical doctor.
Okay.
And I just put buzzwords on it. So instead of saying this helps your depression, I just say depression, immunity, support, just buzzwords.
Feel good. Feel good. Happy. Happy. Natural. Simple. From the earth.
We could sell it. How much we don't have to get anything. We don't have to get anything cleared by anybody.
How much do you think we'd make too much money? And that's why it's like, man, I understand why people do it.
And there is the notion that they could potentially work. There's always like a little bit of evidence coming out that something.
It's going to cause an outbreak for miracle made, which is on it.
It's so tempting. I get it. And I get there's also I don't want to label everyone with a broad brush and say they're evil and just trying to make money.
Some people do believe that they work. They want the belief that this is what else us as society.
And I wish that was true.
I wish it was as simple as giving people some supplements or that eating eight almonds a day will extend your life by 10 years. I wish that was the case.
The subject around gut microbiome is something that I've talked about a lot on this podcast because I've just had a lot of experts talking to me about the subject and something that I didn't even know existed three years ago.
I didn't realize there was loads of bugs in my belly.
There are prebiotics, probiotics, all of these things coming out now for to enhance the what do they call it? It's not gut flora, is it?
Microbiota encompasses all of it. Is that true? That prebiotics and probiotics are useful for?
Well, there's truth in the fact that we have all of these living organisms inside of us.
There's a lot of other connectedness between how we feel disease conditions and what species of those bugs exist in us, the counts by which they exist that people who generally eat specific foods that are rich in them may have better health outcomes and those who don't.
But manipulating those bugs has not been proven or clear in the majority of ways that people promise they do.
We know consuming fiber correlates with better health, less negative health outcomes.
Do we know that taking a prebiotic supplement does the same? We don't know.
Do we know that having specific bacteria in the gut gets destroyed if you have a health condition? We do know that.
That means reestablishing it by taking in an appeal will fix that condition. We don't know that. But people will make that jump and say no big deal. We're trying to help.
But to me, it's a big deal because we're promising something that we're uncertain of without even some good evidence for it.
There's very few conditions that probiotics can actually help with.
What advice would you give someone that comes into your practice and you identify that they have some kind of gut related gut microbiome related issue? Is there anything that you would recommend that they do to improve their gut microbiome?
Well, it would be focusing on foods that are considered healthy for the microbiome. So foods that are rich in fiber, plants essentially, avoiding bad habits, poor quality sleep, over drinking alcohol, smoking, all those things are unhealthy.
The thing that makes health advice so boring is that the things that grandma told us still is what I say in my office. And it's not sexy and it puts people to sleep. But it's true. That's what we know works.
We don't have a perfect answer as to why. And right now, there's like tests on the market to check your microbiome to know what food to preliminary to recommend.
We don't know what to do with the information. The promises that they make don't hold up when we look at it long term genetic tests.
Potential is there for a lot of value. Most of them are very preliminary unless you're working with the geneticists on a very specific condition.
So I think the hype oftentimes speeds up the selling of the products before the evidence is there. It outpaces the evidence. And in some instances, medicine does that too, a traditional medicine.
But it does that with some thought in mind, for example, if we create an emergency use authorization or if we allow someone to have a treatment exemption for something that is not proven for a disease that's already lethal that they're going to lose their life anyway.
Or if we don't act now, we're going to lose so many lives in the moment. Then yeah, there might be instances where we can speed up the process of certain things. We can create some shortcuts because we're taking that trade off that's thought about.
But with a lot of these products. They come and go. And there's just so much misinformation around them. You know, like one of the big individuals that does this in this space and hate to single out, but it's just been such a
voice in this community is Gary Breka. You know, I talked about them on my show.
I respect to him. No, and seems like a really good person seems very passionate about what he's talking about.
But the promises that are being made are not proven and the intention may be good and good intentions can have that outcomes. But if the information is not accurate, no matter how passionate you are about the subject long term, it's going to have negative outcomes.
And you use the word proven there. Do you mean that there's not a significant or a reliable sort of basis of research that's been done yet to validate the hypotheses or the statements or you're not saying that it's been disproven.
It just hasn't been proven.
So that's a good point to bring up the things that I say that are inaccurate largely have not been disproven because if I say the juice inside this cup will help you live forever.
Would you say that's true or not?
I theory would be that that's not true.
And you would have to run a study to disprove it. And that's how I function as a doctor. So I can't disprove what he's saying because then I would have to run my own study.
But based on what we do know based on remember how I said at the beginning when a new study comes out, I try and bring it to the re the established information that we have.
It doesn't vibe with what we know to be true. If you want to go against public health standards from what we've established as science, you better have a good reason for doing it.
And if you do, I'm all ears. I'm excited for that kind of stuff. If you have some breakthrough of why you disagree with the CDC with the WHO with Harvard Health, please tell me why you disagree.
But if you disagree because you said so, that's where things get problematic. Like I'll give you the simplest of examples.
There's a very famous clip that I reacted to on my podcast where Gary breakfast as a few of headaches. It's because you're low on pink, Himalayan sea salt.
How many reasons do you think people get headaches?
Many reasons. You're not even you're not even a doctor. My brother has had chronic headaches since he was a since he was a kid.
You got a concussion. You have stress. You have a hormone issue. You have a tumor. There's so many of my grains. You have a neck cramp.
Possibilities are endless, right?
To have the confidence to say this is what you're missing. Everything else almost doesn't matter. The confidence is the misinformation.
Like notice every time you asked me a question today, it was either I don't know. It depends. New wants for who? It's almost annoying because I can never give a clear answer.
But that's what science is. And that's actually why people have lost trust in science because we're not as confident as Gary Brecker when he talks about salt for headaches.
Sometimes you've been wrong, right? Of course.
Sometimes you've I remember reading something where you said I admit that I change. I've changed my mindset when presented with new information and I've explained why.
I think when we think about doctors, this is the part I think that some people struggle with is if you look over the course of sort of 10, 20, 30, 40 years, some of the things we were told were healthy back then are no longer healthy and new information comes about.
I'm well aware that this is a scientific model, but I'm sure this is great.
For yourself in that shoot. How do we know who to trust when doctors say that they've been wrong and they've changed their mind on really critical things before.
And even, you know, when we think about vaccine disinformation, right, a lot of the arguments you'll get from the right of that you said this and now look what happened. So we'll never trust you again.
How do we navigate and know who to believe even doctors when doctors will say information I gave you in the past was actually no longer true.
You have to take the hard route and do the work to find out why they said what they said then and why they're changing their mind now.
So I'll give you an example. Yeah, actually, maybe this isn't a doctor. This is studies. I remember having a guest on my podcast that talked about I think there was a bit of a crisis with depression drugs in the early years where they had because of the way that the tests had been done by the big pharmaceutical companies.
The CEO of the pharmacy to company knew that the depression drug did not work and had all these side effects, but they pushed it through even though the vast majority of the studies hadn't shown that the drug worked. They found one study that had they pushed it through got to market loads of kids used it.
And then I think a decade later, again, I'm paraphrasing here a link to what I'm talking about below. It was discovered that the CEO of that company knew it didn't work, but there was a study and research that got it to market and people started using it.
I think Johan Hari, who's been on my podcast before he was the in Zempek episode, we released him. He was one of the people as a young man that started taking that depression drug only to find out that five, six years, seven, eight years later.
It didn't work and the CEO knew that it wasn't really working. So that was the that was trust in the medical system. It was trust in research that was trust in big farmer.
Much of the counter movement we're seeing now is we think big farmer is corrupt and we think they're meddling with doctors to get drugs into market that maybe don't work.
There's a lot of drugs on the market agree? Yeah.
If science is so problematic and we shouldn't trust for all those reasons, why is it the one example that we're stretching to find of the mistake that was happened or the fraud that happened with this one drug.
We're talking about something that happened decades ago. It does happen. Fraud happens. It happens in health care. It happens with policing. It happens politicians. There is fraud.
But pointing to that one episode and saying we should throw the whole field away is going to cause a loss for us. And there are issues with farmer. There's huge issues with farmer.
I frequently talk about even from like the pricing standpoint of farmer, how problematic they are. We've seen the issues with the opioid epidemic, how that was driven largely by farmer.
But we're calling them out. The beauty of Western medicine of what we do here is that we are the best at calling ourselves out on our failures.
But actually the more we call ourselves out on our failures, the more trust we've lost.
And in fact, when someone owes up to their failures and seeks to learn from them and seeks to make change, that's the person you want to follow.
The person who is not confident, who is open to be transparent, who explains why these things are happening without 100% confidence. That's the people they're giving you advice that's true.
The same way that we said earlier that everything was all natural does not mean it's all good.
Everything for profit is not necessarily evil. My YouTube channel's for profit. I make a very healthy living doing what I'm doing doesn't mean it's evil.
So while it's easy to make shortcuts and over generalize, we have to talk about specific instances and call balls and strikes as they are.
Empires make mistakes, healthcare industry has made mistakes. There's been vaccine incidents in the past that have hurt people.
We've learned from them. We called it out. We've studied it. We are there are doctors constantly studying where we need to do better.
This is ongoing at all times.
And the ironic part is most people have no idea that it's happening because we only find out about it on issues we're passionate about. I recently did a video or I was on a podcast where I was asked about birth control.
I gave a very simple answer. It was non-motivated in any way. It was just kind of presenting the information as it was.
There were a lot of very mean comments in that information about how birth control can potentially be harming people that I don't believe the negative side effects I can come with it all these statements that were being made.
And I found them to not be true. I had to do like a little soul searching to see if they were true because I do that with all the negative comments.
And I said, no, birth control can have side effects just like with any medication. The reason why birth control maybe is being brought up is because this is a topic people are very passionate about.
This is a topic where doctors have discriminated in the past about. So it's a bit more triggering to the emotional part of our brains.
If we look at what's leading hospitalizations from a drug in the United States, Tylenol. You don't see anyone uproar making YouTube videos that Tylenol is problematic.
What is Tylenol?
I said a medicine, paracetamol for you.
Paracetamol.
The amount of hospitalizations for Tylenol and Duce liver failure is sky high. I'm sure we could pop up the statistics on screen.
Someone gets upset about Tylenol because it's not emotionally triggering. And that is true for all of healthcare. There's side effects to taking medications.
So it's easy to only focus on one part of that equation and say, well, doctors used to say this. What about this? Why did doctors say it?
What got them to say it there? And the idea of us getting it perfect?
We're always working with incomplete information. All of medicine is just our best guess.
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What about these animal studies? A lot of them.
Actually, I've been thinking about getting married and getting married. I'm so happy to be able to get married. I'm so happy to be able to get married.
I've never heard of such a thing. I'm so happy to hear it. It's just simple and easy to understand.
I'm a student at the Toto Fuken Minkyo Sai. I'm a student at the Toto Fuken Minkyo Sai Group. I'm a student at the Toto Fuken Minkyo Sai Group.
Research that's presented from experts is from animal studies rats and things like that.
Yes, that's where people like to skip steps. The amount...so Farma is out for money, right? That's fair to say. That's their job. They're trying to create a return for their stockholders.
They try and pick research to do that hopefully will drive the best profits. 99% of the stuff that they start researching on from the initial promise of animal studies, 99% of it fails.
And they're only picking the top. Then you go one step further. Once it works in animal studies in petri dishes and then it goes into human trials.
Another 99% of it fails. So the idea that something has mechanistic value then works in a petri dish, then it works in an animal model.
For it to make all those steps is so astronomically rare that it ends up working for the general population.
The fact is that we shouldn't jump to animal model to human because 99% of that is going to fail.
So what are we saying then? Do we have to go back to just living like our ancestors lived? Because you said earlier on that the world we live in has never been more unnatural.
So is the antidote for all of this stuff we're talking about? Is it to go back to being human and like we always say our ancestors were?
Well, I think what we need to look at is the evolution of humans and the anthropology aspect of it because we can then better understand ourselves now and why we're having problems with this unnatural world.
So if you look at why anxiety was a survival benefit to us back then versus how it could be very problematic to us now in a safer world, studying prehistoric caveman humans would be beneficial.
But drawing conclusions from their diets and potentially what they ate.
Oh, man, you're going to get into so many fallacies and biases that the information is not going to be great and not very applicable.
If you could redesign society in such a way that it would be in your mind more healthier for the average human yet to start from zero.
So your president of the United States Trump doesn't get it Biden doesn't get it. Dr. Mike gets it. And you could really rewire society.
What are the sort of macro top line changes you would make? I'm taking and I'm going to keep everything on the table.
The first thing that I would do and this is echoing one of the authors in X-Ritz I really enjoy listening to and he's actually coming on my podcast soon Jonathan height.
I would get phones out of schools.
I think that much in the same way that we regulate addictive substances like cigarettes like vaping like alcohol to those of age.
And to start thinking about that for social media. And that's an unpopular thing to say.
But I think if you really look at it, there's a lot of problems that can come from it.
Very limited benefit for someone who's 13 to be looking at those images.
So I think some major changes need to be made in schools.
And so I think that's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it's a lot of things that I think it
you have to carry yourself with a air of professionalism, you have to make people feel comfortable in talking to you about very sensitive subjects. So I've been very careful to balance the world of showing my personal life to some degree and showing people and reminding them that I'm human. I too have relationships. I too play sports. I have a family. I have dogs. But also not do it so much that it actually can cause
harm in my clinical interactions. So initially when I started social media, I was very open about my relationships, who I was dating, what my relationship status was. And I thought that I was under the firm belief that there is no way this could be detrimental. And much in the same way that I thought that reading every negative comment can only be helpful. Boy was I proven wrong. Not only does it cause harm to potentially the clinical interactions, it can cause harm with my audience online. Not
dating patients. That's not what I mean. No, no, just the clinical interactions be something. Well, like it, you know, if a patient is wondering who you're dating or what you're dating that that's going to derail the conversation. Okay. Okay. The same way that it would derail the conversation from social media from people listening to medical talking points to then talking about personal life.
So before while I was being very open with it, now I've kind of said my personal life to some degrees, my personal life, when I begin sharing, everyone will know about it. It'll be everywhere. But now I've tend to become a little bit more. I have some things for my personal life, but the majority of it is an open book.
I was curious about your relationship status because as someone who's so busy in a content creator and going through all of the things we described earlier with your mental health and the feedback and all of that. How you manage to be successful in that realm as well.
Yeah. So like in doing what I do, I feel like I'm very busy because I'm involved in so many different things, but I feel like everyone's busy. You know, you make time for what you're passionate about.
So there was a period of time I was single for a few years, then I got into relationships that got out of relationships. And it really is if you meet the right person and you want to dedicate your time to them, you'll sacrifice something.
You know, before I used to be all about watching sports, like that was my nighttime routine. Now I can't even tell you in the last time I watched the sporting event. I just been so busy, like maybe the Ryan Garcia fight boxing match, but I don't, I don't have the time for it because I've made sacrifices to do other things I'm passionate about.
And I think if you're a partner consistently, I think this is something I said before that if your partner consistently says they don't have time, no matter how busy they are, you need to do a little evaluation and see is that something that they truly want or at least bring up that conversation.
You're someone that strikes me as being quite philosophical and deep thinking in their downtime and probably spends a lot of time thinking about bigger questions about life, meaning purpose and all of those things is that a accurate and be.
What are those big things that you're considering in your mind?
It's accurate, but not big picture, big full, philosophical questions. It's more, I'm deep thinking from an introspective standpoint of running back every day.
What could I have done better? What can I improve on? What should I think about for the future? How can I grow from today?
So I spend a lot of time doing that and that's not something I taught myself to do when I was a kid. I remember this very vividly in high school age 13 being very awkward freshman year of high school.
Talking to girls in my class and then coming home and sleeping in my bed and I'm going to sleep thinking, oh my God, what should I have said to look cool? Maybe I should have just stayed quiet like those cool guys in the movies and playing back those scenarios throughout the day.
And while that was silly when I was 13 now as a doctor, I play back my patient encounters and think about what I could do better in that communication sense.
I play back my podcast interviews in my head and think about what I could do better. So I'm constantly thinking about that. And again, not by choice. It just kind of happening in my mind.
And that's where the anxiety stays from my guess.
And anxiety can creep up there if you feel like you're not improving or your progress is stagnating like the idea that I told you I wasn't exercising a lot.
I start ruminating and thinking, oh my God, you haven't been exercising so long now you're going to not be healthy. What if people online start thinking that, oh, that's not a healthy thing to do.
And you could start catastrophizing very easy. This is what our human minds do. And that's why CBT cognitive behavioral therapy, one of the more popular forms of evidence based therapy is taking those cognitive distortions, those catastrophized black or white labeling thoughts and just talking back to them.
Saying how true is that that if you had all A's on your tests and then you got one C that you're failure, how true is it that if you don't exercise for three months, that means you're an out of shape slob.
And you have to talk back to them. So doctors are not immune to cognitive distortions.
I always wonder with doctors when you're dealing with like people's health and their outcomes, which sometimes are positive and sometimes not positive, how that can sit on your shoulders and how you can take that home with you because you must deal with a lot of people that I no longer here.
Yeah, for sure. Especially when I would be a resident working in the ICU where the intensive care unit patients are the sickest so more likely for them to lose their lives.
You're having conversations with family members about discontinuing CPR, about signing certain papers to say that we're not going to give more medical care. We're only going to focus on comfort as opposed to treatment.
And those conversations are not easy conversations and the way that I have approached them is with unbiased truth.
Just here's what I know I want you to know what I know. I'm explaining to you why I think what I think now you tell me what you'd like to do. And ultimately it gives patients a sense of responsibility in a good way where it empowers them or empowers their family members to make the right choice.
And the right choice is not clear. Two people can make different choices and they both be right choices. Same thing with healthcare, like health care is as much art as it is a science.
So two doctors can see the same patient and recommend two different treatments and not be wrong.
Is there was there a hardest day when you think back over your medical career? Was there a hardest day in your practice?
No, nothing that specifically jumps out. I think it's, it's how it wears on you from a perspective of just length of the amount of administrative work you have to do the amount of time you want to spend with the patient versus what you're given.
The ability of helplessness where you can't fully help a patient no matter how much you want to when you know if a patient does a specific treatment you know they'll get better but they're not interested in it or are being deceived or influenced in a way where they're not going down the right path.
Those really, really drain me because I think about those at night of how can I be more effective so I can help my patient come to the right conclusion or at least help them make a decision that is actively not detrimental to their health.
Your mission at the moment to really help to myth bust and call out disinformation as it relates to health care and advice is that driven in part because as a doctor you're seeing the consequences first hand of information your patients are bringing to you that is patently false or untrue or doesn't isn't quote-unquote proven.
And then you'll basically arguing with them about that or something is that where it comes from yeah that's why I started social media because I was having a very similar conversation with the 30 patients that I saw in a day.
And I was like wow I got to tell the world this so they can all know this information so that they all don't fall victim to these scams where they think doctor I had a hundred dollars this month to spend on my health and I bought this thing I bought these two smoothies and I thought this is the answer this is going to help me right this says it helps with cancer.
And it's that's not the answer and in having those conversations over and over again it's what drove the passion to being on social media and now I think about medicine differently than I did when I first started I used to think medicine is doctor patient.
Now I view it more in a public health sense where my impact on social media goes so much further than patient interactions or viewer interactions where now I can influence policy had a medical emergency on a flight and they made that call is there a doctor on board.
And I was faced with the moment like okay do I volunteer do I just take quiet I don't know what to do but I volunteered and it turned out after some investigation that a young gentleman was going into anaphylactic shock.
Historic closing up to an allergy and I wasn't worried I said what where's your happy pen he said I don't have one I didn't even know I had this allergy so I asked the pilot can we land pilot says well it's an hour and a half back to Canada and an hour to Portugal some island in Portugal that's not enough time is drugs closing is going to die in five minutes.
So I'm like what can I do so I open the planes emergency kit thinking there's going to be some epinephrine in there are an happy pen and there's no happy pen.
I'm like okay what do I do now there's no internet when you're over the Atlantic Ocean so there's nothing to Google.
But I'm finding that there is epinephrine which is the same medicine that is found in an epine in a different formulation in a different dosage for cardiac arrest.
So when someone's hard stops we also give the same medicine if they're flat line if they have a specific rhythm to try and restart the heart.
So it's a much thicker needle much longer not those cute little epiped needles that just go into the side of your thigh and I said okay well I need to do some rough calculations here and just guesstimate here because otherwise he's going to lose his life.
And right there in the first class cabin we take off his pants we inject them with this huge needle he's screaming like a little bit of blood coming out I inject the medicine I'm praying that it's working and fast forward that story I stayed with him for eight hours for the rest of that flight until he landed we didn't need to divert I checked his blood pressure and pulse every 15 to 30 minutes and we saved his life.
And you think that would be the end of it like look at that I did my doctor job and that's it but I went and told that story on YouTube got almost 10 million views if not more now I don't know what it's at and the center majority leader Chuck Schumer calls from his office or his office calls and says hey I'd like to get epipans on planes can you stand with us and tell us your story to the media.
Yes we tell the story we call on the FAA to make these changes and now 70% of planes I don't know what the exact number is but something like 70% of planes have epipans on board where that will never have to happen again.
That's incredible and that's the power of social media that people don't talk about that's public health that's helping people that aren't even needing to help yet so that's the kind of medicine I like to think about now.
Well you have a half a body lying over there in the corner so in the in the sake of helping people using social media I asked you if you could bring a I didn't even know what to call that looks like a half a mannequin it's a mannequin because early in my life I got told that learning the skill of CPR is one of the sort of simplest potentially life saving things that I could learn because you never know and I've got people in my family that died of various cardiovascular related conditions heart attacks and things like that.
And so I would love to learn I get again this is probably not official certification this is our official to learn the basics of CPR and how to keep someone alive in such a situation.
Could Jack could you bring the what we call him we'll call him half mic.
Yeah we'll call him a baby Mike.
So I'm curious before we do any kind of instruction on it what do you know thus far about CPR and all wrong answers are acceptable here.
You push on the chest can't really round the top of the rib cage and then you blow into the mouth and you just do that over and over again until they come back to life.
Do you know what the reason of doing CPR is.
This is why I do what I do so this is not it's something to do with keeping oxygen flowing around the body through the blood you're right on target. So the purpose of CPR is if you find someone who's unconscious not breathing is pulseless that means their hearts not beating that means clinically they're dead.
So anything you do here can only potentially help can't hurt right because the person's already dead.
So by doing proper CPR what you're doing is you're compressing the chest chest compressions to squeeze the heart which has some blood in it to circulate the blood throughout the body that still has some residual oxygen in it to deliver oxygen to the vital organs.
So you're not actually saving someone's life by doing CPR you're buying them time.
So the purpose of doing CPR is to allow time for first responders to arrive to then give advanced cardiac life support.
Oh, okay.
And that's why the first step of doing CPR has nothing to do with the person and has everything to do with calling for help.
Okay, so I called the first responders or because that would so ideally you never want to do anything that will distract you from starting chest compressions because the faster you can get to doing chest compressions the better your outcomes.
So I tell someone else to call ideally if you're alone obviously that's not happening.
But you can't just say out into the open hey someone call 911 because what happens everyone assumes the other person calls no one calls this happened with many medical emergencies and it's terrible when it happens.
There's actually criminal cases about that someone screaming for help and everyone assuming the other neighbor would call and the no one ends up calling.
So you have to say hey you in the blue shirt you in the pink hat you call 911 and they will call 911 and you immediately start pushing hard and fast in the center of the chest one hand on top of the other.
When you say center of the chest you mean in between the packs correct.
Okay, so right in between the packs 100 top of the other.
And what if I be correct body doesn't person's dead.
So I can go as hard as I want to go you want to go two inches deep which means pretty hard because in order to compress the heart you need to go two inches deep and two inches deep is pretty five centimeters deep.
So one hand on top of the other pushing hard and fast in the center of the chest in between the packs and you're doing that until help arrives.
Okay, so you see how you're.
Much like most people who are really good shape you're using your triceps try doing that for more than two minutes.
You will fade no matter what good shape you're in in fact when we're in the hospitals the way that we do this is maximum two minutes at a time and then we tap out and get the next person in because it's so tiring.
The way to max full body correct and you hear the click that means you're doing it to the correct depth and that way you will get less tired and you'll be able to do that for longer periods of time.
So that click means I'm hitting the heart for this little device. Yes, I had to go down a long way away.
I had to go down so far that I would never have naturally done that to somebody I would have thought that I was going to do more damage correct.
And because of that fear that people have we unfortunately have worse outcomes with people who have cardiac arrest in the field and in fact most cardiac arrests meaning heart stopping happen not in hospital settings.
They happen in community settings they happen on the street at dinners with our loved ones and the important point to remember here isn't what you do for someone who's talking and is having heart attack.
This is for cardiac arrest they're not talking they're not moving they're not breathing because if they're talking that means they have a pulse.
Because I've seen in some videos online like someone's trying to talk or moving around people are doing chess and I'm like no stop doing chess compression.
But if they're pulseless if they're not breathing they're unconscious start hands only CPR after calling for help.
I can't I really want to emphasize how hard I had to push down then it wasn't just like pushing on the surface I had to put all my weight and shove down on the chest.
And you know that insecurity about the amount of pressure that you're talking about.
There is even worse outcomes for women who have a cardiac arrest because people are afraid of pushing in between breasts.
If the person's life can be saved when first responders arrive because you bought them time do it. It's not fair that women are less likely to receive CPR from by standards because of their bodies.
I thought because I think again because I've watched so many movies that when you start doing the CPR the person comes back to life.
It can happen.
Okay, because I thought that's what you were doing. I thought you were like bringing them back to life. That's what if that's the notion that some people have that's why I wanted to make sure that you're not actually bringing them back to life.
You're buying them time and circulating the residual oxygen so that help can arrive to try and restart the heart.
How long do you have to do what's the longest you've had to do CPR on someone for and then they've ended up surviving.
I've been in double digits before or young patients because young patients we will like if you have a patient who's elderly who's in the ICU who's already very sick.
When their heart stops the odds are that you'll bring them back are obviously very low but even if you will bring them back to life they're going to be in a worse quality of life than they were already were.
So many times we actually have a conversation as the CPR is ongoing with the families explaining that and saying that this is not beneficial that even if we bring them back they might be in a worse state and that we don't recommend it we actually have scores and guidelines that we can discuss with patients about statistics on this but when someone's very young let's say you have a 20 year old who has an unusual cardiac arrest we would fight much longer because they have an opportunity to heal once we bring them back.
So it's very dependent on a specific situation and you have to have that exact same conversation when someone was operating when treating your mother.
Yep that's the conversation that was my first interaction with that kind of environment I actually remember when I was in the room and the alarms were going off and the residents or the doctors were doing CPR and I called it off.
I remember the next time I heard those alarms was during my training in a patient simulation lab and that was like the first moment I ever had a flashback where a sound brought back a feeling where that sound of those alarms brought me back to how I felt and how uncomfortable I felt I've never felt that before.
You must have heard that sound a lot since then. Oh yeah and I've had some difficult conversations with my fellow colleagues because of it.
I remember very vividly when my mom passed away we're in the waiting room waiting for documentation forms to sign and I came out to check and see if they're finishing up and some of the nurses and doctors I don't even know what medical professionals they were they were kind of laughing in their little work area in the back not where they were patient facing but hearing those laughs got me so angry how can anyone laugh during a time like this.
But then I had to remind myself these are people to these are people who are losing patients every day and if they took the loss the way that I'm taking this loss they wouldn't last they wouldn't be able to help my mom or other moms.
So I had to remind myself about that but my takeaway from it was when I saw a whole residents of mine maybe writing their notes after someone's family passed away and I see the family in ear shot and they're talking about their day or they're laughing or they're giggling or something.
I'm saying or they're giggling or saying some kind of joke not related to the situation I just I don't correct them that's not my place to do I just share my story of how I felt and I thought I created a really good learning opportunity.
Dr. Mike we have a closing tradition on this podcast where the last guest leads a question for the next guest not knowing who they're leaving it for.
If you could go back to a pivotal moment in your life and make a different decision what would that moment be and why I think about the social isolation and loneliness that you described that I felt when I lost my mom.
And how I isolated myself from my classmates to this day out of 300 students in my class or so.
I didn't make a lot of friends in fact any friends.
And I was not involved.
I was fully disconnected from my class and I think it's because of what I was going through at that time and I wish that.
I either reached out for support from the school or.
Created conversations amongst my classmates.
Because the friendships that they've created have lasted to now.
This is over a decade.
People got married in those classes.
They've created lifelong friends and I feel like because I moved away and I was two hours away from the school I wasn't a part of it.
And I feel like that has significantly impacted the number of friendships I carry to this day that the friends that I do have are my close friends from high school.
Maybe some from college but almost none from medical school and I feel like that's a really, really big missed opportunity.
I feel lonely.
Yeah, sometimes for sure.
But I think that's a byproduct of society.
These days and my work adds to that as well.
Dr Mike, thank you so much.
Thank you for all of the work you do and the way you do it.
You're the one of the most accessible voices on the internet as it relates to medical information and I say accessible intently because.
Exclusive, they're too smart and they don't really let us in but I think you're both confronting disinformation in a really honest, fair, balanced way.
But at the same time you're providing information in such an accessible way and you've drawn a tremendous audience to you across YouTube and your podcast and across your socials and everywhere else and.
It's there's no doubt in my mind that you've not just saving the lives in your practice every day but you're saving hundreds of thousands of lives you'll never meet but also you're improving so many lives because you're helping us to navigate towards.
Better information or a better way to think about the information we receive and I'm on that journey to.
I'm doing my very best to try and navigate that and as someone that sits here with a lot of experts, which is your lowest criteria of like acceptable evidence experts and medical practitioners.
And I'm doing this two three times a week sometimes there's often conflicting information.
I always struggle with how to present that information because on one hand you don't want to sense the people because that assumes that I know what's right but on the other hand, you feel a sense of responsibility that the platform you're creating is is not doing any harm and I think that's the first kind of.
Principle of anyone that's trying to produce content is do no harm so my cure prime example of someone that I see doing no harm and a lot of good in the world so thank you so much appreciate you saying that it means a lot.
You know a lot of days mean my team my small team will sit in front of the camera and talk and forget the implications and the outcomes that we can make in the world with the content that we make so that's what continually drives us by reminders like what you just said so I appreciate you saying that please keep going.
I know it's difficult some days and I know people do a very vicious I've been on the receiving end of that for much of my life but I think you know that I don't have to tell you this but you know that the net impact of your mission is so unbelievable it's so you'll never see it you'll never meet the people the families the father the mother the grandfather.
But I just wish you could because I because I think if you could see the net impact it would put all of that stuff in perspective where it should be so my thank you thank you appreciate you having me on.
you
