Part Two: Peter Attia and the Cult of Longevity

In Part Two, Robert is again joined by Dr. Kaveh Hoda to discuss the rise and fall of the doctor at the center of the wellness podcast circuit: Dr. Peter Attia. From his stent as a McKinsey consult consultant to his pricey concierge longevity practice, a hit podcast, and a #1 bestseller. We break down "Medicine 3.0" and where the evidence holds up, where it doesn't, and how a smart, credible doctor can end up giving cover to the MAHA crowd. Finally, we get into his emails with Jeffrey Epstein, the fallout at CBS and his sponsors, and what it all says about doctors, fame, and wealthy patients. Content note: discusses Jeffrey Epstein and sexual abuse. Sources: Attia, Peter. Outlive: The Science and Art of Longevity. March 28, 2023. Johansson, Minna, et al. "Continuous Glucose Monitoring for Persons With and Without Diabetes." JAMA, August 3, 2026. Khullar, Dhruv. "How to Die in Good Health." The New Yorker, April 15, 2024. Mann, Brian. "McKinsey & Company to Pay $650 Million for Role in Opioid Crisis." NPR, December 13, 2024. Martin, Kristen. "The Problem With Peter Attia: The Longevity Guru Turned Up in the Epstein Files. Should We Have Taken His Health Advice So Seriously in the First Place?" Slate, February 26, 2026. Ruetenik, Daniel, and Arden, Farhi. "Dr. Peter Attia, Longevity Expert, Apologizes for 'Indefensible' Emails to Jeffrey Epstein." CBS News, February 2, 2026. Tyrangiel, Josh. "The Epstein Spectrum." The Atlantic, April 3, 2026. Walker, Graham. "A Skeptic's Review of Peter Attia's Outlive." LinkedIn, January 13, 2024. https://www.linkedin.com/pulse/skeptics-review-peter-attias-outlive-graham-walker-md-z6rsc Blum, Dani "Peter Attia's Ties to Epstein Spark Backlash From Doctors." The New York Times, February 10, 2026 Kaufman, Maya and Gardner, Laura . "I Think She Will Be Loyal: Jeffrey Epstein's Role in Peter Attia's Rise." Politico, March 16, 2026. Pollack, Neal. "The Plight of Peter Attia." The Spectator, July 15, 2025. Greene, Jenna. Epstein files up in lawsuit, over stock options by longevity expert, Peter Attia. March 20, 2026 Podcasts: The Peter Attia Drive. Episode 168, August 2021. The Peter Attia Drive. Episode 172, August 2021. The Peter Attia Drive. Episode 190, January 10, 2022. The Peter Attia Drive. Episode 298, April 15, 2024. The Joe Rogan Experience. Episode 1735, 1961 Jocko Podcast. Episodes 55, 56, and 392. The Tim Ferriss Show. Episode 398, "Peter Attia, MD: Fasting, Metformin, Athletic Performance, and More," November 27, 2019. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:05Robert Evans?

  Welcome back to Behind the Bastards, a podcast about the very worst people in all of history. And here to talk about, well, here to do a special reverse bastards episode where I don't have to research and write about a terrible person. My guest does is Dr. Cave Hoda, who has been very kindly teaching us about Dr. Peter Attia.

• 0:28Speaker 01

  Yeah, Attia? I don't know, actually. It's a good question.

• 0:30Robert Evans?

  Attia, Attia, sorry. Peter Attia.

• 0:32Speaker 01

  Peter, I apologize.

• 0:33Robert Evans?

  I know that. You said that correctly. I got it wrong because my brain does not hold pronunciations well.

• 0:38Speaker 01

  I might have, I might be wrong. Listen, I don't know if I'm saying my own name right. So I can't be certain about anyone else. So sorry, Peter, if that's the case.

• 0:49Robert Evans?

  Who's to say?

• 0:52Speaker 02

  This is an iHeart Podcast. Guaranteed Human.

• 0:57Robert Evans?

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• 1:56Speaker 04

  I'm Melissa Jelton, host of the What Happened to Her podcast. We're kicking off the season with the Sandra Birchmore story, a case the police wrote off as a suicide in a snowstorm. Her family never bought it, and the man they suspected wore a badge.

• 2:11Speaker 05

  You never know who that devil is because he's wearing a disguise. Sometimes it's a police uniform.

• 2:16Speaker 04

  And you can get access to all episodes 100% ad-free with an iHeart True Crime Plus subscription exclusively on Apple Podcasts, available only to iHeart True Crime Plus subscribers. So don't wait. Head to Apple Podcasts, search for iHeart True Crime Plus, and subscribe today.

• 2:37Speaker 06

  If anyone wanted to commit a murder, up here would be the greatest place in the world to hide the body. But soon they'll find it. He acted friendly. He talked friendly. He sounded friendly. They all knew that I did the scary boogie stuff. And they said, maybe she'll find out where this girl is. I saw him violent. Backhanded her. Pow!

• 3:03Speaker 03

  Listen to The Devil's Quarry, Season Two, in the Bone Valley feed, on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 3:17Speaker 05

  Malcolm Gladwell here. My new book, The American Way of Killing, investigates America's gun violence crisis. Why is the richest country in the world plagued by such lethal violence? Through a series of stories, interviews, and archival tape, I confront one of today's most urgent moral dilemmas and examine why the US has never quite understood its own problem, and why you can't fix what you refuse to see clearly. Get The American Way of Killing at pushkin.fm/audio-books.

• 3:55Speaker 01

  Okay, you guys ready to get back into this?

• 3:58Robert Evans?

  Yeah, yeah, yeah. Let's do it.

• 3:59Speaker 01

  Okay. When we left off, our hero, Peter Attia, had left the oppressive group think of medical training.

• 4:09Robert Evans?

  Finally.

• 4:10Speaker 01

  It was finally. It was only a matter of time. He was pretty upset about not being appreciated for attempting to operate outside the Johns Hopkins protocols.

• 4:21Robert Evans?

  Being a maverick, a renegade.

• 4:23Speaker 01

  Yeah.

• 4:23Robert Evans?

  He's a play-by-the-rules, but he gets results.

• 4:26Speaker 01

  Yeah, you want a rebel doctor. That's what you want.

• 4:29Robert Evans?

  That's right. I level with my doctors are rebel.

• 4:32Speaker 01

  Just really outside the box, getting weird with medicine. Yeah.

• 4:36Robert Evans?

  A lot of people say smearing poop into an open wound is bad for you, but they're just sheep. I like to get away from the herd. I like to try new things.

• 4:44Speaker 01

  Yeah, get that in there real good.

• 4:46Speaker 04

  Can we stop this?

• 4:47Robert Evans?

  Yep, yep. Nothing's bolder than sepsis.

• 4:50Speaker 04

  I don't get, I don't get paid enough for this shit. Can we, that?

• 4:54Speaker 01

  Yeah. Well, I mean, if you didn't stop me, I might have gotten stuck in that.

• 4:58Speaker 04

  Yeah.

• 4:58Speaker 01

  It is, it is disturbing how easily my brain can just like, in, like, get into that role of the manosphere dude. And that is

• 5:08Robert Evans?

  It's easy.

• 5:09Speaker 01

  Something I need to work on.

• 5:09Robert Evans?

  It's fun to joke about. Yeah.

• 5:11Speaker 01

  Yeah.

• 5:12Robert Evans?

  But back to Pitar.

• 5:13Speaker 01

  So let's get back to him. So he decides to join, leaving the residency, decides to join a consulting firm called McKinsey and Company.

• 5:22Robert Evans?

  Oh, good. Oh, I'm glad they're showing off. That's fun. Yeah.

• 5:25Speaker 01

  Yeah, I was gonna ask, have you?

• 5:26Robert Evans?

  Real peak McKinsey years.

• 5:28Speaker 01

  Yeah, yeah, okay. So McKinsey

• 5:30Robert Evans?

  They're one of those like, bloodless consultants. Sorry, you're gonna talk about them. Yeah, yeah, yeah.

• 5:33Speaker 01

  No, no, no, please, please, please.

• 5:34Robert Evans?

  They're one of those like consulting firms who you bring in to tell, like, here's how many people you should fire to maximize shareholder value and the like, right?

• 5:42Speaker 01

  That is correct. They are a global management consulting firm that advises major corporations, governments, both here and abroad, and institutions on strategy operations.

• 5:56Robert Evans?

  Some people call them bloodless ghouls, but, you know.

• 5:59Speaker 01

  Right, no, I mean.

• 5:59Robert Evans?

  I don't, because I, I support actually the bloodless ghoul community. You are valid, you are beautiful, and I love you, bloodless ghouls.

• 6:07Speaker 01

  You are seen. They are one of the most influential, oldest, and maybe controversial consulting firms in the world. Let's talk about them, because he decided to go work for them. And I think that says something about a person. So they're a firm with the history of being criticized for a lot of things, including involvement with the opioid crisis. Have you heard of the opioid crisis?

• 6:31Speaker 04

  I have.

• 6:32Robert Evans?

  Oh, man. Yeah, I've had a few myself.

• 6:36Speaker 04

  Robert?

• 6:37Robert Evans?

  As a bit, as a bit.

• 6:38Speaker 01

  It's a bit. Please say it's a bit. I'm a medical doctor. I'm a professional.

• 6:43Robert Evans?

  I only do opiates in Mexico. And now I don't do opiates in Mexico anymore because of fucking fentanyl. Man, it ruins so much. You used to be able to just buy opiates off of a pharmacy in Guatemala or something, and know that they were just hydrocodone. You could pick it up in the grocery store. It was beautiful. Anyway, whatever.

• 7:00Speaker 01

  Yeah. So McKinsey and Company, both of them, were hired by Purdue Pharma to work on strategies to increase opioid sales because they just weren't selling enough.

• 7:12Robert Evans?

  Yeah, 2006 is like, peak getting Americans addicted to painkillers years.

• 7:18Speaker 01

  And that's exactly what we're talking about here.

• 7:20Robert Evans?

  Yeah.

• 7:21Speaker 01

  And they, they provided them service for over 15 years, specifically advising them on marketing and sales strategies to aggressively increase the revenue of OxyContin, the opioid painkiller. Now

• 7:36Robert Evans?

  You want to aggressively increase people using oxy. Yeah.

• 7:40Speaker 01

  It's what they did. So they advised Purdue, really focusing their sales representative visits on doctors who were already writing high volumes of prescriptions. And according to the New York Times in 2013, McKinsey designed a specific strategy to turbocharge OxyContin sales. And they advised the Sackler family, the people who own Purdue, to push the higher dose pills. They did a lot of really fun stuff. Because of this, they faced a lot of legal challenges and some setbacks for the company. They've had to cut back

• 8:18Speaker 01

  at least 10% of their global workforce. They had to pay nearly $600 million to settle investigations.

• 8:27Robert Evans?

  A fucking pittance, honestly. But yeah.

• 8:29Speaker 01

  Probably. Yeah. And by these investigations, brought on by 49 different American states. I'm not sure which state didn't, actually. I wish I had looked that up because I'm betting it's Alaska, but I don't know. And the DOJ announced a settlement resolving civil and criminal probes, with McKinsey accepting responsibility for a misdemeanor charge of conspiracy, of conspiring, sorry, to aid and abet the misbranding of prescription drugs. This is, so they also had a senior partner, Martin Elling, who faced felony obstruction of justice charges for intentionally deleting Purdue. And they had to pay also $125 million into the Purdue Pharmacy bankruptcy estate to fund treatment programs. But I, what I

• 9:14Speaker 01

  have here is, I printed out, I went to the Department of Justice, the Office of Public Affairs.

• 9:19Robert Evans?

  Okay.

• 9:20Speaker 01

  And I printed out there some interesting stuff that they, that they posted about this, these court hearings. So they leveled a couple of complaints against the Purdue family, and they leveled a number against McKinsey. Now

• 9:38Robert Evans?

  The Sackler family, yeah.

• 9:39Speaker 01

  Sackler family, sorry. And the, two of the ones they leveled, two of the charges they leveled were criminal misbranding and false claims to the, to the FDA. So this is fun. So the DOJ, this is quote, this is from the Office of Public Affairs, the Department of Justice, quote, "The DOJ leveled a criminal misbranding charge against McKinsey for falsely marketing it as less addictive, less subject to abuse and diversion, and less likely to cause dependence and withdrawal than other pain medications." This was specifically their recommendations that McKinsey made to Purdue. They were like, they worked on messaging. They're like, hey, we have to counter these emotional public health warnings, including

• 10:21Speaker 01

  these complaints that mothers had of teenagers that had overdosed. And so they had this whole marketing campaign to fight that. Among other strategies, intensifying marketing to high-value prescribers, including prescribers who were writing opioid prescriptions for uses that were unsafe, ineffective, and medically unnecessary. So McKinsey did, basically, let me translate some of that, was like, hey,

• 10:46Speaker 04

  Yeah.

• 10:47Speaker 01

  these people who are writing the worst prescriptions, the most questionable prescriptions, let's really drill down on them and get them to write even more. Hit them up. That should be number one. Don't go to the person that you have to convince. Go to the person that's just doing it and just work on them the whole time.

• 11:10Robert Evans?

  Makes sense.

• 11:11Speaker 01

  McKinsey consultants spoke with Purdue about the concerns and increasing reluctance of pharmacists and pharmacy chains to fill prescriptions for Oxycontin as abuse of the drug rose. McKinsey consultants also went on several ride alongs with Purdue's sales representatives in the field.

• 11:29Robert Evans?

  Sure.

• 11:31Speaker 01

  As these sales representatives called on prescribers and pharmacists. In notes about one of the ride alongs, a McKinsey consultant wrote, quote, pharmacist had a gun and was shaking. Abuse is definitely a huge issue.

• 11:46Speaker 01

  It just kept doing it.

• 11:49Speaker 01

  They set them on ride alongs to convince them to work harder. It's insane.

• 11:54Robert Evans?

  That's nuts.

• 11:56Speaker 01

  And then on top of that, they also got leveled for claims against the FDA. McKinsey US knowingly misled the FDA by assigning consultants to concurrently work on both FDA projects and competitively sensitive Purdue projects. So basically what they did was they said to the FDA, hey, we're going to give you some of our consultants. They're going to help you with managing this opioid crisis. And it was the same consultants that were working on Purdue.

• 12:25Robert Evans?

  Yeah. These guys really know the opioid crisis because they helped cause it, but they're experts. Yeah. It would be like bringing in a bunch of former SS guys as experts on denazifications. Like, look, they know who the Nazis were.

• 12:39Speaker 01

  They know what they're talking about. They know what they're talking about.

• 12:43Robert Evans?

  Oh, man.

• 12:44Speaker 01

  There's also criticism of their work with Enron, as well as their work with China and Saudi Arabia and their efforts to enable authoritarian regimes in those places. Well, I'll, I'll leave that for James and Mia to discuss. I feel that's probably the more their wheelhouse, but they, they've done worse things also in other places as well. Now, Attia's work did not seem to be related to anything medical. So I have to say, even though he was there during the opioid crisis, it doesn't seem like it was, he was a part of it. He was focused on corporate risk and he worked as a management consultant during this time.

• 13:25Speaker 01

  He considers this his recalibration phase where he's exposed to systems level thinking. I don't know who he was working with, but clearly it signals he has an interest in working with affluent, optimization oriented populations.

• 13:40Robert Evans?

  Right.

• 13:41Speaker 01

  His core audience is high income, like high income, health maxing professionals, people with the ability to pay top dollar for the health. And I'm sure this is a big part of why he ended up there. So he's there for two years and it kind of correlates when the first major actions are taken against Purdue. So I don't know if that was a part of why he left or not, but he leaves after a couple of years. I think that's common for people doing the consultant gigs.

• 14:08Robert Evans?

  Yeah, yeah, yeah.

• 14:10Speaker 01

  Right. And for reasons that I'm not clear about, he's drawn back to medicine. He gets very busy. He starts doing presentations, lots of media stuff, doing TED Talks. He talks about metabolic dysfunction a lot. He co-found a startup called the Nutrition Science Initiative, or NUCY.

• 14:31Robert Evans?

  Yeah.

• 14:32Speaker 01

  Gives him a very public facing scientific role and one that he does without needing board certification.

• 14:39Robert Evans?

  Oh, that's handy.

• 14:40Speaker 01

  That's great, right? His blog helps establish him as a bit of a contrarian and, but one that can actually discuss data. Sophie knows my thoughts about medical contrarians. It's not great. And this is where the Attia content machine really starts. These long form, technical pieces framed as this is what your doctor won't tell you. Again, has that real, the one secret your doctors won't tell you energy. And the rise of these doctors, these contrarian doctors is something that is very much a sore spot for me.

• 15:16Robert Evans?

  Yeah.

• 15:16Speaker 01

  And not, not that medicine's perfect is not, I'm not going to say that is, but a lot of these folks, him included, did a lot of what is called, or I call, I don't know if this is a term, I'm sure it is, science washing. Like taking some of the more blatantly crazy, quack people, making them seem more legitimate and making the more blatantly anti-vax doctors seem a little bit more legitimate, really paves the way for the Maha movement and where we are currently, again, in our golden age of diarrhea. Now, eventually in 2014, he starts his own private longevity clinic, Early Medicine.

• 15:59Speaker 01

  And this is really the scaffolding on what this whole shtick is built on moving forward.

• 16:05Robert Evans?

  Yeah, yeah, yeah, yeah.

• 16:07Speaker 01

  It, it allows him to operationalize the Med 3.0 framework that he loves talking about.

• 16:13Robert Evans?

  I feel like you can see a hint of this in the fact that he got so into nutrition because obviously nutrition is massively important for like health, but also when you're in the business of like nutrition, because of the way supplements and stuff are regulated, it means that you can, you can, I'm not saying he was, but you can be in the business of just selling people nonsense and claiming it's basically medicine, as long as you avoid certain phrasing, right? I just, anytime I hear nutrition, my warning bells start going off and like when it's in the, in the context of a medical professional.

• 16:46Speaker 01

  Absolutely true. It's, it's really the Wild West because being a nutritionist could mean you have like two to three PhDs in the matter.

• 16:55Robert Evans?

  Yes.

• 16:55Speaker 01

  Or it could mean you're a wellness influencer online. And there's really a wide breadth of the, the conversation between the two. So, yeah, absolutely true. So during this time, as he's creating this clinic, things he's doing are things like continuous glucose monitors for non-diabetic patients, which you may have already gathered from the way I said it, is not appropriate. Repeated advanced lipid testing, VO2 max labs, routine MRI scans, DEXA scans, is giving people expensive wearables, using off-label drugs, doing after-hours consults. His clientele's are elite. They want high-touch care.

• 17:39Speaker 01

  They aren't taking new clients, by the way, I checked. It's years-long waitlist to get in. And although it's not disclosed exactly how much, from the accounts I've seen, he charges anywhere from a hundred to $500,000 annually for this care in this clinic.

• 17:57Robert Evans?

  Nice work if you can get it, Jesus.

• 18:00Speaker 01

  I mean, if I could find three people to do that.

• 18:03Robert Evans?

  Yeah, yeah. I'll give you a nutrition advice for half a million dollars a year, anyone listening, you know? Why are the money ahead of time? And I'll give you all the advice you fucking want.

• 18:13Speaker 01

  Will you be on call though? Will you be on call all the time?

• 18:16Robert Evans?

  Sure, sure. You can call me.

• 18:19Speaker 01

  I may not answer.

• 18:20Robert Evans?

  Eat more fiber. I don't know, man. Fuck it.

• 18:23Speaker 01

  That's, they, hey, you're hired. You're in. If I started a.

• 18:26Speaker 07

  Well done, buddy.

• 18:28Robert Evans?

  Could be worse.

• 18:28Speaker 01

  If I start a concierge clinic, I am going to hire you in a minute. Anyways.

• 18:32Robert Evans?

  Yeah.

• 18:33Speaker 01

  I, I could see why it's so appealing. I, I will say this though, as an aside, I can only imagine as a doctor, how annoying it would be to be a regular doctor of one of these patients, once they leave this concierge clinic and you have to see them, like the stuff they would expect, it would just be wild and I would not be giving them. But like, they'd be like, my last doctor, he did this and this, he ordered this and this and this, and he did this for me. And I'd be like, no, I'm sorry. That's just, none of that's appropriate or reasonable to do. And it would be so painful. And of course, none of this is accessible to the average patient, or I'm sure you can guess, covered by insurance.

• 19:18Robert Evans?

  Yeah.

• 19:18Speaker 01

  People like Attia or tech weirdo Brian Johnson, other longevity enthusiasts, they're famous, that guy, that's the guy with the son's blood boy for you listeners out there.

• 19:30Robert Evans?

  Yeah, yeah, yeah. And, and tracked his erections. Don't forget about that. Really loves bragging about his four-hour erections at night when he's sleeping.

• 19:38Speaker 01

  Yeah, yeah, yeah.

• 19:39Robert Evans?

  Cool, man.

• 19:40Speaker 01

  I did an episode on him and it was troubling. Lots of weird tweets about his girlfriend's vagina.

• 19:49Speaker 07

  Yeah.

• 19:49Speaker 01

  And his, and his son's erection, just real weird, real weird stuff.

• 19:53Speaker 07

  Really, uh, TMI, my guy.

• 19:56Speaker 01

  Yeah, yeah. And I'm not a person who says that. Like, I don't think I've ever said TMI before, but I think if I were to use it, it would be in this case, TMI. So, uh, these people, the reason I bring them up, both him and Attia would, would have you believe that this is all proof of concept stuff and that, yeah, only rich people have it for now, but eventually everyone's going to have it. But, I mean, that's just not true. It's not scalable. These longevity wellness people are essentially creating a two-tiered medical system with a different level for the wealthy. I mean, you could argue we already kind of have one, but that gap will only grow.

• 20:36Speaker 07

  Right.

• 20:37Speaker 01

  Of course, like all bad people, he starts a podcast. It's called The Drive in 2018. They cover a range of topics built around his practice and early medicine framework. He's really starting to build this parasocial relationship with a high value audience during this time. He's making appearances on Oprah at least three times on the Joe Rogan Experience. He's hanging out with Bill Ackman, Hugh Jackman.

• 21:07Robert Evans?

  Oh, boy.

• 21:07Speaker 01

  Paltrow.

• 21:08Robert Evans?

  Yeah. A lot of Ackmans in there.

• 21:10Speaker 01

  A lot of Ackman and Jackmans.

• 21:12Robert Evans?

  Yeah.

• 21:13Speaker 01

  And Gwyneth Paltrow and other New York elites.

• 21:15Robert Evans?

  Sure.

• 21:16Speaker 01

  His book, Outlive, comes out in 2023 and shortly afterwards becomes a number one bestseller.

• 21:22Robert Evans?

  Yeah, they love, love titles like that. I can see why that one sold.

• 21:26Speaker 01

  Really a good one, right?

• 21:27Robert Evans?

  Yeah, yeah.

• 21:28Speaker 01

  Over 3 million copies and spent 131 weeks on the New York Times nonfiction bestseller list. It's crazy.

• 21:38Robert Evans?

  That's bleak.

• 21:39Speaker 01

  He's, it's not great. He becomes a major figure in the health and wellness scene. Millions of people tuning into what he has to say or write. And I am a little, I don't want to get too far into the medical minutia here, but I think it's kind of important to do. And, and your audience is very smart and I'm not just saying that because I'm pandering, although I'm clearly pandering. They are very intelligent. I think they can hang with this. So I'm going to dig in a little bit to the medical advice he's endorsing and why it matters. Okay. He's moving past the lifespan stuff. He's now about health span, the good years again, where your mind and body are sharp. Well, I'm into that. I like that. And this medicine 3.0, which his clients are paying top dollar for.

• 22:23Speaker 01

  And he would describe as preventive, personalized and data-driven approaches to healthcare that focuses on avoiding disease rather than treating it, treating disease.

• 22:34Robert Evans?

  Yeah.

• 22:35Speaker 01

  And what's, you know, by the way, um, you know, I get called a shill a lot for being part of Big Pharma. And it's a lot of these same people who are like, you only want to, these diseases to happen. So you can be paid by pharma to treat them. And I'm like, what do you think he's doing in these situations? You think that these medicines he's giving you are free? It's not, I just, anyway, sorry. A key part of his justification for aggressive preventative treatments and aggressive pharmacology is this assertion that he has that 90% of the US population has at least one of five markers of metabolic syndrome. Have you guys heard of metabolic syndrome?

• 23:20Robert Evans?

  Yeah. Is that real?

• 23:22Speaker 01

  It's real.

• 23:23Robert Evans?

  Okay.

• 23:24Speaker 01

  It's real, but it is vague. So you are right to be a lot of, yeah, is it real?

• 23:28Robert Evans?

  I hear a lot of things called signs of metabolic syndrome that just sound, okay. So sure, I'll listen to you.

• 23:33Speaker 07

  It's like, uh, you know, a number of things that make you at risk for other things. Am I, am I in the right space?

• 23:40Robert Evans?

  Crops up a lot in grift kind of medical spaces.

• 23:43Speaker 07

  Things you might have a stroke or all these things means you might get type 2 diabetes or all these. Am I in the right, is that correct, my friend?

• 23:52Speaker 01

  You guys, you guys are so smart. I'm not just saying that, honestly.

• 23:55Robert Evans?

  I mean, I had a lot less specifics than she did, but sure.

• 23:58Speaker 01

  Yeah, that was good. No, I mean, but I meant you guys, I meant her. Um, this is really smart. Um, I just don't want you to feel bad. That is correct. Metabolic syndrome is a real thing, although you're right to be kind of questioning it because it's used by people both professionally who know what they're talking about and by grifters to sell you an enema made out of like coffee. So you're right to be concerned about it. Now, what it, what it is, let's go through it here. Okay. Metabolic syndrome is important and we should touch base on what these five markers of metabolic syndrome are. One, central or abdominal obesity, basically a waist circumference greater than or equal to 102 centimeters in men, 88 centimeters in women, just a big gut.

• 24:43Speaker 01

  You get adipose tissue in your gut, it changes the way your body acts with insulin.

• 24:48Robert Evans?

  Sure.

• 24:48Speaker 01

  Another marker, elevated triglycerides, greater than or equal to 150. Low HDL, which is quote unquote, good cholesterol.

• 24:57Robert Evans?

  Right.

• 24:57Speaker 01

  Lower than 40 for men, lower than 50 for women. Hypertension or high blood pressure with a systolic of 130 or greater. And a diastolic, that's the bottom number. Systolic is the top number. You see like, it's like 130 over 85. That's top number systolic, bottom number is diastolic. Probably more information than you need, sorry. And the last of these markers is elevated fasting glucose, if it's over 100. Now, Sophie is 100% right. If you have metabolic syndrome, it puts you at risk for diabetes, coronary artery disease, heart problems and stroke. And his assertion that 90% of people have at least one of these markers is actually not far off.

• 25:40Speaker 01

  The CDC runs this research program called the National Health and Nutrition Examination Survey, or NHANES. And there was an NHANES study from 2009 to 2016. And it showed that about 12 only, I should say, only 12% of US adults were considered quote unquote metabolically healthy or basically optimal on all five of those markers I mentioned without medication. That implies that roughly 88% of Americans have at least one abnormal test. I'm assuming that's where he gets this 90% number that talks about. And that part is, I think, true. Hey, everyone. This is Cave, uh, you know, from the future after this recording.

• 26:21Speaker 01

  And I just wanted to jump in here real quick to say that, uh, what I said was totally correct. No, uh, nothing factually wrong. I just hear Robert doing this every now and then, and you know, it sounded fun to me. So I wanted to give it a try, but yeah, everything, uh, everything I said was right. So, uh, anyways, back to the podcast.

• 26:44Speaker 01

  But the thing is, that's not how you define metabolic syndrome. To have metabolic syndrome, you have to have three or more of those markers. Having just one isolated marker is probably very, very common, but it's also clinically far less meaningful. For metabolic syndrome, you have to have at least three of those and it kind of just drops it to one to start treatment. Does that, does that 90, does that make sense? Let me stop right there. Does that make sense?

• 27:11Robert Evans?

  Yeah. Sure.

• 27:13Speaker 01

  Like, yeah, these things are important to note and I want people to be thinking about all these things.

• 27:19Robert Evans?

  Right.

• 27:19Speaker 01

  But this concept of saying like, he, he's changing the goalpost here about definitions that would justify treating people aggressively. And we'll talk about why you don't want to treat everyone aggressively. But I don't believe this justifies it. It's certainly not justifying in a uniform approach like he applies to his patients. We always say lifestyle modification should be the first thing you discuss rather than reflexively treating people with medication. I'm the one that gets accused of being a shill for pharma. And I'm the one that's usually saying, hey, let's hold off on this medicine that's unproven. You know, I don't, I don't get it. So.

• 27:55Speaker 07

  You do say that to me often.

• 27:58Speaker 01

  Yeah, I get it a lot.

• 27:58Speaker 07

  I'm like, what do you think of this thing? And you're like, uh, no, no.

• 28:03Speaker 01

  Yeah. And writing medicines like my bag, I'm an internal medicine doctor at heart. That's what we do. Anyways, you, you should think of interventions, I feel, as a staircase and not a switch. And the first step should always be lifestyle modifications, if you can help it. Now metabolic syndrome is a risk indicator, not an absolute risk. It doesn't account for everything, age, sex, smoking, LDL, other factors. Aggressive lab testing that he does is a big part of his like practice and recommendations. But in these cases, it's highly questionable about what kind of use that serves. He focuses on these aggressive tests for blood markers that could potentially represent heart disease.

• 28:47Speaker 01

  His core panel includes something called APOB, uh, LP little A, CRP. And then he also recommends imaging the coronary artery calcium or the CAC scoring.

• 28:58Robert Evans?

  Okay.

• 28:58Speaker 01

  As well as a coronary CT. I don't think other people refer to it as CAC, but I think it's funnier to refer to coronary artery calcium as CAC scoring.

• 29:06Robert Evans?

  CAC scoring.

• 29:07Speaker 01

  I'm not opposed to early focused cardiac intervention. Of all the stuff he does, I'm the most open to hearing about this. But a lot of what he is recommending, a lot of this testing outruns the evidence that we have to support its use. Some of it hasn't even been shown to be something we could change. So for example, these CAC scoring tests that he does, they're expensive. They expose you to radiation and downstream test events. And there's no trial so far that shows that doing that actually helps you in any way or decreases cardiac events.

• 29:41Robert Evans?

  Yeah.

• 29:42Speaker 01

  And whenever you do a test, you should always ask, will the results of this test change our management? That should always be a question you ask. And if there's nothing different you can do, if there's nothing different it will, it will give you, then you have to have serious conversations. It doesn't mean you can't do it, but it means you can't be applying that to everybody. He also is a proponent for early screening tests for things like colonoscopy, which he sees as being proactive, but I see as a gastroenterologist who does them as being a bit reckless. This is my wheelhouse, of course, and we could talk at length about wanting to start colonoscopy, but for someone without risk factors, it's 45. That's our

• 30:25Speaker 01

  recommended time for screening for colon cancer. And that's lower than 50 where it used to be. He pushes for 40. Now-

• 30:34Robert Evans?

  I mean, there's a lot more younger colon cancer cases, right? So I don't know. Is that wrong?

• 30:38Speaker 01

  Yeah. Don't, don't, I could, I could talk to you about that. This is a fascinating topic to me. In fact, I just released an episode about early onset colorectal cancer, and you are correct. There are increasing rates. Overall, the absolute risk is still low, but there is increasing rates of why that is. But that's why we drop it to 45. Now, people online constantly get mad when I talk about this because they'll be like, hey, I want a colonoscopy and you doctors are not giving it to me. And I'll be like, how old are you? And they'll be like 30. And I'll be like, do you have any risk factors? Like family with colon cancer or family with advanced polyps or history of inflammatory bowel disease? Or do you have any signs or symptoms that are concerning? And the answer is no, they just want it. I'm like, that's not what we want you to do. I don't want

• 31:23Speaker 01

  you getting colonoscopies. I'm a guy who does colonoscopy. I get paid to do colonoscopies, but I don't want you to get it unless you need it. And he's-

• 31:31Robert Evans?

  Yeah, it's not free for everyone's, not just out of money standpoint, but like doctors don't have unlimited time. Like we, yeah, I get that.

• 31:38Speaker 01

  Yes. That's a big part of it. And there's more. We'll discuss that a little more. We'll come back to it. But what I think he is tapping into here is a very real dissatisfaction, disillusionment with mainstream medicine. And I feel that. People feel that doctors, for one reason or another, are always gatekeeping healthcare. And to be clear, I am 100% for preventive care. This is, this idea is not new. We've had primary cares for this exact reason. Why he went into surgery, I don't know. He would have been better off if had he gone to endocrinology, but you know, not a lot of money there. So maybe that's, I don't, I don't want to assume that's why he did it. But there are other things you

• 32:19Speaker 01

  can do to, to get preventative care. And I'm, as I said, I'm a simple country doctor. Four years of medical school, three years of internal medicine training, a year of chief residency, three years of gastroenterology, and a year of liver transplant fellowship under my belt. Simple country doc stuff. And I feel so much less confident taking the giant swings he does on all these medical issues. He has no formal training in cardiovascular disease, neurodegenerative disease, endocrinology, or even nutritional science, yet these are the pillars of his practice. Again, very smart, incredible potential as a doctor, but what he's describing as research into these fields seems more like, ah, maybe read

• 33:04Speaker 01

  a couple of studies and having relationships with people that are his friends that do know more about than him. There's something you have to consider when you're doing all these tests, all these advanced genetic testing, CT angiograms, these colonoscopies, there's real harms, real risks associated with them, and we have to weigh the benefits of them. I'm assuming you probably want to take a commercial break before we do that.

• 33:29Speaker 07

  Yeah, why not?

• 33:30Robert Evans?

  Yeah. Speaking of that, ads? Why not?

• 33:38Speaker 04

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• 38:19Robert Evans?

  And we're back.

• 38:21Speaker 01

  Uh, yes, we are back. Now, there was a JAMA study I want to talk about because I think this is really funny. And funny may not be the right word. It came out of UC Davis in 2012. It's an old study. And what it did was this. It showed how happy a patient was with the care they received and how that related to their outcomes. That study showed that the most satisfied patients had not only higher healthcare spending, but more hospital admissions, and most strikingly, a 26% higher risk of death compared to the least satisfied patients.

• 38:59Robert Evans?

  Cool.

• 39:00Speaker 01

  The satisfied patients were doing worse.

• 39:04Robert Evans?

  Yeah.

• 39:04Speaker 01

  What thoughts do you have about why, why may that be? We don't know for sure, by the way, the test, this study wasn't powered to give us the answer to that.

• 39:11Robert Evans?

  I would guess because people like are, are satisfied because they like their doctor and they feel listened to, but that doesn't necessarily correlate to actually improving their healthcare outcomes at all. It's just like how people can be really satisfied with a doctor who's selling them like snake oil that doesn't actually cure their cancer and until they fucking die, they don't notice something's wrong. I don't know. That's would be my guess.

• 39:34Speaker 01

  No, that's right. So the more satisfied patients are probably getting more than they asked for, more tests, more side effects, more complications. Doctors who always say yes, score very well. And sometimes saying no in medicine is really hard, but sometimes, and not always, declining to test or medicine or antibiotic, or refusing to do a low value scan or imaging study may actually serve patients better. Now, this is a big nuanced and difficult conversation because you have to weigh those considerations with listening to your patients and advocating for them. And it is not an excuse to not listen to your patients and take their complaints seriously.

• 40:16Speaker 01

  I'm fully aware that our country has a very serious problem taking patients seriously, particularly if they are black and or female. This is a real problem that we have in this country. But it's always important to keep in mind that sometimes do no harm is the right step. Not doing the thing is the, the better approach. To be totally transparent also, there have been follow-up studies to that 2012 studies. Some have supported, some have detracted. I feel the weight of time has sort of borne this out though, and it does seem to be true. There was a 2019 Cochrane meta-analysis that showed real dangers to over diagnosis and treatment. It can lead to unnecessary interventions.

• 41:00Speaker 01

  One test leads to another test, leads to another test, and these things have risks. Sometimes they're necessary, sometimes they are not. And these things carry not only real harm, but also psychological burden as well. So I, I think largely his reason for doing this is not bad or malicious. I think he does want to help before a problem exists.

• 41:20Robert Evans?

  Okay.

• 41:21Speaker 01

  And like I said, a lot of his advice is reasonable stuff, and I actually kind of like some of it. Eat less processed food, exercise, sleep well. Great. But it's also paired with this really over the top monitoring with intense and very pricey strategies that lack evidence. And some of the relationships he has to these things are not ideal. For example, he, as I mentioned, promotes continuous glucose monitoring for people without diabetes or signs of insulin resistance.

• 41:51Robert Evans?

  Yeah. Yeah.

• 41:52Speaker 01

  Not necessary. Yes, in your medical professional experience, you would also agree with me and you are correct, but it's become a big hit with the Maha crowd, these, these tests. And there's no evidence that's of any use to non-diabetic patients. And, and it can lead to unnecessary dietary restrictions, anxiety, even disordered eating. And the information, the, the data you get from these continuous glucose monitories, it's, it's often difficult to interpret and getting one with an ongoing data plan is hundreds of dollars per month.

• 42:27Speaker 07

  It's expensive. A lot of people that, you know, have diabetes that need these sorts of devices are either unable to get it or the prices are increasing because of things like this. And I, I know a specific device that you're going to talk about. And I know that it is extremely difficult to, to at times get that device. And I, I can't imagine this helps.

• 42:56Speaker 01

  No, you're exactly right. That's what happens. You, the resources are limited. Our problem in this country is not so much that we don't have the things to help patients. It's that we don't have access for them to get to it.

• 43:09Robert Evans?

  Yeah.

• 43:10Speaker 01

  And also rounding out what Sophie was alluding to there, he was a paid advertiser for a company called Dexcom that sells these devices.

• 43:19Robert Evans?

  Oh.

• 43:20Speaker 01

  That's not ideal. It's not ideal. He, he's been criticized for not disclosing that very well. I have seen him mention it, but I don't think he did it every time. So I think it's a valid criticism.

• 43:33Robert Evans?

  Sure.

• 43:33Speaker 01

  By the way, that, that company has since said his advisory role ended in 2021. But when, when this topic comes up of concerns, hey, that aren't we just creating a new tier of medical care for just those with extreme wealth and that it's preventative medicine for people who are already privileged and probably doing better? He, he'll downplay the cost of these things he's ordering by correctly pointing out that the end of life care is also very expensive. And that is true. A disproportionate amount of healthcare in this country spending is at the end of a patient's life. The cost of all the machines and the labor and medicine in those critically ill hospitalized patients, that adds up quickly.

• 44:18Speaker 01

  But both things can be true and nobody's saying we shouldn't practice preventative care. But the thing is this, even if his measures do work, which is a big if, it's still just pushing the end of life care and all the money that goes into it further down the road. So you're not saving money this way. You're spending money on both ends. A lot of it, a lot of healthcare dollars are going to go into this on both ends. And, you know, and for that reason, actually is real quick before we move on from end of life care. It's an important reason that doctors recommend having those goals of care discussion and what you would want done if you were to become critically ill and not be able to, to weigh in.

• 45:00Speaker 01

  Unfortunately, when this is reasonably discussed, Republicans refer to it as death panels and we never get to have this.

• 45:06Robert Evans?

  Right. I remember the death panel days. Yeah. And then we had real death panels under a Republican, anyway, whatever.

• 45:13Speaker 01

  We've had real death panels, but having end of life care discussions is not only important for saving money, it's also just really important for knowing really what your loved ones want. So I think it's, anyways, have that discussion, folks, even if you are healthy, you should at least be having those discussions along the way. Now, all this, I think are things that you kind of learn in the actual practice of medicine, something he missed, this do no harm.

• 45:41Speaker 07

  Yeah.

• 45:42Speaker 01

  The, the colonoscopy part, I think, is a great example of this. So our current guidelines have dropped to 45. He wants it to go down even further to 40. And again, despite how strange it might seem to some people, there are people who want these tests done as early as possible. But that's, as Robert said, it's, one part of it is we just don't have the people to do it. I mean, I could do colonoscopies every day, all day for the end of time, and I will not have scratched the surface of, of the colonoscopies that need to get done. So we're taking it away from people who need it. But on top of that, there's risk to doing these tests. There's actual physical risks that you, bad things can happen. It's rare, thankfully.

• 46:25Speaker 01

  You should get colon cancer screening, but colonoscopy does have some risk and it's not cheap. And again, I'm telling you this, as someone who stands to make a lot of money off of you getting colonoscopies.

• 46:37Robert Evans?

  Yeah.

• 46:38Speaker 01

  So, so take my word for this one. You're like, it's something we have to be more mindful about.

• 46:43Robert Evans?

  Yeah, for sure.

• 46:46Speaker 01

  He, he talks about some other stuff with his patients that's overall less fun for me. He emphasizes zone two training as optimal for mitochondrial capacity and longevity. This does contradict some substantial evidence behind higher intensity training. Again, kind of what he's doing here is these cherry picking studies that look at observational data in elite endurance athletes. Not sure how that translates.

• 47:11Robert Evans?

  Yeah.

• 47:11Speaker 01

  But that cherry picking study stuff is something that RFK Junior does as well. And what they all do in this sort of world.

• 47:17Robert Evans?

  It's in vogue these days. Yeah.

• 47:19Speaker 01

  It's the mode, is the modus operandi of our current administration. So one thing that they will all do is they will take a little bit of data and then extrapolate it far beyond what that data was meant to do. Something he does this with is one of his quote unquote horsemen. He talks about the four horsemen of the apocalypse and one of them is cancer.

• 47:41Speaker 07

  Oh, sorry. That was like an audible groan.

• 47:50Speaker 07

  Okay. Sorry, I'm back.

• 47:51Speaker 01

  I felt that way. I felt that, again, I actually liked parts of his book. Parts of it were, I thought, very reasonable, but.

• 48:00Speaker 01

  For example, when he talks about cancer, he points out that cancer cells require more glucose than normal human cells. And that is true. And you'll hear a lot of wellness people take that little bit of information.

• 48:13Robert Evans?

  Yeah, starve your cancer by avoiding sugar or whatever. I've seen that a lot.

• 48:18Speaker 01

  Right. They take a little bit of truth and they make giant leaps from there regarding the nature of cancer's formation and sugar's role in it. And it's honestly, it's still not clear what that means, you know? Is it the cause of the cancer, the sugar? Or is it just some interesting feature of the cancer? To make jumps from a simple lab-tested fact to saying dietary manipulations could help the growth of cancer is shaky at best. And like diet is important. I'm a huge proponent of a healthy diet that is high in fiber. Again, fiber folks, I'm deep in the pocket of big fiber. But there, while there is solid evidence that healthy dietary patterns can lower your risk for things, right now, there isn't the risk of these things he's recommending,

• 49:03Speaker 01

  like ketogenic diets, prolonged fasts, caloric restrictions. There's no evidence that those things work. When we want people to like learn, when I want people to learn about what they're eating and how it affects them, I want it to be broad and sustainable patterns. Mostly plants, limited red meat, limited processed meats. And I don't disagree with limiting sugar either. I agree, for the purposes of maximizing your cardiometabolic risks. That's well proven. I don't find it to be a good argument in the case of cancer. The data just isn't there yet. Or if you're cool, you call it data. Let's talk a little bit more about the medications because again, I'm the one that gets accused of being a pharmaceutical, but if a right-wing doctor tells you to buy like a year's supply

• 49:48Speaker 01

  of ivermectin, you do it out there. So I don't, I'll never understand that. Not that he's recommended ivermectin.

• 49:55Speaker 07

  For the non-Netflix watchers, I just rolled my eyes very, very, very, very, very dramatically.

• 50:02Speaker 01

  You gotta strain something, gotta be careful. So he's a big fan of aggressive pharmacologic intervention, using medications off-label. Now, I'll give one example. I could give a lot, but there's one, and I think it's a fun one. And there's a little nerd in me that wants to share this story with you guys. And I think your listeners will enjoy it. It's about a medicine that he prescribes for his patients called rapamycin. You might have seen it, sir, all of us. And he prescribes it for longevity-enhancing purposes. And yeah, there is a little bit of promising preclinical data to suggest some longevity benefits.

• 50:44Robert Evans?

  Okay.

• 50:45Speaker 01

  It's still very much a hypothesis and there's no phase three trials to prove it. As an interesting aside, this rapamycin is actually an antifungal. And this is fun, how it was discovered. It was discovered in the dirt of an Easter Island volcanic crater in the 60s in Rapa Nui.

• 51:02Robert Evans?

  Okay. How did they find it?

• 51:05Speaker 01

  Great question.

• 51:06Robert Evans?

  What in the world is going on here? Sucking up different things that they found on the island. Like, does this have medical? I don't know. Like, how did they find it?

• 51:14Speaker 01

  Yeah, great, great question. So there was this microbiologist who was collecting soil because they wanted to take samples and they wanted to figure out why the islanders who lived there never got tetanus despite walking around with no shoes.

• 51:30Robert Evans?

  Okay, actually, that's a really, that's a really cool thing to do. Yeah, you know, that makes sense.

• 51:33Speaker 01

  Right. But like, you could imagine some Republican talking about this in the day being like, hey, we're wasting money testing the dirt in Rapa Nui. You know, that's, that's how it is.

• 51:45Robert Evans?

  Yep, that makes sense.

• 51:46Speaker 01

  You never know where research is going to lead you. And that, it leads you some really amazing places. Anyways, since discovering it, people have studied its use for all kinds of different things. It was actually found to have some immunosuppressive effects. So because of that, it's used for transplant patients to alter their immune system. So if you get a transplanted kidney, you take this medication usually to help prevent your body from rejecting it. Now, as I mentioned, there is some early data that suggests it can affect lifespan of mice. Human trials have been very limited, though. Maybe it might help improve the flu vaccine response. It's not quite clear.

• 52:29Speaker 01

  People thought it could be potentially used for weight loss, but that really didn't pan out. And it's not shown the metabolic stuff that they expected to, but it's a really small example of something that the anti-vaccine community and something that RFK Jr. do. Extrapolating a small truth in a small study or an animal study to a large truth in humans, something that's not powered, meant, or designed to do.

• 52:56Robert Evans?

  I see a lot of this.

• 52:58Speaker 01

  Yeah, it's a big stretch.

• 53:00Robert Evans?

  Yeah.

• 53:01Speaker 01

  And I mean, it's, it's great clickbait stuff, right? You see an article that says like, this secret medicine discovered in the Easter Island crater will expand your life. And you're like, that's awesome. And you read it, and sometimes if you're lucky, they'll explain that it's not that. But it's really fun, clickbaity stuff. It's really, it sits with people and is exciting.

• 53:23Speaker 07

  So yeah, he's also a guy that like is a soundbite guy. So you know, you're going to get, you know, two minutes of him talking on some other guy we hates podcast, talking about how great said thing is, and it just spreads like wildfire and is actually just not scientifically sound. And you're just spreading scientific misinformation and causing harm.

• 53:47Speaker 01

  That's exactly right.

• 53:48Robert Evans?

  Yeah.

• 53:49Speaker 01

  Now, because it's off-label, there's no regulating the dose. There's no guidelines on dosing or monitoring. Maybe there's some protective effects against aging, but these same exact pathways drive immunosuppression. So you can't take these things lightly. You don't want to be immunosuppressed if you don't need to. Because as, as the title suggests, your immune system is being suppressed. And your immune system is a good thing.

• 54:17Robert Evans?

  I wouldn't want to take immunosuppressants as a longevity treatment because your immune system sometimes helps you stop dying. Like, I get why it helps your longevity if you've got like a transplant. That makes sense.

• 54:27Speaker 01

  Right. And people haven't studied its use in situations like this. It's long-term risk of use for people who don't have a transplant, for example. And you know, there's some real risk with it that we do know about. There's some increased risk to infection, as I mentioned, the development of lymphoma, and some metabolic problems that the whole field of longevity is really supposedly aimed to prevent. So it's this kind of fast and loose relationship to science and medicine that's made him a pop culture scientist and star. He sounds really convincing, intelligent when he talks about the stuff, especially if it's in these short bursts. He knows how to talk about data in a way that's even more convincing, I feel, than Andrew Huberman. He's good at it.

• 55:13Robert Evans?

  Yeah.

• 55:13Speaker 07

  Yeah.

• 55:14Speaker 01

  And he, he's influencing people. He's gained the attention of everyone in the manosphere. His approach to medicine is great for people like RFK Jr. and anti-vaxers. He can speak intelligently about the data and sound authoritative, and it can help science wash them a little bit. He's got like a real credibility behind him. It's like when Brian Cox shows up in Super Troopers, he gives the thing this whole like sense of gravitas.

• 55:38Robert Evans?

  Great. I often think about Super Troopers when I'm considering the validity of different medical opinions. Yeah.

• 55:44Speaker 01

  He doesn't, he doesn't even need to vocally support RFK Jr. He doesn't vocally support him. He's pretty careful about what he says about him. But all he has to do is give them the plausibility by not refuting them and coexisting in the same world with them and going out of his way to not trouble them. For example, when he's asked about RFK Jr.'s accusation that Tylenol causes autism, something that every doctor I know of, even ones who don't have the same political leanings as me, they look at that, they've seen it, they know anything about it, they're like, that's kind of nonsense. When he's asked about it, he describes it sort of as a low probability event and kind of tries to move on from that discussion.

• 56:24Robert Evans?

  Okay.

• 56:25Speaker 01

  A low probability. Is it, Pete? From all the available data, it's a no probability event. That's the kind of thing, you have to be able to stand up. You have to be able to take a side. And I know people will say doctors shouldn't be political, but this isn't even political.

• 56:39Speaker 07

  This is not political. This is, this is just due diligence. This is just.

• 56:43Robert Evans?

  Yeah.

• 56:44Speaker 01

  Say the truth. Say the medical truth. Say the scientific truth.

• 56:48Speaker 07

  This is just the sky is blue bullshit. Yeah.

• 56:51Speaker 01

  It absolutely is. So when it comes to his bastard, his bastardosity, is he a medical bastard? Obviously not on the level of Marion Sims, who we discussed.

• 57:02Robert Evans?

  Right. Or on RFK Junior even. Yeah.

• 57:05Speaker 01

  Or Dr. Oz either, who I really don't like either. He's, he's not as creepy. He's not as creepy as some of the other longevity girls.

• 57:13Speaker 07

  I pre, I pre laughed at that. Sorry.

• 57:16Speaker 01

  No, no.

• 57:17Speaker 07

  He's not as creepy. You're not wrong.

• 57:21Speaker 01

  He's not as creepy.

• 57:25Speaker 01

  He's not, he's not as creepy as some of the other longevity guys like Brian Johnson, who deserves his own episode. Have you done Brian Johnson?

• 57:34Speaker 07

  No. I mean, he comes up every now and again.

• 57:37Robert Evans?

  Nah, he's not, cause he's not really a bastard. He's a, like, we might do him because he's funny.

• 57:41Speaker 01

  Yeah.

• 57:41Robert Evans?

  But he's not, like, the, the thing about him that I actually do respect a little bit is that like of all of the super crazy rich maniacs out there, most of them are spending all of their money on like horrible shit or really boring bland shit. Like, I've got a bigger yacht. No, I've got a bigger yacht. He's spending a lot of his money on like dangerous self experimentation. And that's the kind of mania that I actually do respect a little bit. Like, oh, you're, you're genuinely kind of unhinged, but you're, you were committed to being unhinged. And like, I, I kind of respect that more than like the way Bezos spends his fucking money.

• 58:16Speaker 01

  Yeah, no, he walks the walk. Yeah, that's a very good point. Very good point. It's the same way that like, I mean, I'll never totally understand deeply religious people because it's just not, I don't have that part of me. But when somebody believes it enough to proselytize, as annoying as that is, and how little I want to see it, there's a part of me that's like, okay, well, they seem to really believe it, or they wouldn't care to proselytize. Like, the proselytizing, they really believe they're, these people are going to hell, so they want to change their minds about it because they really believe it. So I kind of, I kind of, I kind of see that. Anyways, um, so he's not, he's not that bad. Uh, and actually compared to ghouls like that, he actually kind of seems reasonable. He did go to medical school. He didn't

• 58:58Speaker 01

  finish his residency, but he did some of it. If you saw him profiled on 60 Minutes last fall, or read some of his stuff in Scientific American, he actually comes across as a pretty sound thinker. But this whole shtick is based on critiques of what he calls medicine 2.0. And all of this is based on limited experience actually practicing medicine 2.0.

• 59:20Robert Evans?

  Yeah.

• 59:21Speaker 01

  A key point he makes in his book, which he illustrates, is that the mortality rate per 100,000 people declined relatively little over the course of the 20th century, if you subtract out the deaths from the eight top infectious diseases, implying that contemporary medicine has made scant progress against the horsemen of things like cancer and neurodegenerative diseases. Basically.

• 59:47Robert Evans?

  Very frustrating.

• 59:48Speaker 01

  Well, first of all, yeah, one, if you take out all these deaths that we're avoiding with, you know, treating these infectious diseases, which is like, come on, that's, that's pretty good. Let's be.

• 59:57Robert Evans?

  Yeah. The, the problem is that like, there are individual cancers, like up until recently, because there have been, there do seem to be some like breakthroughs maybe occurring in pancreatic treatment. But like, there wasn't a massive amount of progress made on pancreatic cancer compared to some other cancers up until fairly recently. But like lung cancer, we've gotten way better at dealing with, right? And like, yeah, there's still some sorts, there's still varying sorts of like, you know, heart disease or whatever that we don't have, but we've gotten better at like a lot of other kinds. Like, it's, it's just, people are, I think a lot of it is like, yeah, you lose a loved one to like a disease that we just haven't gotten a good handle on. And it's easier to, for people in that situation to be like, medical science still hasn't made any progress. And it's, well, I'm sorry, you got hit by that

• 1:00:40Robert Evans?

  fucking bullet, but that's not the only thing going on, you know?

• 1:00:44Speaker 01

  No, you're exactly right. And it is medicine 2.0, as he would call it, that is providing those advances in things like pancreatic cancer, which, I mean, agreed, not as fast as it should be. And, and we, we should be pushing this forward, but I don't think that's what medicine 3.0 really is. This, this whole thing is really not only downplaying the role of antibiotics and vaccines, but these horsemen he's talking about, in particular cancer and Alzheimer's, are diseases of older people. The fact that he gets to write books about how we're not treating them aggressively enough is because our public health system had improved enough to keep us alive long enough to get these diseases, these diseases that are largely of

• 1:01:29Speaker 01

  older people, not completely, but largely. Um, and, and this whole 3.0 thing doesn't even make sense internally. In his book, Outlive, he discusses how immunotherapy is amazing, and it is, but that's very much 2.0 medicine. That's conventional medicine and research working. At the end of the day, who has the time and the money to do these things? We have a real problem in this country with access. It's not enough tasks, as I said, it's enough access. And he's clearly chosen on purpose to surround himself with only the wealthiest Americans who have the time and the money for all the exercise he recommends, the ability

• 1:02:10Speaker 01

  to pay for all the things, the testing, the wearable devices, and the desire to live forever. And that's what brings us to the last part of our conversation.

• 1:02:19Speaker 07

  But first.

• 1:02:21Robert Evans?

  Speaking of, oh yeah, Toby's got it.

• 1:02:24Speaker 07

  But first.

• 1:02:28Speaker 04

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• 1:03:10Speaker 07

  She was starting to get worried and get scared for her safety.

• 1:03:17Speaker 04

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• 1:03:19Speaker 05

  The only difference between me and her, frankly, was a little bit of luck, because by all rights, I should be dead.

• 1:03:25Speaker 04

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• 1:03:28Speaker 02

  They can't convict her, right? Like, she has so much evidence.

• 1:03:32Speaker 04

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• 1:03:44Speaker 05

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• 1:03:56Speaker 04

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• 1:04:27Speaker 05

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• 1:04:32Speaker 04

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• 1:04:39Speaker 05

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• 1:04:44Speaker 04

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• 1:04:51Speaker 01

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• 1:04:56Speaker 04

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• 1:05:03Speaker 03

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• 1:06:42Speaker 02

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• 1:07:10Speaker 07

  And now Jeffrey Epstein. I know, I know it's here. I know it's here. I brought it up in the beginning.

• 1:07:17Robert Evans?

  Carly Rae Jepstein himself.

• 1:07:20Speaker 01

  So that's right. Where does all this lead us to? All this medicine 3.0, all the cost. Who can do it? Only the wealthiest people. And that is how our hero, Dr. Peter Attia, gets connected with one Jeffrey Birmingham Epstein. I'm just kidding. I don't think that's his middle name.

• 1:07:42Robert Evans?

  Nope, that was it. Yep.

• 1:07:43Speaker 01

  Earlier this year, you might have heard, CBS News announced a whole new slate of 19 contributors as part of the efforts of they are trying to go with Barry Weiss to revamp the network's public image. One of the contributors that they had hired, along with, again, Andrew Huberman, which we could do another two parter on, conservative Mel Ferguson, was Dr. Peter Attia. Three days after that, the DOJ released a chunk of Epstein files, which included over 1,700 mentions of the name Peter Attia, and a lot of very

• 1:08:22Speaker 01

  embarrassing and very douche chill inducing emails between Attia and J E, as he calls him, J E.

• 1:08:32Speaker 07

  Ew.

• 1:08:32Speaker 01

  And also with Epstein's handlers, a lot of emails with Attia Epstein's handlers. Because of this, Attia was forced to step down from his role at CBS. Because it turns out, before he became this wellness influencer that he was destined to become, with millions of followers, a very influential book, he relied on Jeffrey Epstein's advice to help get his concierge medical practice going. So let's get into the Epstein files here.

• 1:09:02Speaker 07

  Yeah.

• 1:09:04Speaker 01

  Here we go.

• 1:09:05Robert Evans?

  Okay.

• 1:09:06Speaker 01

  Yeah. So from Attia's own report, he met J E in 2014.

• 1:09:13Speaker 07

  I hate every time you say that.

• 1:09:14Speaker 01

  I know. But like, it's just, well, it gets worse. Wait, hold on.

• 1:09:19Speaker 07

  Yeah.

• 1:09:19Speaker 01

  So he met Jeffrey while he was raising funds for scientific research. And interestingly, he makes a point to note that it was facilitated, the meeting, by a female healthcare leader, Dr. Eva Anderson Dubin. Interesting person. She was a former model, became a doctor and philanthropist. And that makes sense. Epstein clearly kept ties across academia. They remained in contact over the years, exchanging emails. They exchanged advice. Eventually, Attia lets Epstein know that he's looking for someone to help run his office. I have this office, it's concierge practice, but I need a patient care coordinator, someone

• 1:10:01Speaker 01

  to like walk them through the whole thing, someone that's gonna make the experience really enjoyable for them. And he's asking for his help in finding him or her. Epstein invited Attia to his Upper East Side mansion and introduced him to a foreign-born model.

• 1:10:19Robert Evans?

  Okay.

• 1:10:20Speaker 01

  Yeah, you might see where this is starting to head.

• 1:10:22Robert Evans?

  Oh, this is 2014, right?

• 1:10:25Speaker 01

  2000, yes, 2014.

• 1:10:27Robert Evans?

  Okay, so he had been convicted and everybody knew.

• 1:10:29Speaker 01

  Oh, yeah. That was 2008, if I remember correctly.

• 1:10:32Robert Evans?

  Just always really wanna highlight when somebody befriends Jeffrey after that. Yeah.

• 1:10:37Speaker 01

  Yes. Oh, yeah. We're, we're gonna get to whether or not he, he had a sense of what was going on or not here, too. I think there's some telltale signs in his emails. So Attia is introduced to this foreign-born model. They, they exchange emails. And in other emails, it's clear that Attia has invited her to a hangout with some other potential candidates, other people at Swinkie Bar in Midtown. "I think she will be loyal," Epstein writes to Attia in an email. Turns out, this woman was also a victim. Her name is redacted, but she was one of Epstein's victims. And from Attia's spokesperson, they say that

• 1:11:20Speaker 01

  this person never ended up working for them after all. They said that for some other reason, they went with somebody else. That wasn't even the reason he was at Jeffrey Epstein's apartment. But Politico reports that it was visa issues that were the problem. And you can see this in the emails. The emails are like, hey, I, she's great, but there's this visa issue, and I don't think we're gonna be able to get past that. And this is the kind of thing you see a lot in these emails. Attia relying on Epstein for referrals and providing him with health advice and testing. He downplays the relationship. He'd missed a hanging out about 10 times after that until Jeffrey Epstein's arrest. He says the hangouts happened at Jeffrey Epstein's home, although from emails, he did have interest in going

• 1:12:05Speaker 01

  to the island. And there was even a plan to go to the New Mexico ranch that Epstein owned, but there was no evidence that actually proves that he actually did that.

• 1:12:13Robert Evans?

  Zorro Ranch.

• 1:12:14Speaker 01

  Is that what it's called?

• 1:12:15Robert Evans?

  Yeah, the Zorro Ranch. Yeah.

• 1:12:16Speaker 01

  Oh, my God. So he definitely did stay at one of Epstein's apartments in New York for some time period, and he used, yeah. He used Epstein to help fill out his clientele as well. That's really where I think Epstein came on big.

• 1:12:31Robert Evans?

  Great. Yeah, because you can connect him to other rich guys who are interested in longevity stuff.

• 1:12:35Speaker 01

  That's exactly right. And it looks like he's giving him medication. He's probably giving him Metformin, which is another diabetes medication, which I don't think Epstein had.

• 1:12:43Robert Evans?

  It's very popular for life extension folks.

• 1:12:45Speaker 01

  Right. Yeah. In return, he provides medical care and advice. And to quote Attia later, he says, "To be clear, I never witnessed illegal behavior and never saw anyone who appeared underage in his presence." But to also be clear.

• 1:13:01Robert Evans?

  Appeared. Doing a lot of work. That is a very, very strong piece of verbiage there. There's a lot weighted on that.

• 1:13:11Speaker 01

  Yes, exactly right.

• 1:13:13Speaker 07

  Disgusting.

• 1:13:14Speaker 01

  It's not ideal. No, no, no. No, men are terrible. I don't think you're gonna find Robert and I defending men in general.

• 1:13:21Speaker 07

  No.

• 1:13:21Robert Evans?

  I, I'm being very specific about who I'm, I'm attacking here. Yeah.

• 1:13:27Speaker 01

  Okay. Like, also, to be clear, it was not a mystery at this point who Epstein was. As you mentioned, he already had a record and a reputation well-known. And you can even tell from these emails that Attia knows his friend is infamous. I reviewed as many of these emails as I could tolerate, and there's a couple of lines I wanna read through some of these for you guys that I think stand out. 2015, an email thread from Attia with a redacted photo and the subject line, "Got a fresh shipment." Not clear what Attia was referring to there.

• 1:14:03Robert Evans?

  Oh.

• 1:14:05Speaker 01

  Well, hold on. It's not clear what Attia is referring to there. He said later it was the medication Metformin, but that's kinda weird. But Epstein responds with an email, says, "Me too," with an attached photo, but the attached photo is redacted.

• 1:14:21Robert Evans?

  I got some theories.

• 1:14:23Speaker 01

  Well, Attia's response, let me tell you first, before you tell me your theory, Attia's response was, "Please tell me you found that picture online..." dot, dot, dot, bastard.

• 1:14:34Robert Evans?

  Cool.

• 1:14:35Speaker 01

  Yeah.

• 1:14:35Speaker 07

  These fuckers.

• 1:14:37Robert Evans?

  Not a lot of, we're not exactly, we're not exactly connecting, like, this isn't like a crazy board situation where we have to like draw lines between pictures with like twine. It's pretty obvious what's happening here.

• 1:14:51Speaker 01

  Yeah. Epstein's, Epstein's response was, "Afraid not." He just, he's so ghoulish, even in his emails.

• 1:15:00Robert Evans?

  What always takes me is not Epstein's ghoulishness, because he's Epstein. It's the degree to which you can tell there's so many of these guys that all cool is to them is having access to frighteningly young women. Like, that's cool. That's what makes you have like an enviable life is the young girls around you.

• 1:15:21Speaker 01

  And, and to be clear, Attia is not the only doctor in these files providing medical care or doing something for, for, for Epstein. And that bums me out so much. There's like one normal Norman Finkelstein to every like 20 other dudes trying to like get in on Epstein in Epstein's world. You know Norman Finkelstein was invited to go to his, he's a Columbia professor. I don't know if you know who he is. Cool dude. Anyways, he was invited by another like academic colleague, and he was like, "No. And if I ever see you bringing your daughter to hang out with Epstein, I'll throttle you." Like that, there are some

• 1:16:04Speaker 01

  cool dudes out there. But for the most part, it's just dudes like this who just want, they wanna be close to power. They wanna be close to it. They wanna suckle at the teat of these rich and powerful people. And doctors are no exception. And that really bums me out. And not just because we took a stupid oath, but because like, we, it's not our job. And it leads to, leads to more, we'll get to that. I got, I got some to do with it. Okay. So anyways, Epstein said, afraid not. So, um, you know, uh, in, in defense of Etia, he said it was a picture of an adult woman. Now, I don't think that makes a lot of sense

• 1:16:46Speaker 01

  because if it was a picture of an adult woman, why would he say, please tell me you found that picture online, dot, dot, dot bastard?

• 1:16:53Robert Evans?

  Yeah. I mean, I guess because he's like theoretically, maybe just some hot adult lady that he's like, oh, please tell me that's not someone you're in front of right now because it's so cool that you get to fuck her, right? Like, that would be the offensive thing, knowing what we know about Jeffrey. My assumption isn't that she's of age.

• 1:17:10Speaker 01

  I don't think so either. And I also doesn't, I mean, if my, if my buddy was like, hey, this is this hot chick that I'm hooking up with, um, and she's of age and it seems like normal, I don't think I'd be.

• 1:17:22Robert Evans?

  If he just sends me a picture of her sight unseen, that's also upsetting.

• 1:17:25Speaker 01

  That's pretty weird.

• 1:17:26Robert Evans?

  But also, I mean, here's what I'll say. There were, there were guys, uh, and I kind of suspect Bill Clinton was one of them, who Jeffrey would have plied them with women, but would have played with adult women because he didn't just automatically send to someone underage. Some, that's not what every creepy guy prefers. There's some creepy men who prefer to have sex with like 20 year olds, right? Uh, like that are provided to them by a service or whatever. So that's not impossible, but even if, even if the, he's playing you with adult women, you know what Jeffrey, you know, he got arrested for trafficking children. You know what he's doing to other guys? Just because your taste is like not a felony, doesn't mean that you're not enabling and supporting a guy who's trafficking children as a pimp, right?

• 1:18:09Speaker 01

  Even if you never saw it, you know what was happening.

• 1:18:14Robert Evans?

  You know, and I don't believe the never saw it part either, right? I think, I think Jeffrey brought out a smorgasbord, you know, for the, the rich, powerful men and some of them were adults, some of them weren't. But the guys, they know what's happening and they often see what's happening, even if their tastes are not in that direction.

• 1:18:32Speaker 01

  Yeah. Yeah. Um, so another email from 2016, Etia tells Epstein that he would, quote, "Love to add five years or more to your life, even if the only reason to do so is to have more sex."

• 1:18:45Robert Evans?

  It's so gross. Cool stuff, Peter.

• 1:18:48Speaker 01

  It's so gross.

• 1:18:49Robert Evans?

  Nice, bro.

• 1:18:50Speaker 07

  Yeah, disgusting.

• 1:18:52Speaker 01

  I want you to, I'm gonna read this next one also, but I want you to take a drink of your water while you, while you do it.

• 1:18:57Robert Evans?

  Okay.

• 1:18:58Speaker 01

  Okay. In a related exchange, he asked, "JE, have you decided if you're interested in living longer, solely for the ladies, of course?" Spit take.

• 1:19:07Robert Evans?

  I was gonna do a spit take, but I don't wanna actually like.

• 1:19:09Speaker 01

  I don't wanna have to then, yeah, clean up after that.

• 1:19:11Robert Evans?

  I've got like, like vegetable powder in my water. I don't know.

• 1:19:16Speaker 01

  I don't want you aspirating vegetable powder. Okay, another email, and this is one's a big one. "The biggest problem with becoming friends with you, the life you lead is so outrageous and yet I can't tell a soul." Why not, Pete? Why can't you tell a soul, Pete?

• 1:19:31Robert Evans?

  Yeah, because of, because of the felonies, because of the felonies.

• 1:19:33Speaker 01

  I, I, listen, he, he knew the guy was a dirtbag, but I'll say this, I've become friends from doing this podcast with a couple of famous people. I tell everyone about it because they're not ghouls, Pete. They're not ghouls. You, if you hang out with people that aren't terrible, you can, you can tell people.

• 1:19:52Robert Evans?

  Yeah. It's this idea that like what cool is and like the real, like the only kind of life that's really worth bragging about is one in which you just have constant, very young women or girls around you all the time. And it's all about like, it's, it's a very, wasn't cool enough in a high school and never got over it attitude as opposed to like, I don't know, like, when I think of the people I know who are like really cool and who I like tell people about because their lifestyle is so amazing, it's folks who like have hobbies and do stuff, like, you know, they participate in like fucking incredible races or they like build things. They make like weird custom cars or motorcycles, uh, or they, they engage in like incredible feats of athleticism, you know? They build things, they into 3D

• 1:20:36Robert Evans?

  printing or like, they have skills and they make stuff and they, I don't know, that all takes money, but it's, it's actually impressive as opposed to just like, oh yeah, you're just hanging out a bunch of, around a bunch of like really young women who you're probably applying with money. Cool.

• 1:20:50Speaker 01

  Yeah. Okay. Um, another email that struck me was him pleading with Epstein's handlers to basically help arrange a playdate with him. I go into JE withdrawals when I don't see him. Uh, famously, there is the email from Etia to Epstein discussing the issue of cunnilingus that I brought up in the very beginning of the first podcast. And I apologize, I'm sorry. Uh, pussy is indeed low carb. Still awaiting results on gluten though. Okay. Now I'm gonna say something that's very, very controversial here. Okay. And I apologize in advance. Feel free to cut. But in a vacuum, this conversation I don't think is completely terrible for a couple of reasons. One, it would at least suggest they're attempting

• 1:21:35Speaker 01

  to provide some pleasure, but that is something that I encourage men to do in general with their partners because I think there's a potential health benefit in terms of probiotics for men to get and more men should be doing it if their partners want it. But I don't know if there are benefits because nobody will ever fund that study. But the point is, if one of the two people in this conversation weren't the worst people in history, this could be a genuinely interesting scientific question. The nerd in me has curiosity.

• 1:22:03Robert Evans?

  If, if Jeffrey, if someone's talking about like giving a massage to like a partner, that's perfectly fine. If it's Jeffrey Epstein, it's not because that partner's probably not an adult, right? Like, that's the thing. That's the issue, I think, is that you just have no idea.

• 1:22:19Speaker 01

  It's very gross. I agree. It's very gross. But I mean, as a scientist, there's a part of me that has, has questions. Um, but let's move past that. Um, there's one other thing that his emails shed light on and something that was dug up afterwards. I'm not sure if it got enough attention. In his book, he shares that in July of 2017, while he was in New York, his one month old son back in California almost died, has to be resuscitated by his wife who's a nurse. And for four days, his wife is begging him to come back home. She had to perform the resuscitation herself. The child is in the ICU. She needs him back home and he didn't because he felt his work was too important.

• 1:23:02Speaker 01

  That's his own admission. Now, he will say that this was a mistake. He frames it as having deep disgust with himself for doing that. He's like, I thought my work was so important. I had to stay to do my work. But here's the thing. In his book, he shares the date being July 11th. And when you go through the files, the Epstein files, he has an email exchange on July 13th to Epstein, where basically he's planning to meet him and he's like, yeah, I'll meet you wherever you want. Like, so during this time, while this kid is in the ICU, he is still there doing important work, quote unquote, but really it's to try and hang out with Epstein. And that is rough out of all the things. That's

• 1:23:42Speaker 01

  a really, that's a tough one. And I will say this, I think if anything gives him shame, it is that. I, that's the only good news is that probably does feel terrible about that. No.

• 1:23:54Robert Evans?

  Yeah.

• 1:23:55Speaker 01

  Okay. Along with the CBS fallout, he also parted ways with protein bar company David and powdered supplement maker AG1 or Athletic Greens. Uh, and he's currently in a lawsuit with wearable medical tracker Aura, the Aura ring, after they distanced themselves from him. They sound kind of like a sketchy company themselves, but I don't know.

• 1:24:13Robert Evans?

  Yeah.

• 1:24:14Speaker 01

  Uh, the, the thing about this, this is really a cautionary tale, I think, for all doctors. It's the cautions of interacting with people with fame and power. Doctors, as I mentioned, are people pleasers at heart. And just like anyone else, we can be drawn to the appeals of the rich and famous. And doctors can find themselves doing things to and for these people that they wouldn't do for other patients. And like that 2012 study, this is not always a service to people.

• 1:24:40Robert Evans?

  Nope.

• 1:24:41Speaker 01

  Patient satisfaction doesn't always correlate with good outcomes. They want to be liked by these individuals. They want to be seen as useful and that can land the doctor and more importantly, the patient in serious trouble. Look at Michael Jackson's doctor, Matthew Perry's, Joan Rivers. These are all examples of when doctors probably overstepped the bounds of what they should have done, in part at least because they were dealing with a famous and rich person. So my, my closing thoughts.

• 1:25:10Speaker 01

  Again, there's a lot of what he does that is not bad. Uh, I'm well aware, as I said, that he is not the worst person, one of the least bad people we've ever done the show, and I still hold out-

• 1:25:21Speaker 07

  I don't know, hung out with Epstein.

• 1:25:23Robert Evans?

  The Epstein stuff really changes my opinion on that a bit.

• 1:25:26Speaker 01

  Yeah, I still hold out hope for redemption arc as I do for everyone. I don't know why I do that, but I can't help but do that. But what it does, it says a lot about the practice of medicine in this country and how it is moving towards becoming something even more economically inaccessible and unequal. It says something about the common pitfalls doctors make once they become public figures and, and what can happen when influence outweighs the actual science, becomes more important than the, the actual science. I think he's sort of the missing link between the dangerous Maha pseudoscience practitioners and the more mainstream, but kind of also problematic healthcare leaders like recent FDA Commissioner

• 1:26:09Speaker 01

  Marty Makary, who he claims is his close, uh, personal friend. He's not a bastard because he's malicious. He's because it's consequential. He's part of this push that's making medicine-

• 1:26:21Speaker 07

  I, I think he's a bastard. I'm just gonna say it.

• 1:26:24Robert Evans?

  That's what I'm saying, yeah.

• 1:26:26Speaker 01

  I, I will say this, like, I feel comfortable when he talks about certain things. He talks about strength training, fine, do it. Um, but, and I do want people listening to these things and learning about metabolic syndrome and learning what it is. I also don't want them being so hyper focused on it. I think we face bigger problems when he faces into areas where he doesn't have expertise. Like, for example, we talked about colon cancer, and I know, and I know what's right there. Then it sounds really silly to me. And I'm like, you just can't be an expert in all things, which is something that we have to address and grapple with as medical podcasters. And this is something I have to wrestle with all the time, which is, how do we do what we do and not fall into these common mistakes?

• 1:27:08Speaker 01

  And, and I try hard, but I don't know, maybe I'm not perfect either about this. I don't consider myself a medical influencer like he is, but it, it always, it's always concerning to me if I'm overstepping my expertise or my bounds. So, you know, having the air of authority, but without the same responsibility and guardrails of real medical practice is a concern for all physician podcasters, myself included, and is a concern here with him. It's something we should all be aware of. Um, but the long and short of it is, I, I think he is a part of this push that is making medicine less scientific and is making medicine less accessible. And it really worries me and concerns me. And that is my, uh, shtick on, uh, Dr. Peter Attia.

• 1:27:51Robert Evans?

  Well, thank you. Yeah.

• 1:27:54Speaker 07

  Thanks, Kavay.

• 1:27:54Robert Evans?

  He's on the, yeah, bastards of things. You wanna plug things before we're all out here?

• 1:27:59Speaker 01

  I certainly do. I want to plug my podcast, The House of Pod. It is a fun-ish medical podcast. We look at science, we look at wellness grifters and make fun of them. Uh, and we talk about what RFK Jr. is doing to our terrible country. But even more than that, I want you to listen to my brand new podcast that I'm very excited about called Persian of Interest. It's about, uh, Persian contributions to art, music, philosophy, science, a lot of the fun stories that we've been written out of or minimized in. And we're gonna cover a lot of great topics with a lot of great guests. It's gonna be a really fun time. Please check it out. Uh, bye.

• 1:28:33Robert Evans?

  Bye.

• 1:28:34Speaker 07

  Bye.

• 1:28:38Speaker 07

  Behind the Bastards is a production of Cool Zone Media. For more from Cool Zone Media, visit our website, coolzonemedia.com, or check us out on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Full video episodes of Behind the Bastards are now streaming on Netflix, dropping every Tuesday and Thursday. Hit Remind Me on Netflix so you don't miss an episode. For clips in our older episode catalog, continue to subscribe to our YouTube channel, youtube.com slash at Behind the Bastards. We love about 40% of you, statistically speaking.

• 1:29:13Speaker 04

  I'm Melissa Jelton, host of the What Happened to Her podcast. We're kicking off the season with the Sandra Birchmore story, a case the police wrote off as a suicide in a snowstorm. Her family never bought it, and the man they suspected wore a badge.

• 1:29:28Speaker 05

  You never know who that devil is because he's wearing a disguise. Sometimes it's a police uniform.

• 1:29:33Speaker 04

  And you can get access to all episodes 100% ad-free with an iHeart True Crime Plus subscription exclusively on Apple Podcasts, available only to iHeart True Crime Plus subscribers. So don't wait. Head to Apple Podcasts, search for iHeart True Crime Plus, and subscribe today.

• 1:29:54Speaker 06

  If anyone wanted to commit a murder, up here would be the greatest place in the world to hide the body, but no one will find it. He acted friendly. He talked friendly. He sounded friendly. They all knew that I did the scary boogie stuff, and they said, maybe she'll find out where this girl is.

• 1:30:14Speaker 03

  I saw him, I backhanded her, pow!

• 1:30:20Speaker 03

  Listen to The Devil's Quarry, Season Two, in the Bone Valley feed on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts.

• 1:30:34Speaker 03

  Malcolm Gladwell here. My new book, The American Way of Killing, investigates America's gun violence crisis. Why is the richest country in the world plagued by such lethal violence? Through a series of stories, interviews, and archival tape, I confront

• 1:30:49Speaker 07

  one of today's most urgent moral dilemmas and examine why the US has never quite understood its own problem and why you can't fix what you refuse to see clearly. Get The American Way of Killing at pushkin.fm slash audiobooks.

• 1:31:09Speaker 07

  In 1986, a man named Scott Macklem was killed in broad daylight. Police quickly found their suspect. Prosecutors convicted him. But now, almost 40 years later, I'm reexamining this case.

• 1:31:24Speaker 07

  I really didn't believe any of it was real. And I was like, well, they're, they're gonna figure out this is not me. They're, they're gonna do their police job. Has the wrong man been in prison this whole time?

• 1:31:36Speaker 07

  Listen to Examine: The Backfire Effect on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

• 1:31:47Speaker 02

  Black Lit. October is Black Fiction Month, and the Black Lit Podcast explores the minds of Sebo Campbell-

• 1:31:54Robert Evans?

  How speculative fiction works, is you enter into a story with a question.

• 1:31:58Speaker 02

  Nisi Shaw.

• 1:31:59Robert Evans?

  What kind of world would it be if these people had not perished?

• 1:32:04Speaker 02

  And Octavia Butler. In science fiction and fantasy, I can do absolutely anything. As they pose the question, what if? Listen to Black Lit on the Black Effect Podcast Network, on iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is an iHeart Podcast. Guaranteed Human.